I need a license to smoke? Say it isn’t so!

In recent years, public health experts have been looking for ways to curb the number of deaths caused by tobacco use since prolonged use of tobacco causes the death of about half users. The CDC reports that more deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.

 

Cigarettes in particular, are really dangerous when you look at the number of annual deaths they cause in the US alone. Cigarette smoking causes about 1 of every 5 deaths in the United States each year according to the CDC.

Should cigarettes be considered as dangerous as guns or illegal drugs?

Some public health experts believe tobacco products, like cigarettes should be considered as dangerous as guns, explosives and hazardous chemicals because of their effect on the health and well being of individuals. Some experts would even argue that the government needs to step in and regulate its use. Regulation would hopefully prevent underage sales, reduce individual smoking and ensure that all users are aware of the unfavorable health effects of using tobacco.

Tobacco = Drug

The regulation of tobacco products would be similar to the regulation of pharmaceutical drugs. A license would serve as a prescription needed to purchase tobacco products.  An application for a license would require contact and identity information validated by a government issued ID such a birth certificate, passport, or driver’s license. This information would allow users to be contacted with tailored cessation information as well as provide data for longitudinal studies on f the sale and usage of tobacco. The license could be paired with a smart card, which would be required when making a tobacco purchase. The smart card license would have a set daily consumption limit set by the card owner and a daily purchase limit so that the cheapest license would correspond with a lower consumption level and vice versa. Smokers would also be offered a monetary incentive to surrender their license, or even reduce their daily consumption limit at any time.

This licensing idea may seem a bit radical.

While the rationale behind this initiative is justified, I think the actual implementation causes mixed feelings. The writer of the article is from Australia where public opinion tends to favor government regulation as opposed to the United States where it widely varies.

Nonetheless, it is important to note that the initial claims that cigarettes are harmful were viewed as radical. The regulations on tobacco product advertisements and the spread anti-smoking legislation were also viewed as radical.

According to the writer, “A smoker’s license may today seem a radical step toward ending the epidemic of tobacco cause disease, but it is far less radical than prohibiting the sale of tobacco [...]. The requirement for a license would send a powerful, symbolic message to all smokers and potential smokers that tobacco was no ordinary commodity, akin to grocery items, confectionary, or any product on unrestricted sale. It would mark tobacco as a product uniquely deserving of such regulation and thereby invite reflection among smokers on why this exceptional policy had been introduced. This step may diminish self-exempting views that smoking is just another, unexceptional risk in ‘life’s jungle’ “.

At the end of the day, it all comes down to one question: does making it more difficult for smokers to smoke really encourage them to quit? Who knows, it just might!

Citation:

Chapman S (2012) The Case for a Smoker's License. PLoS Med 9(11): e1001342. doi:10.1371/journal.pmed.1001342

 Cprch Jffrs is a PhD student in the Department of Biostatistics and Bioinformatics at Emory University, who enjoys math and terrible reality TV shows.

Can’t quit smoking? Cutting back may be an option.

The negative health effects of smoking are clear and well established. As a result, smokers have been encouraged to completely quit smoking in order to reduce the risk of health problems. However, despite repeated attempts, most smokers find quitting to be extremely difficult. Without help, less than 1 in 20 smokers can quit; even with outside help, less than 1 in 4 smokers are successful at quitting.

Despite these rather gloomy statistics, the potential benefit of simply reducing the amount of smoking (as opposed to quitting) has not received much attention from the scientific community. However, a recent study changes this. A team of researchers from the School of Public Health at Tel Aviv University followed individuals over a 40 year time period. Smoking habits were recorded for the first two years of the study. The study found that, although quitting resulted in the greatest benefit to survival, reducing smoking was also beneficial. Individuals who reduced their smoking within the first two years lived longer than those who did not change smoking habits. Survival of individuals who quit smoking was even greater than those who reduced smoking habits.

While previous research has focused primarily on the benefits of quitting smoking, this study is among the first to show a health benefit from a reduction in smoking. Jennifer Taussig, MPH, of Emory University notes that “These findings should provide encouragement for smokers who haven’t been able to quit. For these individuals, reducing the number of cigarettes smoked per day may have a positive effect on long-term health.”

If quitting doesn’t seem to be an option, current smokers should consider how to reduce their overall intake of cigarettes. Physicians should use the results of this study to encourage patients to reduce their overall smoking, especially those patients who feel frustrated by not being able to quit.

In addition to smoking cessation programs, this study shows that smoking reduction programs may have the potential to improve health and may be a stepping stone towards quitting. For the larger healthcare system, smoking reduction programs should be designed, researched and implemented, possibly in conjunction with existing cessation programs.

While this is a single study, the results provide evidence that any reduction in smoking may improve health. Although quitting is the best option, for those who currently smoke, these new findings provide a second option to improve health throughout a lifetime.

Adam Vaughan, MPH, MS is a PhD student in epidemiology at Emory University’s Rollins School of Public Health.

Reference: Gerber, Y. et al. Smoking Reduction at Midlife and Lifetime Mortality Risk in Men: A Prospective Cohort Study. American Journal of Epidemiology. 2012;175(10):1006–1012

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