Tobacco control: States can do more

Although there has been success in tamping down tobacco use, states must continue making strides through cigarette taxes, public smoking bans and cessation support.

Posted May 17, 2010.

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In recent years, there's been some good news from the trenches in the war on tobacco. But in some places, the advance has bogged down, leading to more tragic reminders that the price of not moving forward is paid in people's lives.

A report on state tobacco control efforts from the Centers for Disease Control and Prevention shows more states have been signing onto winning strategies against tobacco-related illness and death. Nearly half of the states have enacted tough smoke-free laws, and more than a dozen have raised taxes on cigarettes. These are proven ways of getting people to quit smoking -- and to convince those who haven't yet lit up that it's just not worth it.

The medical evidence alone should be enough to convince people that tobacco use leads to a dead end. An estimated 46 million American adults still smoke cigarettes, and nearly 450,000 of them will die this year. For every person who loses his or her life from tobacco use, there are another 20 people who have a tobacco-related illness -- in many cases, more than one.

For the people who are not dissuaded by those ghastly statistics, more immediate financial and practical disincentives often work better. California, which has had a comprehensive tobacco control program in place longer than any other state, has managed to cut its adult smoking rate by nearly half in the last few decades.

Michigan is another state that understands what it takes to help. Since May 1, people there have been breathing easier, thanks to the Dr. Ron Davis Smoke Free Air Law, which prohibits smoking in all restaurants, bars and businesses.

The statute is named in memory of a former American Medical Association president who dedicated much of his professional career to fostering preventive health and healthy behaviors. The AMA has carried on the legacy of the late Dr. Davis in its unyielding efforts to get the upper hand on tobacco use, whether through education, legislation or litigation.

When combined, prevention components can form a powerful weapon in the anti-tobacco arsenal. Making it more difficult to smoke helps keep people out of medical trouble in the first place. For those who are addicted and haven't been able to stop smoking, higher tobacco taxes increase revenues that can go toward cessation programs, which can offer the last push they need to quit.

Still, despite all of the progress that physicians and policymakers have made in the tobacco fight, the reduction in smoking rates has stalled.

Many states just don't seem to get it. Twenty-eight states aren't doing enough to ban secondhand smoke in public areas such as workplaces, restaurants and bars, according to the CDC. In a dozen states, the tax on an individual pack of cigarettes is less than 60 cents.

Take this example. Buying a pack of cigarettes in New York City costs a smoker $4.25 in state and local taxes alone, according to the Campaign for Tobacco-Free Kids. That's more than someone would pay for the entire pack in South Carolina, where the state tax is a meager seven cents. The South Carolina state Senate voted May 13 to raise the cigarette tax to 57 cents a pack, completing a legislative override of a May 11 gubernatorial veto. The hike takes effect July 1. Missouri's 17-cents-a-pack tax will then be the country's lowest.

States also need to do a better job of using that revenue the right way.

Even as tobacco taxes have increased this year, a smaller portion is going toward tobacco prevention efforts -- 15% less in fiscal 2010 than in the year before, according to another recent report from a coalition of anti-smoking and public health groups. Few states require adequate coverage of cessation programs. More money needs to flow to the right places.

The path that can lead to victory is clear. Now every state needs to get on it.

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