Tobacco Policy in the United States
LESSONS FOR THE OBESITY EPIDEMIC
KENNETH E. WARNER
On June 16, 2004, cigarette smoking killed some twelve hundred Americans. That shocking death toll warranted no headlines. Neither did the same outcome—some twelve hundred more deaths—the following day, nor the day after. Indeed, it is the rare headline that informs the public that smoking accounts for nearly one of every five deaths in the United States, one in three during middle age. Smoking is simply too commonplace, too mundane. Yet it is far and away the nation's—and increasingly the world's—leading killer. In this chapter I examine the burden smoking has imposed on society and what we have learned in attempting to deal with that burden. I then consider lessons drawn from this experience for addressing the most rapidly growing behavioral cause of chronic disease: the epidemic of obesity, the only behavior that threatens to overtake smoking as a cause of death.
Cigarette smoking currently kills over four hundred thousand Americans annually. The vast majority are long-time smokers—smoking kills about half of lifelong smokers—but thousands are nonsmokers, victims of exposure to smoke from other people's cigarettes (U.S. Department of Health and Human Services 1989; Samet 2001; Glantz and Parmley 1995).
The lethal danger lies in the chemical stew that is cigarette smoke and the frequency with which it is inhaled. Cigarette smoke consists of more than four thousand chemical compounds, including arsenic, hydrogen cyanide, formaldehyde, benzene, naphthalene, vinyl chloride, lead, polonium-210, cadmium, ammonia, carbon monoxide, and, of course, nicotine. More than forty of the chemical compounds in smoke are known carcinogens. Taking about ten puffs per cigarette, a pack-a-day smoker inhales this potpourri of chemicals 200 times daily, or 73,000 times per year. Over a lifetime of fifty years of smoking, a pack-a-day smoker inhales 3.65 million times, having consumed more than a third of a million cigarettes. There may be no greater testimony to the strength of the human organism than the fact that roughly half of lifelong smokers survive this remarkable chemical assault.