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While smoking has long been linked to an array of health problems, recent research shows that the harmful habit is worse than previously known: A new report from the U.S. surgeon general found that smoking causes diseases in almost every organ of the human body.

Released in late May, "The Health Consequences of Smoking: A Report of the Surgeon General," cites more than 1,600 scientific articles on the health effects of smoking. In addition to the well-known effects of smoking, such as lung, mouth and esophageal cancers, the new report found that smoking is conclusively linked to leukemia, cataracts and pneumonia as well as cancers of the pancreas, cervix and kidneys. Other complications linked to smoking in the report included diabetes complications, hip fractures and reproductive complications.

"The toxins from cigarette smoke can go everywhere the blood flows," said U.S. Surgeon General Richard Carmona, MD, MPH, FACS. "I'm hoping this new information will help motivate people to quit smoking and convince young people not to start in the first place."

The new report was released on the anniversary of the historic 1964 surgeon general's report on smoking, which was the first to draw widespread attention to the dangers of tobacco use. While U.S. smoking rates have notably dropped since the publication of the first report - 42 percent of the public smoked in 1964 versus 22.5 percent of adults today - the practice still leads to 440,000 U.S. deaths each year.

More than 12 million Americans have died from smoking since the 1964 report, and another 25 million Americans alive today are expected to die of a smoking-related illness, according to the U.S. Department of Health and Human Services.

Among the report's other conclusions was that low-tar or low-nicotine cigarettes are not healthier than regular cigarettes.

Despite the damaging effects of tobacco use, quitting smoking has immediate and long-term effects such as improved circulation and a drop in heart rate, the report found. Even quitting late in life can have positive effects: Giving up tobacco at age 65 can reduce a smoker's risk of dying of related disease by 50 percent.

The scientific articles cited in the report are featured in a new online interactive database that is available via the surgeon general's Web site at http://www.surgeongeneral.gov/. The database will be updated as new studies are published.

Legislation introduced

The surgeon general report findings came as courts, legislators and advocates stepped up their attention to tobacco control in recent months.

In Washington, D.C., legislators from both sides of the political table embraced new legislation that would give the U.S. Food and Drug Administration the authority to regulate tobacco products.

While such legislation has been proposed in previous sessions of Congress, the new bills, introduced in May, are notable in that they were introduced by Republicans and Democrats in both congressional chambers. In the House, H.R. 4433 was introduced by Reps. Tom Davis, R-Va., and Henry Waxman, D-Calif., while in the Senate, S. 2461 was introduced by Sens. Mike DeWine, R-Ohio, and Edward Kennedy, D-Mass.

The bills would provide FDA with the authority for actions such as prohibiting unsubstantiated health claims, requiring changes in the composition of tobacco products to make them less harmful and protecting children from tobacco marketing. A June poll by the Campaign For Tobacco-Free Kids found that 69 percent of respondents favored passing legislation that would provide regulation authority to FDA.

"Many consumers, including smokers, are surprised to learn that no federal agency has the authority to require tobacco companies to list the ingredients that are in their products - things like trace amounts of arsenic, formaldehyde and ammonia," DeWine said. "No federal agency has the authority to inspect tobacco manufacturers - how the cigarette and smokeless tobacco products are made, whether the manufacturers' machines and equipment are clean."

FDA regulation of tobacco is supported by health and tobacco control advocates, including APHA, which has long had policy on the books specifically calling for such a move. APHA also supports measures that would provide incentives to tobacco farmers to switch to other crops, such as a tobacco industry-financed buyout of such farmers.

However, APHA and other tobacco control advocates were opposed to a taxpayer-financed buyout plan that was making its way through Congress in June. The measure, introduced in the House by Rep. Ron Lewis, R-Ky., would provide $9.6 billion over several years to tobacco growers to help them transition to new crops.

Unfortunately, the bill would do nothing to protect public health and would instead eliminate price and production controls, allowing tobacco to be grown anywhere, according to critics. Because the buyout would be funded by the existing federal cigarette tax, money could be diverted from the federal Children's Health Insurance Program, which is funded by the same tax.

The buyout would also provide most of its payments to large corporations, with 80 percent of recipients receiving only about $5,000 or less over five years, according to Environmental Working Group.

Such a plan would provide an "unwarranted windfall" to tobacco companies, said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

"Tobacco companies benefit because they do not have to pay for the buyout and they end up with cheaper tobacco," Myers said. "The Congressional Research Service has estimated that tobacco companies will save between half a billion and $2 billion a year under such a buyout proposal. In contrast, tobacco farmers are left with no economic safety net and at the mercy of tobacco companies."

In late June, the measure had passed the House as part of H.R. 4520, a corporate tax bill, and tobacco control advocates were calling on senators to reject the language. APHA members contacted their senators in opposition to the buyout plan as part of an APHA action alert. The Association was also part of a letter sent in June to senators and representatives asking for their opposition.

In the courts, a district judge ruled in May that the federal government can continue with its racketeering lawsuit against the tobacco industry. In the case, which began in 1999 and has been held up by challenges from tobacco companies, the U.S. Justice Department is working to hold the tobacco industry responsible for deceptive marketing and concealment of health risks. The case is scheduled for trial beginning in September.

In another court case, the Florida Supreme Court agreed in May to accept jurisdiction of a class-action case against the tobacco industry. An early trial in the case, Engle v. Liggett Group Inc., awarded $145 billion in punitive damages, but an appeals court found the amount excessive. APHA, the American Medical Association and other health groups are part of a friend-of-the-court brief in the latest court proceeding on the case.

For more on the surgeon general's report on smoking, visit http://www.surgeongeneral.gov/. For more on the legislation that would give FDA the authority to regulate tobacco, visit http://thomas.loc.gov/ and search by bill number. For more on the tobacco buyout bill, visit http://www.stopbigtobacco.org/.

Michele Late
Reprinted with permission from The Nation's Health, APHA

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