Advocacy Project: Issue Overview

Goal: To reduce illness, disability, and death related to tobacco use and exposure to secondhand smoke.


What is the issue?
Tobacco use causes more than 440,000 deaths each year in the United States. For every person who dies from a smoking-related disease, 20 more people suffer with at least one serious illness from smoking. Since the release of the 1964 Surgeon General's report on smoking and health, more than 12 million Americans have died prematurely due to smoking. Currently, estimates of annual smoking-associated economic costs in the United States are more than $167 billion. The sub-issue that I'm addressing is the proportion of adolescents and young adults (grades 9-12) who are exposed to tobacco advertising and promotion through the internet, magazines, and newspapers. Healthy People 2010 has moved away from its target by -333% in regards to the internet and moved towards its target by 57% in regards to magazines and newspapers.


Listed below is a piece of legislation proposed to address the issue:
H.R. 1261: Youth Prevention and Tobacco Harm Reduction Act of 2009.


Who is affected by the issued?
Although there's a good majority of people who are affected by smoking and its harms, the people most affected by this particular issue are youth and adolescents grades 9-12. The group with the best rate for specified characteristic in regards to internet advertising and promotion were white non-Hispanics and the group with best rate for specified characteristic in regards to newspaper and magazine advertising were American Indian or Alaska Native. It's no surprise to me that white non-Hispanics are most affected by advertising via internet because of its availability and more often than not socio-economic status. Also, it's not a surprise that Healthy People moved away from its target in regards to internet advertising because of the growth and availability of technology. Technology is growing at a rapid rate and that aspect alone makes it tough to combat tobacco advertising.


What are the consequences?
Each year more than 400,000 Americans die from a tobacco-related illness, the number one preventable cause of death in the United States. More lives are lost to tobacco than those caused by fires, alcohol, suicides, car accidents, AIDS, illegal drugs, and homicides, combined. Most of these deaths occur in adulthood, but the damage begin on the onset of smoking which in about 90 percent of the cases, begins at or before the age of 18. Close to 1,000 of the 3,000 youths who begin smoking every day will prematurely die of a tobacco-related disease. An infant's risk of dying from Sudden Infant Death Syndrome (SIDS) increases 5 times if he or she is exposed to secondhand smoke in the room. Second hand smoke also increases the risk of lung cancer and asthma. Smoking in childhood or adolescence increases the risk of developing cardiac disease – the number one cause of death in the United States. Young adult smokers are 1.43 times more likely to have a stroke than their nonsmoking peers. Smoking is linked to not only lung cancer, but also other respiratory problems like coughing, wheezing, and shortness of breath. Children and adolescents who use tobacco have smaller lungs than their peers, and therefore tend to be less physically fit than their peers. Lastly, adolescents' use of smokeless tobacco increases their risk of oral cancer and nicotine addiction.


What is the economic/social impact of the issue?
Currently, estimates of annual smoking-associated economic costs in the United States are more than $167 billion. Tobacco products continue to be one of the most heavily marketed and least regulated consumer products in the United States. In 2005, the latest year for which information is available, the five largest cigarette manufacturers spent a total of $13.11 billion – or more than $35 million a day - to promote and advertise their products. A study published in the May 2007 issue of the journal Archives of Pediatric and Adolescent Medicine found that retail cigarette marketing increased the likelihood that youth would start smoking; cigarette pricing strategies contributed to increases all along the smoking continuum, from initiation and experimentation to regular smoking; and cigarette promotions increased the likelihood that youth will move from experimentation to become regular daily smoking. Certain tobacco products are advertised and promoted disproportionately in diverse communities. Advertising and promotion of cigarette brands with names such as Rio, Dorado, and American Spirit have been marketed toward Hispanics and American Indians/Alaska Natives. African American communities have been bombarded with cigarette advertising. Since the Master Settlement Agreement (MSA), the average youth in the United States is annually exposed to 559 tobacco ads, every adult female 617 advertisements and every African American adult 892 ads. Expenditures for magazine advertising of mentholated cigarettes, popular with African Americans, increased from 13 percent of total ad expenditures in 1998 to 49 percent in 2005. While positive trends are noted in eliminating tobacco-related disparities, continued and enhanced efforts across a broad spectrum of players, including the Federal Government, States, and the private sector, need to address tobacco use in racial and ethnic populations disproportionately affected by the health burdens of tobacco.


