Jonathan Samet, MD, paints a smoky picture of his early medical career when smoking was the norm and even allowed in hospitals.
“The so-called hospital station was full of smoke, some special officers were walking around with cigarettes in their hands, and instructors were smoking in class,” said Samet. “The world was completely different.”
Samet, founding director of the Institute for Global Tobacco Control, shared these experiences Public health on-call episodewhere are he and Joanna Cohen, Ph.D., M.Sccurrent director of the IGTC and Bloomberg Professor of Disease Prevention at Department of Health, Behavior and Societythey discussed the past, present and future in the fight against tobacco.
When Samet first came to the Bloomberg School in 1994 to chair the Department of Epidemiology, Johns Hopkins “didn’t have a focal point for tobacco work,” he said.
While the US began to see some progress and policy changes during those years, the tobacco industry strategically focused its marketing efforts on other countries that may not have had the ability to implement strong anti-tobacco policies.
“Clearly there was a need to work with colleagues in other countries, bringing some of the lessons learned in the US and other higher-income countries to places that faced the dangers of increasing tobacco use with aggressive and well-rehearsed industry tactics,” Samet said.
Samet’s early work with countries like China led to the founding of the IGTC. In the 25 years since, the Institute has become a global leader in efforts to end the tobacco epidemic.
Today, tobacco smoking rates, especially among children, are on the decline in the US, but the fight against tobacco continues as new products like e-cigarettes enter the tobacco market.
“There is always a constant need, unfortunately, in tobacco control … to counter the ever-changing strategies of this very chameleon industry,” Cohen said.
Under Cohen’s leadership, the IGTC focuses on global surveillance work to influence tobacco control policy.
For example, the IGTC investigated tobacco marketing at the point of sale (the physical location where people can buy tobacco products). Cigarettes and other tobacco products are not only seen by the people who buy them, but every other customer “sees all the advertisements and beautiful products displayed,” Cohen said. More study spanning 42 different countries shows how these products are explicitly targeted at children by placing tobacco products at eye level for them to see—and even being advertised and promoted in stores near schools and playgrounds.
With these types of studies and surveillance, Cohen hopes to equip policymakers and public health experts with the evidence to help them say, “We’ve got to do something about this,” and enact policies that will change the way cigarettes are designed and where they are placed in stores.
Many countries, including some low- and middle-income countries, have made great strides in reducing smoking rates. Cohen was holding a pack of cigarettes from Australia, one of the first countries to put graphic health warnings on cigarette packs. The label paints a disturbing picture of the effects of smoking and is meant to evoke an emotional response. This package featured a protruding eye with the words “Smoking Causes Blindness”.
In this regard, the US has some catching up to do.
“Since 2009, the Tobacco Act has promised us that there will be pictorial warnings. We are still waiting,” Cohen said.
In other countries, efforts to reduce smoking include banning tobacco displays and placing tobacco products under the counter or behind closed shelves, out of sight of customers.
Samet points to Beijing as a pioneer in enforcing strict no-smoking regulations. The city is now 100% smoke-free, but smoking is still widespread in other parts of the country. The Chinese government produces and sells cigarettes, primarily through its state monopoly, China National Tobacco, and generates significant income from tobacco.
The future of tobacco control looks set to be more complex with tobacco-free, nicotine-filled, fun-flavored e-cigarettes aimed at kids.
“We’ve seen a whole epidemic of young people starting to use these products, getting nicotine addicts, who wouldn’t use nicotine without them,” Cohen said.
Cohen would like to see the FDA regulate the use of these products for good, such as helping people quit smoking tobacco.
Despite changing product trends, Cohen remains optimistic and focused on the tobacco finish.
“I’m really excited about the energy being put into ending the tobacco epidemic once and for all.”
Grace Fernandez is a communications associate in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health and an associate producer for Public Health On Call.