ATLANTA (AP) — Health officials have begun to predict the end of cigarette smoking in America.
They have long wished for a cigarette-free America but shied away from calling for smoking rates to fall to zero or near zero by any particular year. The power of tobacco companies and popularity of their products made such a goal seem like a pipe dream.
But a confluence of changes has recently prompted public health leaders to start using terms like “endgame” and “tobacco-free generation.” Now, they talk about the slowly declining adult smoking rate dropping to 10 percent in the next decade and to 5 percent or lower by 2050.
Acting U.S. Surgeon General Boris Lushniak last month released a 980-page report on smoking that pushed for stepped-up tobacco-control measures. “I can't accept that we're just allowing these numbers to trickle down,” he said. “We believe we have the public health tools to get us to the zero level.”
This is not the first time a federal health official has spoken so boldly. In 1984, Surgeon General C. Everett Koop called for a “smoke-free society” by the year 2000. “What's different today is that we have policies and programs that have been proven to drive down tobacco use,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids. “We couldn't say that in 1984.”
Among the changes:
» Cigarette taxes have increased, making smoking more expensive.
» Laws banning smoking in restaurants, bars and workplaces have been enacted all over the country.
» Federal officials are increasingly aggressive about anti-smoking advertising. The Food and Drug Administration launched a new youth tobacco prevention campaign last week. At the same time, the Centers for Disease Control and Prevention debuted a third round of its successful anti-tobacco ad campaign.
» Tobacco firms have suffered huge defeats in court. Perhaps the biggest was the $200 billion settlement in 1998 of a case brought by more than 40 states demanding compensation for the costs of treating smoking-related illnesses.
» Cigarette retailing is changing, too. CVS Caremark said last week that it will stop selling tobacco products at its more than 7,600 stores.
These developments have made many in public health dream bigger. It has caused Myers' organization and others to tout the goal of bringing the adult smoking rate down to 10 percent by 2024, from 18 percent. For that to happen, the rate would have to drop twice as fast as it has over the past 10 years.
The bigger goal is to reduce U.S. smoking-related deaths to fewer than 10,000, from the current 480,000. But even if smoking rates dropped to zero immediately, it would take decades to see that benefit, since smoking-triggered cancers can take decades to develop.
Others say the key to reaching such goals is action by the U.S. Food and Drug Administration to regulate smoking.
A 2009 federal law gave the FDA the authority to regulate tobacco products. The law barred the FDA from blocking the sale of cigarettes, but the agency is free to take such pivotal steps as requiring cigarette makers to ratchet down the amount of addictive nicotine. But nearly five years after gaining power over cigarettes, the FDA has yet to propose such regulations.
Kenneth Warner, a University of Michigan public health professor, and Michigan colleague David Mendez estimate that, barring any major new tobacco control victories, the adult smoking rate will drop from its current 18 percent to about 12 percent by 2050. If health officials do make huge strides, the rate could drop as low as 6 percent, they say.
But Lushniak said zero. Will that ever happen?
Some experts doubt it. As long as cigarettes are legal, it's likely that some people will smoke. Efforts to prohibit them are likely to fail, they say.
“It's hard to do a ban on cigarettes because you're taking something away from people they have and are using. Once you have something, you hold tight,” said Richard Daynard, a Northeastern University law professor who focuses on tobacco issues.
A growing number of experts believe that the most promising option is to get people to switch to something else, like electronic cigarettes. E-cigarettes are battery-powered devices that provide users with aerosol puffs that typically contain nicotine and sometimes flavorings.
If the FDA can ratchet down the nicotine in cigarettes to levels below those in e-cigarettes, perhaps everyone will switch to the higher-nicotine products. That could achieve the end of smoking, at least of combustible, carcinogen-filled cigarettes.
In the past, “the country really wasn't ready” to walk away from cigarettes,” Daynard said. “I think the country's ready now.”
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