Page 9 - July Aug 2022 Newsletter Final_Neat

Continued from page 8 county’s support of vaping as a strategy to reduce cigarette smoking. The goal of this plan is to
reduce cigarette smoking from 13% of the general population and 29% of the Māori population
to a total of 5% by 2025. It is anticipated that the plan will significantly reduce the levels of morbidity and mortality
from cigarette smoking.
For many reasons it is unlikely that a similar single step plan could be implemented at present in the United States.
But, reviewing some of the history of tobacco use in the US will illustrate how a variety of stepwise measures for re-
ducing tobacco use came to be. Tobacco is a plant native to the Americas, where it has had medicinal, ceremonial and
social uses as far back as 12,000 years. Tobacco became a crop with powerful economic impact in the early days of
this country. In the 1880’s tobacco taxes accounted for about one third of the tax revenue collected by the United
States government. In 1881 the cigarette rolling machine was invented, leading to growth of both the tobacco indus-
try and the use of cigarettes until health consequences of smoking became clear by the end of the 1950’s. The US to-
bacco industry fought the emergence of research data showing the dangers of tobacco use. They did this by denying
or questioning the reliability of public health and research findings. And, they mounted aggressive advertising cam-
paigns supporting smoking and denying health consequences with slogans like, “Not a cough in a carload” and,
”20,679 physicians say Luckies are less irritating. It’s toasted. Your throat protection against irritation, against
cough”. And, the tobacco industry mounted an endless battle denying that nicotine is addicting. It was not until 2000
that Phillip Morris was the first tobacco company to admit that nicotine is addicting despite the industry’s manipula-
tion of nicotine levels to promote addiction. The admission that nicotine is an addicting substance contributed to no
longer seeing tobacco use as just a “habit”, and opened the door to a substance use disorder, addiction treatment
model for cessation of smoking.
A monumental step in the struggle against smoking and the power of the tobacco industry came in 1964 with the re-
lease of the first Surgeon General’s Report on Smoking and Health. It was based on extensive research and review of
more than 7000 articles about smoking and disease. Its primary conclusions were that smoking is: a cause of lung
cancer and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of
chronic bronchitis. As a result, in 1965 the U.S. Congress passed laws that: required health warnings on cigarette
packages, banned cigarette advertising in broadcast media, and called for an annual report on the health consequenc-
es of smoking. The Public Health Service was charged with supporting state and community programs to reduce to-
bacco use, promoting distribution of research findings on tobacco use and maintaining public visibility of antismok-
ing messages. The antismoking campaign is credited with reducing smoking by adults who had ever smoked by one
half (1964 Surgeon General’s Report).
2014 saw the release of The Surgeon General’s Report on the Health Consequences of Smoking—50 Years of Pro-
gress. At over 1000 pages it is an exhaustive and damming documentation of the efforts of the tobacco industry to
mislead the public about risks of cigarette smoking and a detailed scientific review of the harmful effects of smoking
on essentially every organ and organ system of the human body. In addition, it reviews the disease risks from second
hand smoke and the large “disparities in tobacco use across groups defined by race, ethnicity, educational level and
socioeconomic status and across regions of the country” (2014 Surgeon General’s Report). And, it is undisputed that
“smoking cessation can reduce the relative risk of all-cause and cardiovascular mortality by 70-80%” (JAMA).

In 1992 Mississippi was the first state to sue the tobacco industry to recover Medicaid costs for tobacco related ill-
nesses. This eventually led to a consolidated 46 state suit and 1998 Master Settlement Agreement with the four larg-
est tobacco companies agreeing to pay $206 billion to states through 2025. The agreement “forbids participating ciga-
rette manufacturers from targeting youth, imposes restrictions on advertising and promotional activities, and bans or
restricts transit advertising, outdoor advertising, product placement in media, branded merchandise, free product
samples and sponsorships” (National Association of Attorneys General, and publichealthlawcenter.org). With the
decline of smoking and cigarette sales tobacco companies and others began exploring E-cigarette and vape pen nico-
tine delivery devices called Electronic Nicotine Delivery Systems (ENDS). They were initially presented as devices to
assist in smoking cessation. But their real target was offering a nicotine addiction device to youth. While there are
fewer chemicals in E-cigarettes than in tobacco cigarettes, vaping exposes users to many toxic chemicals. E-cigarette
users get higher levels of nicotine than in smoking cigarettes. And, E-cigarette users can buy extra-strength cartridg-
es for higher concentrations of nicotine (hopkinsmedicine.org). E-cigarette manufacturers targeted advertising at
youth and marketed youth-oriented E-cigarette flavors like bubble gum, Peach Green Tea, Frozen Lime Drop, and
fruit and desert flavors as a strategy to promote nicotine addiction. The dominant ENDS manufacturer Juul Labs,
Inc. dismissed its original advertising firm, whose ads targeted adults. They replaced it with a
firm whose ads were targeted at teens and young adults, placing ads on The Cartoon Net- Continued on page 10

NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 9 July/August 2022