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Mr. Bergman, the main focus of the ePrevco Website is promotion of environmental strategies for preventing substance abuse among youth, but this site may also be a venue for addressing prevention of substance use through intergenerational efforts or among older adults. As an expert on law and aging issues as they relate to tobacco use and as Director of the National Center for Tobacco-Free Older Persons (NCTFOP) at The Center for Social Gerontology, you have experience that contributes significantly to environmental strategies for preventing substance abuse. Do you agree that the aim of intervention for older adults is to prevent further abuse of tobacco and that we are not talking about preventing older adults from starting to smoke?
Absolutely. With older persons, the two major issues related to tobacco and smoking are cessation of current smoking and protecting people from second-hand smoke. When it comes to smoking itself, the major focus is on encouraging smoking cessation. However, second-hand smoke is also a very severe issue. Only about 10 to 13 percent of persons 65 years of age and older are currently smokers, but that’s still almost four million people. Almost as many people over age 65 smoke as youth under 18 years old, so this is a very significant problem that needs to be addressed for both older persons and youth.
Have you found receptivity among older adult groups to prevention and cessation efforts?
There haven’t been many studies, but those that have been done tend to show that older smokers are a bit less likely to try to quit smoking than younger smokers. However, when they do try to quit, they generally are a little more successful. Part of this may be that smoking cessation programs have generally been set up to target younger adults, and that may be part of the reason that the quit rates or quit attempts are a bit lower for older smokers. On the other hand, when older people try to quit smoking, it is often because they’re facing a crisis – a health crises, generally?and it is much easier to quit, try to quit, or want to quit when the doctor says to you: “The next one you smoke could be your last,” rather than simply saying: “You know, you really shouldn’t be smoking; it’s not good for you.”
Can you elaborate on how smoking cessation at a late age really makes a difference in quality of life and disease prevention for older adults?
Every bit of research that’s been done in this area confirms the fact that quitting, no matter at what age, improves a person’s health, and for older people, the same thing is true?health begins to improve almost immediately. Breathing is easier almost immediately, and the longer the person continues to not smoke, the more his or her health improves. After 5 years, certain problems such as heart conditions can basically be back to normal or at the level of a non-smoker if the person continues not smoking. Certain diseases such as chronic obstructive pulmonary disorder will not improve, but they won’t get any worse. The research now shows three things: first, quitting at any age works; second, it increases the length of a person’s life span; and third, it improves the quality of life. The latter part gets emphasized too little, and yet, it is so vitally important. Death is a very final thing. Once it happens, the person isn’t worried anymore. Maybe family members are, but the person isn’t, obviously. Emphysema, asthma, heart disease, and cancer are some of the worst diseases you can possibly imagine in terms of suffering, pain, and emotional distress. That’s what many people go through once they get the diseases caused by tobacco, so improving the quality of life is probably even more important for older people than lengthening the life span.
What was the inspiration for the creation of the NCTFOP? Did certain specific events or individuals provide the impetus?
There really weren’t any specific events or individuals. A lot of people do something based on what happened to parents or grandparents. Even though my father suffers from diseases that are caused by or exacerbated by the many years he smoked, that wasn’t the impetus. The impetus truly was the belief that the NCTFOP furthers the mission of the Center for Social Gerontology, which is to enhance and protect the autonomy and dignity of older people. Nothing does more to effect the autonomy and dignity of a person than getting sick, becoming ill, and becoming dependent on other people. The real impetus for creating the National Center for Tobacco Free Older Persons (NCTFOP) was to raise the consciousness of people within the aging network, as well as the general public and policymakers, about the impact of tobacco on older people. Our hope is that with this information, the tobacco control movement will focus on older persons in the same way they have focused on youth
What do you feel is the most important work carried out or achieved by the NCTFOP?
