For far too long, tobacco use has remained the leading preventable cause of death and disease in the United States. That’s why the President has prioritized protecting Americans from tobacco’s deadly health consequences. From the early months of his first term, President Obama has demonstrated a steadfast commitment to ending the tobacco epidemic, focusing on prevention for youth and young adults.

As part of this promise, the President has signed into law historic legislation that promotes tobacco control and moves the country toward ending the epidemic. This includes: The Affordable Care Act; The Family Smoking Prevention and Tobacco Control Act; The Children’s Health Insurance Program Reauthorization Act; and the Prevent All Cigarette Trafficking Act. Together, these laws provide more resources and more authority than ever before to reduce the death and disease caused by tobacco.

To implement the President’s commitments on tobacco, the Department of Health and Human Services (HHS) accomplished an unprecedented set of actions:

Preventing Youth from Using Tobacco

• The Food and Drug Administration (FDA)’s robust enforcement program has partnered with 45 states and territories to crack down on violations, especially retailers selling tobacco products to youth. Specifically, since 2009, FDA has conducted more than 138,000 undercover inspections of tobacco retailers and issued more than 7,700 warning letters, the majority involving violations relating to tobacco sales to minors.

• The landmark 2009 Family Smoking Prevention and Tobacco Control Act protects children by banning certain candy, fruit and other flavored cigarettes and ending tobacco product sponsorship of athletic and entertainment events.

• The Children’s Health Insurance Program Reauthorization Act raised the federal excise tax by 62 cents per pack. Surgeon General’s Reports have noted that young smokers are more price-sensitive than older smokers and price affects initiation, prevalence and intensity of smoking among youth and young adults. As a result, this price increase has been projected to prevent initiation of smoking by nearly two million children, avert nearly 900,000 smoking-attributable deaths, and produce $44.5 billion in long-term health care savings.

• In 2012, we launched the Tobacco-Free College Campuses Initiative (TFCCI), a public/private partnership with universities, colleges, and the public health community to promote the adoption of tobacco-free policies at institutions of higher learning.

• The National Cancer Institute has launched Smokefree Teen, which offers evidence-based smoking cessation information and interactive tools designed especially for teens.

• The 2012 U.S. Surgeon General Report, Preventing Tobacco Use among Youth and Young Adults, documents the health consequences of tobacco use among young people and identifying effective strategies to prevent and reduce tobacco use among youth.

Helping People to Quit Smoking

• In 2010, HHS launched the first-ever national strategic roadmap for tobacco control entitled, Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan for the U.S. Department of Health and Human Services, which outlines specific action steps to end the tobacco epidemic.

• The Affordable Care Act, signed into law three years ago this week, ensures that health plans cover tobacco use screening and tobacco cessation interventions without cost-sharing. It also expands employment-based wellness programs, such as those that focus on helping employees decrease tobacco use.

• The Affordable Care Act also provides for Medicaid coverage of comprehensive tobacco cessation services for pregnant women, without cost-sharing. Furthermore, it provides 50% reimbursement to states providing telephone quitline support.

• Medicare has expanded coverage of tobacco cessation counseling to make it available to approximately 5 million Medicare tobacco users, not just those with tobacco-related diseases.

• The National Institutes of Health (NIH) has launched a new, free interactive smartphone app, QuitPal, which uses proven quit strategies and tools to help change behavior and assist individuals in giving up smoking.

• In 2012, the Centers for Disease Control (CDC) launched the “Tips from Former Smokers” to encourage people to quit smoking by featuring people discussing the health effects they are living with as a result of their tobacco use. The campaign resulted in a 132% increase in calls to state quitlines. The 2013 version will launch in the coming weeks.

• HHS launched in 2012, BeTobaccoFree.gov, a comprehensive tobacco website that provides Americans with information on avoiding or ending tobacco use.

Supporting State and Community Prevention Efforts

• CDC has invested in state and local programs to prevent and control tobacco use and expand tobacco quitlines. CDC has also supported national networks to reduce tobacco use among specific at-risk populations.

• Thanks to the Affordable Care Act, the CDC has awarded more than $170 million in Community Transformation Grants to states, communities and tribes to design and implement community-level programs that improve health and wellness, including through strategies to enhance tobacco-free living.

Improving Research and Knowledge

• The FDA and the NIH have launched the largest-ever national cohort study of more than 60,000 tobacco users and those at-risk to assess the health effects and consequences of tobacco use.