What are the barriers? How can they be overcome?
One of the huge barriers of tobacco is the constant advertising and growth of technology. Ads are all around us no matter where we go. Technology is also constantly growing and with that comes more and more advertising. Public health efforts continue to be partially offset by several factors that encourage smoking, such as lack of indoor air regulations, discounted tobacco prices, and smoking scenes in movies. Significant countervailing forces include increased advertising and promotions by the tobacco industry. In the time between the Master Settlement Agreement in 1998 and the year 2003, cigarette company marketing expenditures increased by more than 125 percent. More than three-fourths of the total is for discount pricing or promotional allowances to retailers, which undercut the effect of tax increases. Another factor, which may slow or even reverse these positive trends, is the loss of funding for State tobacco prevention programs and national counter-marketing campaigns. Some ways to overcome these barriers are as follows: 

• Increasing tobacco prices.
• Sustained media campaigns.
• Smoke-free policies in workplaces and public places.
• Reduced out-of-pocket costs for cessation services.
• Telephone quit-lines.
• Prompts to clinicians to provide evidence-based intervention counseling.
• Community mobilization combined with additional interventions.

What are the resources?

There are many resources that people can obtain on the prevention of tobacco and it's health risks. The Center for Disease Control (CDC) offers some great resources and information on the affects and problems associated with smoking and other forms of tobacco use. Some other great resources are: The Truth, Smoke Free America, and The American Lung Association just to name a few.

What is the history of the issue?

Tobacco has a long history in the Americas. The Mayan Indians of Mexico carved drawings in stone showing tobacco use. These drawings date back to somewhere between 600 to 900 A.D. Tobacco was grown by American Indians before the Europeans came from England, Spain, France, and Italy to North America. Native Americans smoked tobacco through a pipe for special religious and medical purposes. They did not smoke every day. Tobacco was the first crop grown for money in North America. In 1612 the settlers of the first American colony in Jamestown, Virginia grew tobacco as a cash crop. It was their main source of money. By the 1800's, many people had begun using small amounts of tobacco. Some chewed it. Others smoked it occasionally in a pipe, or they hand-rolled a cigarette or cigar. It was not until James Bonsack invented the cigarette-making machine in 1881 that cigarette smoking became widespread. Bonsack's cigarette machine could make 120,000 cigarettes a day. The American Tobacco Company was the largest and most powerful tobacco company until the early 1900's. In 1902 Philip Morris company came out with its Marlboro brand. They were selling their cigarettes mainly to men. Everything changed during World War I (1914-18) and World War II (1939-45). Soldiers overseas were given free cigarettes every day. At home production increased and cigarettes were being marketed to women too. By 1944 cigarette production was up to 300 billion a year. Service men received about 75% of all cigarettes produced. The wars were good for the tobacco industry. Since WW II, there have been six giant cigarette companies in the U.S. They are Philip Morris, R.J. Reynolds, American Brands, Lorillard, Brown & Williamson, and Liggett & Myers (now called the Brooke Group). They make millions of dollars selling cigarettes in the U.S. and all over the world. In 1964 the Surgeon General of the U.S. (the chief doctor for the country) wrote a report about the dangers of cigarette smoking. He said that the nicotine and tar in cigarettes cause lung cancer. In 1965 the Congress of the U.S. passed the Cigarette Labelling and Advertising Act. It said that every cigarette pack must have a warning label on its side stating "Cigarettes may be hazardous to your health." By the 1980's, the tobacco companies had come out with new brands of cigarettes with lower amounts of tar and nicotine and improved filters to keep their customers buying and to help reduce their fears. The early 1980's were called the "tar wars" because tobacco companies competed aggressively to make over 100 low tar and "ultra" low tar cigarettes. In 1984 Congress passed another law called the Comprehensive Smoking Education Act. It said that the cigarette companies every three months had to change the warning labels on cigarette packs. It created four different labels for the companies to rotate. Since the 1980's, federal, state, local governments, and private companies have begun taking actions to restrict cigarette smoking in public places. The warning labels were the first step. As it becomes more difficult for tobacco companies to sell their products in the U.S., they are looking outside. U.S. tobacco companies are now growing tobacco in Africa, South America (Brazil and Paraguay), India, Pakistan, the Phillipines, Greece, Thailand, and the Dominican Republic. Fifty percent (50%) of the sales of U.S. tobacco companies go to Asian countries, such as Thailand, South Korea, Malaysia, the Phillipines, and Taiwan.

Allies and Opponents:

Allies of this issue would be health professionals, health organizations, and others who are concerned with the growing rates of tobacco use and tobacco advertisement campaigns. Some very useful allies would be: The Truth, Tobacco Free Kids, CDC, and The American Lung Association. Tobacco lobbyists, however would argue that advertising does not increase the overall quantity of tobacco sold. Rather, the tobacco industry maintains that advertising merely enhances the market share of a particular brand, without recruiting new smokers. I don't see any way of appeasing both parties on this issue. When one side benefits the other fails and vice versa in my opinion.

My Recommendation:

Vote YES on the Youth Prevention and Tobacco Harm Reduction Act Bill of 2009!!!

Sources: Center for Disease and Control, American Lung Association, The Truth, Tobacco Free Kids, History of Tobacco, Smoke Free America, Healthy People 2010, Tobacco Control, and THOMAS.