Lots more to do in fight against deadly tobacco epidemic

A message to all physicians from the president of the American Medical Association, J. Edward Hill, MD.

By J. Edward Hill, MDis a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06. Posted March 20, 2006.

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What kills more Americans, every year than alcohol, AIDS, car crashes, illegal drugs, murders and suicides combined? The answer, as always, is smoking.

As a physician deeply committed to public health, and as president of an organization that has made tobacco control one of its top priorities, I am appalled by this statistic -- and saddened that I have to keep trotting it out year after year.

What's most maddening is that there are dozens of effective, proven programs for preventing tobacco use and helping motivated smokers to quit. What's more, we, as a nation, have the funds to support these programs. All we lack is the political will -- and the good sense -- to use those funds appropriately.

A little more than seven years ago, every state received millions upon millions of dollars from the settlement of a multistate lawsuit against the tobacco industry. In return, the medical and public health community were led to believe that the states would use those funds to combat tobacco use at every level.

Anti-tobacco activists hoped that these dollars could save some of the 400,000 American lives lost annually to tobacco addiction. They also hoped to reduce the direct and indirect costs of tobacco use, which in 2005 added up to $182 billion.

Today, states are collecting record amounts of tobacco-generated revenue from the tobacco settlement and from higher tobacco taxes. Yet these dollars are not, in most cases, going to tobacco education, cessation and prevention programs. Instead, this money has been used to fill state budget gaps or to fund various pet projects, including, in the AMA's home state of Illinois, a new parking lot at a state facility.

Thirty-seven states and the District of Columbia fund tobacco prevention at less than half the Center for Disease Control and Prevention's recommended minimum. Four states -- Michigan, Missouri, South Carolina and Tennessee -- have committed no tobacco settlement or tobacco tax dollars to ending the epidemic.

Good news, bad news

My own state of Mississippi represents both the best and the worst of what states can do in terms of tobacco prevention, and so it serves as a good case in point.

Let me begin with our success. Currently, Mississippi spends $20 million per year of its settlement funds on tobacco prevention. This number slightly exceeds the minimum amount recommended by the CDC.

These dollars are having a huge impact. Between 1999 and 2004, Mississippi's tobacco prevention programs helped to reduce smoking among public middle school students by almost half (from 23% to 12%). We also saw smoking rates for public high school students drop by almost one-third (from 32.5% to 22.1%).

How did we do it? The Partnership for a Healthy Mississippi, which runs the state's tobacco control programs, has used counter-advertising, faith-based initiatives, and school and community programs to reduce tobacco use. It has aided smokers who want to quit and helped law enforcement in its efforts to stop cigarette sales to minors.

The $20 million annual price tag for this outreach has an incredible rate of return, both in terms of dollars and lives saved. Indeed, if the Partnership for a Healthy Mississippi simply continues its work at current levels, public health experts conservatively estimate that the state will:

  • Prevent nearly 33,000 kids from starting to smoke.
  • Save 10,500 of them from premature, smoking-caused deaths.
  • Save Mississippi more than $400 million in long-term health care costs.

Unfortunately, while smoking rates for the children of Mississippi have declined significantly, they are still slightly higher than the national average. Many Mississippians, including me, believe we can bring down smoking rates even further by using another proven tactic: increasing tobacco taxes.

The American Medical Association strongly supports increasing state taxes on tobacco. Studies show that for every 10% increase in the price of cigarettes, there is an estimated 7% decrease in youth smokers and 4% decrease in adult smokers.

Unfortunately, Mississippi has the third lowest cigarette tax in the nation. This is, quite simply, bad public policy. I made this point very publicly last month, while standing on the steps of the state Capitol building to support a proposed state excise tax on cigarettes.

As this article goes to press, Mississippi's governor has vetoed legislation that would raise tobacco taxes and at the same time reduce grocery taxes. In the days ahead, leaders in the state Legislature will be trying to override that veto, and they can count on my support -- as a physician, and as a leader of the American Medical Association. We must take action against this scourge, as physicians and as physician organizations.

I ask that you, too, support anti-tobacco activities in your practice and in your community.

To find out how your state is doing in terms of tobacco settlement spending, tobacco taxes and tobacco control overall, a great place to start is the Campaign for Tobacco-Free Kids (link). You might also see how your state was graded by the American Lung Assn. in its annual State of Tobacco Control report lungaction.org/reports/tobacco-control05.html. Your county and state medical associations are also great resources for finding out more about local anti-tobacco initiatives.

For our part, the AMA will continue to work at the federal level, supporting legislation that would enable the Food and Drug Administration to regulate tobacco and pushing for U.S. ratification of the World Health Organization's Framework Convention on Tobacco Control treaty -- a global treaty aimed at curtailing tobacco use across the world.

We'll also continue to lend support to tobacco control efforts at the local level, such as clean air ordinances, by helping state and county medical societies, individual AMA members and anti-tobacco coalitions.

It will take many people and groups to stop this scourge that takes the lives of 400,000 people -- our patients -- every year.

Let's give a voice to those who can no longer speak for themselves. Let's do all we can to stamp out this deadly killer once and for all.

J. Edward Hill, MD is a family physician from Tupelo, Miss., was AMA board chair during 2002-03 and served as AMA president during 2005-06.

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