Prompted in part by the institute's effort, the Centers for Disease Control and Prevention, the Atlanta-based arm of the United States Public Health Service, has announced the award of seed grants for tobacco control to health departments in 20 states, plus the District of Columbia, that are not included in the Assist project. The agency plans to provide funds to the remaining states this year. Congress has awarded the agency $20 million for the fiscal year 1994, which began last month, for this effort, up from just $3 million in 1991.
Dr. Michael Eriksen, who heads the centers' technical assistance program, said, "By 1994, every state in the U.S. will have dedicated tobacco control activities."
In addition, the Robert Wood Johnson Foundation is soliciting applications from public and private organizations for $10 million in grants for tobacco control programs.
The enemy these organizations are battling is a particularly tough and tenacious one. Although for the first time ever there are now more American men who have quit smoking than who still smoke and though the overall smoking rate among adults is now just below 25 percent, more than 43 million American men and women still smoke. And there has been no decline in smoking by teen-agers, with 17 percent of high school seniors now smoking daily.
Dr. Samuel Broder, director of the National Cancer Institute, noted that more than 434,000 Americans die each year, almost 50 people every hour, from smoking-related diseases like cancer, heart and blood-vessel diseases and respiratory disorders. The victims are not just old people. Smoking accounts for more than on-quarter of all deaths among Americans 35 to 64 years old.
An further 50,000 nonsmokers a year are believed to die as a result of environmental exposure to tobacco smoke. A third of all cancer deaths are smoking-related. The North Carolina Assist project put it this way: "The loss of life from smoking in North Carolina equals the death toll if two fully loaded Boeing 737 passenger planes crashed each week in our state, with no survivors."
How, then, to contain the costs of smoking? The studies sponsored by the cancer institute have shown that community-wide approaches work together in keeping youngsters from starting to smoke and enabling adults to quit. These community efforts include everything from public information campaigns to school-based educational programs that "inoculate" youngsters against smoking to professionally run stop-smoking clinics with long-term programs to help people stay away from tobacco.
"If we can keep teen-agers from starting, chances are they will never become smokers." Dr. Marshall said. By 1998, the states participating in the Assist project expect to have research-proven smoking prevention curriculums for all children in kindergarten through 12th grade and to have all public schools designated as smoke-free environments.
Major emphasis will also be placed on stemming illegal sales of tobacco products to minors. In Assist communities, teen-age undercover agents will monitor compliance with the law by acting as buyers, and states that fail to enforce their laws will lose Federal funds.
To help the two-thirds of current adult smokers who want to quit, doctors and other health care professionals will be armed with stop-smoking expertise and sources of referrals to programs with good track records. High Relapse Rate
But quitting itself is not the hardest task. Relapse rates among smokers, especially the hard-core smokers who make up the bulk of adult smokers, are as high as 90 percent. One premise of the Assist project is that the rapidly expanding restrictions on smoking in public places and at work sites are a major key to preventing relapse. Community groups within each state in the Assist project will encourage employers to restrict or ban smoking at work.
Major lobbying efforts will be devoted to raising state tobacco taxes, with a portion of the revenue set aside for smoking control programs. The California experience showed that an increase in prices can produce an immediate decline in tobacco sales, but unless other tactics are then used, sales soon creep back up.
By JANE E. BRODY
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