Tobacco Control – Yesterday, Today and Tobacco Control – Yesterday, Today and TomorrowTomorrow

Christopher SquierChristopher Squier

Commission on Tobacco Use Prevention and ControlCommission on Tobacco Use Prevention and ControlAmerican Cancer Society (ACS)American Cancer Society (ACS)Clean Air for Everyone (CAFÉ)Clean Air for Everyone (CAFÉ)

In the Beginning………In the Beginning………

Iowa Cigarette Control Law—1897Iowa Cigarette Control Law—1897

In 1897 Iowa banned the In 1897 Iowa banned the manufacture, sale, exchange, and manufacture, sale, exchange, and disposition of cigarettes and disposition of cigarettes and cigarette paper.cigarette paper.

The ban was repealed after the 1The ban was repealed after the 1stst World War but in 1921 Iowa World War but in 1921 Iowa became the first state to impose a became the first state to impose a cigarette tax!cigarette tax!

In the Beginning………In the Beginning………

Strange Bedfellows – Henry Ford and Adolf Hitler Strange Bedfellows – Henry Ford and Adolf Hitler

In the Beginning………In the Beginning………

Strange Bedfellows – Henry Ford and Adolf Hitler Strange Bedfellows – Henry Ford and Adolf Hitler

19141914

In 1941, Hitler introduced In 1941, Hitler introduced a comprehensive public a comprehensive public health program to restrict health program to restrict smoking and limit smoking and limit advertisingadvertising

1930’s and 1940’s -the Age of Innocence?1930’s and 1940’s -the Age of Innocence?Physicians selling cigarettes!Physicians selling cigarettes!

Physicians and Physicians and cigarettes cigarettes Physicians and Physicians and cigarettes cigarettes

The 1950’s - the Health ContextThe 1950’s - the Health Context-cruel realities; tobacco can kill you-cruel realities; tobacco can kill you

The 1950’s - the Health ContextThe 1950’s - the Health Context-cruel realities; tobacco can kill you-cruel realities; tobacco can kill you

1964 - the 1st Surgeon General1964 - the 1st Surgeon General’’s Reports Reportlinked smoking and lung cancerlinked smoking and lung cancer

The Health Context -The Health Context -cruel realities; tobacco can kill youcruel realities; tobacco can kill you

1966 Health warnings begin 1966 Health warnings begin on cigarette packson cigarette packs

1971 Cigarette advertisements1971 Cigarette advertisements are taken off TV and radioare taken off TV and radio

Smoking prevalence among US adults (%)

0

5

10

15

20

25

30

35

40

45

1955 1966 1974 1979 1983 1985 1988 1991 1993 1997

Year

Caution--cigarette smoking may be hazardous to your health

The Response of Big Tobacco – lies and prevaricationThe Response of Big Tobacco – lies and prevaricationThe Response of Big Tobacco – lies and prevaricationThe Response of Big Tobacco – lies and prevarication

April 14, 1994; the chief executive April 14, 1994; the chief executive officers of the 7 major tobacco officers of the 7 major tobacco companies testified before Congress that companies testified before Congress that they did not believe nicotine was they did not believe nicotine was addictive.addictive.

Tobacco Control ?Tobacco Control ?Tobacco Control ?Tobacco Control ?

• ‘‘Education’ and just say ‘no’Education’ and just say ‘no’

• An ‘adult habit’An ‘adult habit’

Website funded by R J Reynolds to Website funded by R J Reynolds to promote promote ‘‘adult choiceadult choice’’

Q: ‘Could you please explain Q: ‘Could you please explain the recent historic tobacco settlement?’ the recent historic tobacco settlement?’

A:’ Sure. Basically, the tobacco industryA:’ Sure. Basically, the tobacco industry has admitted that it is killing people by the millions, and has agreed thathas admitted that it is killing people by the millions, and has agreed that from now on it will do this under the strict supervision of the federal from now on it will do this under the strict supervision of the federal government’. government’.

Dave BarryDave Barry

The Litigous Nineties and the 1998 Master The Litigous Nineties and the 1998 Master Settlement AgreementSettlement Agreement

The The AttorneysAttorneys General Master Settlement Agreement General Master Settlement Agreement

In 1998 the tobacco industry agreed to pay 46 states $206b over 25 years: the agreement included provisions to:

• refrain from targeting youth

• to limit brand name sponsorship

• reduce outside advertising (billboards and transit)

• refrain from opposing state or local laws intended to protect youth

• cease to sell merchandise with tobacco brand names

2000 - a new era for tobacco control2000 - a new era for tobacco control2000 - a new era for tobacco control2000 - a new era for tobacco control

Comprehensive Tobacco Comprehensive Tobacco Control Programs WorkControl Programs WorkComprehensive Tobacco Comprehensive Tobacco Control Programs WorkControl Programs Work

CDC showed:CDC showed:

