ASTHO Celebrates World No Tobacco Day By Leading Tobacco Control Efforts

May 25, 2017|9:14 a.m.| ASTHO Staff

Georges Benjamin

Each year on May 31, the World Health Organization celebrates World No Tobacco Day to highlight the importance of tobacco prevention and cessation initiatives. In anticipation of this year’s World No Tobacco Day, ASTHO is promoting its host of tobacco control resources designed for state and territorial health departments. We are also recognizing state and territorial leaders who have had a positive impact on tobacco control in their jurisdictions and throughout the nation.

Rahul Gupta, MD, commissioner of the West Virginia Department of Health & Human Resources, demonstrates his leadership in state and territorial tobacco control by serving as chair of ASTHO’s Prevention Policy Committee, which oversees ASTHO’s organizational commitment to state and territorial tobacco control. Gupta also chairs ASTHO’s Tobacco Issues Forum, a national workgroup led under the guidance of the Prevention Policy Committee that fosters collaboration and shares best practices between state and territorial tobacco control leaders and national partners.

In his capacity as a state health officer, Gupta oversees the promotion of tobacco control and cessation initiatives in West Virginia, a largely rural state that faces significant health burdens from the use of both cigarettes and smokeless tobacco products. ASTHO spoke with Gupta to get his perspective on the biggest tobacco control challenges facing West Virginia and the nation, as well as learn about what can be done at the state and territorial level to reduce the use of tobacco products and promote clean air.

What accomplishments in tobacco control have been achieved under your leadership in West Virginia?

In January 2015, the year I began as state health officer, the West Virginia Bureau for Public Health successfully supported passage of the first tobacco tax in West Virginia in several years. This law, which increased tax on cigarettes from $0.65 to $1.20 per pack, was expected not only to decrease smoking rates and keep youth from starting, but also raise nearly $70 million per year in new general revenue.

In 2015, West Virginia initiated the Management of Maternal Smoking Program, a state and federal cooperative partnership that addresses smoking during pregnancy. Since then, the prevalence of smoking during pregnancy in West Virginia has dropped approximately 10 percent when compared to 2014 rates. Youth tobacco prevention efforts in West Virginia have proven successful in maintaining the trend in reduction of overall youth tobacco use. According to data from the West Virginia Youth Tobacco Survey, there has been a 58 percent decrease in the prevalence of high school students who currently smoke cigarettes. In fact, there has been a 135 percent increase in the prevalence of high school students who have never used any form of tobacco.

Last year, we created the State Tobacco Use Reduction Plan 2016-2020, which was approved by the West Virginia Department of Health and Human Resources and the West Virginia Bureau for Public Health as a key component for the state health improvement plan. If these tobacco use and health improvement plans are fully implemented, this would create an incredible and unprecedented environment for lowering tobacco use and nicotine addiction, as well as improving the overall health of the West Virginia population.

How can other state and territorial health officials lead efforts to increase smoking cessation among populations who are still left smoking?

West Virginia remains a state with traditionally high smoking rates and other tobacco use prevalence. It is well known that persons of low socioeconomic status and those covered by Medicaid are much more likely to smoke than other populations. They also have a higher prevalence of smoking-related diseases. Cigarette smoking is one of the greatest drivers of adverse health outcomes. It is also one of the most expensive burdens on a state’s Medicaid program and other state and private insurers. State and territorial health officials must work closely with state Medicaid and state public employee insurance programs to ensure tobacco dependence treatment is deemed an essential service, as it remains one of the most cost-effective preventive services, providing a substantial return on investment in both the short and long term. It is also critical that state and territorial health officials place an enhanced emphasis on vulnerable populations, such as pregnant women, infants, and children.

Based on your insights from leading the Tobacco Issues Forum, what challenges do states face with their tobacco control and prevention work?

Electronic cigarettes and the myriad of other vaping devices remain a significant challenge for public health leaders to address and, if possible, alter the perception of. Electronic nicotine delivery systems (ENDS) all essentially function the same. They create aerosol that can contain nicotine, flavorings, and other additives. Because these products are so new and more products evolve almost weekly, there is little research being done and the long-term health effects of these products remain unknown, making ENDS a key threat to the progress that has been made in tobacco control.

Additionally, many states face the unfortunate reality of reduced budgets and other more pressing health issues that take precedence over tobacco control. Even though comprehensive tobacco control programs have a high return on investment, more and more state programs are losing funding and being down-sized or eliminated, in some cases leaving only CDC and other federal support for tobacco control infrastructure.

The most effective tobacco control interventions comprise of a comprehensive approach, including: sustained best practices level funding for comprehensive programs, tobacco product excise tax increases, comprehensive, 100 percent smoke-free policies, sustained, aggressive, and supportive media campaigns, as well as access to tobacco cessation services. This is difficult to accomplish when support isn’t being adequately provided to fund it.

As a leader in public health, what national tobacco control policies do you consider the most important and what results have you seen?

In June 2009, the Family Smoking Prevention and Tobacco Control Act (FSPTCA) gave FDA the authority to regulate the manufacturing, distribution, and marketing of tobacco products. This should have had far-reaching influence on tobacco use by reducing tobacco product addictiveness and harmfulness, but at this point, any actual regulation from FDA has been deliberate and gradual, and thus the expected public health results (e.g., prohibiting false and misleading product claims by the tobacco industry as well as preventing new tobacco products from being marketed unless a manufacturer demonstrates that the products meet the relevant public health standards) have also been sluggish. It must be stressed that even with the passage of FSPTCA, our work as public health leaders to protect our youth and improve the public's health is not complete. We must continue to work as one integrated tobacco control movement to complete the mission to eliminate ill-health and suffering caused by tobacco use and nicotine addiction.