Special Report: Surgeon General, CDC Empower Youth Activists

By Nick Fradkin and Tonya Veitch, Legacy Youth Activism Fellows

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The Legacy Youth Activism Fellowship Program is an 18-month leadership & professional development program for young adults committed to tobacco prevention and control designed to offer training and support to advance local and national projects. Currently, there are 11 Fellows representing 10 different states.

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One week ago, we were working at our respective jobs—Nick in Arizona and Tonya in California. A couple of emails and phone calls later, we were both booked to fly to the nation’s capital to attend and cover the press conference announcing the release of the 31st Surgeon General’s report on tobacco control, Preventing Tobacco Use Among Youth and Young Adults. As young anti-tobacco activists, this was a once-in-a-lifetime opportunity to witness and share our government’s latest public declarations about the state of tobacco control.

Getting There

Nick Fradkin, Legacy Youth Activism Fellow

Asked to arrive at 9am, Nick took the Metro red line from Farragut North over to Judiciary Square and headed down to the Newseum on Pennsylvania Avenue, where the press conference would be starting at 10am. Nick went up to the 8^th floor, checked in, and learned that he had a reserved seat in the second row (not too bad!). As he was meeting with Legacy staff and getting the run-down on the morning, Nick spotted a familiar face walk into the room. It was Dr. Victor DeNoble, the original tobacco industry whistleblower and subject of the new documentary, Addiction Incorporated, which Nick had just seen at FilmBar in Phoenix two nights before. Nick introduced himself and said he enjoyed the film, so Dr. DeNoble gave Nick his card to stay in touch about an upcoming promotion in Phoenix.

Tonya Veitch, Legacy Youth Activism Fellow

Meanwhile, Tonya, who had just landed at nearby Reagan International Airport after a two-stop, red-eye trip to D.C. from San Jose, California, was quickly making her way to the Newseum. It had been a long night of traveling but Tonya was too excited thinking about the press conference to focus on how tired she was. She rushed off the plane and ran to a taxi, which arrived at the Newseum at about 9:30am. She checked in, put on her complimentary “We Can Be Tobacco-Free” button, and then proceeded into the press conference. Immediately, she was amazed by all the people and countless cameras. As she was about to call Nick so that they could meet up, she looked into the sea of people and saw a friendly face (Nick). After saying their hellos and getting up to speed from Nick and the team from Legacy, the two proceeded to their second row seats! The press conference was minutes away and as Tonya started noticing all the tobacco control activists make their way into the room she gasped to herself, “I’m here.”

Lights, Camera, Action

Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS), opened the press conference with some high-level findings from the report and some brief thoughts about the state of youth tobacco prevention. She applauded the progress that our society has made since the first Surgeon General’s report on tobacco control in 1964, but she said that our progress is “not good enough,” considering that an estimated 443,000 people die per year from cigarette smoking—and, for each smoker’s death, two “replacements” under the age of 26 take up the same habit. Clearly, as the Secretary put it, “we have a lot more work to do,” as “one child picking up a tobacco product is one too many.”

Next to speak was Dr. Howard Koh, Assistant Secretary for Health at HHS, who echoed the Secretary’s words by insisting that youth tobacco use, as a “completely avoidable and completely preventable” phenomenon, is in a state of “heightened urgency.” Dr. Koh shared a number of striking findings with everyone, but perhaps the most memorable moment was when he emphatically said that advertising, movies and media featuring cigarette use cause youth to take up tobacco products. With $10 billion dollars spent per year on advertising, the tobacco industry has made it simple for us to conclude that “youth smoking is not an accident,” as the Assistant Secretary put it. Dr. Koh closed by saying that we need to “give our youth a fighting chance” against the temptation to try tobacco.

