"The National Academy of Sciences and the Advisory Committee on Tobacco Policy and Public Health seem to agree . . . boosting the price, they say, has proven to be the most effective way to discourage teens from smoking."

"'Raising the cost of tobacco through increasing excise taxes will do more good for the public health than anything else I can think of. By raising taxes . . . the number of victimized children drops.'" -- Shane Hopkins

And see, "School Anti-Smoking Programs Don't Work," below.
 

    Thank you, Gazette, for supporting smoke-free schools (‘‘Clear the air at schools,’’ March 4). That’s a step toward treatment of our most serious health problem, and cost: tobacco use.

    There are at least four aspects of the problem:

    1. There’s the political and economic reality of tobacco growers. Like the poppy growers (heroin) in Afghanistan and the coca growers (cocaine) in Colombia, without an alternative cash crop it’s unrealistic to ask them to give up their livelihood.

    2. There are the adult smokers. Nicotine is more addictive than heroin. Many smokers will join those 435,000 Americans who die every year from tobacco (5 million worldwide). (This is more than from alcohol and other hard drugs, homicide, suicide, AIDS and motor vehicle accidents combined.) Increasing the cigarette tax for addicts is more likely to increase the number of smokers in poverty than in treatment. Compassion might suggest a tax rebate for them.

    3. Secondhand smoke claims more victims annually than the total of dead soldiers and civilians in Iraq. It’s especially tough on the developing respiratory tracts of young children in smokers’ homes.

    4. Our most cost-effective approach is to prevent young people from starting smoking. Few start after age 25; 3,000 people younger than that start every day. The tobacco industry calls them ‘‘replacement smokers.’’ They replace the customers tobacco kills.

    We need to help adult addicts. But the long-term solution is prevention. We know how to do that. Anti-smoking TV spots can help, as can The Gazette’s proposal for smokefree schools.

    But the most effective means, it turns out, is increasing the price of cigarettes. And that’s why Iowa needs to increase its cigarette tax.

    Nicholas Johnson

    Iowa City

"That's why med students aren't the cream of the crop anymore," he writes from Iowa City. "All the smart folks become dentists."

Hopkins, a third-year U of I med student from Utah with an American Medical Association leadership award on his resume, types one of those smiley faces into his e-mail.

I get it. He's exaggerating. But while Hopkins can still joke around about that, he's deadly serious about this: raising the tobacco tax.

He approves. A few years ago, Hopkins wrote a resolution for the American Medical Society . He called for a tax on tobacco products that matched - at least - smoking's cost to society.

Most Iowans favor Tom Vilsack's proposal to raise the state cigarette tax from 36 cents a pack to $1.16. They're especially in favor if it means an additional $40 million.

The governor says the state needs the money to pay for soaring health costs and to make more room in the budget for education.

Opponents say natural revenue growth will provide the money. Raising the cigarette tax, they say, is a short-term solution at best. Stewart Iverson, the Senate Republican leader from Dows, calls it "a big lie."

I don't know about a big lie, but it seems like a big tax. Almost $300 a year for someone who smokes a pack a day.

Too big? Not in Hopkins' mind. The average pack-a-day smoker will die before the average person who doesn't smoke. If that $300 keeps people from smoking and dying, it's worth the price.

"Whether in dollars or deaths," Hopkins says, "the cost of not increasing the tobacco tax is unbearable. A dollar-a-pack hike should be just the beginning."

The National Academy of Sciences and the Advisory Committee on Tobacco Policy and Public Health seem to agree. Both recommend a $2 increase.

Boosting the price, they say, has proven to be the most effective way to discourage teens from smoking. Clearly more effective than anti-smoking campaigns or advertising limits.

It's a mystery how Hopkins finds the time to worry about this. He's the medical student chairman of an AMA computer and technology committee. He's a student member of the AMA Council on Scientific Affairs, which speaks to his interest in public health and policy. Friday morning, he travels to Washington, D.C., for a meeting.

"I'm a little short on discretionary time right now," he admits.

Shortly after Hopkins wrote his resolution, the federal Centers for Disease Control and Prevention, in its Morbidity and Mortality Weekly Report, said society pays more than $10 in health care and lost work per pack of cigarettes sold.

"I have complete respect for the rights of Americans to exercise their freedoms to be unhealthy, but I do not believe the rest of society should have to pay for it," Hopkins says.

