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Dangerous Addiction

Tobacco kills, as state death rates prove, and a new product could make matters worse.

INDIANAPOLIS - No wonder Philip Morris decided to use Central Indiana as a test market for its new smokeless tobacco product, Taboka. Indiana has the second-highest rate of adult smokers in the country. Only the tobacco-growing state of Kentucky ranks higher.

With more and more cities and towns, in Indiana and nationally, restricting smoking in public places, tobacco companies are searching for new ways to addict people. Taboka, the new spitless product, is a result.

With an adult smoking rate of 27 percent, tobacco-related diseases take the blame for more deaths in the state than any other cause, says Karla Sneegas of Indiana Tobacco Prevention and Cessation. Unfortunately, cuts in funding have stalled progress in reducing adult smoking, notes William V. Corr, executive director of the Campaign for Tobacco-Free Kids. And, he adds, smokeless tobacco is hardly a safe alternative to cigarettes.

They argue that only additional funding, through taxes on tobacco products, can pay for the resources necessary to reverse this killing addiction.

Indiana's smoking rates have careened out of control

By Karla Sneegas

Public health officials, health organizations and health-care professionals shared startling news when they gathered in Washington, D.C. this month for the 13th World Conference on Tobacco or Health. Tobacco use is killing a person every six seconds around the world, and if trends do not change, by 2020 tobacco will kill someone every three seconds. All told, tobacco will kill a billion people this century, 10 times the toll it took in the 20th century.

What does a world conference on tobacco-use reduction have to do with our normal lives in the Hoosier state? Tobacco-related diseases account for more deaths in Indiana than any other cause. When it comes to adult smoking in the state, the numbers have careened out of control, making this already serious problem even more alarming.

Data from the 2005 Indiana Behavior Risk Factor Surveillance System survey show that Indiana's adult smoking rate increased from 24.9 percent in 2004 to 27.3 percent in 2005; this represents a troubling reversal from just two years ago when the smoking rate declined from 27.7 percent in 2002 to 24.9 percent in 2004.

As a result, Indiana is in the unenviable position of having the nation's second-highest adult smoking rate in the U.S., with only Kentucky "ahead" of us in smoking rates.

The reversal of our progress to drive down tobacco rates, sad to say, is not a surprise.

Funding for Indiana's tobacco prevention and cessation program was cut by almost 70 percent from $32.5 million in 2003 to the current annual amount of $10.8 million. At the same time, our state's cigarette tax rate remains well below the national and Midwest averages.

Meanwhile, our Eastern neighbor, Ohio, funds comprehensive tobacco-reduction programs near the minimum level established by the Centers for Disease Control and Prevention and recently increased its cigarette tax. These actions have paid off. Ohio's smoking rate went down from 27.7 percent in 2001 to 22.3 in 2005.

In contrast to Indiana's reduced funding in its fight to stop smoking, the tobacco companies have increased the amount of marketing dollars they spend in Indiana to a record $475 million, amounting to 44 times what the state invests in programs to prevent kids from smoking and help smokers quit. Tobacco product marketing, since the settlement between the states' attorneys general and the tobacco industry, has shifted drastically to young adults ages 18 to 24. Indiana's rate of smoking among this age group increased from 28.2 percent in 2004 to 39 percent in 2005.

Central Indiana recently was selected as the site for test marketing a new smokeless, spitless tobacco product, further damaging Indiana's image as unhealthy. This product appears as though it will be marketed to current smokers who are working in environments that do not allow smoking. Its design enables these smokers to maintain their addiction easily without forfeiting their cigarettes.

In spite of the 2003 fiscal cuts, Indiana Tobacco Prevention and Cessation -- the state's tobacco control agency -- is aggressively continuing with programs. When cuts were made, care was taken to keep investing in youth tobacco prevention. And this investment is paying off.

Smoking among Indiana high school students declined 32.5 percent over a four-year period, dropping from 31.6 percent in 2000 to 21.3 percent in 2004. At the same time, smoking among middle-school students declined by 20 percent, from 9.8 percent to 7.8 percent.

While drastic cuts were made in the programs targeting adult smokers, progress on some fronts has continued. The number of Hoosiers protected from secondhand smoke by local smoke-free air laws increased from 3 percent in 2000 to more than 33 percent today. These efforts impact citizens' ability to breathe healthier air, and also serve to encourage smokers to try to quit and discourage youth from starting to smoke.