Dr. Regina Benjamin, Surgeon General
(Courtesy: Zimbio.com)

Finally, Dr. Regina Benjamin, United States Surgeon General, took the podium. Since 1964 the Surgeon General’s report has highlighted the dangers of tobacco; however, it has been 18 years (the 1994 Surgeon General report) since the report has specifically focused on youth! Dr. Benjamin hit the ground running by stating, “the burden of tobacco burdens all of us.” She followed with the most recent statistics about youth and young adult smoking rates and many were shocking to hear. For example: Did you know that for everyone one tobacco related death, there are two new youth smokers? We didn’t and we were shocked by this finding. Dr. Benjamin stressed that “we need to bring back that commitment to tobacco control that was so effective between 1997-2003.” The Surgeon General expressed that Tobacco Prevention and Education Programs have been effective in reducing youth and young adult smoking rates, so we can’t stop now just because those rates are at an all-time low. Like Secretary Sebelius said, “one child picking up a tobacco product is one too many.”

Lastly, the Surgeon General’s Video Challenge was released. This challenge encourages youth and young adults to share with the world why they choose NOT to buy tobacco (double entendre) in a short English or Spanish video. There will be four grand prize prizes ($1,000) and 12 runner-ups ($500). Dr. Benjamin’s got a jump-start on the competition and actually had a video to share with all of us at the press conference! This PSA will hopefully be coming to a town near you. Tonya is challenging the youth groups that she works with as well as college advocates in Santa Clara County. Will you?

Afterthoughts and Impact

As Legacy Youth Activism Fellows, our efforts epitomize the commitment that the Surgeon General challenged us to revive. 2,500 miles away from Washington, D.C., we plan to use the startling findings from the report in our own local advocacy efforts.

The fact that nearly all adults who smoke daily started smoking before age 26 is critical to Nick’s efforts in advocating for smoke-free universities in Arizona. While 80% of daily smokers started before age 18, Nick wants to make it clear that college administrators have a unique responsibility to address tobacco use in the 18-26 age range by adopting smoke-free or tobacco-free campus policies. Meanwhile, Tonya has been working with youth and young adults for the past two years on tobacco control efforts through a CPPW (Communities Putting Prevention to Work) grant; however, the funding is ending this month. Being at the press conference encouraged Tonya to fight to make tobacco prevention a priority within Santa Clara County. Even though we won’t have the same amount of funding that we’ve had for the past two years doesn’t mean we can’t continue to do amazing things; we just have to be more creative and financially savvy when it comes to opportunities.

We aren’t the only ones who will take this 899-page report and run with it. The nine other Legacy fellows and the other youth advocates who attended the press conference will surely do the same. Nick and Tonya met a great group of anti-tobacco activists from Youth Empowered Solutions from North Carolina. Their passion and dedication to tobacco control was evident and they seemed inspired to bring back what they learned to their hometowns (and they even got a head-start on their video!).

Overall, we had an amazing experience. We even got to meet and take pictures with the Surgeon General, herself. From the bottom of our hearts, we are truly grateful to Legacy for this once-in-a-lifetime opportunity. Being at this press conference has inspired us to take what we’ve learned and share it with our communities. We truly feel that, together, we can end the tobacco epidemic.

From left: David Satcher, M.D., Ph.D.; Director, Satcher Health Leadership Institute; Director, Center of Excellence on Health Disparities; 16th Surgeon General of the U.S. - Tonya Veitch, Legacy Youth Activism Fellow - Nick Fradkin, Legacy Youth Activism Fellow - U.S. Surgeon General Dr. Regina Benjamin, M.D., M.B.A., V.D.M., U.S. Public Health Service

Thank you to Legacy and the CDC for making this possible, and thank you to Kim Homer Vagadori of California Youth Advocacy Network, who (coincidentally) has been a mentor to both of us.

Digest #28: This Month in Smoke-free News

I am organizing this month's digest by type of news: government, higher education, and other. It seems logical, so I'm going with it.