In the short time the center has existed, the most important thing is probably that we have begun to raise the level of consciousness among people in the tobacco control community and the aging network about the importance of tobacco-caused diseases on older people. When we started this effort, tobacco-caused disease was not on the radar screen of either aging network organizations or the tobacco control field. Now, it is well known among them. Now, it’s hard for the folks in either of those fields not to realize that they ought to be dealing with this issue. They still haven’t done a good job of it on either side, but I think we’ve raised a lot of consciousness. The second thing is that we made a very strong push immediately, as soon as the Master Settlement Agreement was signed with the tobacco companies (which brought billions of dollars into the states) to put a real emphasis on the fact that older people should be benefiting from that money since they are the ones who are suffering and dying as a result of the tobacco-caused diseases.
We have been extraordinarily successful in working with aging groups across the country to the point that a large amount of that settlement money has now been appropriated to programs for older people as well as tobacco control programs. In the past 3 years, more than $1 billion of that tobacco settlement money has gone for older people’s programs, mostly for in-home care or prescription drug programs. If you count some of the money that has gone for Medicaid, much of which goes to older persons’ programs, about $3 billion of that settlement money has gone for older persons. To me, that is a tremendous success. Third is that we really have just begun to focus on smoking cessation for older people and have created a portion of our Website to deal specifically with that. We have also begun to conduct focus groups with older people to try and give us a better sense of what prompts older people to try to quit smoking and what makes them more successful. A lot more work needs to be done, such as finding out how price increases or cigarette tax increases affect consumption and quitting in older people, and we’ve begun to work on that area as well.
What have been some of the greatest challenges for the NCTFOP?
The two biggest challenges are inertia and, quite frankly, ageism. It’s hard to get any organizations or groups to change what they’re doing and refocus. Even now, when people are beginning to understand the importance of smoking cessation and dealing with smoke-free environments for older people, it’s still hard to get organizations?whether they are governmental, private non-profit, or healthcare?to change their programming and begin to focus on those issues, so inertia is a tough one.
The other challenge is ageism. Among healthcare providers, people who work with older people, and many older people themselves, some attitudes are simply ageist. “Oh, she’s already lived 70 years. She doesn’t have that much longer to live, so let her go on doing it. It’s not going to hurt her.” Or “Why should we spend money on folks who are only going to live for another 5, 10, or 15 years when we could focus on younger people who have a much longer life span ahead of them?” I think those are extremely ageist attitudes and ones that people should be ashamed of even having, but they have them, and it is tough to get past them.
What tobacco-related issues are especially pertinent for older adult minority groups?
This area has received far too little focus. Part of our Website specifically deals with tobacco and older minorities. The reason we created that part of the site was because almost no one was looking at that issue. Older persons from minority populations are affected in the same ways as Caucasian populations. The difference is that, by and large, whatever happens to Caucasians happens more frequently and worse to minority populations, so you often see higher smoking rates, much more chronic illness that is brought about by tobacco or tobacco-caused diseases, and much less comprehensive treatment available for treating persons with those diseases. Everything that can go wrong tends to go wrong in those minority populations. That’s true in healthcare generally, but it is definitely true where tobacco has been a factor.
Does the NCTFOP have initiatives for qualitative or quantitative research that might help to transfer these issues to public policy?
We tend to do policy-related research. We want anything we do to have some direct effect on public policy, and we’re doing a number of things right now. We have one very comprehensive study going on to look at smoking policies within facilities that serve the elderly?nursing homes, senior centers, adult daycare, and assisted living facilities?specifically to find out what the policies are within those facilities, if they protect the non-smoker from second-hand smoke, and how they affect even the smokers within those facilities. We’re currently conducting a random sample nationwide survey of those facilities in terms of what their smoking policies are. We’ve done legal research on what specific State laws say about that, and we’re developing model policies for those facilities. Also, we’re about to embark on a study that will look specifically at how price sensitive older smokers are. If we increase the price of cigarettes or the tobacco taxes on them, would it in fact cut consumption, or will it also increase smoking cessation? The evidence suggests that older people may be more price sensitive than youth are. If that’s the case, legislators and Federal officials should look at increasing the price of tobacco specifically because it would cut consumption and perhaps increase smoking cessation.