Restoring funds for comprehensive tobacco prevention and cessation programs in Indiana will allow more community groups to offer programs that work, all of which can be tailored specifically to help Hoosiers. It will allow for more public education to counter the tobacco industry's endless marketing machine. It will also allow us to help more smokers who desperately want to quit but are not currently successful.

There is no "magic wand" that can be waved to suddenly reverse Indiana's troubling tobacco-use statistics. Indiana was headed on a hopeful trend when resources were severely cut. Adequate and consistent funding together with strong public policy that is consistent and builds over time are critical. So too is programming that is comprehensive and heavily integrated with the best practices as prescribed by the CDC.

The payoff? Hoosiers will enjoy greater freedom from the strong-armed influence of the tobacco industry and its addictive products. Sneegas is the executive director of Indiana Tobacco Prevention and Cessation.

Raise tax, strictly regulate and fund prevention programs

By William V. Corr

Philip Morris' decision to use Indianapolis as a test market for its new smokeless tobacco product, Taboka, should be a wake-up call for all Hoosiers that it is past time to improve Indiana's health by reducing tobacco use.

Indiana has the second-highest adult smoking rate in the country after Kentucky. The latest surveys show that 27.3 percent of Indiana adults smoke, compared to 20.9 percent of all Americans. No wonder Philip Morris jumps at the chance to test new ways to addict Hoosiers.

It is imperative that Indiana leaders strike back by implementing scientifically proven solutions that reduce smoking and exposure to secondhand smoke. These solutions include well-funded programs to prevent kids from smoking and help smokers quit, higher tobacco taxes, and local smoke-free laws that protect all workers and the public from secondhand smoke.

These measures have worked in large and small states in every region of the country. Ohio, which set aside an endowment of more than $300 million in tobacco settlement money to reduce tobacco use, has reduced high school smoking by 40 percent since 1999 and cut adult smoking by a remarkable 17 percent in just one year, from 2003 to 2004. California, the nation's pioneer in fighting tobacco use, has reduced lung cancer rates three times faster than other states.

It was not long ago that Indiana was also a national leader.

From 2000 to 2003, Indiana kept the promise of the 1998 state tobacco settlement and funded tobacco prevention and cessation programs near levels recommended by the U.S. Centers for Disease Control and Prevention. Because of these programs, run by Indiana Tobacco Prevention and Cessation (ITPC), this state reduced high school smoking by a third between 2000 and 2004 and adult smoking by 10 percent between 2002 and 2004.

Unfortunately, rather than reward success, Indiana leaders cut funding for ITPC by two-thirds in fiscal year 2004; the program today is funded at just $10.8 million a year, less than a third of the CDC's minimum recommendation. So it's not surprising that progress in reducing Indiana's adult smoking rate appears to have stalled.

While ITPC continues to be one of the nation's best-run tobacco prevention programs, its reach is limited by its budget. If Indiana is to get back on track, state leaders must restore funding to at least the $34.8 million a year recommended by the CDC. This would require less than 8 percent of the $458 million a year in revenue Indiana collects from the tobacco settlement and tobacco taxes, leaving plenty for other needs. Better yet, it would take just 6 cents of a new cigarette tax increase.

Indiana should significantly increase its cigarette tax, as Gov. Mitch Daniels proposed last session. At just 55.5 cents a pack, Indiana's tax is well below the national average of nearly 96 cents. Michigan and four other states now have cigarette taxes of $2 or more a pack, and Chicago now has the highest in the country at a combined state and local total of $3.66 a pack.

We urge Daniels to build on last year's effort by advocating for a cigarette tax increase of a dollar or more, with the revenue from the first 6 cents dedicated to restoring ITPC's programs.

Indiana and the rest of the nation must also resist the siren song of smokeless tobacco, which some companies advocate as a "safer" alternative to cigarette smoking. Smokeless tobacco is far from harmless -- the Surgeon General has found that it causes oral cancer and other serious diseases -- and there is no evidence that smokeless tobacco as used in the United States reduces the number of people who smoke.

The current marketing of smokeless tobacco points to a large missing piece in the fight to reduce tobacco's toll -- federal legislation to grant the U.S. Food and Drug Administration authority over all tobacco products. Until Congress grants the FDA such authority, there's nothing to stop tobacco companies from marketing their products deceptively or in ways that encourage kids to start using tobacco or discourage smokers from quitting entirely. Indianapolis residents are guinea pigs in just such an industry experiment right now.

