Fifty years ago, the U.S. surgeon general first reported on the association between tobacco and lung cancer. In the five decades since then, an expansive body of scientific research has linked smoking with a host of other health issues, and efforts to raise awareness of those harmful effects helped spur a historic decline in the number of Americans who regularly smoke.
Nonetheless, more than 42 million adults remain addicted to cigarettes, and the head of the Centers for Disease Control and Prevention (CDC) says that tobacco is still the greatest public health challenge of our time.
Why, despite the indisputable evidence on the harms associated with smoking, is tobacco still at the top of the CDC’s list? Why haven’t we moved past this yet? Well, according to a new report by the Campaign for Tobacco-Free Kids, it’s largely because cigarette manufacturers have worked tirelessly to keep their products relevant — and even in the midst of aggressive public health campaigns to crack down on smoking, Big Tobacco is still successfully convincing people to light up.
‘Designed for Addiction’
Over the last five decades, the tobacco industry has engineered cigarettes to be more addictive — and has also made them more dangerous. In fact, according to the new report, “[t]he evidence is sufficient to infer that the relative risk of dying from cigarette smoking has increased over the last 50 years in men and women in the United States.”
Smokers suffer from higher risk of lung cancer and chronic obstructive pulmonary disease (COPD) today compared to 1964, when the very first Surgeon General’s report on cigarettes was issued. That’s because cigarettes sold today are quite different from the cigarettes that were on the market five decades ago, which, according to the new report, is the result of extensive research — and deliberate design changes — orchestrated by the tobacco industry to make smoking more appealing for new customers:
Compared to cigarettes in Australia and Canada, tobacco blends used in U.S. cigarettes have higher levels of tobacco-specific nitrosamines (TSNAs), chemicals known to cause cancer. TSNA levels have increased substantially since 1964, according to the report.
Cigarette companies also introduced ventilation holes in cigarette filters so that cigarettes would look healthier on paper (the FDA was only recently able to ban cigarette manufacturers from advertising their products as “light,” “low,” or “mild”). The ventilation holes cause machines to report lower levels of tar and nicotine when testing cigarettes. However, it’s been documented that these ventilation holes actually change how people smoke cigarettes. Smokers inhale more frequently and more deeply, drawing cancer-causing chemicals farther into the lungs.
The ill effects of these design changes are compacted by efforts to make cigarettes more attractive and more addictive. Basically, the tobacco industry has made it easier to get hooked on their products by increasing the levels of nicotine — the addictive chemical in cigarettes — and using new additives to maximize nicotine’s impact. For example, added ammonia compounds produce higher levels of “freebase” nicotine and increase the speed with which nicotine hits the brain.
They’ve also added flavoring, sugars, and menthol to mask the uncomfortable effect of inhaling smoke, ultimately hoping that will make it more pleasurable to use cigarettes. Bronchodilators, for example, expand the lungs’ airways, making it easier for tobacco smoke to pass into the lungs, while menthol cools and numbs the throat to reduce irritation and make the smoke feel smoother.
Higher levels of nicotine, ammonia, and sugars have increased the addictiveness of cigarettes over time — and they’ve also made them more deadly.
Deliberate Efforts Targeting Youth
Cigarette manufacturers have long engaged in aggressive marketing techniques to target young people with their advertising. Before a series of regulatory efforts tried to rein in this practice, it was even more explicit than it is now. Remember Joe Camel? It was that campaign, specifically — which was infamously used by the R. J. Reynolds Tobacco Company — that mobilized anti-tobacco advocates to launch a counterattack against marketing aimed at younger Americans.
Despite these efforts to prevent youth exposure to cigarette advertising, the tobacco industry has recently placed increased emphasis on direct marketing to teens and adolescents. Thanks to the Internet and social media, cigarette manufacturers now have an entirely new avenue to reach young people, and in 2010 they spent more than $22 million on Internet marketing. And they’re getting their money’s worth: According to one recent study, not only are young people exposed to tobacco advertising, they are also influenced by it. Teens who report greater exposure to direct marketing — whether online or via mail and other sources — are significantly more likely to initiate smoking.
But according to the new report, tobacco companies have actually gone even further to woo teens. The R.J. Reynolds Tobacco Company didn’t just rely on its “cool” smoking camel; it also looked to change the design of its cigarettes to appeal to a younger demographic. “Two key areas identified for improvement were smoothness and sweetness delivery. Smoothness is an identified opportunity area for improvement versus Marlboro, and sweetness can impart a different delivery taste dimension which younger adult smokers may be receptive to,” a 1985 product development plan for the company noted.
