Tobacco Control in 2014

Gauloises CaporalLAKE MACBRIDE— When I was in the military, I bought my first and only packs of cigarettes. I tried a few puffs, and never had another. Tobacco control is a complicated issue that affects much of society, and has little to do with one person’s choices about tobacco use. It is one where tobacco control advocates need to stick together.

Tobacco products are readily available to anyone who wants them today, despite restrictions on sales to minors. Tobacco is a legal, addictive substance, the use of which is widely accepted. The disease treatment costs of tobacco use have been quantified, and tobacco use presents a tangible, persistent and preventable threat to public health.

Both of my parents smoked tobacco when I was a child, and until the Iowa Smoke Free Air Act was passed in 2008, the air in many public places contained tobacco smoke. We don’t hear as much about tobacco issues these days, despite the ubiquitous presence of tobacco products in retail stores. The legal struggle between tobacco companies and tobacco control advocacy groups has continued, but has largely gone silent.

In Iowa, the coalition of tobacco control advocates includes the American Cancer Society, American Heart Association, American Stroke Association, American Lung Association, the Iowa Tobacco Prevention Alliance (ITPA) and Clean Air For Everyone Iowa Citizen’s Action Network (CAFE Iowa CAN). I was previously a board member for the latter organization. The work of this coalition is focused on securing government funds for a comprehensive tobacco control program.

In a December 2013 letter to legislators, the group wrote,

Smoking cessation efforts are essential public health initiatives that both directly and indirectly impact our entire state.  Statewide programs that are funded through the Division of Tobacco Use Prevention and Control can help reduce the enormous financial toll attributed to tobacco related use, not to mention the 4,400 Iowans who die each year from usage. Annually, tobacco related disease costs Iowans nearly $3 billion, of which $301 million is billed to Medicaid. To substantially reduce this expenditure, the CDC recommends Iowa appropriate $36.7 million annually to properly implement a comprehensive tobacco control policy.  However, last year the division only received $5.3 million.

Governor Branstad’s budget proposal would reduce expenditures in the tobacco control program by $75,000, with reductions targeted to printed educational materials and social media funding. It is a small percentage of the total, and depending upon who the governor appoints to fill the vacant director of the Iowa Department of Public Health position, the proposed budget should have support. It is a modest budget compared to the CDC recommendation.

What is at issue during the remainder of the 85th Iowa General Assembly is regulation of e-cigarettes, which are currently unregulated. Tobacco control advocates want e-cigarettes regulated as a tobacco product, something the U.S. Food and Drug Administration (FDA) would like as well. The tobacco industry is working toward creating an environment where e-cigarettes are socially acceptable, are widely available, and can be used everywhere.  At the beginning of the legislative session, the issue was largely off the radar of legislators who were focused on the youth prevention aspect of this issue. Tobacco control advocates are expected to change that, and are trying to pass legislation they can support.

There are at least three bills pertaining to e-cigarettes written by the tobacco industry (companies like Altria and RJ Reynolds). In parentheses are the tobacco control advocates’ concerns with the legislation as written. The bills were all introduced by Democratic legislators:

HF 2034, which will define e-cigarettes as other tobacco products, regulating them like most other tobacco products. (In this bill, e-cigarettes are not rolled into the Iowa Smoke Free Air Act).
SF 2038, prohibits the sale of e-cigarettes to minors. (The bill doesn’t define e-cigarettes as other tobacco products).
SSB 3101, prohibits the sale of e-cigarettes to minors. (The bill doesn’t define e-cigarettes as other tobacco products).

Like with any legislation, the pro- and anti-tobacco control lobbyists will advocate with legislators to get favorable wording in any potential law. I have lived in Iowa long enough to know that the probable outcome of the legislative initiative may be for Iowa to wait until the FDA rules on e-cigarettes, then deal with the regulatory issues. I’m not hopeful the legislature will pass any of these three bills this session. Preventing the tobacco industry wording in them would be a victory of sorts for tobacco control advocates.

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