We can’t move into 2020 without a look back on 2019.
In this post, we share the comprehensive perspective of our acclaimed leader, Dr. Andrew Hyland. As head of the tobacco control programs at Roswell Park Comprehensive Cancer Center, Director of the New York State Smokers’ Quitline, and researcher who has spent 25 years working to reduce the terrible burdens of tobacco products both here in New York and across the globe, he addresses the wins we had in fighting tobacco in 2019. Plus, he gives us a look inside his crystal ball for the future. We can’t be more gratified or inspired.
Health Behavior 2019 Year in Review
What a year! 2019 will be remembered as the year when Roswell Park gained national attention like never before, when major policy advances took effect, when e-cigarette use truly captured the nation’s attention, and when a bold plan was put in place to make dramatic reductions in the leading cancer killer.
Roswell Park National Attention
Roswell Park moved way up the cancer center rankings to number 14 in the country – better than every other New York cancer center except the venerable Memorial Sloan Kettering cancer center. This is ranked higher than the Ohio State Cancer Center and the University of Southern California Cancer Center and right there with the Cleveland Clinic and Dana Farber cancer centers. Not too long ago, Roswell Park fell completely off the ranked lists of cancer centers. The high ranking is because of the added synergy of the research and clinical programs Roswell Park has.
Our research is making an impact and drawing national attention. Our faculty are sought after by leading national news outlets like CNN and the Wall Street Journal. Film crews from NBC and CBC are coming to us. And we are contributing to the national debate about tobacco products. By my definition of translational research we are doing an incredible job.
The New York State Smokers’ Quitline has been sought after by the CDC for advice on smoking cessation and is featured in national CDC outreach. Roswell Park has gained national accreditation to train tobacco treatment specialists and we have developed one of the most robust tobacco cessation programs in the country for our cancer patients.
Our outreach knows no borders. We continue to follow the New York State priority areas but we’ve taken advantage of new opportunities to advance our tobacco outreach in the LGBT population locally, we’ve partnered with Roswell’s Community Outreach and Engagement team to enhance efforts in urban and rural areas alike, we are charting new outreach territory to see tobacco products not only as a threat to our health but as a threat to our environment, and we are beginning to publicly ask the question when will the last cigarettes be sold and what is the endgame for tobacco products?
Major Policy Advances
2019 marked the implementation of the most comprehensive tobacco policies ever implemented in Erie County that eliminated tobacco sales in pharmacies, reduced the number of tobacco outlets in the community, placed restrictions on tobacco product advertising and protected kids from secondhand smoke in cars. Smoke-free spaces are the norm even in parks and apartment buildings due to our outreach team efforts.
Statewide the minimum age to sell tobacco products was raised to 21 due to the ground work laid by our outreach teams in the Southern Tier. E-cigarettes were made less affordable and e-cigarette retailers are now required to be licensed so that they can be appropriately monitored in the future. Legislative efforts to restrict e-cigarette flavors failed in 2019, but the renewed efforts are now also including restrictions on menthol cigarettes and flavored cigars as well, which is a significant policy improvement.
At the national level, a bi-partisan bill raising the minimum tobacco sales age to 21 nationwide awaits the president’s signature. And funding for the national tobacco program has been maintained even in a political environment where other public programs are seeing significant budget reductions.
E-cigarettes Truly Capture the Nation’s Attention
2019, perhaps, will be most remembered by the ‘vaping scare’ over this summer and fall. A mysterious lung illness spread throughout the nation making thousands sick and killing about 50 people. Initially the cause was uncertain though vaping seemed to be a common factor. The CDC and New York State advised people to stop vaping until more information was gathered. Eventually it became clear these lung conditions were caused by tainted e-cannabis liquids, and not commercially available nicotine e-cigarettes.
It is unclear at this time what the long-term impact of this will be and whether it will result in great regulation and control of these products, whether public perceptions of vaping will be changed, and whether some people might turn to cigarette smoking instead of vaping.
While these acute lung conditions captured most of the headlines, national data continued to come out showing that youth e-cigarette use continued to rise dramatically with rates approaching 30% in some surveys. Even more compelling was data showing a sharp increase in the frequency of vaping among those that are vaping, so what used to be an occasional behavior was becoming more regular suggesting more and more kids were becoming addicted to vaping .
Our team published national data showing flavored e-cigarettes were a cause of this increase in youth e-cigarette use and calls to ban flavored products are widespread. Our team has also studied whether flavored e-cigarettes may help some cigarette smokers get off of cigarettes, which the data suggest there is merit to this argument as well making this is very complicated issue on what the science tells us what the best approach forward is.
At the end of 2019 the public health community is in need of credible data more than ever to guide the best public policy for public health.
Bold Plan To Make Dramatic Reductions in the Leading Cancer Killer
Lung cancer kills more people than the next 3 cancers COMBINED or about 30% of all cancer deaths. That’s about 1,000 deaths every year right here in Western New York or 51.7 deaths per 100,000 people in the region. 2019 marked the first steps to implement an action plan to reduce the lung cancer death rate in Western New York by 30% by the year 2030. We will dramatically reduce cigarette smoking rates, dramatically increase lung cancer screening rates, and develop new promising science that could result in more clinical ways to prevent lung cancer before it even starts. This will be done with equal parts science, service and outreach.
My wish for the new year is to hear people talking about this Roswell Park initiative. I want to see billboards, hear radio, and see social media light up with Roswell Park’s leadership to tackle the leading cancer killer once and for all. I want to hear people at the supermarket, dance studios, and ball fields talking about the new Roswell Park thing they are doing for lung cancer. I want to hear from my colleagues around the country talk about Roswell’s bold move to take science to the community. Cancer IS personal to us. Others will join us and I’m confident we’ll see the number of lung cancer deaths go down ever faster.
Crystal Ball for 2020
Cigarettes continue to be our focus because they are responsible for the vast majority of lung cancer. I expect our science will continue to play a leading role in helping us understand under what conditions, if any, e-cigarettes are beneficial for public health and I expect our outreach efforts will play a leading role in helping to shape the positions of others on this topic. New York State will have a significant push to do something about flavored tobacco products and we will advocate for the science which says comprehensive policies that cover all tobacco products including menthol cigarettes and flavored cigars is what works best.
Our tobacco cessation efforts will undergo substantial change and expansion to incorporate these new data and I expect we will build added programs for cancer patients, e-cigarette users, young people, and people with mental health co-morbidities.
At the national level there are multiple critical issues on the horizon. Heated tobacco products will gain much wider retail availability, SNUs smokeless products will begin to be marketed with an explicit modified risk claim, and nicotine free cigarettes will gain increased public attention. I also expect to see increased attention placed on cannabis and how cannabis, vaping, and tobacco are all substitutes for each other meaning that we need to understand how one product influences use of the other products. Our jobs will be more complicated than in the past when we only worried about cigarette smoking.
In 2020, we will submit a major center grant that will focus on international tobacco policy efforts, which will continue Roswell Park’s longstanding leadership in this area. These studies will be on the cutting edge to tell us about these new products and the best ways to address their use.
Lastly, I expect Health Behavior will grow and expand beyond tobacco to other areas including nutrition, physical activity, cancer screening behavior, and vaccinations. We will not diminish our focus on tobacco but through partnerships and collaborations with others we will grow in to these other areas that are also important for cancer prevention.
Stay tuned. This time next year I’ll provide an update on our accomplishments in 2020 and report back how well my crystal ball has predicted the future.