The consumption of cigarettes and smokeless tobacco products is considered a significant cause of preventable deaths. It is important to focus on this issue because the strength of the nation is its people. One can just imagine the economic cost to the business sector if workers are unable to work. Imagine the economic cost to the nation as a whole if there is a significantly lower number of Americans who can develop solutions to problems because they suffer from ill-health due to smoking.
Thus, H.R. 1256 is an important piece of the legislature because it attempts to deal with cigarette smoking at its core issue. The proponent of this law correctly identified the main strategy of tobacco companies to entice children and teenagers to try cigarette smoking in the hopes that they will become addicted to it. The enactment of the law creates a major deterrent for tobacco companies to expand their business in the United States.
The International Agency for Research on Cancer provided disturbing facts with regards to smoking tobacco. The report says that half of the chronic smokers are killed by a tobacco-related disease (Moyer, 2005, p.25). In the same report, half of the people who died from tobacco-related diseases lost an average of 20-25 years in terms of life expectancy and they die between the ages of 35 and 69 (Moyer, 2005, p.25).
One way to address this problem is to limit access to cigarettes and smokeless tobacco products. In 1996, the Food and Drug Administration issued their so-called Tobacco Rule. But it was struck down by the U.S. Supreme Court because there was no legal basis for the FDA to regulate products from tobacco companies using its current mandate. A new law had to be enacted to provide the FDA the authority to protect public health and regulate the use of tobacco-related products by minors (Civic Impulse, 2012, p.1). Thus, Representative Henry Waxman authored a bill entitled H.R. 1256 or the Family Smoking Prevention and Tobacco Control Act.
On June 22, 2009, President Barack Obama signed it into law H.R. 1256 and it gave the U.S. Food and Drug Administration the authority to regulate the manufacturing, marketing, and sale of tobacco products (N, year, p.2016). The authority given to the FDA had certain limitations but it was enough to significantly reduce the capability of minors to buy and consume tobacco products.
Significance for Nurse Practitioners
The enactment of the law does not only curtails the use of tobacco products but also initiates a chain-reaction of events that will increase awareness of the dangers of tobacco use. It has forced to the forefront the health indicators related to tobacco use. It has been shown that nurses can help deal with the problems related to tobacco use. Furthermore, those who are interested in quitting the smoking habit can receive assistance from nursing practitioners as they visit their local health care providers.
There are three areas with regards to population-based concepts that nurses need to be mindful of and these are prevalence, morbidity, and mortality. The enactment of this law will affect knowledge with regards to the prevalence of the health issue. It will strengthen the initiative to inform the general public on the number of affected persons present in a population at a specific time (Truglio-Londrigan & Lewenson, 2011, p.128). If a nursing practitioner is knowledgeable about issues about prevalence, the nurse is not only aware of the need but also knowledgeable about the issue of health literacy. This will allow nursing practitioners to determine those who have a greater need for assistance.
The enactment of the law makes it easier for people to get involved in the discussion on the dangers of cigarette smoking. But in the case of nursing practitioners, they are made aware of the incidence rate (Truglio-Londrigan & Lewenson, 2011, p.128). This information enables nursing practitioners to increase their participation when it comes to preventive strategies and other educational programs that will help reduce the number of children who will attempt to try this particular habit.
This law will also help heightened awareness with regards to the mortality rate or death because of the disease (Truglio-Londrigan & Lewenson, 2011, p.128). As a result, nurse practitioners can have another different perspective on this particular health problem. This added knowledge enables them to become effective when it comes to convincing children and teenagers of the hazards of consuming tobacco products. Nurse practitioners must also be made aware that health workers are in a unique position to encourage smoking cessation by their patients (Bonnie, Stratton, & Wallace, 2007, p.12).
Tobacco products were not used extensively enough to cause major health concerns. But everything changed in the year 1913 when a popular brand named Camel began a mass marketing campaign (Schneider, 2011, p.244). In 2007 alone, there are 45 million adults in the United States that consume tobacco products (Truglio-Londrigan & Lewenson, 2011, p.128). But more importantly, there are about 4,000 children ages 12 to 17 years old who will smoke their first cigarette in the next 24 hours (Truglio-Londrigan & Lewenson, 2011, p.128).
In 2006 alone there are 2.6 million children who are smokers and 77% of that number is already addicted to smoking cigarettes; so much so that only 4% of that number was able to quit successfully (Truglio-Londrigan & Lewenson, 2011, p.128). It is therefore imperative that children must not have a direct link to tobacco products so that they will not try them.