Time for ‘Bolder Actions’ to Combat America’s Tobacco Epidemic
The Tobacco-Free Kids’ report was released to coincide with the five year anniversary of the Family Smoking Prevention and Tobacco Control Act, a historic act of legislation signed by President Obama on June 22, 2009, that gave the Food and Drug Administration the power to regulate tobacco products and marketing efforts. At the time, that measure was hailed as the “toughest anti-tobacco bill in American history” — and the Campaign for Tobacco-Free Kids wants the government to use it to undo some of the changes that have been made to cigarettes over the past several decades.
“For decades, the tobacco industry had complete control over how cigarettes were made, and they responded by making a deadly and addictive product even worse,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “Now that it has the authority to regulate tobacco products, the FDA must require changes in these products to reduce the death and disease they cause. Decisions about how tobacco products are made and what is in them must now be based on protecting public health, not tobacco industry profits.”
Along with a number of leading public health organizations, the Campaign for Tobacco-Free Kids is calling on the FDA to issue the first-ever product standard to reduce the toxicity, addictiveness and/or appeal of cigarettes and other tobacco products. Among its key recommendations for accelerating progress in reducing tobacco use, the latest Surgeon General’s report called for “[e]ffective implementation of FDA’s authority for tobacco product regulation in order to reduce tobacco product addictiveness and harmfulness.”
As such, the Campaign for Tobacco-Free Kids issued the following three recommendations:
Extend the FDA’s jurisdiction to all tobacco products, with no exceptions.
On April 25, the FDA issued a proposed rule (called the deeming rule) to begin regulating tobacco products not currently under its jurisdiction, including electronic cigarettes and cigars. Within 12 months (no later than April 25, 2015), the FDA should issue a complete, effective final rule with no exceptions and address critically important issues not addressed in the proposed rule, such as marketing and flavorings that appeal to kids. The FDA should take even faster action to require child-proof packaging on nicotine-containing liquids to address the skyrocketing number of calls to poison control centers related to the nicotine liquids used in e-cigarettes.
Issue the first-ever product standard governing the design and content of tobacco products.
The FDA should issue a final product standard to reduce the toxicity, addictiveness and/or appeal of cigarettes and other tobacco products in light of the Surgeon General’s conclusion that cigarettes today are more deadly than 50 years ago and the FDA’s conclusion that menthol increases youth cigarette use. This is one of the most powerful tools provided by the 2009 law, and the FDA should utilize it in light of two recent reports: 1) The latest Surgeon General’s report on tobacco and health, issued in January, found that cigarettes today pose an ever greater risk of lung cancer than 50 years ago, when the first Surgeon General’s report was issued. The new report attributed this increased risk to “changes in the design and composition of cigarettes.” 2) The FDA’s report on menthol cigarettes, issued in July 2013, found that menthol cigarettes lead to increased smoking initiation among youth and young adults, greater addiction and decreased success in quitting smoking.
Require large, graphic cigarette warning labels that comply with the 2009 law and can withstand legal challenges.
The FDA should issue a final rule that requires graphic warnings covering the top 50 percent of the front and back of cigarette packs, as the 2009 law requires, and that complies with First Amendment requirements. The FDA retains the authority to require such warnings because, while one federal appellate court blocked the specific warning labels the FDA initially developed, a separate federal appellate court upheld the law’s underlying requirement for large, graphic warnings. The U.S. needs to update its woefully outdated and nearly invisible cigarette warnings and catch up with the more than 60 countries that now require graphic warnings. The evidence shows that graphic warnings are most effective at informing consumers about the health risks of smoking, discouraging children and other nonsmokers from starting to smoke, and motivating smokers to quit.
The smoking rate in the United States has hit an historic low — but tobacco use remains the greatest source of preventable death in the United States. According to the Surgeon General, smoking kills 480,000 Americans each year. It’s estimated that half of today’s smokers will die prematurely, losing, on average, ten years of life. It takes a toll on the nation’s economy, too: $289 billion is spent on health care and other financial losses associated with cigarettes. These are signs, the new report says, that our nation’s tobacco epidemic calls for even bolder actions.
- Researchers Discover Key Brain Activity That May Explain Why Some Smokers Find It Harder To Quit (publichealthwatch.wordpress.com)
- CDC Reports Teen Cigarette Smoking At ‘Lowest Level Since Survey Began’, But Other Risky Behaviors On The Rise (publichealthwatch.wordpress.com)
- Nowhere To Hide: Exposure To Tobacco Advertising Online Associated With Increased Smoking Among Kids (publichealthwatch.wordpress.com)