In the United States, about 660,000 people are diagnosed annually with complications stemming from chronic tobacco usage (‘Policy Issue Brief: Tobacco and Cancer’, 2017). In addition, each year about 343,000 deaths are attributed to tobacco usage (‘Policy Issue Brief: Tobacco and Cancer’, 2017). Smoking has been linked to several types of cancer, heart disease, and reproductive complications (‘Tobacco Use | Healthy People 2020’, 2018). Smoking not only affects direct consumers of tobacco but others exposed to tobacco smoke, also known as second hand smoke.
According to the Centers for Disease Control and Prevention (CDC) American Indians are by far the most prevalent users of tobacco at about 32% prevalence (‘Burden of Tobacco Use in the U.S.’, 2018). This may be attributed to two primary reasons. Firstly, tobacco has important roles in ceremonial, religious, and medicinal practices. Also, tobacco that is sold in American Indian reservations is not taxed at state or national levels, thus making it more affordable. In general, there is a correlation between lower costs of tobacco products and increased smoking rates.
On average, about 18% of men smoke while about 14% of women smoke (‘Burden of Tobacco Use in the U.S.’, 2018). When considering age demographics, the percentage of smoking prevalence increases slightly among 18-24, 25-44, and 45-64 year olds at 13%, 18% and 18% respectively (‘Burden of Tobacco Use in the U.S.’, 2018). However, after 65 years of age, smoking prevalence drops to about 9% (‘Burden of Tobacco Use in the U.S.’, 2018). It is worth noting that since the Surgeon General’s first report on tobacco in 1964, tobacco use has considerably declined and at the same time, public knowledge of the harmful effects of tobacco has considerably increased.
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Despite positive statistical trends indicating dwindling usage and increasing public awareness of the dangers of tobacco, consumption of tobacco products continues to be a very important public health issue. A research study by the CDC estimated that roughly 170 billion dollars are spent annually (Xu, Bishop, Kennedy, Simpson & Pechacek, 2015) for illnesses stemming from tobacco use. This figure represents almost 9% of all healthcare spending in the United States (Xu, Bishop, Kennedy, Simpson & Pechacek, 2015). According to Xin Xu, the researcher who led the CDC study, “Tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence”. From a broader view, this is concerning not only to smokers, but to the public as a whole since over 60% of the 170 billion dollars is paid by public programs such as Medicare and Medicaid (Xu, Bishop, Kennedy, Simpson & Pechacek, 2015). In other words, the financial cost of tobacco induced health issues is a burden borne by everyone – smokers and non smokers alike.
In addition to the financial woes created by smoking related health issues, the effects of second hand smoking on the non smoker are often overlooked in comparison to the deleterious health effects on the smoker. In recent years, much progress has been made in banning smoking in public. However, there is a need to raise awareness about the dangers of exposure to second hand smoke in homes, having children and infants.
Therefore, in light of these things, it is imperative that additional measures be taken to curb tobacco usage and thus, consequentially mitigate its hazards.
One of the primary means presently employed to reduce smoking tobacco is the levying of cigarette taxes. These taxes are levied at the federal, state, and sometimes, local levels. In April 2009, the federal tax rate on cigarettes increased by 62 cents to $1.01 per pack of cigarettes (‘U.S. State and Local Issues: Tobacco Taxes’, 2018). Since July 1, 2018, the average state tax per pack of cigarettes is $1.75 (‘U.S. State and Local Issues: Tobacco Taxes’, 2018). However there is great variation between states. For example, the tax rate per pack of cigarette in the state of New York is $4.35 while in Missouri; it is only 17 cents per pack (‘U.S. State and Local Issues: Tobacco Taxes’, 2018).
In general, taxation of tobacco products provides a strong and viable solution toward reducing tobacco usage. It provides local, state, and federal governments additional avenues for revenue with minimal risk of backlash from their constituents. National and state polls have shown that the public very strongly supports taxation of tobacco products (Kruger, Patel, Kegler, Brener & King, 2015). Political analysis shows that voters have a strong preference for increasing on taxes on tobacco as opposed to other types of tax increases (Kruger, Patel, Kegler, Brener & King, 2015).
