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Why comprehensive tobacco control?

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In my post of May 9th I described some of the reasons why it is unwise to cut funding for comprehensive tobacco control. But what exactly is it and why does it need to be “comprehensive”?

The main reason for trying to reduce tobacco consumption within a population is of course because tobacco (primarily cigarette) smoke is extremely harmful to health. The main goals are:
Reduce initiation of tobacco use (primarily in teenagers)
Reduce exposure to tobacco smoke pollution (in the whole population)
Encourage and help existing tobacco users to quit.

There are lots of different ways of achieving a reduction in use and exposure. Some of the main ones include:
(a) use of mass media to inform the public about the harms from tobacco
(b) pass legislation to protect the public from exposure to tobacco smoke pollution in public places
(c) increase taxes on tobacco products
(d) provide community based activities to educate local communities and organizations about the harms from tobacco and ways of avoiding these
(e) provide services designed to help existing tobacco users to quit. These include brief interventions by health professionals, intensive treatment at special clinics, telephone quitlines, websites to encourage cessation, and free/reduced cost medications
All of these activities need to be organized and evaluated to ensure that they are producing the desired effects.

Evaluations of previous state-wide comprehensive tobacco control programs have found that although each of the components mentioned above have an effect on their own, they work best when combined. If the population is unaware of how harmful tobacco smoke is, they will be less likely to support legislation to ban smoking in workplaces (remembering that bars and restaurants are workplaces). Similarly, if smokers are not aware of the cessation services being provided, they won’t use them. So mass media helps with the other components. Similarly if smoke-free legislation and high cigarette taxes encourages more smokers to try to quit, but there are no treatment services, then the more addicted smokers will be unlikely to succeed in quitting, no-matter how much they want to. So each of these components has a positive influence on and supports the other components, to produce a measurable decrease in the social acceptability of tobacco use, and a decrease in tobacco use in the population. This decrease in tobacco use then translates into a healthier population, with lower rates of smoking caused disease.

CDC has calculated the appropriate level of funding for each State, corresponding to $15 to $20 per capita, depending on the State’s population, demography and the current level of tobacco use. If all states funded tobacco control as recommended by CDC, in 5 years there would be around 5 million fewer smokers in the United States and hundreds of thousands of premature tobacco-caused deaths would be prevented each year. A more detailed review of the evidence supporting this is provided in the Introduction (particularly pages 8-12) of the CDC “Best Practices 2007” document.

Unfortunately, when a state funds tobacco control at too low a level, it becomes impossible to deliver “comprehensive” tobacco control. Unfortunately my own state, New Jersey, is one of 17 states that have committed minimal funds to tobacco control over recent years (less than 10% of CDC recommended funding). That’s why it is so short sighted of legislators to be even considering a cut to the current budget.

Comprehensive tobacco control is the most cost-effective way to improve health and prevent premature deaths from cancer and heart disease and chronic illnesses caused by respiratory diseases and exposing the unborn child to tobacco smoke. With the tobacco industry spending around $13 BILLION per year on promotions and advertising, underfunding tobacco control is a recipe for hooking another generation on these deadly addictive products.

For the CDC’s best practices for Comprehensive Tobacco Control (2007), click on:
http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/

For evidence of a direct effect on health in one of the first states to implement tobacco control see:
http://www.cdc.gov/MMWR/preview/mmwrhtml/mm4947a4.htm
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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