• In The Trenches

    Closing Down Tobacco Road

    "I mean, there's Attila, Genghis and me, Nick Naylor, the face of cigarettes, the Colonel Sanders of nicotine."
    -- Aaron Eckhart as Nick Naylor in
    Thank You for Smoking

    Smoking and society smoker death and smoke health danger concept as a cigarette burning with people falling as victims in hot burning ash as a metaphor causing lung cancer risks with 3D illustration elements.

    On Oct. 24, HHS Secretary Alex Azar announced the release of the much-anticipated request for applications for the new Primary Care First payment model. Originally unveiled by the Center for Medicare and Medicaid Innovation in April, Primary Care First will be open to family physicians practicing in 26 participating states and regions starting in 2021. Practices interested in taking part in the program must submit an application by Jan. 22, 2020.

    The AAFP will publish a detailed summary of the program soon. If you are interested in learning more before then, I encourage you to participate in a webinar CMMI will host on Oct. 30.

    I'm going to focus the rest of this post an important public health issue and the AAFP's advocacy efforts to address it.

    Family medicine has a long and honorable history of promoting wellness and prevention as cornerstones of health care. Because of the discipline's longstanding commitment to wellness, prevention and public health, family physicians have been leading advocates for public policies that promote healthy behaviors and disincentivize unhealthy behaviors. Smoking and vaping are clearly near the top of the unhealthy behaviors list and, as such, are the target of significant AAFP advocacy.

    Despite decades of public education campaigns emphasizing the health damage and death caused by smoking cigarettes and the use of other tobacco products, our country and the world continue to experience unnecessary mortality rates due to tobacco use.

    According to the World Health Organization, tobacco kills more than 8 million people each year worldwide. More than 7 million of those deaths are the result of direct tobacco use. Roughly 1.2 million nonsmokers die each year from exposure to secondhand smoke.

    According to the CDC, smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. Smoking accounts for roughly one in five deaths every year, or 1,300 a day. Smokers, on average, die 10 years younger than nonsmokers.

    In 2017, tobacco marketers spent more than $9.3 billion promoting their deadly products. That's more than $1 million an hour. The total economic cost of smoking is more than $300 billion a year, including $170 billion in direct medical care for adults and $156 billion in lost productivity.

    Here is another truly horrifying statistic: According to the CDC National Youth Tobacco Survey, 27.5% of high schools students reported having used a vaping device in the 30 days preceding the survey -- an increase of nearly 7 percentage points from 2018. Additionally, NIH's Monitoring the Future survey found that 37.3% of high school seniors had used an e-cigarette in the previous 12 months.

    Conclusion? We have a lot of work yet to do.

    To its credit, the administration has been extremely active in promoting policies that would raise awareness and reduce the availability of cigarettes and vaping devices, especially among children and young adults.

    Former FDA Commissioner Scott Gottlieb, M.D., placed a target squarely on the back of the tobacco industry from day one of his tenure. On June 28, 2017, he gave a speech outlining a series of steps the FDA would take, using its regulatory authority, to reduce the use of tobacco products. During his two-year tenure, Gottlieb advanced a number of policies to regulate the tobacco industry and its outreach and advertising activities. On his retirement, Vox called him "the most aggressive anti-tobacco FDA leader in years."

    In December 2018, U.S. Surgeon General Vice Admiral Jerome Adams, M.D., M.P.H., released an advisory regarding the e-cigarette epidemic among youth. In the advisory, Adams called on the nation to protect children "from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use."

    Then, on Sept. 11, 2019, the president announced a plan to remove all non-tobacco-flavored e-cigarettes from the market, including mint and menthol flavors. These products have become a gateway to nicotine and tobacco addiction. The AAFP sent a letter of support to the president, following up just days later by joining more than 50 health professional, consumer advocacy and other stakeholder groups in letters to both the president and the first lady expressing  appreciation and full support for this plan to help reverse the youth e-cigarette epidemic.

    Facing intense public and government pressure, JUUL Labs caved and announced it was immediately suspending sales of popular fruit-flavored e-cigarettes on Oct. 17 -- weeks ahead of the administration's expected move to remove all flavored e-cigarettes from the market.

    As I noted, the AAFP has a longstanding and honored history of fighting the tobacco industry, its supporters and the epidemic they have created. From the Tar Wars program to our advocacy push for greater regulation of the industry, the AAFP remains committed to eliminating the use of tobacco products.

    Our work has intensified in recent months, and I would like to highlight some additional key advocacy actions from this year:

    The AAFP also works closely with our state chapters on tobacco issues. The Academy actively promotes the enactment of state laws that restrict the sale of tobacco products to individuals younger than 18 and strict enforcement of those laws. We also are starting to push Tobacco 21 at the state level, further restricting access to these deadly products.

    Our state legislative issue backgrounder provides details on our state-focused advocacy efforts.

    Eliminating the tobacco epidemic is a high-priority issue for the AAFP, and we will continue to devote resources to achieving this objective. We will continue to advocate at all levels of government to achieve the following three bold goals:

    • reduce smoking rates to less than 10% by 2024,
    • protect all Americans from secondhand smoke by 2019, and
    • eliminate the death and disease caused by tobacco use.

    You can learn more about our advocacy efforts and download resources on our tobacco-related work on the AAFP's Tobacco Use webpage.  

    To stay informed about the AAFP's other advocacy efforts and activities in Washington, consider joining the Family Medicine Action Network.  

    Shawn Martin is senior vice president of advocacy, practice advancement and policy.


    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.