The silver lining in the recent announcements by Philip Morris and R.J. Reynolds, the nation's two largest tobacco companies, that they are entering the smokeless tobacco business is that they are doing so in response to the tremendous progress our nation has made in reducing smoking -- and especially to the growing number of communities that require smoke-free workplaces and public places. Unfortunately, they still find a safe haven in the plentiful smokers in Indiana.

It is time for Indiana to fight back by increasing tobacco taxes while providing enough funding to get successful prevention programs back on track. Indiana communities must also continue the recent progress in passing smoke-free laws, and the Indiana congressional delegation must help pass strong FDA regulation of tobacco.

Together, these solutions will help us win the fight against Indiana's No. 1 killer.

Corr is executive director of the Campaign for Tobacco-Free Kids, a national anti-tobacco advocacy group based in Washington, D.C.

SPIT TOBACCO USE IN INDIANA

Spit tobacco, also known as smokeless tobacco, comes in two forms: moist snuff and chew. Snuff is finely ground tobacco placed between the bottom lip and gum. Chewing tobacco is shredded tobacco leaves that are placed between the cheek and gum. These products contain 3,000 chemicals, 28 of them identified as causing cancer.

  • 17%: Number of Hoosier adults who have tried spit tobacco; of those, nearly 22 percent use these products every day or at least some days.
  • 12%: number of high school boys in Indiana currently using spit tobacco; About 3 percent of middle school boys use it.
  • Nearly 16% of high school boys and 12% of middle school boys believe smokeless tobacco is definitely or probably safer than cigarettes.
  • 37% of middle school students and 46% of high school youth know about new tobacco products claiming to have fewer toxins than regular cigarettes.

CIGARETTE TAX IMPACT IN INDIANA

  • 55.5 cents: Indiana's current cigarette tax per pack.
  • $7.10: Smoking-caused costs in state per pack sold.
  • 95 cents: Nationwide state average tax per pack.
  • 35th: Indiana's rank among all states in tax per pack.

An increase in tax of 50 cents per pack would:

  • Raise $206.5 million a year.
  • Cause 87.7 million fewer packs to be sold.
  • Reduce the youth smoking rate by 9%.
  • Prevent 51,400 future youth smokers.
  • Lower the adult smoking rate by 2.1%.
  • Save $822.4 million in related lifetime health costs.

An increase in tax of $1 per pack would:

  • Raise $339.3 million a year.
  • Cause 166.4 million fewer packs to be sold.
  • Reduce the youth smoking rate by 18%.
  • Prevent 102,900 future youth smokers.
  • Lower the adult smoking rate by 4.2%.
  • Save $1.6 billion in related lifetime health costs.

Sources: Indiana Tobacco Prevention and Cessation, 2004 Indiana Youth Tobacco Survey, Campaign for Tobacco-Free Kids

Spit tobacco carries several health risks

Indianapolis was picked by Philip Morris to test market its new spitless tobacco product, Taboka. With tobacco sales decreasing in the U.S., tobacco companies are looking for new customers, particularly young ones. In Indiana about 25,000 kids in middle and high school regularly use spit-tobacco products. Will Philip Morris' slick marketing of Taboka threaten years of progress in reining in tobacco addiction and related disease in our youth?

Tobacco companies tout such products as an alternative to cigarette smoking. Here are the facts:

The U.S. Surgeon General and the National Institutes of Health say that spit tobacco is a health risk and not a safe substitute for smoking cigarettes. Spit tobacco is addictive, causes oral cancers, cardiovascular disease, reproductive disease and dental diseases, excessive tooth wear and other problems. About 20 percent of spit-tobacco users also smoke cigarettes.

Claims that newer non-smoke products are safer than other tobacco products may be true, but how will we know since these unregulated companies are free to make unproven claims? Will marketing spit and spitless tobacco products cause smokers not to quit because they think they are safe? Will young, non-tobacco users take up these products, and then switch to cigarettes?

Only independent research will answer such questions. But we already have the tragic answer to the question of how Philip Morris will measure the success of its market test in Indianapolis -- by counting the number of Hoosiers addicted to Taboka.

Stephen J. Jay, M.D. Arden G. Christen, DDS Co-directors, Clarian Health Partners Tobacco