Reader Roger Albin (a professor of medicine at the University of Michigan) writes:
One of the things we’re likely to lose with the accession of Trump is competent governance aimed at producing incremental, but significant, improvements in American life. A very good example is tobacco control. While not widely known, improved tobacco control was a major accomplishment of the Obama administration. Smoking prevalence among American adults has been declining since the 1960s. From the early 1990s to 2008, the rate of decline was approximately 0.3% per year. During the Obama presidency, the rate of decline approximately doubled (http://www.nejm.org/doi/full/10.1056/NEJMp1607850). At present, approximately 15% of American adults smoke. Extrapolating the pre-Obama administration rate of decline predicts a 17-18% prevalence of smoking among adult Americans. Converted to absolute numbers, this is a large effect. A difference of 2% is > 5 million people. The rule of thumb is that tobacco abuse leads to premature death in one third to one half of smokers. Using the conservative one third parameter, a 2% reduction in smoking prevalence translates to approximately 1.5 million avoided premature deaths.
How much credit does the Obama administration deserve for the accelerated decline? As documented in a recent concise and useful article in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMp1607850), a variety of actions by the Obama administration played major roles in the acceleration. If the rate of decline returns to the pre-Obama baseline, the result will be a shortfall of several hundred thousand avoided premature deaths.
Its likely that the Trump administration will pull back on tobacco control efforts. The venal and clueless Pence actually doesn’t accept that smoking causes lung cancer. This isn’t a hopeless situation as there was a successful ballot initiative in California to boost cigarette taxes and reinvigorate state anti-tobacco efforts. In the past, California has been something of bellwether for state-level tobacco control efforts. Reduction of Federal efforts, however, will result in the unnecessary deaths of hundreds of thousands of Americans.
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