•Dose response relationship between levels of spending and Dose response relationship between levels of spending and program effectprogram effect

•Increase in spending per capita associated with larger Increase in spending per capita associated with larger tobacco control program effecttobacco control program effect

•Increased efficiency from lessons learned Increased efficiency from lessons learned

Tobacco Control in IowaTobacco Control in IowaTobacco Control in IowaTobacco Control in Iowa

2001 - Iowa Code Annotated

Chapter 142A. Tobacco Use Prevention and Control •Establishment of a Establishment of a DivisionDivision of Tobacco Use Prevention and of Tobacco Use Prevention and Control with a Control with a full time Directorfull time Director•Establishment of a Establishment of a CommissionCommission to develop policy and to develop policy and provide directionprovide direction•Establish Establish youth programs youth programs that are directed by youth that are directed by youth participants for youth.participants for youth.•Establish Establish community partnershipscommunity partnerships

What Happened in Iowa?What Happened in Iowa? - an unprecedented decrease in smoking prevalence!- an unprecedented decrease in smoking prevalence!

What happened in Iowa?What happened in Iowa?A relationship between tobacco control spending and outcomesA relationship between tobacco control spending and outcomes

A greater reduction in youth smoking in Iowa than nationallyA greater reduction in youth smoking in Iowa than nationally

What happened in Iowa?A successful youth program (JEL) and a reduction in youth smoking

What happened in Iowa?What happened in Iowa?A decrease in hospital admissions for diseases related to A decrease in hospital admissions for diseases related to secondhand smoke exposuresecondhand smoke exposure

What happened in Iowa?What happened in Iowa?A decrease in hospital admissions for diseases related to A decrease in hospital admissions for diseases related to secondhand smoke exposuresecondhand smoke exposure

Tobacco Control - what is happening Tobacco Control - what is happening nownow in Iowa? in Iowa?

Snatching Disaster from the Jaws of SuccessSnatching Disaster from the Jaws of Success

Tobacco Control - what is happening Tobacco Control - what is happening nownow in Iowa? in Iowa?

Snatching Disaster from the Jaws of SuccessSnatching Disaster from the Jaws of Success

• Since 2009 we have Since 2009 we have seen continual cuts in seen continual cuts in the budget of the the budget of the Division of Tobacco Division of Tobacco Control Control

• This culminated in a This culminated in a halving of the current halving of the current years budget!years budget!

Tobacco Control - what is happening in Iowa?Tobacco Control - what is happening in Iowa?Snatching Disaster from the Jaws of SuccessSnatching Disaster from the Jaws of SuccessTobacco Control - what is happening in Iowa?Tobacco Control - what is happening in Iowa?Snatching Disaster from the Jaws of SuccessSnatching Disaster from the Jaws of Success

Devastating budget Devastating budget cuts are having cuts are having predictable effectspredictable effects

Iowa smoking rates have gone up to 16% in 2010 (Iowa Adult Tobacco Survey)

O

Tobacco Control - what is happening in Iowa?Tobacco Control - what is happening in Iowa?Snatching Disaster from the Jaws of SuccessSnatching Disaster from the Jaws of Success

Tobacco Control - what is happening in Iowa?Tobacco Control - what is happening in Iowa?Snatching Disaster from the Jaws of SuccessSnatching Disaster from the Jaws of Success

But there is no But there is no shortage of funding!shortage of funding!

Meanwhile, the tobacco Meanwhile, the tobacco industry spends $102M a industry spends $102M a year promoting its year promoting its products in Iowa!products in Iowa!

Tobacco settlement and Tobacco settlement and tax income is almost one tax income is almost one hundred times greater hundred times greater than the appropriations to than the appropriations to tobacco controltobacco control

Tobacco Control - what is happening in Iowa?

• We have a Governor who claims that Iowa We have a Governor who claims that Iowa will be the healthiest state in the nationwill be the healthiest state in the nation

• But actions speak louder than words!But actions speak louder than words!

− Tobacco funding has been halvedTobacco funding has been halved

− The Director was dismissed and the Division The Director was dismissed and the Division of Tobacco Control is threatened with of Tobacco Control is threatened with elimination!elimination!

Is there a tomorrow?Is there a tomorrow?An end game for tobacco? An end game for tobacco? A global viewA global view

As smoking rates

decrease, how do we

finally eliminate a lethal

but addictive product?

Framework convention on tobacco controlFramework convention on tobacco control 2005 2005

The treaty sets an international floor for tobacco control with The treaty sets an international floor for tobacco control with provisions on advertising and sponsorship, tax and price provisions on advertising and sponsorship, tax and price increases, labeling, illicit trade and secondhand smoke. increases, labeling, illicit trade and secondhand smoke.

