Editorial
Navigating the Minefield Between Smoking
and Obesity
Justin B. Moore
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I know a man who gave up smoking, drinking, sex, and
rich food. He was healthy right up to the day he killed
himself.
Johnny Carson (1925–2005)1
As the legendary comedian Johnny Carson implies
in the previous quote, there is only so much abstinence
an individual will suffer. While it can be argued that
unbridled hedonism is largely responsible for the lead-
ing causes of death in the United States, the reining
in of harmful health behaviors by the public health
community requires careful consideration of the tactics
to employ and the justification for such actions. One
of the greatest public health success stories of the last
50 years is the decline in smoking prevalence and re-
sulting declines in associated morbidity and mortality.2
As detailed in a number of articles from this issue of
the Journal of Public Health Management and Practice,
these declines in the prevalence of smoking have been
achieved through a number of means including pro-
vision and utilization of quitlines3,4 and clean indoor
air policies.5 Other research has shown that increasing
taxes on tobacco products positively impacts smoking
cessation rates.6 More important, interventions such as
clean indoor air policies have been met with increas-
ing public approval7 and without unintended nega-
tive effects on employment.5 This month’s News From
NACCHO outlines current best practice guidelines for
tobacco control programs at the local level. The success
in reducing smoking behaviors has led many to suggest
the adoption of successful tactics from the tobacco lit-
erature to improve other health behaviors, specifically
eating behaviors.8–10 However, the most relevant com-
parative example from the last 50 years is not tobacco
control but rather the campaign for motorcycle helmet
laws. The helmet law campaign has been far less suc-
cessful and can serve as a cautionary tale for those who
seek to regulate eating behaviors.
J Public Health Management Practice, 2010, 16(4), 275–276
Copyright C 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Katz and Bhatia10 lay out a compelling argument for
“putting our money where our mouth is” by utilizing
tax incentives and food surcharges to promote healthy
eating and (in turn) healthy body composition. In doing
so, they also attempt to refute two common arguments
against excise taxes; (1) such taxes are regressive and
(2) sugar-sweetened beverages can be enjoyed in mod-
eration. However, I would argue that these are not the
main arguments that will be levied against such poli-
cies. If one considers the well-organized public resis-
tance to motorcycle helmet laws,11 one might conclude
that the most likely argument to be made by public
advocates and politicians will be less about social jus-
tice and much more libertarian in philosophy. Like hel-
met use, poor food choices ultimately hurt only the
individual’s health while enacting huge financial bur-
dens on the population as a whole. While an argument
can be made for protecting the children, any impact
of an excise tax would be moderated by parental de-
cisions. Social effects of eating behavior aside, there
is no secondhand effect of poor food choices. While
many in public health would argue that paternalism
is justified, some will not. I doubt that the majority
of the public will share such a sentiment, especially
in the current charged political climate of tea parties
and angry protests over healthcare reform. Consider-
ing that the battle for comprehensive helmet laws began
in the 1960s yet helmet use remains at about 60 percent
nationally,11 it is not inconceivable that attempts by the
public health community to enact such controversial
measures as an excise tax will be met with considerable
Corresponding Author: Justin B. Moore, PhD, MS, Department of Public
Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834
(moorej@ecu.edu).
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Justin B. Moore, PhD, MS, Assistant Professor & Director of Research, Department
of Public Health, Brody School of Medicine, East Carolina University, Greenville, North
Carolina.
275
276 ❘ Journal of Public Health Management and Practice
resistance. Furthermore, any accomplishments might
ultimately be pyrrhic victories as the backlash of public
opinion might hamper effective but less controversial
approaches such as environmental and educational ap-
proaches aimed at children.
Ultimately, if such policies are to be implemented in
a sustainable fashion, the will and desires of the public
must be carefully considered or the history of helmet
laws may be repeated. Eventually, decisions whether
to impose excise taxes on certain foods will be made.
If the decision is to move forward with such policies,
lessons can be learned from tobacco. For example, care-
ful elucidation that the tax revenue will be used to
aid individuals in adopting healthy eating behaviors
might engender more positive attitudes toward such
taxes, as has been observed in attitudes toward tobacco
taxes.12,13 If public health professionals are to make
progress in curbing American’s thirst for empty calo-
ries, it will be through lessons learned not only from our
stories of success but also from the cautionary tales of
history.
REFERENCES
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2010.
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