• FDA has also released draft guidance that will ultimately provide the public with previously unknown information about the chemicals in tobacco products and help prevent misleading marketing about the risks associated with tobacco products.

• In Fiscal Year 2012, the NIH invested $363 million in tobacco-related health research, a 17% increase since 2008.

• In 2010, the Surgeon General released How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, which documents how and why smokers become addicted.

Although we pushed forcefully for Graphic Health Warning Labels to appear on cigarette packages, the D.C. Circuit’s ruling against the warning labels won’t deter the FDA from seeking an effective and sound way to implement the law. The FDA has announced it will undertake research to support new rulemaking on graphic warning labels consistent with the Family Smoking Prevention and Tobacco Control Act.

In the coming years, with the President’s leadership, we will continue to take action to combat the death and disease caused by tobacco. The Administration will also continue its commitment to educate all Americans about the devastating consequences of tobacco use. We will use all of the tools available to us to move the nation closer to ending the epidemic once and for all.

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Life hasn’t gotten any easier for Big Tobacco. Last week, Russia became the latest country to impose major new restrictions on smoking in public places. Starting in June, Russians will no longer be able to smoke in restaurants, and cigarette advertising will be banned.

I have my doubts as to how strictly the ban will be enforced, but the fact remains that one of the friendliest countries towards public smoking just got a lot chillier. According to the Wall Street Journal, 44 million Russians smoke, and they collectively account for 9% of Philip Morris International’s (NYSE:PM) profits. Japan Tobacco and British American Tobacco (NYSE:BTI) get 11% and 8% of their profits from Russia, respectively.

Russians will not quit smoking overnight in response to the ban. That didn’t happen in theUnited States. It may be years before it makes a serious dent in consumption. But it does blow a major hole in one of the bullish arguments supporting Philip Morris International: emerging markets will not be growth markets for tobacco forever. As countries reach higher levels of development, the costs to the health system prompts a crackdown.

We saw the same in China. In 2011, China banned smoking in restaurants, bars, and in several other enclosed public spaces, though it is still legal to smoke in offices. But there are now plans to ban smoking in virtually all public place, New York City style, by 2015.

Again, we’ll see how strictly it is enforced. Though China has no qualms with crushing freedoms of expression or religion, the right to light up a cigarette is one they seem to let slip.

Latin America? Same. Brazil, Argentina, Chile, and Peru all have bans in most indoor areas, and enforcement is starting to be taken seriously.

India? You guessed it. As of 2008, smoking was banned in most public places, though enforcement has been a little touch and go.

By now, you should be getting the picture. Though enforcement varies from country to country, there is really no such thing as a “tobacco friendly” country anymore. Everywhere you look, the noose is getting tighter.

Sizemore Insights readers know that I have been a Big Tobacco fan for a long time. They tend to be dividend-paying powerhouses with consistent returns. And like other “vice investments,” they tend to be priced as perpetual value stocks, which has made them an outstanding performer in recent decades.

But I no longer advocate buying tobacco stocks at any price. Tobacco stocks have been a great investment precisely because they were cheap and no one wanted them. But you can’t make that argument today. In fact, if anything they have become trendy.

Last month, I wrote that At Current Prices Tobacco is a No-Go, and I want to repeat that sentiment today. Domestic Big Tobacco stocks such as Altria (NYSE:MO) and Lorillard (NYSE:LO) trade at a slight premium to the S&P 500 earnings multiple. That simply should not be. These are companies in terminal, albeit gentle, decline.

And Philip Morris International, the “growth stock” of the bunch, trades at a significant premium of 18 times trailing earnings and yields 3.7%. That is simply not a high enough dividend yield to make this stock worthwhile given the better alternatives out there. “Boring” tech stocks like Intel(Nasdaq:INTC) and Microsoft (Nasdaq:MSFT) both offer higher dividend yields, as do most midstream master limited partnerships.

If Big Tobacco has a substantial price correction, then I might be interested again. But for now, I consider these stocks as toxic as the cigarettes they sell.

Disclosures: Sizemore Capital is long MSFT and INTC.

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In our letter to the World Health Organization’s consultation on the future Global Action Plan on NCDs (2013-2020), ASH outlines key provisions member states and WHO should consider for successful strengthening of the Global Action Plan on NCDs.  Click on the image below to read the letter.

Take Action! Email WHO here ncdactionplan@who.int to submit your own letter>

When Maria Arundel’s husband, Richard, died from lung cancer aged 65, she felt her life was over.

