Academia's Role in Tobacco Use Reduction
November 6, 2003: Public and Private Sector Roles in Tobacco Use Reduction
Jonathan M. Samet, M.D., Professor and Chairman, Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
Dr. Samet introduced his talk by explaining a bit about his background as a pulmonary physician in New Mexico and an epidemiologist interested in studying the environment. As he explained, cigarette smoking "got in the way of everything else I really wanted to study." As a result, Dr. Samet began to conduct research in tobacco use and health and has contributed to Surgeon Generals'reports for the past several decades.
Dr. Samet presented a graphic description of how he envisions science should work. First, one starts with a hypothesis, next a study is designed, funding is sought, the study is conducted, the results are published, and then the work either disappears, or it is incorporated into the policy utilization process. Although this process can be long and arduous, much of the progress that has been made in tobacco control has been based on this kind of process. As an example, Dr. Samet talked about secondhand smoke and the progress that has been made in the 21 years since the first major studies on the subject were published. The evidence on passive smoking has resulted in the clean indoor air movement which began in the 1970s and has continued to develop momentum to this day.
Moving from the important role that science has played in tobacco control, Dr. Samet described his view of the role of academia in these efforts. The first role is that of generating research evidence ranging from basic science to policy studies. Translating evidence to policy is a crucial role of academics, who are, for example, key in the creation of Surgeon General reports and other documents. Academics are also advocates, and work with organizations such as the American Cancer Society and other non-governmental organizations. Finally, academics play an important role in capacity building.
To illustrate the continuing commitment to expanding scientific evidence, Dr. Samet showed a slide depicting the number of articles on smoking, epidemiology and smoking and lung cancer that can be found through searching the Pub Med database. Dr. Samet also briefly mentioned the commitment to research by various funding agencies including the National Cancer Institute, and the states of California and Maryland, to name only two.
Research continues to expand and deepen. We continue to better understand causation and how smoking causes disease as well as the genetic determinants of response. In the area of prevention, we better understand the factors that influence initiation and are exploring the genetic determinants of susceptibility to addiction. We also continue to understand more about cessation and have translated this science into more effective programs and policies to help people stop using tobacco.
Even with these advances, however, there is still a great need for additional research. Lung cancer is an example of an area with lots of unanswered research questions, including the risks of "low-tar" cigarettes, changing lung cancer types, molecular genetics, CT screening, secondhand smoke risks and national and global variations in occurrence.
Translating Evidence to Policy
Dr. Samet continued by describing the key role that academics play in translational activities. Surgeon General reports and NCI monographs are just two examples of documents that are produced with a great deal of academic input and have been integral in using the science to identify policy implications. The academic community has also been involved in litigation by discussing risks associated with tobacco use.
The most critical element of advocacy, according to Dr. Samet, is that it must be based in science. Accordingly, the academic community is a critical resource for advocacy organizations and many academics contribute their expertise by becoming members of coalitions or providing training in how to use and translate the evidence-base.
Dr. Samet described capacity building needs at many different levels including local, state, national and international. He described a specific product that was developed for U.S and international audiences by the Institute for Global Tobacco Control and the Pan American Health Organization which focused on global tobacco control resources and is available in several languages. This tool illustrates the ability of academia to package these types of materials and make them widely available.
Concluding his remarks, Dr. Samet offered some of his thoughts about emerging issues in tobacco control thereby reinforcing the need for additional research. These issues include the genetic basis of addiction and disease susceptibility; the concept of "harm reduction;" continuing surveillance of the epidemic, particularly in special populations; disparities in the epidemic—local and global—and finally; protecting the developing world from tobacco industry marketing.
Following the formal presentations, Surgeon General Carmona asked for committee member comments.
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