Last month in the New England Journal of Medicine, researchers described how tobacco use remains the No. 1 preventable cause of death. Ironically, the U.S. Surgeon General told the American public almost six decades ago that cigarettes were deadly and over 20 years ago that secondhand smoke from cigarettes and other combustible tobacco is also a major killer.
Today, most say that allowing our children to be exposed to the harmful effects of secondhand smoke is even a form of child abuse.
Still, each day North Carolina youth are still heavily exposed to secondhand smoke, including over 400,000 exposed to smoke in their homes. According to the N.C. Department of Health and Human Services, active tobacco use costs almost $2.5 billion and secondhand smoke exposure an additional $300 million annually. While progress has occurred though, more can be done.
First, our teens are saying “no.” We lead a team that recently discovered a dramatic and somewhat surprising shift in N.C. teen attitudes about smoking. The majority of our teens want to eliminate smoking in all indoor and outdoor places.
Our article in the U.S. Centers for Disease Control and Prevention’s Preventing Chronic Disease showed that more than 80 percent of 3,800 North Carolina middle school students and more than 70 percent of 3,300 high school students surveyed said smoking should not be allowed in homes, in cars or even outdoor places where youth work, play and eat.
This was true whether the teens were smokers or nonsmokers. It is clear that youth want to eliminate involuntary secondhand smoke exposure; it is our obligation as adults to protect them.
Second, we know many answers. North Carolina tobacco prevention programs work. From 1999 to 2011, the number of high school smokers in North Carolina dropped from 31.6 percent of high schoolers to 15.5 percent, and the number of teens exposed to secondhand smoke significantly declined. These declines were directly linked to the TRU, or Tobacco Reality Unfiltered, media campaign, which educated our youth about the dangers of smoking; a statewide measure passed in 2008 that eliminated secondhand smoke exposure and smoking at all secondary schools; increased state and federal tobacco excise taxes; and a 2010 bill that eliminated indoor smoking in restaurants and bars.
More recently, Durham and Orange counties passed smoke-free policies that prohibit smoking in many other public areas, such as bus stops and parks. Combined with tobacco cessation resources, like the free 1-800-QUITNOW telephone line funded by the State Health Department, great progress can occur.
Third, the future of effective tobacco and secondhand smoke prevention programs for youth depends on another generation of leadership. Progress in North Carolina stalled when lawmakers virtually eliminated the state’s model prevention programs in 2012. Yet, in 2013, North Carolina will collect an estimated $140 million from the tobacco Master Settlement Agreement (given to states a decade ago and every year since by the tobacco industry because of national lawsuits) and additional excise taxes on tobacco. The ethical and practical solution is to refund our state’s tobacco prevention – at least $17 million annually – to protect our children.
Our prescription for North Carolina is four-fold:
• Start funding tobacco prevention programs again, including the TRU media campaign.
• Pass strong local secondhand smoke measures, similar to ones passed in Durham and Orange Counties.
• Raise the state’s tobacco excise tax by $1 a pack to further reduce smoking and secondhand smoke.
• Vigorously eliminate secondhand smoke exposure for youth and adults in cars and homes.
Sometimes it is unclear how to solve large societal problems, but that is not the case with smoking and secondhand smoke. Tobacco use still results in over 12,000 deaths (1 in 5) in our state each year. Unlike many other hard-to-solve societal problems, eliminating secondhand smoke and preventing tobacco addiction have a clear path forward if we remain committed.
Leah M. Ranney, Ph.D., is associate director of Tobacco Prevention and Evaluation Program and Adam Goldstein, M.D., is a professor in UNC Family Medicine and director of the Tobacco Prevention and Evaluation Program.