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CARTER BLAKEY: We have a question that I think Dr. McAfee or Kirsten, you might be able to
answer. It has to do with the new products that are on the market now to replace cigarettes.
The question is, are youth and adults switching to new and emerging or much less expensive
non-cigarette tobacco products, and how is that reflected in the way we measure tobacco
use?
DR. TIM MCAFEE: If I could go first, this is Tim.
CARTER BLAKEY: Sure, go ahead. Thank you.
DR. TIM MCAFEE: Yes, thanks. Well, that’s a great question and an incredibly important
question. And as I think we know most of our key indicator has been cigarettes and cigarette
consumption. And the reason for that is that historically the other – particularly the
other combustible, the other smoke products have been a tiny fraction of tobacco consumption.
But actually let me see, do you have a slide on – there’s a slide that we’ve used
on combustible tobacco consumption. Oh, there, thank you. This is a slide that comes from
a Morbidity Mortality Weekly Reports that we just put out back in August that shows
essentially the rise over the last decade of the – as the green, which is cigarette
consumption, has been diminishing, we’ve seen a steady increase in both loose tobacco,
which includes roll your own and pipe tobacco and all cigars small and large. And the disturbing
element of this is that, for instance, the decrease in cigarette consumption that occurred
from 2010 to 2011, the green got smaller between 2010 and 2011. But the total, the height of
that entire curve is completely flat lined between 2010 and 2011 so that the progress
that we made in decreasing cigarettes was made up negatively by the increase in loose
tobacco and cigar smoking.
And there are two things we think have contributed to that increase – well, at least two. One
is that there was a favorable tax status towards pipe – loose pipe tobacco and cigars, and
the other one is that they’re excluded – that cigars are excluded from regulatory authority
from the tobacco – the FDA tobacco regulatory authority so that, for instance, we now see
that in adolescents a majority of the cigars that are being smoked are smoked – are flavored
cigars which are banned in cigarettes. So this is a great question, one where we do
need to spend more attention to the not allow essentially the tobacco industry to simply
shift people between different combustible tobacco products because the harm is likely
to be quite similar between these.
CARTER BLAKEY: Thank you. And Dr. Koh, we have a question for you. What is HHS doing
to promote smoke-free campuses and universities?
DR. HOWARD KOH: Well, we’re very excited about this initiative, and very similar to
what we’re seeing in Oregon through this wonderful presentation that Ms. Aird just
gave you, we want to celebrate local leadership and local champions, people who are establishing
their environments that are either smoke-free or tobacco-free.
So in this particular case, we have created and launched a Tobacco-Free College Campus
Initiative where we encourage college and university leaders to make their campuses
either smoke-free or tobacco-free. Right now, only about 17 percent of colleges and universities
nationwide have that policy, but the numbers are growing by the day. So in our department,
we have attended a number of events. We had one major one at the University of Michigan
this past fall where we thank leaders and recognize the leaders for making this culture
change and sending a message of health to the students on these campuses. So we encourage
other colleagues on this call to be involved in that work to either make their campuses
smoke-free or tobacco-free or recognize leaders who are doing so.
CARTER BLAKEY: Thank you very much, and I also am happy to say that we have another
colleague from CDC in the room with us, Simon McNabb who works with Dr. McAfee, and he has
something to add. So.
SIMON MCNABB: Just this. If you want specific information on how to get involved in making
your campus smoke-free, the initiative that Dr. Koh spoke about has a website and it’s http://sph.umich.edu/tfcci/, and
the TFCCI is for Tobacco-Free College Campus Initiative. That’s hosted by the University
of Michigan, but it’s a great place if you are on a campus and you want to start a movement.
This is a place that can connect you to the existing tools and other campuses who can
help you.
CARTER BLAKEY: Great. Thank you. Thanks for being here today. We have a couple of questions
that relate smoking to other conditions. One has to do with obesity. A participant is interested
if anyone can provide some insight in how tobacco use has affected the obesity epidemic.
Does the push in reducing obesity have any effect on increasing smoking? I don’t know
if anyone has an answer to that. But, if you do?
DR. TIM MCAFEE: Well, this is Tim McAfee. I think the most important thing to realize
in this arena – well, there’s probably two things. The first is that the tobacco
industry has done a masterful job over the past decades in planting the notion that – I
mean this goes back literally to the 1930s, you know, reach for a cigarette instead of
a sweet, that using cigarettes as a mechanism to avoid weight gain is a sensible health
strategy. And we do know that this is something that particularly like adolescent girls, but
probably the general population of smokers, it is sort of a non-motivator for quitting
is anxiety around weight concerns. So I think this is a very important issue that we need
to address. And one of the important things around this that is I think not well appreciated
is that really if you are obese and you smoke, you’ve got a big double whammy, that the
risks for – your risk for disease and death markedly increases. So doing better education
around the idea that smoking is not an effective either weight reduction or weight maintenance
strategy is incredibly important.
I don’t think we have completely teased apart the issue of whether there’s some
– I kind of doubt that there’s a correlation between the increase in obesity and the slow
down in the decline in prevalence. But I don’t think anybody’s figured a way to tease that
out unless one of the other panelists is aware of that.
CARTER BLAKEY: Okay, thank you. And Dr. Sondik, the other question having to do with another
condition has to do with lung cancer. Since smoking has been shown to be linked to lung
cancer, can you tell us what the recent trends are in lung cancer death rates?
DR. EDWARD SONDIK: I’d be happy to. We’ve really seen some very significant changes
here. We may have a slide on that, too. In about 1990, the death rate for men after having
increased for the entire century turned around and has been headed downhill every since,
a really tremendous progress there. And in women, the rate continued to rise up to around
2003, and now the death rate for that is also falling. So these efforts that have been underway
now for decades, the impact on health is really paying off tremendously. This is the leading
cause of cancer deaths, and they’re both in males and females are going down.