Tobacco Use Prevention and Control Position Statement

I. ASTHO Supports State Efforts in Tobacco Use Prevention and Control

The Association of State and Territorial Health Officials (ASTHO) support aggressive efforts to reduce tobacco use, tobacco‐attributable health disparities, and tobacco‐related morbidity and mortality.

II. Within This Context, ASTHO Recommends that State Public Health Agencies:

• Engage in evidence‐based programs and policies to reduce tobacco use and related illness and death, as stated in the Guide to Community Preventive Services¹, and CDC’s Best Practices for Comprehensive Tobacco Control Program².
• Support the Food and Drug Administration’s implementation of the Family Smoking Prevention and Tobacco Control Act.
• Support legislation and programs that address inequities in tobacco use and access to cessation based on gender, education, health conditions, income, sexual orientation or racial/ethnic status.
• Advocate for sustained funding at levels recommended by CDC for comprehensive tobacco prevention and control programs at the state level.
• Promote and support the implementation of tobacco prevention and control provisions in the Patient Protection and Affordable Care Act such as public and private coverage with no cost‐sharing of tobacco use counseling and interventions.
• Support increased prices on all tobacco products to reduce consumption.
• Support efforts to allocate payments from the Master Settlement Agreements and revenue from tobacco excise taxes to fund public health programs including comprehensive tobacco control programs.
• Prohibit minor’s access to all tobacco products through enforcement of youth access laws.
• Advocate for limits to advertising and promotion of tobacco products by regulating the time, place and manner of such advertisements.
• Support legislation to eliminate exposure to second‐hand smoke in workplaces, public places, including restaurants, bars, public housing units, and all other places where a harmful impact is probable.
• Support and promote coverage of tobacco cessation programs including the use of quit line services and cessation interventions.
• Advocate for effective, hard‐hitting media campaigns that educates the public about the health effects of tobacco use, tobacco policies, cessation resources, and tobacco industry marketing tactics.
• Support strong legislative and regulatory autonomy to control tobacco consumption. This includes the preservation of local government autonomy in tobacco control ordinances and regulation.
• Support efforts at the federal, state and local level to increase the regulation of new and emerging tobacco products including electronic cigarettes.

III. Background: Improving States’ and Territories’ Tobacco Prevention and Control Efforts

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. An estimated 443,000 people die prematurely each year from smoking or exposure to second‐hand smoke, and another 8.6 million have a serious illness caused by tobacco use. Coupled with this enormous health toll is the huge economic burden associated with tobacco use. More than $96 billion per year is spent on medical expenses and another $97 billion per year is spent on lost productivity³.

Comprehensive and sustained state‐wide tobacco control programs have been shown to reduce smoking rates, tobacco‐related deaths, and diseases caused by smoking². A comprehensive program is a coordinated effort to prevent initiation of tobacco use, protect the public from second hand smoke, and promote cessation. This approach combines social, economic, regulatory, clinical, and educational strategies and also complements the MPOWER⁴ framework identified by the World Health Organization. CDC’s Tobacco Control State Highlights 2010⁵ is based on the MPOWER framework and guides states in implementing and evaluating high‐impact strategies to:

M ‐ Monitor tobacco use and prevention policies

P ‐ Protect people from tobacco smoke

O ‐ Offer help to quit tobacco use

W ‐ Warn about the dangers of tobacco

E ‐ Enforce ban on tobacco advertising

R ‐ Raise taxes on tobacco.

The Institute of Medicine report ‘Ending the tobacco problem: A blue print for the nation⁶’ reviewed tobacco prevention and treatment interventions and recommended a comprehensive set of strategies to increase the momentum of our nation’s tobacco control efforts. Foremost among its recommendations is that each state should fund their tobacco control program at the level recommended by CDC in ‘Best Practices for Comprehensive Tobacco Control Program‐ 2007.’ Strained economies have forced state and territorial health agencies to cut funding for comprehensive tobacco control programs. However, new opportunities exist within the Patient Protection and Affordable Care Act, the Family Smoking Prevention and Tobacco Control Act, and the American Recovery and Reinvestment Act to strengthen state tobacco control programs. State and territorial health agencies can use these resources to support disease prevention initiatives, insurance coverage of tobacco cessation, quit line services, and evidence‐based policies to reduce tobacco use.

With the creation of incentives by federal agencies and the technical support provided by organizations such as ASTHO, state health agencies can make significant progress in preventing tobacco‐attributable health inequities, ultimately leading to improved health outcomes.

Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Prevention Policy Committee Review and Approval on September 24, 2010.

Executive Committee review and approval on October 19, 2010. Policy Expires on October 19, 2013.

This Position Statement supersedes the Position Statement approved on July 27, 2007, which expired on

July 27, 2010.

For further information about this Position Statement, please contact ASTHO Prevention Policy staff at prevention@astho.org.

Related ASTHO Documents:

Prevention Policy Statement

Policy Action Steps toward Tobacco Use Prevention and Control

Notes

1. U.S. Preventive Services Task Force. Guide to Clinical Community Services. Available at http://www.thecommunityguide.org/tobacco/index.html. Last updated: 03/11/2010.
2. U.S. Centers for Disease Control and Prevention (CDC), Best Practices for Comprehensive Tobacco Control Programs, 2007. Available at http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/index.htm.
3. U.S. Centers for Disease Control and Prevention (CDC), Targeting the Nation’s Leading Killer, 2010. Available at http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2010/tobacco_2010.pdf
4. World Health Organization, WHO Report on the Global Tobacco Epidemic, 2008: the MPOWER package. Available at http://www.who.int/tobacco/mpower/en/
5. U.S. Centers for Disease Control and Prevention. Tobacco Control State Highlights 2010. Available at http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/pdfs/highlights2010.pdf
6. Institute of Medicine, Ending the Tobacco Problem: A Blueprint for the Nation, 2007. The National Academies Press