Texas has a smoking problem

Texas has a tobacco problem. More than 28,000 Texans die each year of smoking-related illnesses. It is estimated that half a million Texans under the age of 18 will die prematurely from tobacco-related causes. That makes tobacco use the single most significant cause of preventable death in Texas.

We can do much better. It’s hard for one person to quit smoking. However, it’s not hard to design policies that can help thousands quit, prevent thousands more from starting, reduce critical health disparities, and save the taxpayers money.

We want to highlight two interventions in particular. They are based on extensive evidence about what works and make political common sense regarding where we should be targeting our efforts.

• Texas should follow the lead of many other states, including Oklahoma, in prohibiting all forms of tobacco use on the grounds and campuses of all state agencies, including state institutions of higher education.

• We should do everything possible to prevent kids from starting to smoke. That should include restoring funding for youth prevention efforts to the Department of State Health Services (DSHS); restricting marketing aimed specifically at getting kids to smoke, including flavoring of cigarettes and e-cigarettes; and raising the minimum age to purchase tobacco products to 21.

The evidence on the efficacy of such interventions is clear. Prohibitions on workplace tobacco use have played a significant role in the overall reduction of smoking over the past few decades. A wealth of research has shown that such policies reduce both the number of smokers and the amount of smoking done by those who continue to smoke. That, in turn, leads to decreases in the rates of heart attack, heart disease, respiratory disease, stroke, and several types of cancer.

We have similarly persuasive evidence when it comes to well-funded youth prevention programs. They reduce the number of teens who smoke, and that has critical long-term effects. As the National Academies reported, in a 2015 brief on raising the legal smoking age: “The initiation age of tobacco use is critical. Among adults who become daily smokers, approximately 90 percent report first use of cigarettes before reaching 19 years of age.”

Reducing and preventing tobacco use is about non-users as well. Texans should be able to visit their state agencies without encountering the health risks of secondhand smoke. Students, faculty, and staff should be able to research, learn, and work without having to incur a health risk as serious as secondhand smoke. The University of Texas System is on track to be tobacco free by June. It would benefit everyone for other state colleges and university systems to follow suit.

Then there’s the cost of inaction. DSHS estimates that tobacco-related disease costs the state more than $18 billion per year, with about half of that coming from direct medical costs and the rest from lost worker productivity. Of the total, $2 billion is traceable to Medicaid spending, which is taxpayer funded. And the state directly funds the health insurance for state employees, so any additional costs to that plan from tobacco use are paid by taxpayers and state employees.

Preventing tobacco use on the grounds of state agencies would serve three high-priority goals. It would improve the health of the employees themselves, protect those who use their services from secondhand smoke, and reduce the financial burden on taxpayers.

More broadly, smoking has become an additional burden on poor and working-class citizens, on people of color, on those with mental illness and disabilities, and on people living in rural areas. People in these groups are smoking at much higher rates than anyone else, and are therefore suffering the consequences of smoking at higher rates. Simply stated, tobacco is exacerbating pre-existing disparities.

In this legislative session, there’s enormous opportunity for the state to take positive steps to reduce the burden of smoking both for the people who want to quit, and for the rest of us who are helping to pay the cost of widespread tobacco addiction. We should seize it.

David Lakey

Associate vice chancellor for population health, UT System

Ernest Hawk

VP, UT MD Anderson Cancer