At present, the disparity in state tobacco taxation rates works against states in which tobacco taxes are lower. As evidenced by the high prevalence of tobacco usage in Native American tribal lands where there is no tax on tobacco products, increased cost of tobacco products discourages tobacco consumption. Therefore, state governments ought to adjust their tobacco tax rates such that the rates are comparable between states. This would also prevent the illegal sale of tobacco acquired from low tobacco tax states in high tobacco tax states. In addition, the federal government should seek to increase their excise tax on tobacco products compounding and reinforcing the efforts of the individual states.
It would be prudent to divert at least some fraction of the revenue generated by tobacco taxation toward investing in tobacco control measures. This would allow for funding of smoking cessation programs and other public programs aimed at assisting smokers quit their addictions. Primary care clinics catering to the needs of out-patients would benefit from such a measure by being able to offer nicotine patches and gum. Funding could also be diverted toward youth oriented programs such as Campaign for Tobacco-Free Kids (‘U.S. State and Local Issues: Tobacco Taxes’, 2018) which seek to raise awareness of the dangers of smoking and the binding hold of nicotine addiction.
Another avenue toward addressing the tobacco public health dilemma is enacting changes in legal regulation of tobacco and tobacco control. Until 2009 tobacco was very minimally regulated (Villanti et al., 2011) despite the fact that its continued use poses very serious risks to the individual directly and indirectly through second hand smoke. Congress recognized that the standards used for regulating typical drugs were grossly incompatible when it came to regulating tobacco products. Therefore, in 2009 the Family Smoking Prevention and Tobacco Control Act enabled the Food and Drug Administration (FDA) to regulate tobacco products (Villanti et al., 2011). Specifically, this act gave the FDA the power to regulate the marketing, distribution, and manufacture of tobacco products (Battle, 2007). This is indeed a major stride in the right direction. Necessary and proper next steps would be to vest more power in the states to take additional measures as they see fit.
Organizations like the American Society of Clinical Oncology (ASCO) advocate at the state and national level by piloting several initiatives aimed at limiting the sale of tobacco products and collaborating with other agencies in lobbying for changes in tobacco legal policy (‘Policy Issue Brief: Tobacco and Cancer’, 2017).
A common conclusion from the preceding suggestions is that federal, state, and local governments are the foremost stake holders in the fight against tobacco. Additionally, by working in tandem, federal, state, and local governments can take significant steps in combating the tobacco public health issue. Policies and regulations enacted by these stakeholders would surely empower nurses and health care providers as they seek to assist those who are trying to quit smoking and as they seek to prevent non smokers from becoming smokers.
References
- Battle, J. (2007). Ending the Tobacco Problem: Opening Statement by Richard J. Bonnie. Retrieved from http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=05242007
- Burden of Tobacco Use in the U.S. (2018). Retrieved from https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united- states.html
- Kruger, J., Patel, R., Kegler, M., Brener, N., & King, B. (2015). National and State Attitudes of US Adults Toward Tobacco-Free School Grounds, 2009-2010. Preventing Chronic Disease. doi: 10.5888/pcd12.150353
- Policy Issue Brief: Tobacco and Cancer. (2017). Retrieved from https://www.asco.org/advocacy- policy/asco-in-action/policy-issue-brief-tobacco-and-cancer
- Tobacco Use | Healthy People 2020. (2018). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use
- U.S. State and Local Issues: Tobacco Taxes. (2018). Retrieved from https://www.tobaccofreekids.org/what-we-do/us/state-tobacco-taxes
- Villanti, A., Vargyas, E., Niaura, R., Beck, S., Pearson, J., & Abrams, D. (2011). Food and Drug Administration Regulation of Tobacco: Integrating Science, Law, Policy, and Advocacy. American Journal Of Public Health, 101(7), 1160-1162. doi: 10.2105/ajph.2011.300229
- Xu, X., Bishop, E., Kennedy, S., Simpson, S., & Pechacek, T. (2015). Annual Healthcare Spending Attributable to Cigarette Smoking. American Journal Of Preventive Medicine, 48(3), 326-333. doi: 10.1016/j.amepre.2014.10.012