Framework convention on tobacco controlFramework convention on tobacco control 2005 2005

The treaty sets an international floor for tobacco control with The treaty sets an international floor for tobacco control with provisions on advertising and sponsorship, tax and price provisions on advertising and sponsorship, tax and price increases, labeling, illicit trade and secondhand smoke. increases, labeling, illicit trade and secondhand smoke.

How effective are these strategies?How effective are these strategies?How effective are these strategies?How effective are these strategies?

The USA has not ratified the Convention!The USA has not ratified the Convention!

Tobacco Free New Zealand 2020Tobacco Free New Zealand 2020Tupeka Kore Aotearoa 2020Tupeka Kore Aotearoa 2020

VisionVisionFuture generations of New Zealand children will be free from exposure to Future generations of New Zealand children will be free from exposure to tobacco and will enjoy smokefree livestobacco and will enjoy smokefree lives

StrategiesStrategies•Tobacco retail displays will be bannedTobacco retail displays will be banned

•Plain packaging and graphic warnings will replace brand imageryPlain packaging and graphic warnings will replace brand imagery

•Tobacco retail prices will increase systematically and significantly (20% per year)Tobacco retail prices will increase systematically and significantly (20% per year)

•The supply and sale of tobacco products will be controlled –retailers licensed The supply and sale of tobacco products will be controlled –retailers licensed and number of licenses decreased annuallyand number of licenses decreased annually

Singapore has proposed the ‘end of tobacco’Singapore has proposed the ‘end of tobacco’Singapore has proposed the ‘end of tobacco’Singapore has proposed the ‘end of tobacco’

Australia is currently enacting Australia is currently enacting

legislation that will only permit legislation that will only permit

‘plain packaging’ ‘plain packaging’ withwith warning warning

labels labels

Australia is currently enacting Australia is currently enacting

legislation that will only permit legislation that will only permit

‘plain packaging’ ‘plain packaging’ withwith warning warning

labels labels

Smoking KillsSmoking Kills Smoking may be Smoking may be the cause of the cause of impotenceimpotence

In the US, the tobacco industry takes the FDA to court over In the US, the tobacco industry takes the FDA to court over warning labels but they even have them in Russia!warning labels but they even have them in Russia!

Tobacco Control TomorrowTobacco Control Tomorrow– – Whither Iowa?Whither Iowa?

Tobacco Control TomorrowTobacco Control Tomorrow– – Whither Iowa?Whither Iowa?

Tobacco Control - what is to be done in Iowa?

• 30% of all cancers are related to 30% of all cancers are related to tobacco usetobacco use

• 80% of lung and oral cancers are 80% of lung and oral cancers are related to tobacco userelated to tobacco use

• 4,400 Iowa adults die each year from 4,400 Iowa adults die each year from tobacco usetobacco use

But there is an industry that lobbies But there is an industry that lobbies against the actions that are against the actions that are necessary to prevent or reduce necessary to prevent or reduce tobacco related diseases!tobacco related diseases!

Tobacco Control - what is to be done in Iowa? Tobacco Control - what is to be done in Iowa? There are new challenges; There are new challenges; smokeless tobacco products -dissolvablessmokeless tobacco products -dissolvables

Tobacco Control - what is to be done in Iowa? Tobacco Control - what is to be done in Iowa? There are new challenges; There are new challenges; smokeless tobacco products -dissolvablessmokeless tobacco products -dissolvables

There are a variety of flavored, soluble There are a variety of flavored, soluble tobacco products being promoted in tobacco products being promoted in the US, some with a great similarity to the US, some with a great similarity to candy!candy!

Attempts to regulate these have been Attempts to regulate these have been resisted!resisted!

Tobacco Control - what is to be done in Iowa? Tobacco Control - what is to be done in Iowa? New challenges; sNew challenges; snuff, snus and cross-brandingnuff, snus and cross-branding

Tobacco Control - what is to be done in Iowa? Tobacco Control - what is to be done in Iowa? New challenges; sNew challenges; snuff, snus and cross-brandingnuff, snus and cross-branding

Snus is a form of smokeless tobacco manufactured in Snus is a form of smokeless tobacco manufactured in Sweden that has much lower levels of carcinogens Sweden that has much lower levels of carcinogens (nitrosamines) than are found in US snuff. (nitrosamines) than are found in US snuff.

‘‘SnusSnus’’ has recently been marketed in the US but there is no has recently been marketed in the US but there is no information on the level of carcinogens or its health effects. information on the level of carcinogens or its health effects. Some is sold under cigarette brand names, suggesting it is Some is sold under cigarette brand names, suggesting it is intended to supplement smoking, not replace it!intended to supplement smoking, not replace it!

4,400 Iowa adults die 4,400 Iowa adults die each year from tobacco each year from tobacco use use

Tobacco Control - what is to be done in Iowa?

• Education – we have an administration and legislature that needs a lot of help

• We must advocate and where necessary apply political pressure – follow the money!

• Grassroot and grasstop support is essential – that means you!