Yet she also credits his death as the reason she was saved from succumbing to the same disease.

With no screening programme for lung cancer in this country, it was only because she’d seen her husband’s illness that Maria reacted quickly when she too started to feel breathless and lost weight.

‘I was much luckier than Richard,’ recalls Maria, 61, a former publican from South London who used to smoke.

‘My lung cancer was picked up early.

‘By the time Richard was diagnosed it had spread to his liver. His suffering was terrible.

‘He went through so much to fight it with aggressive chemotherapy. But he didn’t have a chance.’ 

What saved Maria’s life was a CT scan — which, unlike an X-ray, sends several beams simultaneously through the body to produce a much clearer, more detailed picture of the lungs.

With a chest X-ray, which Richard had, cancer can remain hidden behind the heart in one of the lung tubes or may be too small for a single X-ray to pick up.

So while Maria had to endure six months of chemotherapy and ten bouts of radiation, her cancer was picked up early and the treatment appears to have been a success.

She was one of the lucky ones. Lung cancer is the biggest cancer killer in the UK, causing around 35,000 deaths a year. 

Last week, research revealed that lung cancer has overtaken breast cancer as the deadliest form of the disease among female Britons, killing 16,000 women each year.

The statistics make for grim reading, with the five-year survival rate for a stage-four (advanced) cancer between 2 and 5 per cent. 

Worryingly, 85 per cent of patients remain undiagnosed until the disease has reached an advanced stage, when it is very difficult to treat.

Early detection offers the greatest chance of survival. NHS advice is to seek medical attention if a cough has lasted longer than three weeks.

But in order to catch the cancer while it is still treatable, some experts are calling for a national screening programme of pre-emptive CT scans for people at risk.

‘Ironically, the most common form of the disease — non small cell lung cancer, affecting 85 per cent of patients — is slow growing,’ says Dr Rohrit Lal, a medical oncologist specialising in lung cancers at  Guy’s and St Thomas’s Hospital, South London. 

‘But because a tumour has so much space within the lungs in which to grow, patients aren’t aware they have the disease until they experience symptoms such as a perpetual cough, by which time the cancer is difficult to treat.

Once the cancer spreads, it lodges most commonly in the lymph nodes, then moves to the bones, liver and brain.

By this stage, surgery and radiotherapy cannot target it, and chemotherapy is often of a limited benefit.

‘A CT scan could detect these early growths at a time when we can treat them,’ says Dr Lal. 

Indeed, a recent U.S. study following 50,000 smokers or former smokers found that in five years, there was a 20 per cent decrease in lung cancer mortality in a group offered routine CT screening.

Maria Arundel’s husband first fell ill in January 2009 — he started to experience sharp, indigestion-like pains in his chest. 

Though he was a 20-a-day smoker, Richard was 5ft 11in, slim and enjoyed a physically demanding job laying tarmac.

He went to his GP every couple of weeks, after tablets to treat indigestion didn’t work. 

By now he’d also started to feel out of breath and developed a cough.

By the summer he was losing weight, but was only referred to a specialist in October 2009. He died five months later, in March 2010, aged just 56.

‘It was the most terrible time,’ says Maria. ‘He’d gone from being this strong, fit, robust force in my life to someone who was fading and suffering before my eyes.’

In the midst of her grief, Maria started to feel under the weather: within a few months she began to lose weight, and developed night sweats.

She also had a tickly, intermittent cough.

‘I was so overcome with grief, I didn’t care about my health. I just wanted to die, to be with Richard. But my son, Scott, insisted that I went to the doctor.

‘Because of what had happened to Richard, maybe that’s what prompted my GP but I was sent for a CT scan at Guy’s Hospital and that’s when they found the cancer.’

Maria had smoked up to 20 cigarettes a day until her husband’s cancer diagnosis.

‘I suddenly realised I had to fight it. It had killed him and it wasn’t going to kill me.’ 

Dr Lal says a screening programme would involve inviting patients over the age of 40 who are, or have been, smokers to be scanned once a year for three years.

This could be done through a list compiled by GPs regardless of whether patients have symptoms.

‘There is good evidence to show that lung cancer risk rises slowly during your lifetime if you continue to smoke. When you stop that risk flattens off — but it never goes away completely.’

However, cost aside, though CT scans are effective at detecting early lung cancers there are concerns about false positive results.

‘A huge number of lung abnormalities — possibly as many as 98 per cent — that are picked up by CT scan will be harmless,’ says Stephen Spiro, professor of respiratory medicine at the Royal Brompton Hospital and a board member of the UK Lung Cancer Coalition.