Health experts said that cigarette smoking is associated with a 70 percent increase in age-specific death rates among men. They also asserted that cigarette smoking is the major cause of lung cancer in men. The use of cigarettes is the major cause of chronic bronchitis in the United States (Koop, year). There is also evidence to show that cigarette smokers are at greater risk to develop coronary artery disease (Koop, 1989).
It is important to reduce the consumption of cigarettes because non-users are also affected. Consider the fact that “Exposure to secondhand smoke has serious health consequences. (Institute of Medicine, 2001, p.10). In 2003 The World Health Organization made the declaration that different types of cancers can be linked to smoking or exposure to second-hand smoke (Sloan, 2005, p.200). Health experts also agree that it is one of the leading causes of preventable death (Sloan, 2005, p.200). There is therefore the need to let people know of the impact of cigarette smoking and the consumption of tobacco-related products. At the same time, it is imperative to reduce the capability of tobacco companies to persuade children to try cigarettes.
In the introduction portion of the National Prevention Strategy: America’s Plan for Better Health and Wellness, the author wrote, “The strength and ingenuity of America’s people and communities have driven America’s success. A healthy and fit nation is vital to that strength and is the bedrock of the productivity, innovation, and entrepreneurship essential for our future” (Benjamin, 2011, p.6). It is easy to understand the assertion made by Benjamin if one analyzes the statement based on the premise that health is wealth. A person can only generate wealth if he or she can work and think. A person can’t give his best work if his body fails him.
Political and Legislative Factors
The political and legislative factors are linked to the constitutional rights of businessmen who will profit from the sale of cigarettes and smokeless tobacco products. There is also the issue with regards to the power of the Federal Government to dictate and regulate the capability of tobacco companies to profit from the sale of their products. For example, there is the First Amendment issue with regards to the ban on outdoor advertising. But from a legal point of view, the law did not violate the First Amendment rights of tobacco companies simply because the primary consideration was the fact that children are exposed to the message from a billboard if the same is placed within 1,000 feet from a school or playground.
Difficulties encountered with H.R. 1256
It must be pointed out that the bill contained controversial provisions. An example of which, was the U.S. Food and Drug Administration’s 1996 Tobacco rule. In the said FDA rule there were three sets of provisions that “were designed to reduce underage tobacco use:
- restrictions on the sale and distribution of cigarettes and smokeless tobacco to reduce youth access to those products;
- restrictions on tobacco product marketing and advertising; and
- a new labeling requirement for packaging and advertising (Redhead, 2011, p.2).
It is therefore easy to understand why this particular FDA tobacco rule was struck down by the U.S. Supreme Court. The tobacco companies say that the rule was disadvantageous to them and naturally they did everything in their power to limit the power of the Federal Government to curb their capability to make money through the sale of tobacco products.
The FDA asserted its authority through the Federal Food, Drug, and Cosmetic Act and therefore has the power to enforce the 1996 FDA Tobacco Rule. In this argument, the FDA said that cigarettes and smokeless tobacco products are delivery devices for nicotine. Furthermore, the FDA asserted that nicotine is an addictive drug (Redhead, 2011, p.3). At this point, tobacco companies sought legal relief from the Supreme Court.
The Supreme Court argued that the claims made by the FDA were inconsistent with the intent “expressed in the Federal Food, Drug, and Cosmetic Act. The Supreme Court said that if the FDA wanted to assert its authority through the said law, it has no choice but to prohibit the sale of such products, a move that the Supreme Court said contradicts congressional policy (Redhead, 2011, p.3).
As a consequence, the decision of the Supreme Court forced the U.S. Congress to enact legislation that will provide the FDA with new statutory authority over tobacco products (Redhead, 2011, p.3). In this regard, certain lawmakers in the 105th Congress in the years 1997 and 1998 began to develop a tobacco settlement that will help the FDA go around the issue of safety and effectiveness usually linked to drug use. The purpose of the compromise was to balance the need to protect public health and the interest of tobacco companies.
In the aftermath of the Supreme Court’s decision and the settlement that was created in the 105th Congress, a bipartisan and bicameral group of lawmakers began to lay the groundwork for the Family Smoking Prevention and Tobacco Control Act in the 108th Congress (Redhead, 2011, p.3). The main purpose of this legislative act was to increase the authority of the FDA to regulate cigarettes and smokeless tobacco products; however, it was clear to them that tobacco companies wanted restrictions placed on the FDA’s authority.
