Dear Michelle Obama,
A New York Times article published on July 8 highlighted our national failure to reach “Healthy People 2010” goal of reducing high school smoking to 16%. The decline in smoking rates among high school students from 34.8% in 1995 to 21.9% in 2003 had led to earlier optimism that this trajectory would continue, but recently progress has stalled, with high school cigarette smoking rates hovering just below the 20% mark (around the same as the smoking rate for adults), along with additional tobacco use in the form of smokeless tobacco products and hookah smoking.
As you are probably aware, this article raised the possibility that your efforts to combat childhood obesity “may be hampering donations to antitobacco campaigns as public health issues shift in emphasis and compete for funds.” Although it may be obvious how smoking and obesity could compete for limited financial resources, especially in the context of an economic downturn, they also compete in less obvious ways. Because tobacco suppresses appetite and body weight, smoking and weight are in a seesaw relationship with one another. Many young people, especially girls, are aware of this relationship and take up smoking in the misguided hope of controlling weight (misguided because these effects emerge over time and are not likely to make much of a difference in the early years of tobacco use, when smoking is often light and intermittent). Moreover, stigmatizing obesity may lead to eating disorders such as bulimia nervosa and binge-eating, which in turn are strongly associated with smoking.
Despite the dangers of obesity, tobacco use remains the number one preventable cause of premature mortality in the U.S. One third of high school smokers, for example, can expect to die prematurely from tobacco-related disease. Thus, smoking to control weight is not a good tradeoff for either children or adults.
I know you are keenly aware of the dangers of smoking as well as the difficulty of quitting, and I am sure it was never your intention to pit these health hazards against one another. I therefore urge you to use your bully pulpit as First Lady to ensure that this does not happen – by telling children explicitly that smoking is the wrong way to control weight and by publicly encouraging support for antitobacco campaigns. The fight against these two public health scourges must go hand in hand, mutually reinforcing rather than competing with each other.
Cynthia S. Pomerleau, Ph.D.