‘Finding anything can cause extreme anxiety for the patient as it requires further testing — namely CT scans with heavier doses of radiation. This is a particular issue for women, as it could raise the risk of breast cancer.’ 

There could be even more invasive tests, such as needle biopsies or even surgery to remove a portion of lung.

A small number of people who do not have cancer or have early-stage cancer have died from these tests because of partial lung collapse and respiratory problems.

Similar problems beset the national breast screening programme.

One controversial Danish study found that 7,000 British women a year needlessly undergo treatment, including mastectomy. 

Doubts about unnecessary treatment have been raised following suggestions that a similar screening programme for prostate cancer should be introduced.

‘The other issue is how long do you go on screening for?’ adds Dr Keith Prowse, of the British Lung Foundation.

‘What happens after three years — do we just keep scanning people who don’t have symptoms?

‘Also, a lung cancer can develop at any time. You could scan someone today, and tomorrow they could develop a cancer.’

That’s why any lung cancer screening has to be narrowed, adds Professor Spiro, perhaps to people over 50 that have had a 20 pack or more habit a day and already have chronic obstructive pulmonary disease (COPD) — the umbrella name for a collection of lung diseases, including chronic bronchitis, emphysema and chronic obstructive airways disease, which are linked to an increased risk of lung cancer.

Another option is a blood test screening programme, which is being trialled with 10,000 smokers in Scotland.

The participants have smoked at least 20 a day for more than 20 years — half are being offered a blood test that detects cancer at its earliest stages of development up to five years before it would normally be detected; the other half will not be screened. The first results are expected in 2014.

Another option being researched is breath analysis. Scientists at the Keele University, Staffordshire, have found that compounds in breath could be used as indicators for tumours.

This treatment would be cheaper and less invasive.

However, neither of these offers the definitive diagnosis of a CT scan, which is what Maria favours.

‘A CT scan saved my life — I want others to have that option, too,’ she says.

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New Zealand is set to become the first country after Australia to pass a law requiring that cigarettes be sold in plain packages.

New Zealand’s government will bring in the legislation to cut the appeal of smoking, although it will delay implementation until legal disputes faced by Australia are resolved, Associate Minister of Health Tariana Turia said in a statement today.

“We cannot continue to allow tobacco companies to use sophisticated packaging designs to promote their products,” Turia said. “There is a risk that tobacco companies will try and mount legal challenges against any legislation, as we have seen in Australia.”

In Australia, cigarette packages since Dec. 1 include warnings that include photos of a gangrenous limb and a cancer victim. All cigarettes in Australia must be sold in the uniform packs, with the brand name relegated to the bottom quarter of the package on a drab brown background. The law is being challenged at the World Trade Organization and at arbitration.

“This is a major step,” Skye Kimura, Tobacco Control Adviser for the Cancer Society of New Zealand said of the government’s proposal. “This is another milestone in the journey to New Zealand being smoke-free by 2025.”

Ignores Consultations

The government announcement ignores the result of a public consultation process that ended Oct. 5, The New Zealand Association of Convenience Stores said in a statement.

“Of the 20,000 people that took the time to submit their views, over 11,800 opposed the idea,” Roger Bull, chairman of the association, said in the statement. “By ignoring them, the government is sending a clear message to them that they don’t care about more costs being forced onto the retail sector.”

British American Tobacco Plc’s New Zealand unit said it remains opposed to the introduction of plain packaging in the country.

“While we can’t rule out legal action at this stage, we can say that we will fully participate in the legislative process,” Steve Rush, general manager at BAT’s unit, said in an e-mailed statement.

Tobacco Backlash

Cigarettes kill 5,000 New Zealanders each year, Turia said. She said the consultation process confirmed plain packaging will be effective in removing the impression that tobacco may be less harmful than it is.

The law works in Australia, Fiona Sharkie, executive director at Quit Victoria, said in an e-mailed statement. After the introduction of plain packs, the number of calls to the group’s Quitline spiked with the number of callers sourcing the number from cigarette packages rising to 36 percent from 23 percent, she said.

British American Tobacco, maker of Dunhill, Pall Mall and Australia’s best-selling cigarette brand, Winfield, unsuccessfully sued to block the Australian law, because the country didn’t get any benefit from the removal of trademarks, according to the High Court of Australia.

