A Steadfast Commitment to End the Tobacco Epidemic
By Howard K. Koh, M.D., M.P.H.
Assistant Secretary for Health
U.S. Department of Health and Human Services
The Huffington Post
March 19, 2013
For far too long, tobacco use has remained the leading preventable cause of death and disease in the United States. That's why the President has prioritized protecting Americans from tobacco's deadly health consequences. From the early months of his first term, President Obama has demonstrated a steadfast commitment to ending the tobacco epidemic, focusing on prevention for youth and young adults.
As part of this promise, the President has signed into law historic legislation that promotes tobacco control and moves the country toward ending the epidemic. This includes: The Affordable Care Act; The Family Smoking Prevention and Tobacco Control Act; The Children's Health Insurance Program Reauthorization Act; and the Prevent All Cigarette Trafficking Act. Together, these laws provide more resources and more authority than ever before to reduce the death and disease caused by tobacco.
To implement the President's commitments on tobacco, the Department of Health and Human Services (HHS) accomplished an unprecedented set of actions:
Preventing Youth from Using Tobacco
- The Food and Drug Administration (FDA)'s robust enforcement program has partnered with 45 states and territories to crack down on violations, especially retailers selling tobacco products to youth. Specifically, since 2009, FDA has conducted more than 138,000 undercover inspections of tobacco retailers and issued more than 7,700 warning letters, the majority involving violations relating to tobacco sales to minors
- The landmark 2009 Family Smoking Prevention and Tobacco Control Act protects children by banning certain candy, fruit and other flavored cigarettes and ending tobacco product sponsorship of athletic and entertainment events.
- The Children's Health Insurance Program Reauthorization Act raised the federal excise tax by 62 cents per pack. Surgeon General's Reports have noted that young smokers are more price-sensitive than older smokers and price affects initiation, prevalence and intensity of smoking among youth and young adults. As a result, this price increase has been projected to prevent initiation of smoking by nearly two million children, avert nearly 900,000 smoking-attributable deaths, and produce $44.5 billion in long-term health care savings.
- In 2012, we launched the Tobacco-Free College Campuses Initiative (TFCCI), a public/private partnership with universities, colleges, and the public health community to promote the adoption of tobacco-free policies at institutions of higher learning.
- The National Cancer Institute has launched Smokefree Teen, which offers evidence-based smoking cessation information and interactive tools designed especially for teens.
- The 2012 U.S. Surgeon General Report, Preventing Tobacco Use among Youth and Young Adults, documents the health consequences of tobacco use among young people and identifying effective strategies to prevent and reduce tobacco use among youth.
Helping People to Quit Smoking
- In 2010, HHS launched the first-ever national strategic roadmap for tobacco control entitled, Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan for the U.S. Department of Health and Human Services, which outlines specific action steps to end the tobacco epidemic.
- The Affordable Care Act, signed into law three years ago this week, ensures that health plans cover tobacco use screening and tobacco cessation interventions without cost-sharing. It also expands employment-based wellness programs, such as those that focus on helping employees decrease tobacco use.
- The Affordable Care Act also provides for Medicaid coverage of comprehensive tobacco cessation services for pregnant women, without cost-sharing. Furthermore, it provides 50% reimbursement to states providing telephone quitline support.
- Medicare has expanded coverage of tobacco cessation counseling to make it available to approximately 5 million Medicare tobacco users, not just those with tobacco-related diseases.
- The National Institutes of Health (NIH) has launched a new, free interactive smartphone app, QuitPal, which uses proven quit strategies and tools to help change behavior and assist individuals in giving up smoking.
- In 2012, the Centers for Disease Control (CDC) launched the "Tips from Former Smokers" to encourage people to quit smoking by featuring people discussing the health effects they are living with as a result of their tobacco use. The campaign resulted in a 132% increase in calls to state quitlines. The 2013 version will launch in the coming weeks.
- HHS launched in 2012, BeTobaccoFree.gov, a comprehensive tobacco website that provides Americans with information on avoiding or ending tobacco use.
Supporting State and Community Prevention Efforts
- CDC has invested in state and local programs to prevent and control tobacco use and expand tobacco quitlines. CDC has also supported national networks to reduce tobacco use among specific at-risk populations.
- Thanks to the Affordable Care Act, the CDC has awarded more than $170 million in Community Transformation Grants to states, communities and tribes to design and implement community-level programs that improve health and wellness, including through strategies to enhance tobacco-free living.
Improving Research and Knowledge
- The FDA and the NIH have launched the largest-ever national cohort study of more than 60,000 tobacco users and those at-risk to assess the health effects and consequences of tobacco use.
- FDA has also released draft guidance that will ultimately provide the public with previously unknown information about the chemicals in tobacco products and help prevent misleading marketing about the risks associated with tobacco products.
- In Fiscal Year 2012, the NIH invested $363 million in tobacco-related health research, a 17% increase since 2008.
- In 2010, the Surgeon General released How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, which documents how and why smokers become addicted.
Although we pushed forcefully for Graphic Health Warning Labels to appear on cigarette packages, the D.C. Circuit's ruling against the warning labels won't deter the FDA from seeking an effective and sound way to implement the law. The FDA has announced it will undertake research to support new rulemaking on graphic warning labels consistent with the Family Smoking Prevention and Tobacco Control Act.
In the coming years, with the President's leadership, we will continue to take action to combat the death and disease caused by tobacco. The Administration will also continue its commitment to educate all Americans about the devastating consequences of tobacco use. We will use all of the tools available to us to move the nation closer to ending the epidemic once and for all.
Follow Dr. Howard K. Koh on Twitter: www.twitter.com/@HHS_DrKoh