|Page 3 June 1998||
Smoking has been recognized as a perverse activity for centuries, yet, so far, we remain incorrigible. With money from the multi-billion-dollar settlement of the lawsuit brought against the tobacco companies by Attorney General Skip Humphrey and Blue Cross/Blue Shield in addition to continued hard work by epidemiologists and other health professionals, we may finally be able to make significant headway in the fight against this great killer.
Cigarette smoking has been identified as the single most significant source of preventable morbidity (disease) and premature death. Coronary heart disease, cancer, and various respiratory diseases account for the majority of excess mortality related to cigarette smoking. It has been estimated that an average of 5.5 minutes of life is lost for each cigarette smoked--about the time it takes to smoke it! The direct health care costs associated with smoking amount to billions of dollars annually. To this we can add additional billions in indirect expenditures from lost productivity and earnings due to morbidity, disability, premature death, and the toll of fires started by cigarettes.
We are working on it
Cheryl Perry, professor of epidemiology, was a key witness for the state during the tobacco proceedings earlier this year (See related story, p. 2). Her research efforts are primarily large-scale intervention studies aimed at children, adolescents and their parents, and designed to modify behavior and measure the achieved changes in those population groups. A key area of emphasis for Prof. Perry has been the prevention of the onset of smoking and other substance abuse. Her research indicates that the tobacco industry had been targeting the youth market and that their advertising had reached its mark. Since well over 80 percent of adult smokers start before age 18, focusing on the underaged population clearly has been an effective strategy for the tobacco industry.
Another epidemiology faculty member in the forefront of the war against tobacco is Jean Forster, associate professor of epidemiology. Her research efforts are primarily community-level policy intervention studies in alcohol and tobacco control. Her most visible research focused on the sale of tobacco products to minors. The data provided evidence for much stricter enforcement of existing statutes and the adoption of other intervention strategies. She was also a key contributor to the 1994 Surgeon General's report.
The School of Public Health has had a long tradition of leadership in the fight against tobacco. Leonard Schuman, Mayo Professor Emeritus and former Head, Division of Epidemiology, was a member of the Advisory Committee which produced the 1964 "Surgeon General's Report on Smoking and Health." Cheryl Perry continued this legacy as the senior scientific editor of the 1994 "U.S. Surgeon General's Report on Preventing Tobacco Use Among Young People."
While it is gratifying to learn that some $100 million of the tobacco settlement in Minnesota will be set aside for smoking cessation programs, much more needs to be done. The greatest cost benefit could be realized by dissuading people from smoking in the first place!
A broad variety of smoking control measures need to be implemented in concert, such as smoking cessation programs and community intervention programs especially aimed at the schools-innovative curricula, peer counseling, etc.-- since tobacco use appears to be a common entry point for risk of other substance abuse. More stringent governmental and private sector measures are likewise essential. Among them are taxation of tobacco products, elimination of and substitution for tobacco subsidies, adjusted insurance rates, smoke free environments, and bans on tobacco advertisements. Ads at sporting and popular musical events and the association of smoking with glamour, self-confidence and maturity provide a strong appeal to youth. Limited experience with cigarette counter-advertising does suggest that it can reduce consumption when smoking is portrayed as unattractive, socially unpopular and sexually unappealing.
This country has made considerable progress in controlling smoking in the last two decades. Of all the targets of opportunity, economic incentives coupled with the changing of social norms, hold the greatest promise of success. Public health professionals are prepared to provide leadership as we continue the battle against tobacco in the future.
--Edith D. Leyasmeyer, Dean
School of Public Health
on the case
AHC tobacco experts:
Jean Forster, associate professor of epidemiology, School of Public Health. With expertise in the prevention of tobacco use by youths, she contributed to the 1994 U.S. Surgeon General's Report on Preventing Tobacco Use Among Young People and has been active with the Minnesota Coalition for a Smoke-Free 2000.
Dorothy Hatsukami, professor of psychiatry, Medical School. An expert on nicotine addiction, she has recently focused her work on tobacco use among teenagers. With others, she is also working to curb use of chewing tobacco by major league baseball players.
Stephen Hecht, professor of cancer prevention, Medical School, Cancer Center. He is known for research linking the chemicals in tobacco smoke to cancer in both smokers and non-smokers. He is investigating a chemical in watercress which may detoxify carcinogens in smokers.
Harry Lando, professor of epidemiology, School of Public Health. Lando is known for his work in helping longtime, hardcore smokers, including hospitalized smokers, to quit. He is now involved in a smoking intervention program for teenagers to be carried out in dentists' offices. He has served as an ad-hoc reviewer for the National Cancer Institute.
DeAnn Lazovich, assistant professor of epidemiology, School of Public Health. She specializes in cancer prevention and control, reduction of teen smoking, and occupational exposure to carcinogens.
Cheryl Perry, professor of epidemiology, School of Public Health.
dimmeth the sight,
vitiateth the smell,
hurteth the stomach,
destroyeth the concoction,
disturbeth the humours and spirits,
corrupteth the breath,
induceth a trembling of the limbs,
exsiccateth the windpipe, lungs and liver,
annoyeth the milt,
scorcheth the heart, and
causeth the blood to be adjusted."
Tobias Venner, 1638