Natl Academy of Sciences Backs Cig Tax - Read Report [01/14-2]

The impartial and highly prestigious National Academy of Sciences has recommended that Congress increase the federal tax on a pack of cigarettes by at least two dollars.

Their study shows that it would be the "single most effective way" to prevent children from smoking.

The report, titled "Taking Action to Reduce Tobacco Use," was authored by the Academy's National Cancer Policy Board, which consists of 22 physicians, academics and researchers.

The Board also recommends that tobacco companies be penalized at different rates according to which company's products continue to be popular among children and allowed for the possibility that tobacco companies could raise prices to offset the costs incurred by a settlement.

Below is a copy of the Introduction and Summary of the Report. To see or download a copy of the entire report, click here.

The nation needs a strategy to reduce the death and disability caused by use of tobacco products. That strategy may develop out of a renascent public debate about tobacco control policies that has intensified over the past three years. When the Institute of Medicine (IOM) released its 1994 report, Growing Up Tobacco Free,[1] prospects for federal action were highly uncertain. That same year, the surgeon general's report was also focused on youth tobacco use [2]. Prospects for tobacco control grew brighter when the Food and Drug Administration (FDA) asserted jurisdiction over tobacco products, with strong presidential support, state attorneys general brought suit against tobacco firms on a new legal basis, and class-action lawsuits became more palpable threats to the financial future of private tobacco firms. Media coverage of these events and revelations of hitherto secret files and depositions from former tobacco firm employees has been intense. These and other developments have resulted in a vigorous national debate about tobacco control among the various groups with a stake in tobacco policy--tobacco firms, attorneys general and health officials, public health groups, tobacco growers, tobacco control advocates, and others. Attention now focuses on the U.S. Congress and the executive branch, which are seriously considering federal legislation.

Although public debate has intensified, tobacco use among youths has escalated. Smoking rates among youths have increased for four years in succession (1993-1996), as measured by the largest national survey, the University of Michigan's "Monitoring the Future" project [3]. Today's tobacco use will become tomorrow's health statistics. As a four-decade longitudinal study of smoking in British physicians concludes, "about half of all regular cigarette smokers will eventually be killed by their habit."[4] New users will become addicted to nicotine, followed years later by a sharply increased incidence of tobacco-related diseases. Cancer, cardiovascular disease, and lung disorders cause most tobacco-related deaths, although tobacco use is associated with many other medical conditions. Among the 419,000 Americans who died from smoking in 1990, for example, 151,000 died of cancer. The increased numbers of deaths among women are particularly alarming. Since 1987, more women have died each year of lung cancer than breast cancer. An American Cancer Society graph illustrates the dramatic rise in the rate of lung cancer among women, which follows the rise in women's smoking that began several decades earlier [5].

There are only three basic ways to reduce the death toll: to prevent the initiation of tobacco use, to get current users to quit, and to reduce exposure to tobacco toxins. The vast majority of those who use tobacco start doing so in childhood or youth, so prevention efforts must focus there. Individuals of all ages can quit using tobacco, and the cessation of tobacco use is associated with immediate economic and health benefits from reduced cardiovascular disease [6] and long-term reductions in the likelihood of developing cancer [7]. Reduced exposure to tobacco toxins has followed from bans in public places.

Preventing the initiation of tobacco use among children and youths remains the preeminent long-term goal, but cessation of tobacco use by individuals in all age groups is also essential. The projection that 10 million people will die of tobacco-related illness in the year 2030 is mainly based on the number of current users [8]. This enormous health toll will thus drop only if current users quit and are not replaced by other users, and if tobacco exposure is reduced. The worldwide health consequences also clearly indicate that national tobacco control policies must look beyond national borders.

At its first two meetings in the spring of 1997, the National Cancer Policy Board identified tobacco control as a priority, and tobacco control was the subject of its initial policy statements. The board organized a workshop on July 15, 1997 in Washington, D.C., and summarized its views in a July 18, 1997 letter to Secretary of Health and Human Services Donna Shalala, the president's Domestic Policy Advisor Bruce Reed, and members of the U.S. Congress. This white paper builds on those efforts, addressing (a) price increases, (b) federal regulation, (c) state and local tobacco control programs, (d) performance monitoring, (e) cessation programs, (f) research, and (g) international health impacts.

The National Cancer Policy Board chose to issue its first policy statement on tobacco control because tobacco use is the single largest cause of cancer deaths, [84] and because tobacco joins AIDS as one of two major growing health threats worldwide [85]. The board believes that:

• The single most direct and reliable method for reducing consumption is to increase the price of tobacco products, thus encouraging the cessation and reducing the level of initiation of tobacco use.
• Some of the revenues generated should go to support tobacco control measures.
• Lack of a research foundation and incomplete disclosure of proprietary data about nicotine addiction, health effects of additives, and behavioral responses to levels of nicotine and other constituents in tobacco make it difficult to foresee the optimal regulatory strategy. But as scientific data accumulate, future regulation of nicotine levels, additives, tar and other tobacco constituents might well be needed. Limiting FDA's authority now is unwise.
• Regardless of whether the U.S. Congress passes legislation similar to that proposed in the settlement, the United States needs a much more robust system for monitoring tobacco use and a stronger infrastructure at the state and local levels. Nongovernment organizations must also be supported, as they hold government and private parties to account.
• Federal research agencies should augment their efforts to gain knowledge about which tobacco control measures are most effective, studied at sufficient dose and duration.
• Research is a federal responsibility and must encompass research on tobacco-related diseases and behaviors, but research to understand underlying factors is also needed. Finally,
• The United States should support international tobacco control efforts and should refrain from implementing policies that would increase the future health toll from tobacco use abroad.

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