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RENEE MONTAGNE, HOST:

It's MORNING EDITION, from NPR News. I'm Renee Montagne.

STEVE INSKEEP, HOST:

And I'm Steve Inskeep. Good morning. This month marks the 50th anniversary of the surgeon general's report that linked cigarette smoking to lung cancer, a landmark report and the catalyst for a massive national anti-smoking campaign.

It's started a decades-long conversation about smoking, as a matter of public health and as a matter of personal choice. That conversation continues. Today, the surgeon general released a new report on smoking, the 32nd time the office has spoken out over the years.

NPR's Richard Knox says the report identifies new risks to smoking, and breaks new ground on e-cigarettes.

RICHARD KNOX, BYLINE: Acting Surgeon General Boris Lushniak is the latest in a long line of surgeons general who've tried to pound the last nails in the coffin of America's smoking habit. There's no reason to think his 900-page report will do the trick. But it's not for lack of trying.

THOMAS FRIEDEN: Smoking really is even worse than we knew.

KNOX: That's Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. He ticks off an impressive list of disorders the report now finds are caused by smoking.

FRIEDEN: Diabetes, birth defects and stroke in people who are exposed to second-hand smoke.

KNOX: Also: Liver cancer, colorectal cancer, age-related macular degeneration, ectopic pregnancy, rheumatoid arthritis, erectile dysfunction and more. Frieden says smoking not only causes more diseases, it's more lethal than it used to be.

FRIEDEN: Even though the Americans who smoke are smoking fewer cigarettes, the risk of dying from smoking among smokers is increasing.

KNOX: Maybe because companies have re-engineered cigarettes in recent decades, changing the way people inhale and increasing the toxic components of smoke. Whatever the reason, the report conveys a new sense of urgency.

FRIEDEN: If we don't act now, 5.6 million of our children will be killed by tobacco.

KNOX: Many of the proposed actions are familiar: raise cigarette taxes, do more public education, increase the legal age for buying cigarettes. But there's one new wrinkle. Behavioral psychologist David Abrams says this report makes a distinction between the harmfulness of burning tobacco and less-harmful ways of delivering the nicotine that keeps people addicted.

DAVID ABRAMS: That is new because it implies that less-harmful forms of getting one's nicotine - especially if one cannot quit smoking cigarettes - may be acceptable.

KNOX: That includes e-cigarettes - electronic, cigarette-like devices that don't burn tobacco. They release nicotine in a vapor that doesn't contain the toxic chemicals that cause most of the harm.

Abrams helped write the new report's last chapter on the changing landscape of tobacco control. He's with Legacy for Health, an anti-tobacco group set up as part of past legal settlements against the industry. He thinks e-cigarettes could help wean millions away from cigarettes.

ABRAMS: For the first time in a century, we have an appealing, alternative way to give addicted current smokers a satisfying way to give up their combusted products.

KNOX: Abrams calls this a harm-reduction strategy rather than a total abstinence approach. It's sort of like condoms or clean-needle exchanges to prevent AIDS. And it might be equally controversial.

Dr. Frieden, the CDC director, is a skeptic.

FRIEDEN: It might be possible that things like e-cigarettes, in the future, will have a positive role. As they're being rolled out now, I have grave concerns that they're doing more harm than good.

KNOX: Among other things, Frieden worries e-cigarettes will addict many adolescents and young adults to nicotine, and then they'll take up conventional cigarettes with all their dangers.

FRIEDEN: We know that nearly 2 million American kids have now used e-cigarettes. That's a problem.

KNOX: Frieden says strict regulation is needed to prevent companies from marketing e-cigarettes to young people.

FRIEDEN: Including things like bubble-gum and cotton-candy flavors; marketing over the Internet, where kids can get them; free samples; and the kind of advertising that re-glamorizes the act of smoking.

KNOX: Advocates are waiting for word from the Obama administration on whether the Food and Drug Administration has the ability to regulate e-cigarettes under the Tobacco Control Act of 2009.

Richard Knox, NPR News.

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