SAN DIEGO – Though progress has been made in reducing the burden of disease, disability, and death caused by tobacco use since the 1964 Surgeon General’s Report on Smoking and Health debuted, much work remains to be done, according to Robert T. Croyle, Ph.D.
According to data from the Department of Health & Human Services, more than 42 million adults and more than 3.5 million middle and high school students continue to smoke tobacco. "We’re in a bizarre situation where we have a legal product on the market, which is responsible for about a half a million deaths," Dr. Croyle, director of division of cancer control and population sciences at the National Cancer Institute (NCI), said during a press briefing at the annual meeting of the American Association for Cancer Research marking the 50th anniversary of the Surgeon General’s Report on Smoking and Health. "In any other circumstance, without this long, strange history, we’d feel there would be a lot more engagement by the scientific community, by clinicians, and by organizations in marshalling every effort to address the problem."
© AACR/Vera LaMarche 2014
Robert T. Croyle, Ph.D.
One recurring problem, he said, is the high use of tobacco products by subpopulations of Americans, especially those with low levels of income and education. "This is a challenge, because if you are a college-educated, wealthy individual living in the state of California, you may assume and believe that the tobacco problem is largely one of the past," he said. "But for many of us, we clearly see that across the United States, there are populations where this is still an overwhelming problem that individuals face in their families."
At the same time, Dr. Croyle said, "a rapid uptake" of tobacco use is taking place in many countries around the world. "We have some alarming concerns about the trajectory of tobacco use and the burden of cancer globally," he said. "That’s led us to support more research on global tobacco control and for the NCI to collaborate with international organizations."
In the United States, the National Institutes of Health formed a unique partnership aimed at bringing together expertise from scientists from a variety of disciplines to address the use of tobacco and other addictive substances. According to its website, the goal of Collaborative Research on Addiction at NIH is "to provide a strong collaborative framework to enable the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the NCI to integrate resources and expertise to advance substance use, abuse, and addiction research and public health outcomes."
The time is right for such a partnership, Dr. Croyle said, because many current smokers also use alcohol and other drugs. "Unfortunately, even though scientists for many years have been calling for more research on these comorbid risk factors, the research lags behind what we need to inform clinical practice, so we’re paying special attention to issues of mental health," he said. "For example, tobacco use is incredibly high among those with schizophrenia. We’re also concerned about comorbid [tobacco] use and alcohol use, for example, among college students, where we see huge binge drinking problems that co-occur with tobacco use. We also have a concern about the introduction of electronic cigarettes and the fact that we desperately need a lot more evidence in that domain."
Mr. Croyle had no relevant financial conflicts to disclose.