Tobacco control: the dramatic choice.

Abstract

Congress must soon decide whether to enact legislation that would create a national, comprehensive, well-funded, and sustainable program to reduce tobacco use among children and adults and to reduce secondhand smoke in public places and worksites. This reasonable opportunity to save lives began in June with a historic agreement forged between state Attorneys General and the tobacco industry, with assistance from the public health community. That agreement, recently strengthened by President Clinton, broke down the wall of political resistance that for years prevented Congress from taking serious measures to reduce tobacco use in this country, particularly among children. Despite overwhelming scientific evidence that tobacco causes more than 400,000 deaths each year, our nation's children continue to have easy access to cigarettes and spit tobacco. There are no significant restrictions on tobacco marketing that target teenagers, no national anti-smoking programs under way, and none on the drawing board. Despite all the research on the dangers of secondhand smoke, there are no nationwide protections against it. To top it all off, the United States has among the weakest package warnings and the lowest tobacco product prices in the industrialized nations of the world. The result? Youth smoking is at a 17-year high and spit tobacco use remains a persistent problem among teens. Adult smoking rates have stopped falling. In all, about 50 million adult Americans are addicted to tobacco products. We now have the opportunity to finally address the biggest and most preventable health problem facing this nation. After a long and thorough analysis, President Clinton has come forward with a statement of principles and direction for a national tobacco control plan that represents a major step forward for three reasons: It strengthens and builds upon the Attorneys Generals' agreement; it provides wide enough latitude for Congress to craft comprehensive legislation; and it enables the public health community, which was divided over the previous agreement, to rally behind the President's leadership. The Clinton plan calls for stiff price increases on tobacco products to reduce teen smoking and tough penalties on the tobacco industry if this does not occur; the largest public education campaign in history; full authority for the Food and Drug Administration to regulate tobacco products; aggressive youth access restrictions; strict limits on tobacco marketing to kids; greatly increased tobacco industry document disclosure; protection from secondhand smoke; smoking cessation programs for those who want to quit; and adequate funds from Big Tobacco to pay for all these fundamental changes. Eleven major public health organizations, including the American Medical Association, the American Heart Association, and the American Cancer Society, have committed themselves to achieving legislation. But there are challenges ahead. There is no guarantee that the tobacco industry will agree to the President's changes. President Clinton did not address one of their primary concerns—the protections they would receive in return for all he is asking. Initial reaction to the President's plan from the Republican leadership in Congress has been cautious. Members of both parties had said they would move forward on tobacco only if the President went first. Now that he has, will they step up to the plate? We must remember one thing about American politics at the end of the 20th century. While the tobacco lobby no longer has a choke hold on Congress, it still has considerable influence. Legislation, if it is to pass, must be realistic. The challenge to Congress is to enact a comprehensive plan, not just sermonize about it and say “we tried.” If Congress fails, we will return to creeping progress in our war on tobacco, which will undoubtedly spill into the next century. But I am an optimist, and I hope a realist, when I say I think we can and will achieve fundamental change. A comprehensive, national tobacco control plan may not destroy the tobacco industry or eliminate smoking and spit tobacco. But more quickly and more aggressively than by any other way, congressional action based on the work of the state Attorneys General and President Clinton's broad principles will lead the way to generations of children who will grow up tobacco-free.