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 Policies are being developed to protect nonsmokers, especially children, from environmental tobacco smoke. Comprehensive prevention programs are being directed toward youth; these include peer education, media literacy, and counter-marketing (see text). Media campaigns are publicizing the effects of smoking, reasons not to start and the benefits of quitting. Merchants are being educated and monitored to reduce youth access to tobacco products. Community resources are being developed to help people quit smoking. Community coalitions are addressing tobacco access/use issues at the local and state levels. Laws prohibiting sales of tobacco to minors are being enforced.
The price of cigarettes needs to be increased. Health education in grades K-12 needs to include tobacco use prevention. Restrict the access of minors to tobacco products in retail stores. Restrict tobacco product advertising and promotion in retail stores. Better and consistent enforcement of the law prohibiting tobacco sales to minors. Youth and adults alike need better access to the help they need in order to quit. A greater portion of the Master Settlement funds needs to be directed toward tobacco use prevention. Eliminate cost barriers for smoking cessation services for underserved populations. Decrease the appeal of tobacco use among youth.
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 Smoking in New Mexico Even though cigarette smoking is the leading preventable cause of lung cancer, emphysema and heart disease, New Mexican teens’ smoking rates have been increasing since the late 1980’s (Figure 1). Rates are especially high among Hispanic and Native American teens: in 1997, 60% of Native American teens and 48% of Hispanic teens smoked cigarettes, compared to 41% of non-Hispanic white teens (Figure 2).(1) This is alarming, because it is in the teenage years that a lifelong smoking habit is most likely to start. In contrast, per capita cigarette consumption has been declining overall in New Mexico. In 1997, 22% of adults in New Mexico smoked cigarettes.(2)
Smoking trends during the 20th century: a national view During the first half of the century, annual per capita cigarette consumption increased dramatically among both men and women. There were many reasons for this. These include the invention of the safety match; improvements in production of cigarettes; social changes, including improvements in the status of women; and mass media advertising of cigarettes.(3) In the century’s second half, nationally, the percentage of adults who smoke cigarettes declined from 42% in 1965 to 25% in 1997.(4) This was due to the recognition of the hazards of tobacco. Programs were developed to discourage people from starting to smoke, and to help them quit; public opinion began to turn against tobacco use; and there were increases in federal and state excise tax rates. Master Settlement Agreement The close of the century was marked by the unprecedented Master Settlement Agreement (MSA). Forty-six states had sued tobacco companies for the states’ costs from smoking related illnesses. The settlement, in the amount of $206 billion, will be distributed over twenty-five years, starting in the year 2000. Public health agencies have an historic opportunity to reduce tobacco related illness. They can do this through programs to eliminate exposure to environmental tobacco smoke, keep young people from starting to smoke, help them quit -- and focus especially on population groups with the highest smoking rates. This opportunity can be realized only if funds from the MSA are used to support these programs. Because of the MSA, New Mexico is expected to receive $1.2 billion over the next 25 years from the tobacco companies. For fiscal year 2000 - 2001, New Mexico received $42 million. A small fraction of this -- $1.775 million, or about $1 per person -- was appropriated to the state’s Tobacco Use Prevention and Control Program. By comparison, the Centers for Disease Control have recommended public expenditures of $7 per capita, per year, to fund a comprehensive tobacco control program.(5) The burden of cigarette smoking: death, disability, and dollars Cigarette smoking damages the lungs, and is the leading cause of heart disease, lung cancer, some other types of cancer, and emphysema. From 1987 through 1996, smoking was the second leading cause of premature death in New Mexico; one out of three smokers dies of a smoking-related disease. On average, each smoker gives up four to five years of life compared to nonsmokers of the same age and sex.(6) Smoking increases the risk of serious complications during pregnancy. Children of women who smoke during pregnancy are at higher risk for problems including low birth weight, respiratory infections, and sudden infant death syndrome (SIDS).(7) In addition to the direct effects of smoking, there are indirect effects. Children and others who do not smoke but are exposed to other people’s cigarette smoke (second-hand smoke) have a higher rate of respiratory infections and lung cancer.(8)
In New Mexico in 1996, direct and indirect costs of smoking totaled over $432 million, or $254 per person. In contrast, only $22.8 million was collected in tobacco taxes, or about $13.40 per person. Smoking accounted for over $48 million in Medicaid costs in New Mexico in 1993, and the smoking-related Medicare costs are thought to be double the Medicaid costs.(9) None of these numbers can include the suffering experienced by patients with tobacco-related illnesses and their families. Where do we go from here? Although some effects of smoking are irreversible, quitting has many positive effects - even for adults. Within a year of quitting, a former smoker’s added risk of dying from heart disease is reduced by 50%, and in five years, his risk is the same as if he had never smoked.(10) Several tobacco control priorities have been identified both in New Mexico and nationally: eliminating exposure to second hand smoke; preventing tobacco use among young people; promoting quitting; and eliminating the high smoking rates seen in certain groups. To address these priorities the Centers for Disease Control and Prevention recommends several specific components for tobacco control programs. Based on the limited MSA funds appropriated for tobacco control, the state’s comprehensive plan includes supporting community programs and coalitions, increasing smoke-free environments, decreasing the appeal and accessibility of tobacco products to youth, and supporting effective programs to help people quit (in the schools and elsewhere). This comprehensive approach involves youth and adults. Specific aspects of this approach (e.g., peer education, media literacy and counter-marketing) are youth-oriented. Peer education entails youth teaching youth about issues related to tobacco use. Media literacy enables youth to understand and evaluate the messages of tobacco advertisements; for example, the often implied message that using tobacco products makes a person more attractive. To offset tobacco marketing, counter-marketing promotes health by emphasizing the benefits of living a tobacco-free life style. In addition, cigarette prices need to be raised. It is estimated that a 10% increase in the price of a pack of cigarettes would cause a 4% decrease in consumption, and a 30% decrease among Hispanics aged 18-24.(11) Other important measures include focused education, decreased access to tobacco and restrictions on advertising and sales to youth. The Behavioral Health Services Division of the New Mexico Department of Health administers the Synar Initiative, which requires every state to restrict tobacco promotion and youth access. As a result, New Mexico enacted the State Tobacco Products Act, prohibiting the sale of tobacco products to those under the age of 18. Already, compliance with that law seems to be improving. In 1999, merchant compliance was 81%, increasing to 88% in 2000. The healthcare system can also play a role, by counseling patients about quitting smoking, and by making tools for quitting more available through health plans. We have more information than ever on the negative effects of tobacco on health and on our society. It is our responsibility to act on that knowledge. That will require channeling the resources available through the MSA towards proven methods for tobacco control, especially among young people.     New Mexico Department of Health, Public Health Division:
Behavioral Health Services Division
Chronic Disease Prevention Council
American Heart Association
American Lung Association
American Cancer Society
Office of the Attorney General
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