‘Breaches Rules’

Philip Morris International Inc. is also pursuing the case in international arbitration. The Australian proposal violates a treaty with Hong Kong and may cause billions of dollars in damages, the maker of Marlboro cigarettes said.

“There is no credible evidence that plain packaging will lower smoking rates, but strong evidence it breaches international trade rules,” Philip Morris said in an e-mailed statement today.

The World Trade Organization has agreed to hear a complaint from tobacco producing nations led by Ukraine that Australia’s law breaches international trade agreements and constitutes an unjustifiable encumbrance on the use of trademarks. The WTO hasn’t set a date for a hearing.

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MOSCOW — The lower house of parliament, which has raised the blood pressure of many Russians by banning American adoptions and restricting opposition rights, attempted to lower it to healthy levels Friday as lawmakers moved to pass a bill banning smoking in public places.

The idea was championed in the fall by Prime Minister Dmitry Medvedev, who said that smoking kills about 400,000 Russians a year and that smokers were not only hurting themselves but also setting a bad example and endangering children’s health.Three-fifths of men smoke here, one of the highest rates in the world. About 21 percent of American men smoke.

“Children should not breathe tobacco smoke or see smoking as something normal, which happens every day,” Medvedev said.

The ban was approved on second reading, with 442 in the 450-member State Duma voting for it. A third reading is required before it can be sent to the upper house for a vote. It would become law when signed by President Vladimir Putin.

The law would be phased in over a year, beginning June 1. It would eventually prohibit smoking in all public buildings, including hospitals, schools, stadiums, bars and restaurants, as well as in elevators and apartment building stairwells and on playgrounds and beaches.

Other limits would be imposed on sales, with displays of cigarettes prohibited and only price lists posted. Cigarettes now cost about $1.30 to $2.30 a pack, making them more affordable than in many countries.

The Campaign for Tobacco-Free Kids, a Washington-based nonprofit group that is active in anti-smoking campaigns around the world, says that 60 percent of men and 22 percent of women smoke in Russia, along with one-fourth of children ages 13 to 15.

Tobacco-Free Kids has been offering assistance to Russian anti-smoking groups that have been pushing for the legislation, said Joshua Abrams, director of Russia and Ukraine programs for the group. He said three companies control 95 percent of the Russian tobacco market: British American Tobacco, Philip Morris and Japan Tobacco International.

Smokers have complained that the proposed law would violate their rights, but with the backing of Medvedev and Putin, who have argued that the nation must improve its health and longevity, it is almost sure to pass.

Controversy enveloped another Duma initiative Friday — the introduction of a bill prohibiting promotion of homosexuality among minors, criticized as an anti-gay bill. The bill offers a wide definition of promoting homosexuality, meaning that almost any public affirmation would be illegal, including parades and demonstrations. Gay men and lesbians could even be kept off television and radio broadcasts, and public displays of affection would become illegal.

Similar laws have been passed in St. Petersburg, Novosibirsk, Ryazan, Kostroma and Arkhangelsk. The bill being considered by the Duma would be in effect nationwide. Human rights activists argue that the intent is to threaten sexual minorities rather than protect children.

When a group of gay activists protested outside the Duma on Friday, they were attacked. Police detained 20 people.

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When it comes to preventable deaths and disease, smoking is still a top killer in the U.S., says a new report from theCenters for Disease Control and Prevention.

Approximately 443,000 people die from cigarette smoking each year, and 8.6 million suffer from a serious illness related to smoking, according to the Tobacco Control State Highlights 2012.

Utah claimed the lowest adult smoking rate of 11.8%, according to the report released last week, while Kentucky topped the charts with 29%. California hovered above Utah at 13.7%. The U.S. median was 21.2%.

Tobacco use was responsible for $193 billion in health-related economic losses from  2000 to 2004, the report said: $96 billion in medical expenses and $97 billion in lost productivity — not to mention 5.1 million years of potential life annually.

On the bright side, the share of American adults who smoke has decreased, according to the CDC, and those who do smoke are smoking fewer cigarettes per day.

But smoking was far more prevalent among American Indians and Alaska natives, as well as those who live below the poverty level and those with less education, the CDC study noted.

“If current smoking trends continue, the national Healthy People 2020 objective to reduce cigarette smoking prevalence to 12% will not be met,” the authors wrote.

The report comes days after a study in the New England Journal of Medicine found that smokers who quit by age 34 can add an extra decade to their lives, and little more than a week after the American Lung Assn. issued a report on tobacco control in the U.S. – a report that was littered with Ds and Fs.

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