Fund tobacco control efforts

In response to The Gazette's Aug. 20 article 'CDC study: Smokers have misconceptions about quitline effectiveness”, Linn County Public Health would like to expand the conversation to Iowa's investment in effective tobacco control in general.

Smoking is the leading cause of preventable disease, disability, and death, yet smoking causes 480,000 deaths per year in the United States. On average, smokers die 10 years earlier than non-smokers. Annual health care costs in Iowa directly caused by smoking total more than $1.28 billion annually. While smoking rates have declined since the middle of the 20th century, in recent years those rates have slowed or stalled, demonstrating the need for tobacco prevention and control still exists. Currently 19.5 percent of adults in Iowa smoke, which is an increase from 18.1 percent in 2012. Among the 18-24 age group, 21.9 percent smoke. Among high school students, 18.1 percent smoke. Each year, 2,600 kids in Iowa under the age of 18 become daily smokers. Smoking and tobacco use continues to be a public health concern, and without adequate resources, the progress that has been made to reduce smoking rates is in jeopardy.

To continue reducing smoking and tobacco use rates, comprehensive tobacco control programs must be fully supported and funded at recommended levels. The Centers for Disease Control and Prevention (CDC) defines a comprehensive tobacco control program as a statewide, coordinated effort to establish smoke-free policies and social norms, to promote and assist tobacco users in quitting, and to prevent tobacco use initiation. These programs have been shown to reduce tobacco use, tobacco-related disease, disability, and death.

In addition to improving health, research has shown that comprehensive tobacco control programs save money. In Washington State, for every dollar invested in their program over a ten year period, more than five dollars were saved in hospitalization costs alone. In other state programs such as California, Arizona, and Massachusetts, health care cost savings ranged from two to ten dollars in savings per dollar invested in comprehensive programs. Medicare and Medicaid systems can benefit from comprehensive tobacco control programs as well, since tobacco use causes chronic health effects later in life, when people may be Medicare beneficiaries.

In Iowa, tobacco control programs are extremely underfunded. In fiscal year 2015, the Iowa Department of Public Health Division of Tobacco Use Prevention and Control received $5.2 million in state appropriations; only 17 percent of CDC's funding recommendation for Iowa. The American Lung Association in Iowa recommends increasing funding to fiscal year 2008 levels ($12.29 million) as one strategy for restoring comprehensive tobacco control programming in Iowa. According to the American Lung Association, Iowa only spends one cent out of every dollar taken in from tobacco taxes and settlement payments to prevent people from starting to smoke and to help smokers quit.

If all states invested in long-term comprehensive tobacco control programs at levels recommended by the Centers for Disease Control and Prevention (CDC), thousands of illnesses and deaths from tobacco use could be prevented, and billions of dollars in medical expenses could be saved. The related declines in youth smoking would reduce smoking-caused health care costs of more than $31 billion, and the related declines in adult smoking and in secondhand smoke exposure would result in tens of billions of dollars in additional smoking-caused cost savings.

The call to increase tobacco control investment to CDC-recommended levels is consistently made at the Iowa Capitol each year by several groups including Linn County Public Health, Iowa Tobacco Prevention Alliance, American Cancer Society, Cancer Action Network, and American Heart Association.

' Pramod Dwivedi is the health director of Linn County Public Health. Comments: (319) 892-6000; health@linncounty.org