Academic journal article American Journal of Health Education

Tobacco, the Common Enemy and a Gateway Drug: Policy Implications

Academic journal article American Journal of Health Education

Tobacco, the Common Enemy and a Gateway Drug: Policy Implications

Article excerpt


For the four leading causes of death in the United States (heart disease, cancer, stroke and chronic respiratory disease), tobacco use is a common risk factor. Tobacco use is responsible for almost 450,000 deaths per year and impacts the health of every member of our society. Tobacco is a gateway drug for substance abuse. That role is critical to revisit and revalidate. From 490 schools, a total of 175,460 students in grades 6-12 participated in an alcohol, tobacco and other drug use survey, the descriptive analyses of the data being stated in a 2007 technical report. The secondary analyses of the data clearly demonstrated that a dose-response relationship pattern of association existed between increasing quantity of cigarette use and the use of alcohol and other drugs. Additionally, logit analysis revealed that selected demographic and other variables were statistically significant predictors of the past month's use of cigarettes. The secondary analyses were replicated for the 2008 survey, in which 152,732 students responded to the same questionnaire. Similar results were obtained. Smoking is a major risk factor to the leading causes of death and sufficient empirical evidence establishes that tobacco is a gateway drug. To combat tobacco use, a comprehensive ecological approach, including tobacco education and cessation, enacting and enforcing smoke-free policies, and increasing taxes on tobacco products, is recommended.


Mazzone and Arroglio asked, "How many ways can we say that cigarette smoking is bad for you?" (1(p1717) Tobacco use is responsible for almost 450,000 deaths per year in the U.S. and affects every cell, every organ, and every aspect of the human body.

Tobacco use is directly involved in neoplasms in many parts of the body, including the oral cavity, pharynx, esophagus, pancreas, kidney, urinary bladder, cervix and lungs. It is also implicated in cataracts, periodontal disease, cerebrovascular disease, coronary heart disease, chronic obstructive pulmonary disease, respiratory disease, aortic aneurisms and acute myelogenous leukemia (AML). (2,3) While the top four leading causes of mortality in the U. S. are heart disease, cancer, stroke and chronic respiratory disease, the number one risk factor for all of those premature deaths is tobacco use. And, as public health enemy number one, tobacco use is the most preventable.

Whether it be through exposure to second-hand smoke, direct smoking or chewing, (4) through environmental contamination, or increased cost of medical care and lost worker productivity, tobacco has literally impacted the health and wealth of every member of our society. Gro Harlem Brundtland, the former Director General of the World Health Organization (WHO), said, "Tobacco is one of the greatest emerging health disasters in human history." (5(p13) The WHO also states that tobacco "is the only legal consumer product that can harm everyone exposed to it--and it kills up to half of those who use it as intended." (5(p8)

Tobacco causes premature deaths, negatively impacts quality of life and contributes significantly to the exponentially rising costs for health care. Results from the WHO's Global Youth Surveillance Survey (GYTS) suggest that the estimated world-wide deaths from smoking will double from 5 million per year to 10 million per year by 2020 and that these projected 10 million deaths may even be an underestimate. (6 (pl)) The Centers for Disease Control and Prevention (CDC) estimate that smoking and exposure to second-hand smoke cost the United States 5.5 million Years of Potential Life Lost (YPLL) and $92 billion annually in lost productivity. (7) That amounts to $1.9 billion on average per state for loss of productivity, and the average smoking attributable cost per state in 2004 was nearly an additional $1.9 billion or the equivalent of $5.31 per every pack of cigarettes sold. Whereas the CDC estimate of annual health care costs at $75 billion, the direct Medicaid costs from smoking are calculated to be $607 million, or the equivalent of $1. …

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