David A. Kessler, MD, JD, commissioner of the Food and Drug Administration, calls smoking a pediatric disease. He says that seeing smoking as simply an adult problem is a dangerously short-sighted view. “Nicotine addiction begins when most tobacco users are teenagers, so let's call this what it really is: a pediatric disease,” says Kessler.
Dr Kessler goes on to say that if we could affect the smoking habits of just one generation, we could radically reduce the incidence of smoking-related death and disease. And a second generation could see nicotine addiction go the way of smallpox and polio.
More than 3 million children in the United States currently smoke cigarettes. Every day, 3000 kids become regular smokers, and most of them will become addicted to nicotine before they are adults. Nearly 1000 of them will eventually die from a smoking-related disease. More than 80% of all adult smokers started smoking before they were 18 years of age. If a person has not started smoking by age 18, they are unlikely to ever become a smoker.
Smoking is the most important of the known modifiable risk factors for coronary heart disease in the United States. Nearly one fifth of deaths from cardiovascular diseases are attributable to smoking. In fact, cigarette smoking is the biggest risk factor for sudden cardiac death.
The antidote for the youth smoking epidemic is not found in a complex, expensive medical procedure or in an exotic drug therapy but in simple, inexpensive, public policy initiatives designed to reduce youth smoking rates.
There are several pending public policy initiatives that would significantly reduce youth smoking rates. On the federal level, the Food and Drug Administration (FDA), led by Commissioner Kessler, is working to advance its regulatory proposal to protect kids from tobacco. The FDA is still reviewing public comments on its proposal and has yet to issue a final rule. The proposal is intended to reduce the access and the appeal of tobacco products to youth.
Reduced access to tobacco products by youth requires age verification and face-to-face sale, elimination of mail order sales, vending machines, free samples, self-service displays, and sale of single cigarettes and packages with less than 20 cigarettes.
Reduced appeal of tobacco products to youth (1) bans outdoor advertising within 1000 feet of schools and playgrounds; permits black-and-white, text-only advertising for all other outdoor advertising, including billboards, signs inside and outside of buses, and all point-of-sale advertising; (2) permits black-and-white, text-only advertising in publications with significant youth readership (under 18) (significant readership means more than 15% or more than 2 million); no restrictions on print advertising below these thresholds; (3) prohibits sale of giveaway of products like caps or gym bags that carry cigarette or smokeless tobacco product brand names or logos; prohibits exchange of nontobacco products for proof of purchase of tobacco products; (4) prohibits brand name sponsorship of sporting or entertainment events but permits it in the corporate name; and (5) requires the tobacco industry to fund ($150 million annually) a public-education campaign to prevent kids from smoking.
State and local initiatives can be very effective in reducing youth smoking rates, especially the access of tobacco products by youth. Key planks for effective state and local youth access laws should generally include (1) requiring mandatory inspections of retailers that sell tobacco products, (2) designation of the most appropriate state agency to test compliance of retailers and to carry out enforcement of the law, (3) licensing of tobacco retailers with suspension or revocation of the license as a penalty for repeat violations, and (4) establishing a graduated set of civil penalties that get the attention of retailers but are not so severe that they discourage enforcement.
Effective public policy initiatives are necessary if we are to prevent the early youth addiction to nicotine that ensures a lifelong smoker for the tobacco industry. However, very few states and local governments actually have been able to pass effective youth access legislation.
Although the corporate image of the tobacco companies has been sullied by recent charges of fraud, perjury, and other nefarious activities that have been brought to light, they still have great influence with elected officials (by way of generous campaign contributions), which they use to thwart meaningful initiatives brought by tobacco-control advocates.
If future youth access proposals are to succeed, we must increase the strength and force behind those proposals. Where the tobacco industry has money, we have the strength of scientific data, the medical community, health and civic groups, and thousands of individuals capable of taking up the cause at the grassroots level. It is a matter of exerting our strength with greater force.
The problem of youth smoking must be treated immediately and aggressively. We must insist that new proposals be adopted. We must become more forthright with elected officials who continue to find reasons not to support simple, commonsense initiatives.
If we continue to wait to treat tobacco-related illnesses until after the onset of one of the major chronic diseases caused by smoking, we will continue to see hundreds of thousands of lives taken prematurely every year.
- Copyright © 1996 by American Heart Association