Advances in Tobacco Control

Cigarette smoking is the leading cause of death from lung cancer in the United States. That’s why November, lung cancer awareness month, is a good time to highlight new advances in tobacco control, such as the legislation that came into effect Nov. 1, 2017, in New Jersey that raises the minimum age of legal access to tobacco products to 21.

We have come a long way

The relationship between cigarette smoking and lung cancer was first brought to the public’s attention more than 50 years ago, when the U.S. Surgeon General’s report on “Smoking and Health” was published. At the time, more than 40 percent of U.S. adults smoked cigarettes.

We have come a long way since then.

First, our knowledge of the negative impact of cigarette smoking on health has increased substantially. We have learned that it causes not only lung cancer, but also 17 other types of cancer and many other chronic diseases, including cardiovascular disease and respiratory diseases. We have also learned that exposure to secondhand smoke and the use of tobacco products other than cigarettes—including cigars, pipe tobacco, smokeless tobacco products (e.g., chewing tobacco and snuff), and waterpipes—can cause many of these same negative health consequences.

Second, we have developed and implemented numerous public education and policy initiatives, including increased taxation, reduced exposure to cigarette advertising, and the introduction of tobacco regulation by the U.S. Food and Drug Administration (FDA), that have driven down cigarette smoking rates. The most recent data show that in 2015, 15.1 percent of U.S. adults were current cigarette smokers. In addition, the latest statistics show declining use of cigarettes among high school students: In 1999, 35 percent of high school students reported smoking cigarettes on at least one day during the 30 days before being surveyed, compared with 11 percent in 2011.

Researchers estimate that reductions in the U.S. cigarette smoking rate prevented 800,000 deaths from lung cancer between 1975 and 2000. More broadly, an estimated 8 million premature smoking-related deaths from any cause have been avoided because of the decline in cigarette smoking from 1964 to 2012.

However, we must do more

Despite the progress, it is estimated that each year, 660,000 people in the United States are diagnosed with a tobacco-related cancer, and that 343,000 people die from these diseases. In addition, 36.5 million U.S. adults remain cigarette smokers, with 27.6 million of these individuals smoking cigarettes daily. Importantly, the prevalence of cigarette smoking is much higher among certain segments of the U.S. population—including those who are American Indian/Alaska Natives, those who live below the federal poverty level, those who live in the Midwest, those who are insured through Medicaid or are uninsured, and those who have a disability/limitation—making this an issue when considering cancer health disparities.

Moreover, each day in the United States, more than 3,800 youth age 18 or younger smoke their first cigarette, and more than 1,000 become daily cigarette smokers. Researchers estimate that if current trends continue, 5.6 million of today’s youth age 18 or younger are projected to die prematurely from a smoking-related illness.

These grim statistics highlight the need for new tobacco control initiatives.

One legislative tobacco control initiative that came into effect on Nov. 1 in New Jersey is an increase in the minimum age of legal access to all tobacco products to 21. New Jersey is the third state in which such legislation, often known as Tobacco 21 legislation, has come into effect, after Hawaii and California. Similar legislation has been passed in Oregon and Maine and will come into effect in January 2018 and July 2018, respectively. Tobacco 21 legislation is also in effect in many U.S. cities outside the five states in which it has passed. It is important because nearly everyone who buys cigarettes for U.S. minors is under the age of 21, and it is estimated that if it were introduced nationwide there would be 50,000 fewer lung cancer deaths among people born between 2000 and 2019.

Many cities and states in the U.S. are working on additional initiatives to curb tobacco use. For example, in August 2017, New York City passed legislation raising the minimum price for a pack of cigarettes to $13. When this comes into effect in June 2018, New York City will become the most expensive place to buy cigarettes in the nation. Supporters of the legislation, which also bans pharmacies from selling cigarettes and reduces the number of retailers licensed to sell them, hope that it will reduce the number of smokers by 160,000 by 2020.

In addition, later this month, we will be seeing new ads warning of the dangers of smoking cigarettes on television and in newspapers. The “corrective statement” ads will be run by tobacco companies as part of a settlement that they reached with the U.S. Department of Justice over misleading statements they had made in the past about cigarettes and their health effects. Among the messages we can expect to see are:

• Smoking kills, on average, 1,200 Americans every day.
• Smoking causes heart disease, emphysema, acute myeloid leukemia, and cancer of the mouth, esophagus, larynx, lung, stomach, kidney, bladder, and pancreas.
• All cigarettes cause cancer, lung disease, heart attacks, and premature death – lights, low tar, ultra-lights, and naturals. There is no safe cigarette.

In July 2017, FDA Commissioner Scott Gottlieb, MD, announced that the agency’s Center for Tobacco Products will focus on nicotine addiction. The FDA will begin to look at lowering the nicotine content of combustible tobacco products and will be seeking public input on the potential public health benefits and any possible adverse effects of lowering the nicotine content of combustible cigarettes. Additionally, the FDA will be issuing Advanced Notices of Proposed Rulemaking on the role of menthol and kid-appealing flavors in tobacco products in attracting youth.

What is the AACR doing?

The AACR has long been dedicated to fostering scientific and policy initiatives to reduce the incidence of disease and mortality due to tobacco use. The organization issued its first policy statement on smoking in 1968 to encourage educational and research programs aimed at decreasing smoking, formation of a tobacco and cancer subcommittee to foster scientific and policy initiatives to reduce incidence and mortality of tobacco-related cancer, and ongoing advocacy for investment in tobacco regulatory research and the implementation of evidence-based tobacco control strategies.

The AACR Tobacco and Cancer Subcommittee has been particularly active in recent years, working to implement the recommendations outlined in the subcommittee’s 2010 comprehensive policy statement on tobacco and cancer. The need for more research and more collaboration between scientists, policymakers, regulators, and advocates is at the heart of these recommendations, and the AACR is delighted that it has been able to convene research and policy sessions on tobacco control each year at the AACR Annual Meeting.