Bonnie Chairs IOM Committee Recommending Measures to Reduce Tobacco Use

A new Institute of Medicine (IOM) report released yesterday recommends tough measures to reduce U.S. smoking rates, including giving the Food and Drug Administration (FDA) broad regulatory authority over tobacco marketing, packaging, and distribution. University of Virginia law professor Richard Bonnie chaired the committee of 14 experts who wrote the report, "Ending the Tobacco Problem: A Blueprint for the Nation," which recommends a combination of increased excise taxes, nationwide indoor smoking bans, and other measures to reduce the smoking rate, which has leveled off at 21 percent in recent years.

"Tobacco use — especially cigarette smoking — has been one of the nation's major public health problems for most of the 20th century and continues at an unacceptable level in the 21st century," Bonnie said during a press conference announcing the report. "The challenge the country faces today is to develop a feasible strategy for rooting out a problem that is deeply entrenched in our economic and cultural life. There are still 45 million cigarette smokers and another 9.7 million users of other tobacco products. Most of them regret taking up the habit and struggle to quit."

Although the prevalence of smoking among adults has been cut in half from 42 to 21 percent since 1965, and the high school smoking rate is at its lowest level since monitoring began 30 years ago, Bonnie said the forecast for continuing progress is dim.

"There are already signs that the prevalence of smoking among adults is flattening, the initiation rate appears to be up among young adults, and the rate of youth initiation has hovered around 20 percent for most of the past two decades even though it is down at the moment."

Although 70 percent of smokers say they want to quit, the annual rate of cessation among people younger than 65 remains low, he explained. Smoking-related health costs are estimated to be $89 billion a year. Meanwhile, the tobacco industry is spending more than $15 billion annually marketing its products to smokers and potential smokers.

"Taking these realities into account, the committee believes that the annual toll of more than 400,000 smoking-related deaths will continue well into the 21st century."

The report's recommendations include urging states to fund tobacco control programs at the level recommended by the Centers for Disease Control; pushing for Congress to fund a national youth-oriented media campaign; requiring states to license all retail establishments that sell tobacco and to ban the sale or shipment of tobacco products directly to consumers through mail order or the Internet; and having all insurance, managed care, and employee benefit plans, including Medicaid and Medicare, cover reimbursement for effective smoking cessation programs as a lifetime benefit.

"If all this were done, the committee projects that the prevalence of smoking could be brought down to 10 percent by 2025, and about 11 million fewer people would be smoking," Bonnie said.

In the report's proposed FDA regulatory program, key recommendations include requiring graphic tobacco package warnings modeled after those required in Canada; limiting advertising to a text-only, black-and-white format; banning any activities by tobacco companies that target youth; and aggressive regulation of retail outlets, including state experiments to reduce the number of retail outlets. The committee also urges the FDA to explore the feasibility of gradually reducing the nicotine content of cigarettes.

The study was sponsored by the American Legacy Foundation. The Institute of Medicine is a branch of the National Academies, and provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.

Pre-publication copies of Ending the Tobacco Problem: A Blueprint for the Nation are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. A podcast of the public briefing held to release this report is available at http://national-academies.org/podcast.