Government News:

• On February 6, Oklahoma's governor ordered the elimination of smoking and tobacco use on all state property. Leading a state with one of the highest smoking rates in the country at 23.7%, Governor Mary Fallin has made a bold, yet (in my mind) inevitable move to ban smoking. As with any good policy change, an educational campaign is planned to inform the thousands of state employees who smoke about quitting options. The best part? The smoking room in the capitol building will be converted into a fitness center.
• Rhode Island parks and beaches may soon be smoke-free. After visiting a couple of friends up there in October and walking along perhaps some of the most underrated beaches in the country (where I do recall stepping on a few discarded cigarette butts), I certainly hope that state legislators get the job done.
• In the wake of a poll suggesting that a majority of Kentucky residents favor a state indoor smoking ban, Representative Susan Westrom says that it's time for Kentucky to go smoke-free. She says that it's "so typical for Kentucky to be so behind." Apparently, Rep. Westrom saw the state's failing grade for the American Lung Association's annual State of Tobacco Control report and saw the opportunity to get her state ahead. With the highest smoking rate in the country at 29%, Rep. Westrom certainly has her work cut out for her. In related news, a Valentine's Day rally was planned to occur at the state capitol, where smoking ban advocates were going to wear red and raise awareness of the link between secondhand smoke and heart disease.
• After five years of failure, the Indiana Senate has finally passed a statewide indoor smoking ban. However, it wasn't without serious compromise; bars will be exempt from the ban, and so will bingo halls...and mental health facilities...and nursing homes. And the minimum distance from doorways to smoke-free facilities where people are permitted to smoke is actually being reduced from 12 feet to 8 feet (really, FOUR feet? That's 48 inches, people). Anyway, I'd normally emphasize big news like a new state smoking ban a bit more, but this truly is a "watered down" ban. That having been said, it is better than nothing at all, and perhaps this is just a first in a series of intermediary steps toward a more comprehensive ban.
• On June 5, California voters will decide on a measure to increase the state's cigarette tax by $1 per pack. It's called the California Cancer Research Act, and researchers at the University of California, San Francisco have estimated that this would generate an extra $855M per year to fund smoking education, cessation and research, as well as create 12,000 new jobs--not to mention that it would save approximately 100,000 lives from smoking-related deaths. I'm all for it; tax 'em 'til they quit.
• A recent poll in Mississippi suggests that 68% of state residents are in favor of a statewide indoor smoking ban. Although this statistic is itself comforting, I find it especially important to note that the same percentage of registered Democrats and Republicans support such a ban--which is a great reminder about bipartisanship in tobacco control. Rarely, in our society, do we encounter a circumstance in which a vast majority of each party agree about a highly controversial issue. Shouldn't this phenomenon tell us that something is truly special--and pressing--about the anti-smoking cause?
• I found it interesting how a brief article (and video) explains why some Wisconsin bar owners and bar-goers' defiance of the state smoking ban has led to virtually no consequence and no increased enforcement. One bar owner completely disregards the ban, and he hasn't necessarily made a big deal out of the two citations and hundreds of dollars he's paid for them because he knows that, by self-enforcing the smoking ban, he will lose up to 20% of his business. I think that other states and jurisdictions can learn from this simple economic problem; the violation fine needs to be high enough and the risk of getting cited imminent enough for bars to meet or exceed the risk of losing business by enforcing the ban.
• Back in November, I mentioned how a US District Court judge placed an injunction on the FDA's efforts to implement graphic cigarette warning labels by September 2012. As expected, the government appealed the ruling, but now--to most public health advocates' dismay--the court has upheld the original ruling. Again, the tobacco industry claimed that the graphic warning labels violate freedom of speech clause in the First Amendment because they aren't purely factual, and instead aim to prevent people from purchasing the products. In his 19-page opinion, Judge Richard Leon wrote, "The graphic images here were neither designed to protect the consumer from confusion or deception, nor to increase consumer awareness of smoking risks...Rather they were crafted to evoke a strong emotional response calculated to provoke the viewer to quit or never start smoking." As much as I despise Big Tobacco, I certainly understand their argument and feel that it is strong, given the incredibly graphic nature of the proposed warning labels. Even as a non-smoker, my first impression of the labels was shock--mostly because the labels portray the worst-case scenario for cigarette consumers. So, I am not surprised that these won't be showing up on cigarette packs this fall. While I am disappointed about this, I am optimistic that the FDA can rebound from this failure and come up with modified labels that are both effective and in substantial compliance with the First Amendment.
• The Surgeon General's latest report on tobacco control is set to release on March 8, and, as a very lucky American Legacy Foundation Youth Activism Fellow, I will be fortunate enough to be at the press conference, which I plan to summarize and comment on by means of this blog next week. Stay tuned for a special post!

