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Smoking is even worse than you thought [Editorial]

Our view: New surgeon general's report makes the case for new efforts to stop teen tobacco use

6:00 AM EST, January 27, 2014

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It's been half a century since the first U.S. surgeon general's report appeared linking smoking to lung cancer. In the decades that followed, federal and state health officials waged a vigorous public information and education campaign that convinced millions of Americans to kick the habit. But as a new surgeon general's report this month warned, smoking remains the leading cause of preventable deaths in the U.S., and its health consequences for individuals are even more lethal than previously believed.

Some 20 million Americans have died prematurely from smoking-related illnesses since 1964. The new report found that in addition to lung cancer and heart disease, smoking causes liver and colorectal cancer, Type 2 diabetes, age-related macular degeneration, erectile dysfunction and rheumatoid arthritis. It weakens the immune system, aggravates asthma and has been linked to cleft lips and palates in fetuses. Merely being exposed to second-hand smoke can cause strokes.

It's surely safe to say that no other product legally on the market is both so addictive and has so great a potential for killing those who use it. Yet because those risks accumulate slowly over a period of many years or decades, its victims are often unaware of the irreparable damage they are doing to their bodies until it is too late. And ironically smokers today are at higher risk of developing some illnesses than were smokers of an earlier era because of changes in cigarette manufacture and chemical composition. Tobacco is probably the only consumer product that has actually gotten worse for people's health than it was 50 years ago.

As a result, the social and economic costs of smoking are staggering. The surgeon general's report estimates the direct medical costs of treating smoking-related illnesses come to $130 billion a year. Additionally, illnesses and deaths caused by tobacco use cost the economy another $150 billion a year in lost productivity.

The surgeon general's report makes clear that America can no longer remain a nation of smokers. In recent decades the number of Americans who smoke has declined precipitously as a result of effective anti-smoking advertising campaigns that have raised awareness of the risks associated with tobacco use. In 1965, 42 percent of American adults smoked, but by 2012 that number had dropped to just 18 percent. The surgeon general estimates anti-smoking measures have saved some 8 million Americans from premature smoking-related deaths during the last 50 years, but smoking-related illnesses still claim nearly half a million American lives every year.

That is why lawmakers need to strengthen public policies that encourage adult smokers to quit and dissuade non-smokers from starting the habit. That especially true for young people, who are particularly vulnerable to the addictive nature of tobacco use and who can't easily appreciate the long-term consequences of taking up the habit. Discouraging smoking among youth is one of the most effective ways of reducing future health costs and lawmakers must look at all options to keep them from lighting up.

During this General Assembly session, lawmakers in Annapolis will consider a bill to raise the legal minimum age for tobacco purchases from 18 to 21. Maryland would be the first state to do so, though some states have made the smoking age 19, and New York City is poised to raise it to 21. The chief rationale for making the drinking age 21 was the desire to reduce the acute damage done by irresponsible young drinkers to themselves and others, chiefly through drunken driving accidents. The risks posed by teen use of tobacco are different, but given its addictive properties and long-term consequences, it's worth considering whether a similar age restriction should apply.

Another way lawmakers can make a difference is by increasing the state sales tax on cigarettes, which studies have shown has been effective in reducing teens' access to tobacco products and thus reducing the number of teen smokers who become addicted. An OpinionWorks poll released last week showed Maryland residents strongly support a $1 per pack increase in the tobacco tax to fund anti-smoking public health campaigns and smoking cessation programs. We are generally wary of additional state tax increases right now, but this one could be an exception.

Americans have come a long way toward recognizing the grave risks of tobacco use both for the individual and for society as a whole. But there's not been the same commitment to eliminate tobacco-related deaths as there was for eradicating other global killers such as smallpox, polio and malaria. The surgeon general's report calls on Americans to address smoking deaths with similar urgency by enacting tougher regulations on tobacco products, strengthening laws for smoke-free workplaces and creating more effective tax policies and public information campaigns to help smokers quit and keep non-smokers from starting. This is an issue that Maryland lawmakers urgently need to address, and the time to act is now.


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