Tobacco control: A long way to go

Last month, House Speaker Nancy Pelosi (D, Calif.) declared that the Speaker's Lobby of the U.S. Capitol is now smoke-free.

Public health groups applauded her decision, one in line with the District of Columbia's new smoke-free workplace law. They called it a powerful message about the importance of protecting clean air and a symbolic end to the days of smoke-filled rooms in the halls where national policies are made.

But a look past this positive, high-profile action reveals a current tobacco control picture that, at best, can lay claim to only a spotty success record.

Although the American Medical Association, along with other health and anti-tobacco organizations, is heartened by indications of progress, it also is aware that much work remains if tobacco's deadly reach is to be stanched.

Nowhere is this circumstance more clear than in the report, "The American Lung Assn. State of Tobacco Control 2006," which was released Jan. 9. This document concluded that the majority of states are failing to fund adequately programs to prevent tobacco use -- a critical component in keeping kids from starting to smoke.

Specifically, while funding for tobacco prevention and cessation increased across the board in 2006, 34 states still received failing marks in this area. Another 23 states were given failing grades for their lack of smoke-free workplace laws. The federal government also was graded low for failing to enact legislation to give the Food and Drug Administration the authority to regulate tobacco products and for allowing the Framework Convention on Tobacco Control, the world's first tobacco control treaty, to continue to languish on the president's desk -- despite it becoming international law approved by 140 other nations.

Meanwhile, another report, this one released in December 2006, came to similar conclusions. The take-home message of "A Broken Promise to Our Children: The 1998 State Tobacco Settlement Eight Years Later," by the Campaign for Tobacco Free Kids, American Heart Assn., American Cancer Society and American Lung Assn., was that the nation's advances in reducing smoking would be at risk unless states significantly increase resources to help smokers quit and prevent kids from taking their first puff.

The American Medical Association rightly echoed the concern that accompanied these findings. Based on long-standing policy, the AMA supports state and local clean indoor air laws. It also urges state lawmakers to recognize the public health threat associated with tobacco use and to allocate the necessary funds for prevention and cessation programs as recommended by the Centers for Disease Control and Prevention.

Now more than ever, the urgency of such action is evident.

According to the CDC, 23% of U.S. high school students smoked in 2005, up from 21.9% in 2003. Public health and anti-smoking advocates view this as a worrisome turnaround after notable declines from 1997 and 2003. Among adults, 20.9% smoked in 2005, the same as in 2004 -- the first time adult smoking rates have not declined since 1997.

Of course, there was good news, too, stemming from the jump in states with smoke-free workplace laws on the books and a boost in the nation's average cigarette tax -- now at $1 per pack. In November 2006, for example, seven states voted on ballot initiatives to prohibit smoking in most public places and workplaces, increase cigarette taxes or increase funding for tobacco programs.

But these successes still can be viewed as only baby steps forward against the morbidity and mortality associated with tobacco use. After all, according to a report by the AMA Board of Trustees, cigarette smoking remains the nation's leading preventable cause of death, accounting for approximately one of every five -- or 438,000 people -- annually. It also tallies an estimated $167 billion in health care each year.

The fight to protect young and old from tobacco is nowhere near over. It will require continued pressure on all levels of government, from national policy to state and local laws. It will require education, smoking prevention and cessation programs. There is even room for individual physicians to step forward. They should provide cessation counseling in their clinical practices and can join with local public health groups to advocate for full funding of tobacco control programs that move toward these goals.

In the end, those victories, large and small, will help everyone breathe more easily.