As a surgeon for 21 years, I’ve seen the extensive, heartbreaking toll tobacco products take on the human body.
Smoking is the leading cause of preventable death and disability in the world, claiming the lives of nearly 500,000 Americans each year. Smoking is directly linked to over 13 different human cancers, along with a host of other illnesses including heart disease, stroke, emphysema, and diabetes.
As a medical biochemist and former vice president of research and development and environmental affairs at Brown & Williamson Tobacco Corporation, my co-author became a key whistleblower against the tobacco industry.
After everything we’ve seen in the operating room and tobacco research labs, we welcome and champion the global goal to achieve the Tobacco Endgame, often defined as a national smoking rate below 5%.
A visionary new step to catalyze progress towards the Endgame in California is the bill AB 935 by Assemblyman Damon Connolly (D, Marin). The bill will protect those born after January 1st, 2007 from the harms of tobacco products throughout their entire lifetimes.
The bill was modeled after the legislative phaseout strategy from New Zealand to reach its 2025 Endgame goal. Starting in 2023, New Zealand will raise the legal smoking age each year after starting at the age of 15, so that anyone born after 2008 will not be allowed to legally buy cigarettes there in their lifetimes. Current smokers of legal age will continue to be allowed to purchase tobacco products, and no individuals of any age will ever be prosecuted for use or possession of cigarettes.
By phasing out the use of tobacco products over the decades, the next generation of children can be protected from ever becoming addicted to smoking.
AB 935 is consistent with Action on Smoking & Health’s Project Sunset which seeks to convince policy makers globally to phase out the sale of commercial combustible tobacco products, and with the California Tobacco Control Program’s Tobacco Endgame Initiative that seeks to end the commercial tobacco epidemic to achieve a future free of commercial tobacco. Early endorsers of AB 935 include the Union of American Physicians and Dentists, the American Academy of Pediatrics-California, Public Health Advocates, and the International Youth Tobacco Control.
The COVID-19 pandemic highlighted the urgency to promote smoking cessation through visionary new actions like the phaseout. Extensive research shows that smoking is linked to worse outcomes from COVID-19. A lifetime of health problems resulting from nicotine addiction predisposed many patients to develop more severe COVID-19 disease, and to die sooner than expected. The total deaths in America from smoking exceeded the number of deaths from COVID-19 over the past three years (1.44 million vs 1.15 million).
The financial costs and burdens of smoking to our nation and the healthcare system are enormous, totaling over $600 billion in 2018 including $240 billion in healthcare expenditures. Smoking-related healthcare costs totaled over $13 billion in California in 2021, further burdening hospital systems struggling with financial stress from the pandemic with half of California hospitals currently operating in the red. New solutions to the extreme burden created for society by the tobacco industry are necessary.
In 2018, then Marin County Supervisor Damon Connolly led the efforts to extend Mayor Ed Lee’s comprehensive flavored tobacco ordinance into Marin County just days after a referendum attempt by Big Tobacco was defeated. This united success would inspire flavored tobacco restrictions across California and America, and contribute to the American Lung Association’s recognition of Marin County with straight-A ratings for tobacco control in 2023.
A phaseout of tobacco sales similar to AB 935 was implemented in Brookline, Massachusetts, and is being actively discussed in nations across Asia. Massachusetts Governor Maura Healy supported the Brookline phaseout then as the State’s Attorney General in 2021. The law was ruled constitutional after a tobacco industry challenge to block the law’s implementation was dismissed in court in 2022.
There will not be any immediate impact of AB 935 for the next five years, as state and federal Tobacco 21 laws already protect youth born after 2007 who could not legally purchase cigarettes until 2028. The concerns of the creation of a black market and smuggling are exaggerated by opponents of AB 935, as a phaseout is not a ban, and sales to smokers born before 2007 will not be impacted. Thus, there is no need for retailers to be given time to deplete current inventories, and the gradual implementation of this bill will allow the industry and retailers time to change their business models.
Opponents raise concerns about a possible loss of State revenue from AB 935, but this diversion reflects Big Tobacco’s own fears about the inevitable financial losses they will suffer when the Tobacco Endgame is achieved.
There is no single solution to the tobacco problem in America. Ultimately, a multi-pronged strategy spanning local, state, and federal action will be necessary to achieve the Endgame.
California may be the ideal test state towards the Endgame, given its low smoking incidence and multiple state agencies focused upon tobacco control. In 2020, the California Department of Public Health and its California Tobacco Control Program funded programs to advance momentum for a tobacco free California.
If AB 935 is signed into law by Governor Newsom, by 2035 all Californians up to the age of 28 will be fully protected. Through this single step, our State will have immediately achieved nearly one-third of the ultimate 2035 Tobacco Endgame goal.
Prime Minister Jacinda Arden spearheaded the New Zealand phaseout, and commented “When we discussed this in cabinet, it wasn’t lost on us that it was groundbreaking.” The path towards the New Zealand phaseout originated with a bold call in 2010 by public health researchers to completely end commercial sales of tobacco there by 2020. Though that goal was not fulfilled, the New Zealand 2022 phaseout it inspired illustrates the power of identifying targeted goals within a specific timeline.
Continued progress forward towards the final California Tobacco Endgame may require additional legislation to increase smoking cessation services for older smokers, lower the nicotine level in cigarettes, and decrease tobacco retailer density.
In March 2023, Hawaii and Nevada joined this movement by introducing similar legislation in their Legislatures, and cities and States across America should now propose phaseout bills and accelerate this as a nationwide and global movement.
John Maa M.D. is a general surgeon in San Francisco and a former president of the San Francisco-Marin Medical Society. Jeffrey Wigand, Ph.D. is a medical biochemist and former vice president of research and development and environmental affairs at Brown & Williamson Tobacco Corporation based in Louisville, Ky., who worked on the development of reduced-harm cigarettes and in 1996 blew the whistle on tobacco tampering at the company.
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Correction made on 3/23/23 at 3:48PM ET to clarify CTCP information.