Most lifetime smokers start smoking before high school graduation when adolescent brain development is still occurring. The National Academy of Medicine estimated that raising the smoking age to 21 nationwide would result in nearly a quarter-million fewer premature deaths and 50,000 fewer deaths from lung cancer among those born between 2000 and 2019.
It should come as no surprise that studies have shown earlier consumption makes it harder to quit. Behaviors we learn as children, such as our eating and exercise habits, have a long-term impact on our lifetime health outcomes.
This single voluntary behavior—smoking—causes more deaths each year than automobile accidents, firearm-related injuries, HIV, illegal drug use, and alcohol abuse, combined. It cuts life expectancy by a decade and claims nearly half a million lives in the United States annually.
It is also a key driver of our nation’s rising healthcare costs. Healthcare for a smoker costs approximately $18,000 more on average than for non-smokers over the course of a lifetime. Quitting can reduce healthcare costs by as much as $14,000 per person. A new study published last month in JAMA Internal Medicine also found that smokers are less likely to be hired than non-smokers, and are paid on average $5 less per hour, creating another financial disincentive.
The high cost of cigarettes themselves also diverts disposable income from food, housing, and education. A 16-year-old who smokes one pack a day in Tennessee will spend up to $5,400 on cigarettes before he or she graduates from high school.
Despite everything we know about the damage tobacco does to our bodies, our health, and our longevity, over 2,500 children and adolescents try smoking for the first time each day in the U.S. Nearly 600 of those becoming regular, daily smokers. Seventeen percent of Americans still smoke; the national target set by the Centers for Disease Control and Prevention (CDC) is 12%. We are far short of this goal, and the health of our population will suffer if we don’t take action.
On May 5th, the U.S. Food and Drug Administration (FDA) took an important step to improve public health by further regulating youth tobacco consumption and new nicotine-based products. The FDA finalized a rule extending its authority to all tobacco products, including e-cigarettes, cigars, hookah tobacco, and pipe tobacco, prohibiting retailers from selling those products to consumers under age 18. Health and Human Services Secretary Sylvia Burwell explained: “As cigarette smoking among those under 18 has fallen, the use of other nicotine products, including e-cigarettes, has taken a drastic leap.” Burwell called the new FDA rule, “an important step in the fight for a tobacco-free generation. It will help us catch up with changes in the marketplace, put into place rules that protect our kids, and give adults information they need to make informed decisions.”
This is good news for America’s public health. And there’s more good news – a recent Gallup poll found that that nearly 3 out of 4 current smokers want to quit, and 85% of smokers have made at least one quit attempt in their lifetimes.
What can be done to help those who want to quit?
First, many smokers try to quit on their own, “cold-turkey”, without any support. But studies have shown that the use of over-the-counter nicotine replacement therapy (NRT)—such as patches, gum, inhalers and lozenges—increases the likelihood of a successful quit attempt by 50 – 70%. Every state has a toll-free quitline that provides resources, cessation counseling, and in some cases free NRT to any resident that calls. In my home state of Tennessee, callers are eligible for two weeks of free nicotine patches. The types of services offered by quitlines vary by state, and it’s a resource that anyone who wants to quit should use. You can contact your state’s quitline by dialing: 1-800-QUIT-NOW (1-800-784-8669).
Second, we need to address tobacco use whenever an individual comes in contact with the health care system—not just at their annual check-up or initial intake visit. This strategy is known as Ask, Advise, Connect (AAC) or Ask, Advise, Refer (AAR). As hospitals and medical practices increasingly switch to electronic health records, tobacco use should be included in the list of questions asked of any patient by their provider. And it doesn’t have to be doctors asking; it could be a nurse, dentist, social worker, or physician’s assistant. By broadening the number of providers who consider this issue part of their responsibility to treat, more smokers will get the support they need to make a successful quit attempt. This includes prescribing effective pharmacotherapy such as Zyban or Chantix, which blocks the effects of nicotine on the brain and help with cravings and withdrawal symptoms.
One interesting program that has had promising results is the CEASE program, in which pediatricians take into account parental behavior and prescribe tobacco pharmacotherapy to parents to reduce childhood exposure to secondhand smoke.
Third, we should enact policies that reduce tobacco consumption and encourage smoke-free environments at local, state, and national levels. Tobacco 21 has been adopted in over 100 cities as well as in Hawaii and California, and has been introduced for consideration in state legislatures and city councils across the country. Raising the tobacco tax is another proven way to deter consumption, particularly among youths who are more price sensitive. Passing ordinances that make cities and parks smoke-free improves air quality and reduces the harmful effects of secondhand smoke, creating a healthier environment.
In my home state, my organization NashvilleHealth collaborated with the Vanderbilt University Medical Center to successfully encourage Tennessee’s Medicaid program, TennCare, to add tobacco cessation pharmacotherapy to the list of drugs that are exempt from the 5 prescription per month coverage limit, increasing the number of low-income Tennesseans who can access prescription-based quit assistance.
Finally, businesses and employers must step up to the plate. Last October, CVS became the first major American pharmacy chain to stop selling tobacco products, instead promoting quit aids to its consumers. The company has furthered its commitment to public health by partnering with the Campaign for Tobacco Free Kids and offering $5 million in grants over five years to organizations implementing public health strategies to reduce youth tobacco use and secondhand smoke exposure. The positive public support for CVS’s efforts have encouraged other businesses to follow suit.
The tide has changed on tobacco and public health—it’s no longer seen as an issue only to be tackled by our public health departments and medical providers. This is an all-hands-on-deck issue, and it’s time to take action. Today’s generation could be the first in two centuries to live shorter, sicker lives than their parents. Addressing our nation’s tobacco habit—responsible for one in five U.S. deaths—is central to changing our nation’s health trajectory and building a culture of health in every community.