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Tuesday Apr 04, 2017

Not Blowing Smoke: FPs Can Make a Difference on Tobacco

North Carolina has always had a schizophrenic relationship with tobacco. Growing up in a rural town in eastern North Carolina, I saw how tobacco served as an economic engine for local farmers. Many of my classmates spent their summers in jobs related to the cultivation and harvesting of this plant. Topping, suckering, cropping, hanging, tying and curing tobacco were part of the lexicon that we all knew. What we did not talk about were the enormous health costs of tobacco.

As a family physician, I have witnessed the devastating health problems caused by tobacco in my patients, and too many of my male ancestors died of tobacco-related complications. Although the production of this plant in our state has markedly decreased during the past decade, the naïveté and denial surrounding its adverse health effects persist.

Last summer, I visited our local farmer's supply store for advice about pests on my tomato plants. A young clerk suggested a pesticide. I inquired as to whether it was safe to use on my vegetables, and his reply was, "We used to use it on tobacco, and you know that never hurt nobody."

I didn't buy that product to use on my tomato plants, and that conversation underscores the need for continued education about the dangers of tobacco at all levels.

There are also opportunities that we as family physicians have to prevent the damaging effects of this leaf. At a recent meeting of the AAFP's Commission on Governmental Advocacy in Kansas City, Mo., we discussed model legislation that state chapters can use in their advocacy efforts. One example is the effort to raise the legal smoking age to 21.

The Oregon Senate recently passed legislation(portlandtribune.com) introduced by Sen. Elizabeth Steiner Hayward, M.D., of Portland, that would do just that.  

"As a family physician, I always think it's better to prevent disease than to cure it, and one of the best things we can do in Oregon to prevent disease is to stop people from using tobacco and other dangerous products that contain nicotine and other harmful substances," she told The Portland Tribune.

This is an admirable effort that can be duplicated in other states. In fact, bills taking this approach have been introduced in nearly half of the nation's state legislatures, including the North Carolina General Assembly(www.greensboro.com). Furthermore, more than 200 cities and counties across the country have passed local ordinances(tobacco21.org) that raised the minimum age for tobacco purchases to 21.

Steiner Hayward's achievement demonstrates how family physicians can improve the health of patients and communities through efforts outside the exam room. As we move toward improving population health and health equity and reducing disparities, the most effective advocacy may involve service in governmental areas such as becoming a mayor, a school board member or even a legislator. Although this service may not be for everyone, I applaud those who have made these efforts.

But you don't have to hold office to make a difference. We all can advocate for change at the state and federal level, and the AAFP has a wealth of resources to help you get started. Family physicians who want to learn more about advocacy should consider attending the Family Medicine Advocacy Summit,  May 22-23 in Washington, D.C.

Oh, and about my tomatoes: I am happy to report that I used an organic-based soap for my pest problem, and my tomatoes did well. We enjoyed red, ripe, delicious fruit that was safe for us to eat.

Mott Blair, M.D., is a member of the AAFP Board of Directors.

Posted at 10:08AM Apr 04, 2017 by Mott Blair, M.D.

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