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The fight against tobacco is not over

The Boston Globe presents the Harvard Kennedy School PolicyCast, a weekly podcast on public policy, politics, and global issues. HKS PolicyCast is hosted by Matt Cadwallader.

At this point, efforts to end tobacco use seem almost passe.

While it wasn’t so long ago that smoking was ubiquitous, most millennials, the largest generation in the country, have never been able to smoke in a Massachusetts bar or restaurant, much less in an office or on an airplane.

For many of us, the fight against tobacco has fallen off the radar. But that doesn’t mean the problem has been solved.

“Tobacco’s going to kill 1 billion people in the 21st century,” says Dr. Howard Koh on this week’s Harvard Kennedy School PolicyCast podcast. “There’s no other condition that reaches those extraordinary figures.”

Dr. Koh, a professor at the Harvard TH Chan School of Public Health and former assistant secretary for health at the US Department of Health and Human Services, says that it’s not yet time to declare mission accomplished.

“We have to keep talking about this huge issue because so many people are suffering and dying preventable deaths due to tobacco dependence. . . . We still have young people trying cigarettes every day. Several thousand a day, in fact, start for the first time.”

Efforts to curb nicotine addiction have taken on new dimensions in recent years, and in several ways Massachusetts has been at the forefront.

The national movement to raise the minimum age to buy tobacco from 18 to 21 began in Needham back in 2005, and has been picking up steam. Earlier this year Boston followed suit.

Just recently, the Massachusetts State Senate passed a bill that would raise the age statewide, and Governor Baker has indicated that he supports the idea “conceptually.”

Passing such a law would make Massachusetts just the thirdstate to do so after Hawaii enacted the change in January and California passed its law in May.

This year another big change came on opening day at Fenway Park. While smoking has been banned in the park for many years, the use of smokeless tobacco, nicknamed spit or chew, has long been a part of baseball culture.

Now due to new regulations enacted by the city of Boston, Fenway is one of a handful of Major League Baseball stadiums where even smokeless tobacco is unwelcome. This was in response to a study released last year by the US Centers for Disease Control and Prevention, which found that the use of chew among baseball players has a significant impact on whether high school athletes pick up the same habit.

Perhaps the most intriguing issue in tobacco control has been the rising popularity of e-cigarettes.

Koh describes e-cigarettes as a “double-edged sword” that have added an unexpected twist to public health officials’ efforts. Two camps have emerged, one arguing that e-cigarettes can be a useful tool in helping smokers quit, and the other taking a more cautious approach, worried that they may be used by teenagers as a stepping stone into further tobacco use.

So far the data have been inconclusive. A recent study found that 16 percent of US high schoolers had tried e-cigarettes, a more-than tenfold increase over the last five years, but it also came at a time when cigarette use among the same group had dropped significantly.

Tobacco control isn’t a new topic, but in the effort to stop 1 billion preventable deaths, we still have a long way to go.

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