In case you forgot to renew your subscription to the Morbidity and Mortality Weekly Report, Hopkins also wants you to know that not everyone agrees with that $10 estimate. The figure, certain economists say, ignores the so-called "death benefit."

When smokers die of emphysema or lung cancer, for instance, society pays less in Medicare, Medicaid and Social Security.

So let's hear it for dead smokers. They aren't the financial drag, so to speak, they seem. Anyone still wondering why economics is the "dismal science"?

Here's what Hopkins says about the death-benefit argument:

"It makes me want to cry. We're talking about lives ending prematurely. The tobacco companies and their economists are throwing bodies on the scale to tip it back in their favor.

"Raising the cost of tobacco through increasing excise taxes will do more good for the public health than anything else I can think of. By raising taxes, the state gets a healthy new source of revenue, health-care consumption goes down, and the number of victimized children drops. And the people paying the extra taxes are still paying far less than they get back from society in the form of medical benefits they need because of tobacco use."

Which means two things: It's time to raise the cigarette tax, and not all the brainy kids will be doing root canals.

[Note: This report, from Health Day News, appeared in the Des Moines Register, March 6, 2005, p. 7A, under the headline, "Anti-Smoking Programs at School Fail, Study Says." It was obtained from Reflector.com at http://www.reflector.com/health/content/shared-auto/healthnews/cdev/524296.html.

The programs that "don't work," according to this study involve in-classroom education. At least this study doesn't comment one way or the other about the effectiveness of "no smoking on school grounds" regulations. The link at the bottom of the page goes to material from the National Library of Medicine regarding anti-smoking media campaigns.

The material is copyright by HealthDay News and is reproduced here as "fair use" for non-commercial, educational purposes only. Other uses may require the advance permission of HealthDay News.]

A review of eight studies that followed more than 25,000 mostly middle-school-age children who attended anti-smoking classes during the school day found that by their senior year in high school, there was no difference in the smoking habits of the children who'd attended classes compared to those who'd hadn't. Both groups reported that more than half of them had smoked recently.

"It was very discouraging. These were eight well-done studies and only one had a positive result. Based on this evidence, money to promote anti-smoking would be more effectively spent on other areas, including media and tax-based intervention," said study author Dr. Sarah Wiehe, an assistant professor of pediatrics at Indiana University School of Medicine in Indianapolis.

The study appears in the March issue of the Journal of Adolescent Health.

The in-school programs, which included lectures on the health risks of cigarettes, talks by other children about the dangers of smoking, and role-modeling sessions (where kids would act out ways to resist peer pressure to smoke) were 30 percent to 70 percent effective in curbing smoking for up to three years after the completion of the classes, Wiehe said.

But by their senior year in high school, when most of the children were 18, those who had participated in the classes were smoking just as much as those who hadn't taken the classes. This is important, Wiehe said, because the smoking habits of 18-year-olds are predictive of adult smoking habits. About one-quarter of teens in this age group are already regular smokers, she said.

K. Michael Cummings, a smoking expert at Roswell Park Cancer Institute, in Buffalo, said he isn't surprised by the findings because, without reinforcement outside of the classroom, these programs are unlikely to succeed. None of the programs examined in the study included components outside school.

"If you don't have a good strong community program, like counter-advertising, or taxes on cigarettes, all the time and efforts in the school-based program aren't going to be reinforced," he said. "Any school-based program, no matter how well-implemented, is not likely to be termed effective given the other clutter in the environment that tends to work to promote smoking."

The Indiana study comes at a time when states are receiving millions of dollars a year to fund anti-smoking programs from tobacco companies as a result of a 1998 settlement with these companies. However, recent data suggests many states aren't spending this windfall on anti-smoking initiatives.

For example, a study in last month's American Journal of Public Health found states are spending only 2.7 percent of the tobacco-settlement money on anti-smoking programs -- a 27 percent decline in what was spent on these programs in 2001, and far below the 8 percent spending the U.S. Centers for Disease Control and Prevention recommends as necessary to lower smoking rates.

Wiehe said that, with this decline in spending on anti-smoking initiatives, her team's study becomes even more important because it isolates school-based education programs -- a key part of many multi-pronged anti-smoking initiatives -- and shows they may be largely ineffective.

"With limited funding, you need to concentrate the money in the area where you know it's going to pay off, which is not this area," she said.
__________
More information:

A look back at the history of anti-smoking campaigns can be found at The National Library of Medicine, http://www.nlm.nih.gov/exhibition/visualculture/antismoking.html.