Acting U.S. Surgeon General Boris Lushniak

Acting U.S. Surgeon General Boris Lushniak. Photo by U.S. Surgeon General

Imagine a world in which more than half of all adults smoked. Worse, imagine a world in which you were constantly forced to breathe in the proven-deadly chemicals released by tobacco products.

This world was a reality in 1964 before then-U.S. Surgeon General Luther Terry’s groundbreaking report on smoking and health. The findings led to one of our nation’s greatest-ever public health advancements, including cutting smoking rates by more than half and preventing 8 million premature deaths.

Fifty years later, Acting Surgeon General Boris Lushniak says that the tobacco epidemic is far from over, from “more than 40 million Americans still held in the grasp of tobacco use” to an increase in tobacco-produced deaths globally. Public Health Newswire spoke to Lushniak on a wide-range of smoking issues, ranging from challenges and opportunities in curbing tobacco use, e-cigarettes, and the U.S. Food and Drug Administration’s youth-centered public education media campaign on smoking prevention upcoming in 2014.

In the 50 years since your office’s original report, smoking prevalence among U.S. adults has been cut in half. What most explains our nation’s monumental improvements in tobacco cessation?

The 1964 landmark report, released by the ninth U.S Surgeon General Dr. Luther Terry, was the first report that definitively linked smoking with lung cancer and heart disease and laid the foundation for 50 years of tobacco control in the U.S. Since the release of that report, 32 additional surgeon general’s reports on tobacco have increased our knowledge and understanding of the devastating health and financial burdens caused by tobacco use. And over the past five decades there has been a broad societal shift in the acceptability of tobacco use and in the public’s knowledge about the accompanying health risks.

The reports of the Surgeon General have alerted the nation to the health risk of smoking and have transformed the issue — from one of individual and consumer choice to one of epidemiology, public health and risk for smokers and non-smokers alike.

Fifty years following the release of the landmark 1964 Surgeon General’s Report, tobacco use rates have declined, lung cancer death rates are falling and most smokers visiting health care settings are now asked about their tobacco use.

Are there any other Surgeon General’s reports on tobacco that have covered important topics or issues?

Though all the previous 31 Surgeon General’s reports on tobacco have covered important issues, certain reports were especially powerful. The 1986 Surgeon General report changed how the public viewed exposure to secondhand smoke. This led to many changes at the local, state and national levels. Before the 1986 report, only a few states and communities had smoke-free laws.

The 2006 report was even stronger regarding secondhand smoke, stating that secondhand smoke causes premature death in adults and children and recommending the elimination of smoking in all indoor spaces. The strength and credibility of the 2006 report set off a nationwide momentum for laws promoting smoke-free public spaces. In fact, since the 2006 report, more than half the states have enacted smoke-free laws and most of the nation’s indoor work places are now smoke-free. This shows how powerful Surgeon General’s Reports have been in achieving critical public health goals.

E-cigarettes are the new frontier on tobacco control. What role can your office play to define both the risks and opportunities that this technology offers?

As the Nation’s Doctor, the Surgeon General provides Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury.

Several FDA-approved non-prescription and prescription smoking cessation products are available to consumers, including nicotine-replacement therapies. Patients should consult with their health care professional to select the most appropriate smoking cessation method to suit their needs. E-cigarette manufacturers can choose to apply to the FDA for approval as a cessation device. There are currently no electronic cigarettes that are FDA-approved for therapeutic purposes. FDA regulates cessation products and has approved nicotine replacement therapies as safe and effective treatments to help smokers quit.

Even with the improvements, tobacco remains the leading culprit of preventable death in the U.S. It is also a public health problem beyond our nation, responsible for 5.4 million deaths worldwide each year. What more can we do to advance tobacco reduction efforts globally?

Despite the progress that has been made smoking remains the chief preventable cause of death in America, with more than 40 million Americans still held in the grasp of tobacco use. Because of their addiction to tobacco up to 20 million of these individuals are destined to die prematurely if they are unable to successfully quit.

Since the release of the 1964 Surgeon General’s Report, tobacco use has moved from an equal-opportunity killer to an addiction primary concentrated among some of the most vulnerable members of our society. While overall smoking rates have fallen over the last 50 years from about 43 percent in 1964 to about 18 percent today, disparities in smoking rates still persist, particularly among persons of low socioeconomic status, some racial/ethnic minority groups, sexual minorities, high school dropouts and other vulnerable populations including those living with mental illness and substance use disorders.

And the deaths from the global tobacco use epidemic are expected to increase from 5.4 million people who die each year due to tobacco-related illnesses, to more than 8 million a year by 2030. The CDC works closely with the World Health Organization (WHO) at the WHO Collaborating Center for Global Tobacco Surveillance and one of their primary goals is to strengthen international partnerships to leverage resources for efficient and sustainable tobacco control initiatives.

APHA is committed to reducing smoking rates in the U.S., especially among children. What steps can public health professionals take toward building smoke-free communities?

Each day more than 3,200 youth younger than 18 years of age smoke their first cigarette and another 2,100 youth and young adults who are occasional smokers go on to become daily smokers. The 50th Anniversary Surgeon General’s report provides the scientific bases to accelerate the implementation of successful public health and clinical strategies to prevent these needless deaths.

A comprehensive approach to tobacco control, emphasizing comprehensive smoke free policies, mass media campaigns to encourage prevention and quit attempts, restrictions on youth access to tobacco products, and price increases can collectively result in further meaningful and rapid reductions in tobacco use. These actions must also be complemented by clinical advances, including the widespread use of telephone quit lines and science-based counseling and medications for the 70 percent of smokers who visit a primary care clinician each year. It is my hope that this anniversary will bring renewed attention to the issue and re-energize the public health community to take up the battle against tobacco once again.

In 2009 President Obama signed into law the Family Smoking Prevention and Tobacco Control Act, giving the Food and Drug Administration the authority to regulate tobacco as a drug. How can your office work with the FDA to improve tobacco policy?

The 2009 Family Smoking Prevention and Tobacco Control Act plays a critical role in reducing the harm caused by tobacco products. One part of the Tobacco Control Act required that the FDA develop a sustained public education media campaign targeting youth prevention and cessation. And many of your readers may be aware that the first campaign is scheduled to launch in early 2014, with subsequent campaigns rolling out throughout the year. The Office of the Surgeon General will play a critical role in the promotion of these campaigns in the hope that we can prevent the 3,200 youth who are susceptible to smoking, from picking up their first cigarette.