Memoranda and "Economic Empowerment"

              in 1990, according to the Office of Technology
Assessment.5 Adjusted for inflation, the total economic
cost of smoking is more than $100 billion per year.
This does not include costs associated with diseases
caused by environmental tobacco smoke, burn care
resulting from cigarette smoking-related fires, or perinatal
care for low-birthweight infants of mothers who smoke.
Even though smokers die younger than the average
American, over the course of their lives, current and
former smokers generate an estimated $501 billion in
excess health care costs.6 On average, each cigarette pack
sold costs Americans more than $3.90 in smoking-related
expenses.7
Nicotine Addiction and Smoking Cessation
The 1988 Surgeon General's Report on Nicotine
Addiction concluded that:
• Nicotine is the drug in tobacco that causes addiction.
• Cigarettes and other forms of tobacco are addicting.
• The pharmacologic and behavioral processes that
determine tobacco addiction are similar to those that
determine addiction to drugs such as heroin and cocaine.
Nicotine is found in substantial amounts in tobacco.
It is absorbed readily from tobacco smoke in the lungs
and from smokeless tobacco in the mouth or nose and is
rapidly distributed throughout the body.
Tobacco companies are required by law to report
nicotine levels in cigarettes to the Federal Trade
Commission (FTC) but are not required to show the
amount of nicotine on the cigarette brand labeling. The
actual amount of nicotine available to the smoker in a
given brand of cigarettes may be different from the level
reported to the FTC.
In September 1990, the US Surgeon General outlined
the benefits of smoking cessation:
• People who quit, regardless of age, live longer than
people who continue to smoke.
• Smokers who quit before age 50 have half the risk of
dying in the next 15 years compared with those who
continue to smoke.
• Quitting smoking substantially decreases the risk of
lung, laryngeal, esophageal, oral, pancreatic, bladder, and
cervical cancers.
• Benefits of cessation include risk reduction for other
major diseases including coronary heart disease and
cardiovascular disease.
In 1994, an estimated 69% of current smokers
reported that they wanted to quit smoking completely.
Quit attempts, abstaining from smoking for at least one
day during the preceding 12 months, were made by
about 46% of current every-day smokers.2 The percentage of adults who had ever smoked at least 100 cigarettes
but did not currently smoke doubled from 24% to 49%
between 1965 and 1991.3 Smoking cessation was
reported more frequently by men than by women, whites
than by African Americans, non-Hispanics than by
Hispanics, and increased with age and education.
Smokeless Tobacco
There has been a resurgence in the use of all forms of
smokeless tobacco, plug, leaf, and snuff, but the greatest
cause for concern centers on the increased use of
"dipping snuff." In this practice, tobacco that has been
processed into a coarse, moist powder is placed between
the cheek and gum, and nicotine, along with a number
of carcinogens, is absorbed through the oral tissue.
Dipping snuff is highly addictive, and exposes the body
to levels of nicotine equal to those of cigarettes.
In 1986, the US Surgeon General concluded that the
use of smokeless tobacco "is not a safe substitute for
smoking cigarettes. It can cause cancer and a number of
noncancerous oral conditions and can lead to nicotine
addiction and dependence."
• Oral cancer occurs several times more frequently
among snuff dippers compared with non-tobacco users.
• The excess risk of cancer of the cheek and gum may
reach nearly 50-fold among long-term snuff users.
• According to the US Department of Agriculture,
US output of moist snuff has risen 83%, from about
30 million pounds in 1981 to an estimated 55 million
pounds in 1993.8
• The Centers for Disease Control and Prevention's
1995 Youth Risk Behavior Survey reported that about
20% of male high school students used smokeless
tobacco.9
• About 6% of men and 1% of women 18 years and
older use smokeless tobacco (snuff or chewing tobacco)
nationwide.10
• The use of smokeless tobacco is increasing among
male adolescents and young male adults.
Youth and US Food and Drug Administration
(FDA)
In August 1995, President Clinton proposed a comprehensive plan to reduce smoking among children and
adolescents by 50% by reducing access and limiting the
appeal of cigarettes to children. The historic proposal
was prompted by recent data that indicates that smoking
among young people has increased since 1991, with the
largest increase among the youngest smokers. The
University of Michigan's 1995 Monitoring the Future
Project indicates a 30% increase in smoking among 8th
graders between 1991 and 1994.n Between 1970 and
1986, the use of snuff increased 15 times and the use of
24
CANCER FACTS & FIGURES 1997