Since the middle of the 20th century, we’ve known that smoking is bad for us. That’s when the surgeon general first began raising the alarm about smoking’s connection to lung cancer and other chronic diseases. Despite these warnings, according to the American Cancer Society’s Cancer Action Network, (a nonpartisan advocacy affiliate of the ACS), smoking has caused the premature deaths of more than 20 million Americans since 1964. And about 15 percent of Americans still light up regularly. Educational efforts to curb tobacco use have somehow not reached these smokers. But other tools in the tobacco-prevention arsenal that have proven to lower rates of smoking and lung cancer are legislative measures. Continual efforts to restrict access to tobacco may help bring the rate of smoking even lower.
Cathy Callaway, director of state and local campaigns for ACS CAN, says that instituting laws to restrict the sale of tobacco, raise taxes on its sale and improve access to smoking cessation services for smokers really can lower rates of lung cancer as evidenced through previous legislation. “As states have passed and implemented these policies, we’ve learned from their experiences.” She points to California as a leader in the fight against smoking.
[See: 7 Things You Didn’t Know About Lung Cancer.]
“California has had the longest running tobacco control program and they have been able to show a reduction in lung cancer rates. They’ve been reducing those rates four times faster than the rest of the United States,” she says. According to 2014 statistics from the California Cancer Registry of the California Department of Public Health, about 17,000 new cases of lung cancer — 11 percent of all cancers — were diagnosed in the state that year. That’s still a lot of people, but rates of lung cancer incidence have dropped 40 percent in California from 1988 (when California began taxing the sale of cigarettes) through 2014. “Rates in the rest of the country dropped by only 19 percent between 1988 and 2013,” the ACS reports.
These reductions are in part due to the implementation of what Callaway calls a “three-legged stool” approach to tobacco prevention policies. “We prioritize our policy efforts on three different policies, the first being regular and significant increases in tobacco taxes. The second is implementing smoke-free and tobacco-free policies,” which prohibit smoking in specified buildings and spaces, she says. “The third is allocating adequate funding for tobacco prevention and cessation services” to help smokers kick the habit.
Callaway says that although most states do have some tobacco-control policies in place, ACS CAN is working to expand that coverage and help all states adopt comprehensive legislation to reduce the burden of smoking. The organization is also working with federal and municipal authorities to enact legislation at all levels of government.
One state that already has some measures in place but is looking to tighten its tobacco restrictions is Massachusetts. Comprehensive tobacco legislation currently under consideration in the Bay State would elevate the legal smoking age from 18 to 21, remove tobacco sales from pharmacies and designate electronic cigarettes and vaping devices as subject to the same policies as traditional cigarettes.
Marc Hymovitz, Massachusetts government relations director with ACS CAN, says the aspect of the bill that’s gotten the most attention is raising the age at which consumers can buy tobacco products. That policy recommendation was based on the findings of a 2015 report created by the Institute of Medicine of the National Academies and found that raising the legal purchasing age for tobacco products to age “21 is the sweet spot,” because 95 percent of smokers adopt the habit prior to age 21. “If we increase the age of sale across the country to 21, the smoking prevalence would decline by 12 percent. It was also determined that if we increased the age to 21 across the country, about 220,000 fewer premature deaths would occur and 50,000 of those fewer deaths would have been lung cancer,” Hymovitz says. (California raised its smoking age to 21 in May 2016.)
[See: What Not to Say to Someone With Lung Cancer.]
The proposed Massachusetts legislation — which passed the state Senate in April 2016 “by an overwhelming vote of 32 to 2,” Hymovitz says — had to be refiled because “the clock ran out on the legislative session before we could get it passed in the House.” It was refiled in January 2017 and is expected to pass without difficulty sometime in the next month or two. If it does, enforcement could begin as early as spring 2018.
Although the proposed legislation has garnered strong support among lawmakers in Massachusetts, Hymovitz says there has been some pushback from retailers who worry about the financial impact of losing all or some of their tobacco sales. “The Institute of Medicine report looked at that as well,” Hymovitz says, “and the economic impacts they predict would be minimal. What we as public health advocates say is, what’s really impacting small business are increased health care costs. Here in Massachusetts, treating tobacco-related illness is responsible for over $4 billion in health care spending, with a billion of that in Medicaid spending. Those are real costs, and those are costs that are having a significant impact on small businesses. We think it’s kind of shortsighted to look at short-term profits over the health of the population in Massachusetts.”
He says public health advocates heard similar concerns from restaurant owners when the state banned smoking in restaurants and bars in 2004 and “since then, the restaurant business in Massachusetts is actually booming. When you have 86 percent of the population not smoking, do you want to cater to that 86 percent or the 14 percent who are smoking?” he asks. “The bottom line is this is the right thing to do for public health and the right thing to do to make sure that all residents in Massachusetts are protected from the damage that tobacco use causes.” In addition, Hymovitz says some municipalities within the state have already implemented these measures.
Callaway says that ACS CAN is working at all levels of government to regulate tobacco sales and access to smoking cessation services. “We found it to be a best practice to start at the community level and build support and momentum to then pass policies at the state level and at the same time at the federal level.” Taken together, she says these efforts “really do tend to create a tobacco-free norm and they support one another. When we raise the price of tobacco products, that certainly encourages people to quit or to think about quitting. But when we’re also coupling that with a supportive, smoke-free or tobacco-free environment where they live, work and play, that just helps reinforce their decision to quit. And if they’re constantly seeing messages about the health benefits of quitting, that’s also a help in making them successful.”
[See: 7 Innovations in Cancer Therapy.]
She hopes that eventually, it’ll all lead to a smoke-free society despite the challenges of fighting against the tactics of a well-funded tobacco industry. “It’s going to continue to be an uphill battle, but we know how to get there. It’s finding the political will of our elected officials and being able to implement those policies to make [a tobacco-free country] a reality.”
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Can Legislation Reduce Lung Cancer Rates? originally appeared on usnews.com
