July 2009

Earlier this summer, President Obama signed the Family Smoking Prevention and Tobacco Control Act giving the Food and Drug Administration (FDA) authority over the advertising, labeling, and production of tobacco products. This legislation requires manufacturers to obtain FDA approval, mandates large warning labels, bans misleading terms, and establishes strict guidelines for advertising to children. This step forward in the fight against tobacco represents decades of hard work by influential figures in the disparate worlds of tobacco policy, advocacy, and industry.

On the policy front, Dr. David A. Kessler, former commissioner of the FDA, has been fighting for regulation of tobacco products since the 1990s. Matthew L. Myers, President of the major national advocacy organization Campaign for Tobacco Free Kids, has led a persistent national campaign over the past 10 years to raise tobacco taxes, ban indoor smoking, and push for prevention and cessation. His approach was to work closely with like-minded advocates in each state.

Support from the industry has come more recently from former tobacco executive Steve Parrish who foresaw that regulation would lead to important innovation ensuring safer products. This unique blend of forces created collaborative systemic change and acknowledges the power of the tobacco environment to influence behavior. The new legislation contributes to a new era limiting advertising power and emphasizing caution. In other words, smoking is not only a battle of personal responsibility.

Keep in mind that American attitudes towards tobacco did not shift overnight. From the Surgeon General’s 1957 report acknowledging a link between smoking and lung cancer, to the introduction of a hefty tobacco tax, to this 2009 bill allowing FDA regulation, a series of critical steps contributed to shifting policy and public opinion.

Yet, even with this progress, the fight against tobacco is far from over. Smoking currently kills an estimated 25,500 people a year in New York State. And, every day approximately 3,600 children between 12 and 17 smoke their first cigarette. Nearly a third of them will become regular smokers, and approximately half will die from the habit.

A troubling undercurrent lurks below this public health threat—as a nation, we are too comfortable celebrating the two decades of decline in smoking rates and ignoring the implications of rates that are now leveling off. Efforts to prevent tobacco use are now recognized as one of the 10 great public health achievements, yet there is a new generation of smokers adapting to the financial, cultural, and environmental changes that restrict smoking. While the numbers are leveling off, every day thousands of children pick up a cigarette and potentially become lifetime addicts.

It is critical that the health care community and public health leaders continue to support innovative approaches that will effect systemic changes in the tobacco environment to deter people from taking up the habit—especially vulnerable groups like children and adolescents—and strategies to help smokers quit. Leveraging social networks to foster quitting communities, smoking hotlines, help groups, and medications all contribute to individuals kicking the habit, and require further support from public and private groups. So, while we celebrate important victories like this recent legislation to regulate new products and advertising, we must persist with efforts to bring smoking rates down, and prevent people from starting smoking in the first place.

James R. Knickman

Many organizations support initiatives to reduce tobacco use. Practical advice can be found on the following Web sites:

Campaign for Tobacco Free Kids

Smoking Cessation Leadership Center