Institute of Medicine Report: Ending the Tobacco Problem (1)

Last week the Institute of Medicine issued a 400-page report produced by its 14-member Committee on Reducing Tobacco Use, which presents a blueprint for reducing smoking so substantially over the next 20 years that it is no longer a significant public health problem in the United States.

The report first highlights the progress that has been made. Between 1965 and 2005, the percentage of adults who once smoked and who had quit more than doubled from 24.3 to 50.8 percent. Furthermore, the percentage of adults who have never smoked more than 100 lifetime cigarettes increased from 44% in 1965 to 54% in 2005. It predicts that if things continue as they have over recent times, smoking prevalence will decline from 21% in 2005 to 16 % in 2025. However, the report identifies tobacco as the only lawful consumer product for which national policy is to eliminate consumption (reflecting its status as the only one that kills 50% of its consumers when used as intended). It suggests that there is now a need for more aggressive tobacco control strategies designed to reduce consumption more quickly than current trends.

The first major recommendation was for a strengthening of traditional tobacco control measures, including increasing excise taxes on cigarettes by at least $1, comprehensive legislation banning smoking in public places, increasing access to smoking cessation interventions (partly by requiring these to be fully covered by insurance policies), and school and media based prevention interventions. The committee projected that these strategies could reduce smoking rates to 10% by 2025.

The second major recommendation was for a transformation of the legal structure regulating the manufacture, marketing and use of tobacco products. This would include empowering the Food and Drug Administration to regulate tobacco, allowing states to implement their own more stringent regulations, requiring larger more graphic warnings on packs, requiring retailers to be licensed, restricting internet sales, and banning marketing to young people. One particular regulatory strategy that was discussed (but not specifically recommended) was requiring a gradual reduction in the permissible nicotine delivery of cigarettes, so that before 2025 they cannot deliver sufficient nicotine to maintain or initiate addiction.

The committee did not project the full impact of both the traditional tobacco control strategies plus the full legal and regulatory changes. However, if fully implemented now, these could conceivably reduce regular cigarette use to lower than 5% of adults by 2025.

My initial reaction is that this is a very bold but sensible report. State and national legislators should read it and follow its recommendations. I have no doubt that if this were to happen, it would have a dramatic effect in reducing tobacco smoking and improving health in this country.

The full report, and various summaries are available online for free at:
http://books.nap.edu/catalog.php?record_id=11795
In my next posting I’ll give you my slightly more detailed opinion of the report.

Labels: smoking tobacco policy

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