Tuesday, March 20, 2012

The Surgeon General on Teen Tobacco Use: Is She “Shocked,” or Shocking?

Surgeon General Regina M. Benjamin on March 8 released a report on teen tobacco use with the comment, “The numbers are really shocking.” What is truly shocking is that Dr. Benjamin apparently released the report only to a select group of media outlets that published unchallenging stories, precluding any immediate intelligent analysis of this important public health screed.

Stories published shortly after 12 am that day in the Washington Post (here) and USAToday (here) read like tobacco prohibition press releases. Wendy Koch distilled the theme in her USAToday lead: “Many of America's teens smoke cigarettes as well as use smokeless tobacco, and the tobacco industry's marketing fuels their addiction.”

The Surgeon General incorrectly stated in the report’s preface that “today nearly one in four high school seniors … smoke.” That was true eight years ago. According to the authoritative Monitoring the Future Survey, last year only 19% of high school seniors had smoked in the past 30 days, and only 10% smoked daily (here). These are the lowest numbers in the survey’s 36-year history. Before Dr. Benjamin uses the Surgeon General’s bully pulpit, she should get her facts right.

On tobacco industry marketing, the Surgeon General’s allegations strained scientific credibility.

Tobacco manufacturers have been prohibited from targeting children since the 1998 Master Settlement Agreement with 46 states (here). They cannot “take any action, directly or indirectly, to target Youth within any Settling State in the advertising, promotion or marketing of Tobacco Products, or take any action the primary purpose of which is to initiate, maintain or increase the incidence of Youth smoking within any Settling State.” If Dr. Benjamin can make a case against the industry, she should contact state attorneys general, who have expedited processes for policing and enforcing MSA provisions regarding children.

The FDA has said there is virtually no evidence that tobacco manufacturers are marketing to children through retailers. The agency’s extensive multi-state monitoring program shows that 96% of retailers are compliant (discussed in my blog here). Retailers in several states, including Alabama, Idaho, Kansas, Maryland and Maine, have compliance rates of at least 99%.

If the Surgeon General holds the tobacco industry responsible for the 19% of high school seniors who smoke, then what industry does she blame for the 23% of high school seniors who use marijuana (evidence here)? Does she blame the alcohol industry for the 40% of seniors who use alcohol, or for the 25% of high school seniors who had been drunk in the past 30 days (evidence here)?

According to Dr. Benjamin, “Cigarette smoking by youth and young adults is proven to cause serious and potentially deadly health effects immediately…” This appears to be a new line of attack aimed at teens: If you smoke, you are now at risk for disease and death. Dr. Benjamin should reconsider the veracity of this statement. While teen smoking is unacceptable and troubling, it is not a death sentence.

To put the numbers in context: Every year, there are 33,000 deaths among U.S. teenagers and young adults (age 15-24 years); 25,000 of those are due to “external causes,” including 11,000 road accidents, 5,300 homicides and 4,100 suicides. Illnesses of all kinds account for 8,000 deaths.

The Surgeon General has an obligation to focus on the real and tragic causes of death among our youth. She would be wise to adhere to the facts.

1 comment:

Stephen Helfer said...

I don't believe youth cigarette smoking is a problem. Relative to alcohol use, prescription drug abuse, homicide, suicide, and vehicular deaths, smoking is, in fact, benign.

A recent Rockefeller study of persons having attained extreme longevity found that 60% of the males and 30%of the females had used tobacco. The oldest study subject had smoked 95 years.

Medical fundamentalists use youth smoking as a bugaboo to pass evermore restrictive legislation on adult smokers.