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IOM Report Shows U.S. Can Dramatically Reduce Tobacco Use If Congress Grants FDA Authority Over Tobacco and States Redouble Efforts

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
May 24, 2007

Washington, DC — The groundbreaking report issued today by the Institute of Medicine - Ending the Tobacco Problem: A Blueprint for the Nation - makes it clear that the United States can eliminate tobacco use as a serious public health problem, but the main obstacle to achieving this goal has been a lack of political will, not a lack of proven solutions. The report makes it equally clear that while state efforts are critical, the states alone cannot solve the tobacco problem. Congress, long absent from the fight to reduce tobacco use, must provide essential leadership by enacting legislation granting the U.S. Food and Drug Administration (FDA) authority over tobacco products.

The report sets an ambitious, but attainable goal for the nation: 'To reduce tobacco use so substantially that it is no longer a significant public health problem.' However, the report concludes that current efforts, even if fully implemented, are insufficient to achieve this goal and would be hard-pressed to achieve even the far more modest goal of reducing the adult smoking rate from the current 20.9 percent to 15 percent. As the report states, such a modest reduction is not satisfactory because tobacco use would continue to cause a significant amount of premature death and disease.

To eliminate tobacco use as a significant public health problem, the report recommends a two-pronged approach that includes both stepped-up implementation of current strategies, primarily at the state level, and the enactment of federal legislation granting the FDA authority over tobacco products. As the report concludes, 'Incremental reforms... will not end the nation's tobacco problem. A more fundamental shift must occur. It is time for Congress and other policy makers to change the legal structure of tobacco policy, thereby laying the foundation for a strategic initiative to end the nation's tobacco problem, that is, reducing tobacco use to a level that is insignificant from a public health standpoint.'

The IOM report demands a strong and immediate response by elected officials at all levels:

  • As the report recommends, state and local officials should redouble efforts to implement scientifically proven measures to reduce tobacco use. These include higher tobacco taxes, laws requiring that all workplaces and public places be smoke-free, and comprehensive tobacco prevention and cessation programs funded in every state at levels recommended by the U.S. Centers for Disease Control and Prevention (CDC).
  • As the report also strongly recommends, Congress should enact the pending, bipartisan legislation granting the FDA broad regulatory authority over the manufacture, distribution, marketing and use of tobacco products.

The report specifically recommends enactment of the bipartisan FDA legislation introduced by U.S. Senators Edward Kennedy (D-MA) and John Cornyn (R-TX) and U.S. Representatives Henry Waxman (D-CA) and Tom Davis (R-VA): 'The committee concludes that product regulation by the FDA will advance tobacco control efforts in the United States and around the world. The proposed Tobacco Control legislation embodies the principles that should govern the regulation of tobacco products in the coming years.'

The pending legislation would grant the FDA the specific powers recommended in the report. Among other things, the legislation would grant the FDA authority to crack down on tobacco marketing and sales to kids; require that tobacco companies disclose the contents of tobacco products and reduce or remove harmful ingredients; stop tobacco companies from misleading the public about the health risks of their products; and require larger, more effective health warnings on tobacco products. Importantly, and also consistent with the IOM report's recommendations, the legislation would for the first time in 40 years grant states the authority to regulate cigarette marketing. States and localities could impose bans or restrictions on the time, place and manner (but not content) of the advertising or promotion of cigarettes.

The FDA legislation has strong, bipartisan support in both chambers of Congress, with a total of 167 sponsors and co-sponsors in the House and 48 sponsors and co-cosponsors in the Senate. Congress has debated FDA authority over tobacco for nearly a decade. It's time to end the debate and take action that the IOM report concludes is an essential component of eliminating the tobacco problem in the United States.

States also have much to do to meet the report's recommendations:

  • The report calls on states to increase tobacco taxes to 'the level imposed by the top quintile of states' - that means to at least $2 per pack. Currently only seven states meet that standard, while 32 states fall below the national average of $1.14 per pack and South Carolina, Missouri and Mississippi lag far behind at just 7 cents, 17 cents and 18 cents a pack respectively.
  • The report calls on every state to fund comprehensive tobacco prevention and cessation programs at levels recommended by the CDC. Currently, only three states - Maine, Delaware and Colorado - meet that standard, while 28 states and DC spend less than half the CDC minimum and five states - Michigan, Mississippi, Missouri, New Hampshire and Tennessee - provide no significant state funding in the current fiscal year. It would take just seven percent of the nearly $22 billion in annual revenue the states collect from the tobacco settlement and tobacco taxes for every state to meet the CDC recommendations.
  • While 20 states and DC have now enacted smoke-free laws that include all workplaces, including restaurants and bars, the report rightly calls for every state to enact such protections for the right to breathe clean air.

Other essential recommendations in the report include a national, youth-oriented media campaign; improved public and private sector efforts to help smokers quit, including government and private insurance coverage for smoking cessation products and services; and efforts to reduce youth exposure to smoking in movies.

The report reaches several additional conclusions that should guide efforts to reduce tobacco use in the United States:

  • Cigarettes and other tobacco products are uniquely harmful, and there is a strong public consensus in support of reducing tobacco use: 'For no other lawful consumer product can it be said that the acknowledged aim of national policy is to suppress consumption.'
  • While the nation has made significant progress in reducing tobacco use since the first Surgeon General's report on tobacco was released in 1964, we cannot become complacent and assume continued progress: 'The committee believes that substantial and enduring reductions in tobacco use cannot be achieved simply by expecting past successes to continue.... Any slackening of the public health response not only will reduce forward progress, but also may lead to backsliding.'