As smoking has disappeared from television screens, planes, bars and restaurants, and other public spaces, the smoking rate has dropped to a third of its peak of 45 percent in the mid-1950s. The share of high-school students who have smoked a cigarette in the past 30 days is down too, falling from 36 percent in the mid-’90s to just 6 percent today. That latter figure is considered crucial among public-health experts, as most adults who are dependent on cigarettes, and who ultimately die from the habit, start smoking as kids.
Still, smoking remains the leading cause of preventable death in the United States. Thirty-four million American adults smoke. Sixteen million live with a health condition related to the habit, such as lung cancer, emphysema, or heart disease. Half a million die a preventable death each and every year due to their cigarette use. Other effects include lower productivity at work, higher rates of social isolation, and cigarette-induced impoverishment.
Nobody knows this better than smokers themselves, the majority of whom want to quit, sometimes desperately so. Government data show that two in three smokers want to stop. In any given year, 55 percent try to stop. But just 7.5 percent manage to. Hyper-addictive nicotine is a major reason why.
Read: The nicotine fix
Public-health experts have for decades suggested that the government require cigarette makers to produce products with nonaddictive levels of nicotine. (The American Medical Association started recommending the policy in the ’90s.) The Obama administration took a major step toward that goal in 2009 by giving the FDA the power to regulate nicotine levels in tobacco products. The Trump administration—yes, the Trump administration—took another major step forward in 2018, when it started the rule-making process to ban the sale of cigarettes with addictive levels of nicotine.
Scott Gottlieb, Trump’s former FDA director and arguably the best appointment Trump made, described the effort as a moral imperative. This was one area where this administration—so willing to slash regulations, public-health consequences be damned—went full nanny-state. “No statistical model can truly capture the full impact of this effort—including the joy from years of quality life gained with a loved one, or how much pain and suffering would be avoided for millions of families across the country,” Gottlieb said. “This unprecedented public health opportunity, contrasted against the cost of doing nothing, weighs heavily on me.”
Now it is up to Biden to save millions of lives and billions of dollars, to the detriment of the tobacco industry and few others. He could also enact important complementary policies, mostly without the need for new legislation. Those include banning mint and menthol tobacco products (the Obama administration banned the sale of flavored cigarettes but not menthols, and the Trump administration banned the sale of flavored e-cigarette cartridges but not menthol-flavored ones). “It’s hard to overstate how big a public-health difference [this ban] would make,” Matthew Myers of the Campaign for Tobacco-Free Kids told me, given that most kids prefer flavored products. “You would transform the history of heart disease and cancer in the United States.”