The Cost of Lighting Up: New Studies Address Global Tobacco Use

It is addictive. It is glamorized. It directly and indirectly damages hearts around the globe. In fact, smoking is the common denominator in 40 percent of all cardiovascular disease, according to a report published last year in the Journal of the American College of Cardiology (JACC).


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As part of a series on the ongoing global tobacco epidemic  published May 2 in The Lancet Respiratory Medicine, Nancy Rigotti, of Massachusetts General Hospital in Boston, reviewed the evidence behind existing smoking cessation treatment methods, and notes "longitudinal studies show that smoking cessation benefits almost all smokers, irrespective of the age at quitting or cumulative amount of tobacco exposure." In addition, evidence suggests that incorporating psychological counseling with a pharmacological treatment, such as nicotine replacement therapy or anti-smoking medication, is an effective way to quit smoking. Rigotti points out that "improvements in smoking cessation treatments are needed and are being sought, but those already available are among the most cost-effective treatments in clinical medicine."

In the U.S., the FDA passed the Tobacco Control Act in 2009, which added regulatory approaches to tobacco prevention. Corinne Husten of the Center for Tobacco Products, FDA, Rockville, MD, and Lawrence Deyton of George Washington University School of Medicine and Health Sciences, Washington, DC, explain the regulatory authority of the FDA for tobacco products, including advertising, marketing and promotion, distribution and sales, enforcement of the Tobacco Control Act, regulatory science, and public education. They note that although the U.S. has made great efforts to reduce morbidity and mortality from tobacco use, "progress in decreasing the prevalence of tobacco use has slowed." They add that "it is only with the full implementation of both traditional public health strategies and new regulatory authorities" that there will be a decrease in tobacco-related morbidity and mortality.

Tobacco control is also a major public health issue in Europe, and has evolved at different rates in different countries. John Britton and Ilze Bogdanovica of the University of Nottingham, UK, highlight the opportunities for improvement including implementation of policies by governments, and investing in more research related to tobacco addition, treatment and prevention. However, Asia is "at the frontline of the tobacco epidemic" with the highest number of tobacco users. "Asia has shown that tobacco control is note the prerogative of high-income countries, and that Asian nations – including low-income and middle-income countries – can grasp the political nettle of tobacco control, and can do so effectively," said Judith Mackay, MD, of World Lung Foundation, Hong Kong, China. She adds that "despite these positive developments, Asia as a whole still faces devastating loss of life and illness if the tobacco epidemic is not brought under control."

In an effort to help curb the global tobacco epidemic, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was developed in 2003, but there has been a failure to engage all segments of government in tobacco control, notes Alfred Munzer, Washington Adventist Hospital, Takoma Park, MD. He notes that moving forward, "engagement of the whole government in tobacco control, use of the expertise and resources of all potential donor countries (including those that have signed, but not ratified, the convention), recognition of tobacco as a uniquely lethal product and its exclusion from international trade and intellectual property rights agreements, and the incorporation of tobacco control into mutual assistance programs will accelerate implementation of the WHO FCTC."

In addition, increasing education about the impacts of smoking and providing easy-to-use tools and resources to help people quit, is arguably one of the key ways to reducing cardiovascular disease and death around the globe, according to Immediate Past ACC President William Zoghbi, MD, MACC, in the cover feature in the spring issue of Cardiology. Zoghbi noted that the ACC has joined the NCD Alliance, a global task force that established risk factor reduction targets to be reached by 2025, which include a 30 percent relative reduction in the prevalence of tobacco smoking. In addition, the ACC's CardioSmart initiative has developed a number of resources and tools aimed at smoking prevention. "Although smoking is the U.S. is lower than many other countries, the ACC is committed to reduce it further for better health, through many initiatives like CardioSmartTXT, Million Hearts, CardioSmart website, and our state Chapter activities," Zoghbi said. "Such efforts would help further reduce mortality and morbidity from heart disease and bring it down from its number one spot."

Keywords: Nicotine, Intellectual Property, Morbidity, World Health Organization, Risk Factors, Smoking, Heart Diseases, Prevalence, Tobacco, Pulmonary Medicine, Cardiovascular Diseases, United States, Smoking Cessation

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