Higher Education News:

• I really enjoyed the closing line of an op-ed about the UC system going tobacco-free written by a San Diego State University student. It reads: "...if eliminating secondhand smoke on campus and perhaps even discouraging incoming freshmen from picking up the habit are possible outcomes of this decision [by the UC President to make all campuses tobacco-free], then opposing the ban for the sake of your mid-break cigarette is even more disgusting than the habit itself." Hundreds of miles away, an article in the Marquette University student newspaper also featured last month's big news that the University of California is going tobacco-free. Long story, short: the UC news has created a ripple effect around the nation (Go Bears).
• Facing the possibility of losing millions upon millions of dollars in research funding, another large state university system has come close to going tobacco-free. The University of Texas has been receiving funding from the Cancer Prevention and Research Institute of Texas (CPRIT), which recently gave the UT an ultimatum to go tobacco-free by March 1, or risk losing a chance at $100M+. That's one way to enact policy change! Some down in Texas thought it was going to happen, but that doesn't appear to be the case. A smoke-free UT system, in combination with the already-decided smoke-free policies at the University of California, the University of Michigan and the University of Florida, should really put pressure on other leading public institutions to quickly follow suit. I'll hopefully be referring back to this mention next month with good news... 
• Speaking of the University of Michigan, the Wolverines' rival school, Michigan State University, is exploring the possibility of a smoke-free campus. I'll give it six months, at most, to come to fruition.
• Harvard University allegedly has a smoke-free proposal on the table, and the editorial board of the student newspaper has officially denounced it...Who ever said that Harvard students are smart?

Other News:

• Just as I was getting convinced that e-cigarettes may, indeed, be the future of smoking in America, an e-cigarette blows up in someone's mouth. The North Bay, Florida fire department compared the incident to the detonation a bottle rocket in the victim's mouth, which was left with fewer teeth and less of a tongue. Apparently, the battery in the e-cigarette was faulty. This news has surely stalled sales of the device and left the tobacco industry smiling.
• Researchers at the University of Southern California have found a positive correlation between middle-schoolers' involvement in sports and their propensity to reject cigarette smoking. To me, it's no surprise--but for health-conscious parents, it's a reminder to get their kids involved in youth athletics...ASAP.
• Quote of the Month: "There is no public health issue that is more important than preventing our youth from becoming addicted to tobacco." -Dr. James Crucetti, in response to the new smoke-free playgrounds ordinance in Albany, NY.
• The CDC recently had research published that demonstrates how approximately 20% of teens and pre-teens are exposed to secondhand smoke in cars. The tight confines of cars undeniably augment the risk of even the smallest amounts of secondhand exposure emitted within them, and four states--Arkansas, California, Louisiana and Maine--have laws prohibiting smoking in cars with children aged 16 or younger inside. Other than California, these are some unlikely suspects; why aren't other states catching on?
• Last, but certainly not least is some surprising research out of the UK: Public smoking bans do not necessarily lead to increased smoking in private spaces. In fact, the data suggests that anti-smoking legislation in Ireland, France, Germany and the Netherlands may have spurred an increase in "home smoking bans." In other words, decreased smoking in homes was correlated with the public smoking bans. To me, this finding has incredible implications. If this is true (and consistent in the United States), public smoking bans could actually decrease the amount of private smoking; it suggests that government may not have to take paternalistic measures (e.g., illegalization of cigarettes) to achieve a virtually smoke-free society. For more on my stance on public vs. private smoking, please see one of my first posts (nearly two years ago!).