Tobacco Control – Yesterday, Today and Tomorrow Christopher Squier Commission on Tobacco Use Prevention and Control American Cancer Society (ACS) Clean Air for Everyone (CAFÉ)

In the Beginning……… Iowa Cigarette Control Law—1897 In 1897 Iowa banned the manufacture, sale, exchange, and disposition of cigarettes and cigarette paper. The ban was repealed after the 1st World War but in 1921 Iowa became the first state to impose a cigarette tax!

In the Beginning……… Strange Bedfellows – Henry Ford and Adolf Hitler In 1941, Hitler introduced a comprehensive public health program to restrict smoking and limit advertising 1914

1930’s and 1940’s -the Age of Innocence? Physicians selling cigarettes!

Physicians and cigarettes

The 1950’s - the Health Context -cruel realities; tobacco can kill you 1964 - the 1st Surgeon General’s Report linked smoking and lung cancer But in 1961 Philip Morris had already identified 42 carcinogens in tobacco smoke!

The Health Context -cruel realities; tobacco can kill you 1966 Health warnings begin on cigarette packs Caution--cigarette smoking may be hazardous to your health 1971 Cigarette advertisements are taken off TV and radio

The Response of Big Tobacco – lies and prevarication The filtered fifties and the low tar sixties – cruel hoaxes April 14, 1994; the chief executive officers of the 7 major tobacco companies testified before Congress that they did not believe nicotine was addictive.

Tobacco Control ? ‘Education’ and just say ‘no’ An ‘adult habit’ Website funded by R J Reynolds to promote ‘adult choice’

The Litigous Nineties and the 1998 Master Settlement Agreement Q: ‘Could you please explain the recent historic tobacco settlement?’ A:’ Sure. Basically, the tobacco industry has admitted that it is killing people by the millions, and has agreed that from now on it will do this under the strict supervision of the federal government’. Dave Barry

The Attorneys General Master Settlement Agreement In 1998 the tobacco industry agreed to pay 46 states $206b over 25 years: the agreement included provisions to: refrain from targeting youth to limit brand name sponsorship reduce outside advertising (billboards and transit) refrain from opposing state or local laws intended to protect youth cease to sell merchandise with tobacco brand names

2000 - a new era for tobacco control

Comprehensive Tobacco Control Programs Work CDC showed: Dose response relationship between levels of spending and program effect Increase in spending per capita associated with larger tobacco control program effect Increased efficiency from lessons learned

Tobacco Control in Iowa 2001 - Iowa Code Annotated Chapter 142A. Tobacco Use Prevention and Control Establishment of a Division of Tobacco Use Prevention and Control with a full time Director Establishment of a Commission to develop policy and provide direction Establish youth programs that are directed by youth participants for youth. Establish community partnerships

What Happened in Iowa? - an unprecedented decrease in smoking prevalence!

What happened in Iowa? A relationship between tobacco control spending and outcomes

What happened in Iowa? A successful youth program (JEL) and a reduction in youth smoking A greater reduction in youth smoking in Iowa than nationally

What happened in Iowa? A decrease in hospital admissions for diseases related to secondhand smoke exposure

Tobacco Control - what is happening now in Iowa Tobacco Control - what is happening now in Iowa? Snatching Disaster from the Jaws of Success Since 2009 we have seen continual cuts in the budget of the Division of Tobacco Control This culminated in a halving of the current years budget!

Tobacco Control - what is happening in Iowa Tobacco Control - what is happening in Iowa? Snatching Disaster from the Jaws of Success Devastating budget cuts are having predictable effects Iowa smoking rates have gone up to 16% in 2010 (Iowa Adult Tobacco Survey) O

Tobacco Control - what is happening in Iowa Tobacco Control - what is happening in Iowa? Snatching Disaster from the Jaws of Success But there is no shortage of funding! Tobacco settlement and tax income is almost one hundred times greater than the appropriations to tobacco control Meanwhile, the tobacco industry spends $102M a year promoting its products in Iowa!

Tobacco Control - what is happening in Iowa? We have a Governor who claims that Iowa will be the healthiest state in the nation But actions speak louder than words! Tobacco funding has been halved The Director was dismissed and the Division of Tobacco Control is threatened with elimination!

Is there a tomorrow? An end game for tobacco? A global view As smoking rates decrease, how do we finally eliminate a lethal but addictive product?

Framework convention on tobacco control 2005 The treaty sets an international floor for tobacco control with provisions on advertising and sponsorship, tax and price increases, labeling, illicit trade and secondhand smoke.

How effective are these strategies? The USA has not ratified the Convention!

Tobacco Free New Zealand 2020 Tupeka Kore Aotearoa 2020 Vision Future generations of New Zealand children will be free from exposure to tobacco and will enjoy smokefree lives Strategies Tobacco retail displays will be banned Plain packaging and graphic warnings will replace brand imagery Tobacco retail prices will increase systematically and significantly (20% per year) The supply and sale of tobacco products will be controlled –retailers licensed and number of licenses decreased annually

Singapore has proposed the ‘end of tobacco’

Australia is currently enacting legislation that will only permit ‘plain packaging’ with warning labels

Smoking may be the cause of impotence In the US, the tobacco industry takes the FDA to court over warning labels but they even have them in Russia! Smoking Kills Smoking may be the cause of impotence

Tobacco Control Tomorrow – Whither Iowa?

Tobacco Control - what is to be done in Iowa? 30% of all cancers are related to tobacco use 80% of lung and oral cancers are related to tobacco use 4,400 Iowa adults die each year from tobacco use But there is an industry that lobbies against the actions that are necessary to prevent or reduce tobacco related diseases!

Tobacco Control - what is to be done in Iowa Tobacco Control - what is to be done in Iowa? There are new challenges; smokeless tobacco products -dissolvables There are a variety of flavored, soluble tobacco products being promoted in the US, some with a great similarity to candy! Attempts to regulate these have been resisted!

Tobacco Control - what is to be done in Iowa Tobacco Control - what is to be done in Iowa? New challenges; snuff, snus and cross-branding Snus is a form of smokeless tobacco manufactured in Sweden that has much lower levels of carcinogens (nitrosamines) than are found in US snuff. ‘Snus’ has recently been marketed in the US but there is no information on the level of carcinogens or its health effects. Some is sold under cigarette brand names, suggesting it is intended to supplement smoking, not replace it!

Tobacco Control - what is to be done in Iowa? Education – we have an administration and legislature that needs a lot of help We must advocate and where necessary apply political pressure – follow the money! Grassroot and grasstop support is essential – that means you! 4,400 Iowa adults die each year from tobacco use