Evaluation and Impact of H.R. 1256
The Family Smoking Prevention and Tobacco Control Act requires the FDA to reissue its tobacco rule in 1996 minus only one key provision, which is, the labeling provision (Redhead, 2011, p.7). But even if one removes this provision from the equation, this particular law provides the FDA with greater authority to regulate tobacco products. The following areas created a major impact in the tobacco industry:
- new restrictions on youth access to tobacco products:
- new restrictions on tobacco advertising;
- explicit and conspicuous health warnings on all tobacco product packaging and advertising; and
- the law authorizes the FDA to determine if the distribution, advertising, and promotion of a tobacco product meet a new standard and that standard is biased towards the protection of public health that takes into account the risks and benefits of the general public (Redhead, 2011, p.7).
The law did not only create a major impact in the tobacco industry, it transformed the way tobacco products are sold in the United States.
There are at least four groups that were greatly affected by the enactment of the said law. The first group is comprised of those who are under the age of 18. The law states that it is illegal for anyone to sell cigarettes or smokeless tobacco products to those who belong to this age range. The law made it almost impossible to skirt this legal obstacle because retailers are compelled to check photo IDs of potential customers to verify their age. In addition, the law requires retailers to sell cigarettes and other tobacco products if the transaction can be completed in a face-to-face exchange.
The law was strengthened by the language taken from the 1996 FDA Tobacco Rule wherein it is illegal to sell individual cigarettes. There are also strict restrictions when it comes to the sale of cigarettes and tobacco products through a vending machine. Self-service displays of tobacco products are not allowed, those who are responsible must be certain that these vending machines are placed in adult-only facilities. Thus, H.R. 1256 made it extremely difficult for underage smokers to sustain their habit and at the same time made it difficult for teenagers to start a smoking habit.
The second group is comprised of advertisers who used to benefit greatly from marketing cigarettes and smokeless tobacco products. It is now illegal to promote the use of these products through billboards, posters, and placards if the promotion is done within 1,000 feet of a school or playground. If the promotion is done in an audio format, tobacco companies are only allowed to advertise with the use of audible words without music and sound effects. The same thing can be said in the use of the video format because the promotion is limited to static, black-on-white text.
The third group is comprised of tobacco companies who will find it extremely difficult to increase their revenue with regards to the fact that their capability to sell cigarettes and smokeless tobacco products to minors was curtailed by H.R. 1256. At the same time, they will find it difficult to increase their revenue by persuading non-users to try their products. Their ability to mass-market their products was also curtailed by the said law.
The fourth group is comprised of the non-users of cigarettes and smokeless tobacco products. There are now obstacles that are in place to reduce their chance to try the consumption of these products. They have limited access to it as evidenced by the reduced number of vending machines in a particular town or city. There is also less opportunity to come in contact with these products through promotions because there are only a few places where the idea can be broadcasted to the general public.
Smoking Prevention and Control in Other Countries
There are still many areas of H.R. 1256 that require improvement such as the need to communicate through the product’s label that cigarette smoking is the number one cause of preventable deaths. But Americans may take comfort from the fact that the United States leads the way in the enactment of laws that will seriously reduce the number of children who are persuaded by mass-media marketing to try to use cigarettes and other tobacco products.
It is important to note that the United Kingdom is still in the process of enacting laws that will seriously curb the capability of tobacco companies to advertise their products. There is still no law enacted to prevent the sale of tobacco products through the use of a vending machine (Department of Health, 2012, p.1). However, the United Kingdom provides a case study on the use of “stop smoking services” that were established with the use of evidence-based stop smoking support (Department of Health, 2012).
Recommendations for Improvement
H.R. 1256 can become more effective if there is a section that identifies cigarettes as a form of the drug. Thus, there is a great capability to move from prevention to treatment of the problem. In other words, if the law can be refined based on those grounds, then, health care workers will be able to help those who wanted to quit. Nurses and doctors will no longer remain as mere sources of information but active participants when it comes to smoking cessation.
It is important to look into these areas to create strategies that will help improve the health and wellness of Americans. Every stakeholder must work hand-in-hand to build a society that provides a better future for the next generation of American citizens. Without a clear understanding of the legal ramifications of laws like H.R. 1256, it will be difficult for lawmakers to create amendments that will further the interest of the general public. It is important to respect the rights of businessmen, but their rights must be tempered with the rights and privileges of many people. It is also important to take a closer look at the way tobacco products are manufactured to find ways to improve them.
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