accelerating the national progress to reduce tobacco use
TRANSCRIPT
Accelerating the National Progress to Reduce
Tobacco UseTerry F. Pechacek , Ph.D.Professor of Health Management & Policy
Georgia State University School of Public Health
Retooling and Recommitting: Policy, Systems, and Environmental Approaches in Tobacco Control
August 19th, 2015 ● Atlanta, Georgia
• The current rate of progress in tobacco control is too slow.
• The tobacco industry continues to position itself to sustain its sales by:• recruiting youth and young adults• Maintaining current smokers as consumers of
all their nicotine-containing products including cigarettes
Accelerating the National Progress to Reduce
Tobacco Use
Tobacco Product Use by Education LevelNSDUH 2013 Adults aged 18 and older
0
5
10
15
20
25
30
35
40
<HS HS Grad Some College College Grad
Percent Using in Past Month
Any Tobacco Cigarettes Cigars
SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013
5.6 Million Projected Deaths
Key Assumptions• Initiation rates of smoking among adolescents and young adults remain high
• Peak birth cohort smoking prevalence in young adulthood remains high
• Adult cessation rates in young adulthood remain low
• Tobacco products most commonly used remain highly lethal
Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: NSDUH 2002-2013
Numbers in Millions Initiated at Age 18 or Older
Initiated Prior to Age 18
SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013
Past Month Cigarette Use among Persons Aged 12 or Older, by Age: NSDUH 2013
Age in Years
Percent Using in Past Month
SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013
Will ENDS be a panacea or peril? From a clinical perspectiveUsing Electronic Nicotine Delivery Systems could help: • Smoking combusted
cigarettes is the single greatest cause of death in the world.
• Current tobacco control methods will not achieve public health objectives.
• Properly regulated, ENDS have the potential of providing nicotine at a much lower level of harm.
From a population perspectiveElectronic Nicotine Delivery Systems could: • Increase youth initiation• Promote dual use• Delay cessation• Entice former smokers back
to nicotine• Re-normalize smoking• Continue addiction• Set back progress from
establishing health promoting social norms
Potential Health Impacts of ENDS
• Could have negative and positive individual and population health impact
Source: The health consequences of smoking – 50 years of progress: a report of the Surgeon General. – Atlanta, GA. : U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
“The impact of the noncombustible aerosolized forms of nicotine delivery on population health is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes and other combusted tobacco products are being rapidly reduced, especially among youth and young adults.” 2014 SGR, Page 859
2014 SGR Recommendations Sustain high-impact media campaigns such as CDC Tips
and FDA youth prevention for 12 months a year for 10+ years
Raise excise taxes – Average Retail Price of at least $10 per pack most effective
Protect 100% of U.S. Population by comprehensive smokefree indoor air policies
Fully fund comprehensive statewide tobacco control programs at CDC-recommended levels
Expand Smoking Cessation for All Smokers Provide access to barrier-free proven tobacco use cessation treatments Promote proven tobacco use cessation treatment as a standard of care in
primary and specialty care settings
Can novel nicotine products serve as a disruptive technology and advance public health?
Tobacco Industry in Transition
Industry wants broader nicotine product market
Cigarette Target = slow decline in market Slow down regulations
ENDS Market = Keeping Smokers & Recruiting Youth Cautious adoption of less-profitable ENDS Industry favors tight regulations of innovative “vaping” Seek to reverse non-smoking norms Defending public health benefits of dual-use
Non-combustibles & Heat-not-Burn = Growth Seek FDA MRTP approvals (e.g., SNUS, then H-n-B) Rapidly grow markets (e.g., Marlboro iQOS)
Tobacco Industry in Transition
Seeking Public Health Endorsement Remember: “When you are dancing with the
BEAR, it is hard to stay in the lead, and when the lights get low, he will eat you alive!”
Companies want to manage transition Cigarettes have very high profit margins (≈ $1 per pack) Disruptive technologies favor innovation NOT established
products Regulations can create barriers for innovation
Financial Analysts Predict Strong Future Tobacco Sales Volumes (US and Globally)
“A defective and unreasonably dangerous product”1
End Game scenarios for the U.S. include: FDA regulation to:
• Reduce nicotine content to make cigarettes non-addictive
• Make some or all tobacco products less appealing
• Establish standards for toxicant levels in tobacco products
Sales restrictions• including local and state product category
bans 1Proctor RN. Why ban the sale of cigarettes? The case for abolition. Tobacco Control
2013;22:i27-i30
End Game Strategies at State/Local Level
• Raise the age of sale to 21
• Decrease access to and visibility of tobacco products in the community • decrease density of retail outlets, • proximity of retail outlets to schools, • Sales of tobacco products in pharmacies
• Establish Minimum Prices/Prohibit discounting
• Local and state product category bans
bit.ly/NoToTobacco
Thank You! [email protected]
The Georgia State University Tobacco Center Of Regulatory Science