By John Radcliffe – I am expressing opposition to SB 492 on behalf of my client RAI Services Company, which is an affiliate of R.J. Reynolds Tobacco Company, a tobacco product manufacturer.

Background to SB 492

SB 492 would increase the tax on Other Tobacco Products from 70% to an “unspecified amount.  In the bill it states, that “tobacco products other than cigarettes are currently taxed at a lower rate than cigarettes, even though their use carries similar health risks.”

This tax increase and that statement in the proposed legislation sends a message that smokeless tobacco products are just as harmful to public health and costly to the state as cigarette smoking, which numerous scientific studies says are not true.

Other Tobacco Products in Hawaii

The Other Tobacco Product category in Hawaii is primarily made up of smokeless tobacco products, such as moist snuff which are pictured above.

Tobacco Harm Reduction

While it is true that there is no such thing as a “safe” tobacco product, a significant and growing body of science shows that the health risks associated with smokeless tobacco products are significantly lower than the risks associated with cigarettes.  Cigarette smoking results in exposure to nicotine along with tobacco- and combustion-related toxicants, and is associated with an increased risk for developing chronic diseases.  Largely due to the inhalation of combustion by-products, cigarette smoking significantly increases the risk of developing respiratory tract cancers (oropharyngeal, laryngeal and lung), cardiovascular disease (CVD), and chronic obstructive pulmonary disease (COPD).

In contrast, smokeless (non-combustible) tobacco products are largely devoid of combustion-related toxicants; hence, their use results in exposure primarily to nicotine, along with other tobacco toxicants found naturally in tobacco leaf or as a result of processing.  The use of smokeless tobacco products is not associated with most smoking-related cancers or to pulmonary disease.

The graph shows the major diseases caused by cigarette smoking and the risk posed by smokeless tobacco products:

A majority of the science around smokeless tobacco products shows that these products are at least 90 percent less risky than cigarette smoking.  Therefore, good public tax and health policy should give consumers all of the facts about the array of tobacco products.  Equalizing the OTP tax rate to the cigarette tax rate is not good public policy.

Scientific Studies on Tobacco Harm Reduction

Here is what some in the public health community have said about THR and relative risk for various tobacco products:

  • “Consumption of smokeless tobacco products is 10 to 1,000 times less hazardous than smoking.” – Royal College of Physicians (2002)
  • “ACSH bases its position on a comprehensive review of the existing scientific and medical literature, which shows that smokeless tobacco is at least 98 percent safer than smoking cigarettes and can serve as an effective cessation aid.” – American Council on Science and Health (2012)
  • “Smokers have a right to be informed of significant harm reduction options.” – Lynn T. Kozlowski, dean of the School of Public Health and Health Professions at University at Buffalo (Wall Street Journal, Sept. 2006)
  • “Harm reduction is a fundamental component of many aspects of medicine and, indeed, everyday life, yet for some reason effective harm reduction principles have not been applied to tobacco smoking.  This report makes the case for radical reform of the way that nicotine products are regulated and used in society.  The ideas we present are controversial, and challenge many current and entrenched views in medicine and public health.  They also have the potential to save millions of lives. They deserve serious consideration.” – Royal College of Physicians (2007)
  • “More than 90% smoking-related deaths are due to lung cancer, other pulmonary diseases, and cardiovascular diseases among smokers; and deaths in non-smokers from environmental tobacco smoke.  Switching to smokeless tobacco would eliminate these risks.  There is no disease for which the risk from smokeless tobacco is greater than the risk for smoking. – American Association of Public Health Physicians (2008)
  • “Yet many tobacco control advocates generally dismiss the idea of harm reduction in favor of an abstinence-only (or “quit-or-die”) orientation.  The result is that these tobacco control advocates often sound more like moralists seeking to save souls rather than health campaigners seeking to save lives.  This is consistent with what has been experienced in numerous other public health campaigns throughout history and a critical question for future policy directions is just how quickly tobacco control efforts can evolve to become more pragmatic rather than dogmatic.” – David Sweanor, law professor at the University of Ottawa (2008)
  • “The worst that you can say about smokeless tobacco is that it’s the lesser of two evils.  I don’t think we have any problem in telling a person that drinks a six-pack a day that if they could cut it back to two beers a day or two drinks a day that their health risks are greatly reduced.  Finding a way to let people have their nicotine that carries less risk, it’s the realistic solution.”- Dr. Randall Thomas, oncologist with Owensboro (KY) Medical Health System (USA Today Oct. 2011)
  • “Nevertheless, there is little doubt that, if all smokers in the U.S. suddenly switched from smoked cigarettes to smokeless tobacco- and stayed switched – we would see far fewer cancers and less heart disease 20 years from now (although we would also see an increased number of oral cancers).” – Thomas J. Glynn, director of cancer science and trends for the American Cancer Society (2011)

Tobacco Harm Reduction in Other States

States are starting to take action.  For example, Indiana and Kentucky, have accepted and written into law the Tobacco Harm Reduction concept.  In 2005, Kentucky Gov. Ernie Fletcher, who is also a physician, advocated the state legislature to structure tobacco taxation based on relative risk as a part of his tax modernization plan.  Governor Fletcher said at the time, “[T]axing tobacco products according to relative risks is a rational tax policy and may well serve the public health goal of reducing smoking-related mortality and morbidity and lowering health care costs associated with tobacco-related disease.”

Nebraska’s non-partisan, unicameral legislature passed a resolution supporting Tobacco Harm Reduction in 2012.  The resolution states “the Legislature recognizes the importance of Tobacco Harm Reduction strategies as an additional policy choice to assist cigarette smokers in quitting.”

In conclusion, based on the concept of tobacco harm reduction it does not make sense to increase the tax on tobacco products.

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