U.S. Chamber, members at odds Opposite positions on smoking pose challenges
A smoker holds a cigarette outside the Cleveland State University student center.
(Marvin Fong/The Plain Dealer)
Amy Bush Stevens is director of prevention and public health policy at the Health Policy Institute of Ohio.
Attitudes about smoking have changed dramatically since the days of "Mad Men" and doctors appearing in Lucky Strike ads.
Millions of Americans have quit smoking since the 1960s and most who still smoke want to quit. Yet, adult smoking rates remain stubbornly high in Ohio and tobacco use is still the leading cause of preventable death and disease.
Smoking and secondhand smoke exposure contribute to many of Ohio's most pressing health-policy challenges, including infant mortality, rising Medicaid costs and high rates of chronic diseases such as diabetes and cancer. Researchers estimate, for example, that 15 percent of U.S. Medicaid costs are attributable to cigarette smoking.
After some success in reducing tobacco use rates in the 2000s, Ohio now lags behind most other states. In fact, Ohio performs worse than most other states for adult cigarette smoking and secondhand smoke exposure for children, and spends less on tobacco prevention and control.
And the burden of tobacco-related illness and death now falls disproportionately on some of Ohio's most vulnerable citizens. Tobacco use is particularly high among Ohioans with lower levels of education, Medicaid enrollees and people with mental illness or other disabilities. Almost half of working-age Medicaid enrollees were current smokers in 2012.
Ohio's investment in tobacco prevention and control dropped from a high of $54.8 million in Ohio's 2005 fiscal year to a low of $2.2 million in FY 2011, as a result of state policymakers securitizing tobacco settlement dollars to plug a recession-era budget gap. In FY 2015, Ohio spent just 7.4 percent of the amount recommended by the U.S. Centers for Disease Control and Prevention. The number of Ohioans who were reached by the Tobacco Quit Line, media campaigns and prevention activities was therefore greatly diminished.
But several recent state and local policy changes signal that Ohio is ready to renew its focus on reducing tobacco use. First, the 2016-17 state budget recently signed by Gov. John Kasich includes a significant increase in funding for tobacco prevention and cessation. While bringing this funding to its highest amount since 2008, Ohio's investment in prevention still remains far below the CDC-recommended level of $132 million per year and millions short of what Ohio spent in the mid-2000s when Ohio was a national leader in smoking reduction.
Second, the state budget also included a 35-cent increase in the cigarette tax, the first increase since 2005. Research shows that the higher the tax increase, the greater the impact on reducing tobacco use. The 35-cent increase is very modest, representing a compromise between the legislature and the governor's proposed $1 increase, but is a step in the right direction.
Finally, two Columbus suburbs recently became the first communities in Ohio to raise the legal age to purchase tobacco and nicotine products to 21 years, another strategy shown to prevent tobacco use. Other Ohio cities, including Cleveland, are considering taking this step.
The Health Policy Institute of Ohio detailed these and other evidence-based strategies in a recent report. Examples include expanded media campaigns, better access to the Ohio Tobacco Quit Line, helping pregnant women and people with mental illness to quit, integrating tobacco cessation into Medicaid reforms, building the "tobacco 21" movement and revisiting tobacco tax rates in the near future. We need an intensive and comprehensive strategy to overcome the millions spent by the tobacco industry on marketing campaigns in Ohio each year and the power of nicotine, a drug nearly as addictive as heroin.
Recent changes made at the state and local levels may signal a revival of Ohio's commitment to help today's smokers quit, while also preventing young people from ever starting to use tobacco in the first place.
Let's hope that a decade from now, we can look back on 2015 as the year when Ohio rededicated its commitment to address the No. 1 driver of poor health.
Amy Bush Stevens is director of prevention and public health policy at the Health Policy Institute of Ohio.