The death one week ago of baseball's Tony Gwynn, who is often remembered by Baltimoreans for his induction in the Hall of Fame in 2007 with Cal Ripken Jr., called attention to the dangers of smokeless tobacco. The former San Diego Padres batting champ suffered from oral cancer and blamed two decades of chewing tobacco for his plight.
As well-publicized as the health risks of tobacco may be in the U.S., the focus has been placed primarily on the dangers of cigarette smoking. That's understandable given the cigarettes are by far the most popular tobacco product. But smokeless tobacco is by no means safe, and its use among teens, particularly boys, remains significant.
According to the Centers for Disease Control and Prevention, more than 11 percent of high school boys reported using smokeless tobacco in 2012, the most recent year for which statistics are available. That is not terribly far behind the 14 percent overall teen use of cigarettes. For years, tobacco companies have been marketing smokeless tobacco to young men and boys with products that are milder and often flavored.
Smokeless tobacco, which includes chewing tobacco, snuff, snus (pouches of moist snuff) and dissolvable tobacco, is as addictive as cigarettes. The health consequences are serious as well. It's been linked to cancer of the mouth, cheek, gum, throat and esophagus as well as stomach cancer, pancreatic cancer, mouth lesions and heart disease.
Mr. Gwynn, who was only 54, had undergone multiple surgeries on his face including a 14-hour procedure two years ago to remove a tumor from his major salivary gland and graft a nerve in his cheek. More than 43,000 Americans are diagnosed with oral cancer each year, and only slightly more than half will be alive five years after the diagnosis, according to the Oral Cancer Foundation.
One of the most effective strategies to reducing tobacco use has been to raise its price by increasing the applicable state excise tax under a category often referred to as OTP, or other tobacco products, that includes little cigars. Maryland's smoking rate has declined by nearly one-third, or twice the drop in the national average over the last decade, in large part because the tax on a pack of cigarettes was raised by $1 to $2 in 2007.
Unfortunately, the tax on other tobacco products has not kept pace. Health advocates point out that to be the equivalent of the $2-per-pack cigarette tax, the tax on smokeless tobacco would have to be 70 percent of the wholesale price (which is how OTP taxes are calculated). It was raised in 2007 from 15 percent to 30 percent, still less than half of equivalency.
That failure of the Maryland General Assembly to approve a comparable tax on smokeless tobacco is likely to haunt the State House next year. Health Care For All, the non-profit health care lobbying group, has already convinced 213 House and Senate candidates to sign a resolution calling for a $3-per-pack tax on cigarettes and a "comparable" increase in other tobacco products.
By the organization's own accounting, all those candidates are likely to translate into near-majorities if not outright majorities in the two chambers. At $3 per pack, the comparable tax on smokeless tobacco and the other products would have to be 95 percent of wholesale prices, or more than three times the current rate, a jump likely to send convenience stores and other tobacco retailers screaming to their local legislators.
Yet to pass a higher cigarette tax without imposing a comparable burden on other forms of tobacco risks sending more teenagers to a tin of Copenhagen or the equivalent because it's a cheaper way to buy tobacco (and perhaps easier to use in an era of smoking bans). And lawmakers are going to need to raise the cigarette tax not only to adhere to their pledge but because the revenue will be needed to meet rising Medicaid costs.
The war on snuff shouldn't end there, of course. Advertising and public education campaigns, tobacco cessation programs and restrictions on Internet marketing of smokeless tobacco should be part of the effort as well. But raising the tax to the 95 percent target rate — as so many candidates have essentially already promised — is the ideal first step to protecting the next generation from Mr. Gwynn's fate.
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