ATLANTA – Health officials have begun to predict the end of cigarette smoking in America.
They long have wished for a cigarette-free America, but shied away from calling for smoking rates to fall to 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 recently has prompted public health leaders to start throwing around phrases 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 released a 980-page report on smoking in January that pushed for stepped-up tobacco-control measures. His news conference was an unusually animated showing of anti-smoking bravado, with Lushniak nearly yelling, repeatedly, “Enough is enough!”
“I can’t accept that we’re just allowing these numbers to trickle down,” he said, in a recent interview. “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. However, Koop – a bold talker on many issues – didn’t offer specifics on how to achieve such a goal.
“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 things that have changed:
- Cigarette taxes have increased around the country, making smokes more expensive. Though prices vary from state to state, on average a pack of cigarettes that would have sold for about $1.75 only 20 years ago would cost more than triple that now.
- Laws banning smoking in restaurants, bars and workplaces have popped up all over the country. Airline flights long have been off-limits for smoking.
- Polls show that cigarette smoking is no longer considered normal behavior, and is now less popular among teens than marijuana.
- Federal officials increasingly are aggressive about anti-smoking advertising. The U.S. Food and Drug Administration launched a new youth tobacco prevention campaign last week. At about the same time, the U.S. Centers for Disease Control and Prevention debuted a third, $60-million round of its successful anti-tobacco ad campaign.
- Tobacco companies, once considered impervious to legal attack, have suffered some huge defeats in court. Perhaps the biggest was the 1998 settlement of a case brought by more than 40 states demanding compensation for the costs of treating smoking-related illnesses. The industry agreed to pay about $200 billion and curtail marketing of cigarettes to youths.
- Retailing of cigarettes is changing. CVS Caremark, the nation’s second-largest pharmacy chain, recently announced it will stop selling tobacco products at its more than 7,600 drugstores. The company said it made the decision in a bid to focus more on providing health care, but medical and public health leaders predicted pressure will increase on companies such as Walgreen and Walmart to follow suit.
“I do think, in another few years, that pharmacies selling cigarettes will look as anachronistic” as old cigarette ads featuring physician endorsements look today, said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.
These developments have made many in public health dream bigger. It’s caused Myers’ organization and others to recently tout the goal of bringing the adult smoking rate down to 10 percent by 2024, from the current 18 percent. That would mean dropping it at twice the speed it declined over the last 10 years.
The bigger goal is to reduce U.S. smoking-related deaths to fewer than 10,000, from the current level of 480,000. But even if smoking rates immediately dropped to zero, it would take decades to see that benefit, since smoking-triggered cancers can take decades to develop.
But while some experts and advocates are swinging for the fences, others are more pessimistic. They said the key to reaching such goals is not simply more taxes and more local smoking bans, but action by the Food and Drug Administration to regulate smoking.
A 2009 federal law gave the FDA the authority to regulate tobacco products. The law barred FDA from outright blocking the sale of cigarettes, but the agency was free to take such pivotal steps as prohibiting the use of appealing menthol flavoring in cigarettes and requiring cigarette makers to ratchet down the amount of addictive nicotine in each smoke.
But nearly five years after gaining power over cigarettes, the FDA has yet to propose such regulations. Agency officials said they’re working on them.
Many believe FDA’s delay is driven by defense preparations for an anticipated battery of legal and political challenges.