08 January 2014

US needs tougher anti-smoking measures

The US lags behind many countries in adopting measures to reduce tobacco use, including graphic health warning labels, high tobacco taxes and bans on tobacco advertising.

Anti-smoking measures have saved roughly 8 million US lives since a landmark 1964 report linking smoking and disease, a study estimates, yet the nation's top disease detective says dozens of other countries do a better job on several efforts to cut tobacco use.

The study and comments were published in the Journal of the American Medical Association. This week's issue commemorates the 50th anniversary of the US surgeon general report credited with raising alarms about the dangers of smoking.

In one study, researchers used national health surveys and death rates to calculate how many deaths might have occurred since 1964 if Americans' smoking habits and related deaths had continued at a pace in place before the report.

More than 42% of US adults smoked in years preceding the report; that rate has dropped to about 18%.

Read: The toughest anti-smoking law

Increases in life expectancy

The researchers say their calculation – 8 million deaths – equals lives saved thanks to anti-smoking efforts.

Their report also says tobacco controls have contributed substantially to increases in US life expectancy. For example, life expectancy for 40-year-olds has increased by more than five years since 1964; tobacco control accounts for about 30% of that gain, the report says.

The conclusions are just estimates, not hard evidence, but lead author Theodore Holford, a biostatistics professor at Yale University's school of public health, said the numbers "are pretty striking".

Smoking still a problem

Yet smoking remains a stubborn problem and heart disease, cancer, lung ailments and stroke – all often linked with smoking – are top four leading causes of death in the US.

The US Centres for Disease Control says about 443 000 Americans still die prematurely each year from smoking-related causes.

"Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people," Dr Thomas Frieden, the CDC's director, wrote in a JAMA commentary.

Frieden said the United States lags behind many other countries in adopting measures proven to reduce tobacco use, including graphic health warning labels on cigarettes, high tobacco taxes and widespread bans on tobacco advertising.

"Images of smoking in movies, television and on the Internet remain common; and cigarettes continue to be far too affordable in nearly all parts of the country," Frieden wrote.

Read: Anti-smoking vaccine promising


Frieden cited data showing 32 countries have done better at raising tobacco taxes, and at least 30 have adopted stronger cigarette warning labels. These include Australia, Brazil, Canada and Uruguay, and research has suggested that gruesome labels can help persuade smokers to quit.

Tobacco companies have fought U.S. efforts to adopt similar labelling and an appeals court last year blocked a Food and Drug Administration mandate for stronger labels.

Other studies in the journal

Smoking declined an average 25% among men in 187 countries from 1980-2012, and by 42% among women. Because of population growth, the number of smokers worldwide has increased and rates remain high in many countries. More than half of men smoke in Russia, Indonesia and Armenia, and more than 1 in 4 women smoke in Chile, France and Greece.

Smoking rates among US registered nurses dropped to 7% in 2010-11, from 11 percent in 2003, and remained low among doctors, at just below 2 percent. The rate was 25 percent among licensed practical nurses, who have less advanced education than registered nurses.

Drugs including nicotine patches, Chantix and Zyban, work better than dummy treatments at helping smokers quit at least temporarily, but many often resume after a year.

Electronic cigarettes may help some smokers quit but conclusive research is needed and their long-term safety is unknown. Users inhale nicotine vapour from the battery-operated devices – and they could lead to nicotine addiction among non-smokers, according to a review article.

Read More:
Anti-smoking pictures are effective
Anti-smoking efforts do work
SA looks to toughen anti-smoking laws


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