We’re also using focus groups to determine which types of smoking cessation programs or nicotine replacement therapy interventions are most effective with older persons. We have a number initiatives in those areas. We are also doing a great deal of work on smoke-free policies for dealing with second-hand smoke in facilities that serve older people. Those facilities include almost any public places as well, since older people spend a great deal of time in restaurants and other public places, just as younger people do.
You have a listserv, aging tob-talk. What kinds of issues are discussed? Who participates on the listserv?
The listserv is really there for healthcare, tobacco control, and aging professionals. It is much less a listserv for the general public. Its purpose is to share topical information specifically on second-hand smoke and smoking cessation issues as they affect older people. The impetus for it was the recognition that there really was not that much discussion of these issues within the aging or tobacco control communities, so its purpose is to continue to raise people’s consciousness and foster discussion of strategies, but much more to function as an information-sharing listserv.
Do you feel the public is aware that the vast majority of persons who have and continue to suffer from tobacco-related diseases are older persons?
No, I don’t. In fact, one of the posters we did some years ago points out that 70 percent of the tobacco-caused deaths in this country occur in persons 65 years of age and older. Almost 95 percent of the tobacco-caused deaths each year in this country are to persons 50 years of age and older. That poster and that statement shock almost everyone who sees them. In fact, the former Attorney General in the State of Michigan was so impressed by them that every time he received a letter from any constituent talking about tobacco issues, he invariably put those statistics in his response and pointed out that older people were the ones truly suffering. His comment also was that he saw nursing homes as the real “Marlboro country.” The general population doesn’t really think about the impact of those tobacco-caused diseases. Only recently have people begun to realize that 90 percent of the lung cancer deaths in this country are due to smoking, and around a third to 40 percent of cancer deaths and heart deaths are caused by smoking and second-hand smoke. People begin to realize the effect of this when it is their parents, their sister, their brother, or their child who dies of these diseases. Then it comes home to them. We have a long way to go to get people in this country to understand that. The sooner they understand it, the sooner we’re going to see change, and that’s really what we’re all about on this issue.
Do you feel that enough of the tobacco settlement funds have been allocated for the older adult population?
Not nearly enough has been allocated, even though that’s easy to say. If you ask anyone that question about almost anything, that person will say: “No, we need more money.” However, I think this is also a justice issue. Tobacco companies owe older people because their marketing in the 1940s, ‘50s, ‘60s, and subsequently have hooked this generation. The persons at the tobacco companies knew very well that their product killed people if used properly. The tobacco companies withheld information about that and continued multibillion-dollar-a-year marketing campaigns targeting these populations while they said nothing about all the evidence they had in their hands about what tobacco does to people. They owe older people billions and billions and billions of dollars. So far, no State has given any of that tobacco settlement money directly to the victims, and every week, we get calls from people who say: “My mother, my father, my sister, or whomever is suffering from lung cancer,” and they can’t pay their bills. I received a call yesterday from a woman saying that her mother is in the hospital being treated with chemotherapy. She can’t pay her medical bills, and the hospital wants to know what she’s going to do about that before she leaves the facility. Her question was: “I thought a lawsuit a couple of years ago did something about this. Is there any money available?” No, there hasn’t been, and I think it’s time some of that settlement money gets used that way. We’re using the money raised in New York City to help the families of the victims of September 11th, and that money is supposed to be going directly to the victims. We should be using some of that settlement money in the same way for persons who are suffering from these diseases so they don’t have to go on Medicaid or don’t have to drain their own resources. If we’re going to drain some resources, we should drain them from the tobacco companies, which are still making profits that are simply unconscionable.
How do you translate this knowledge about how older adults have been and are affected by tobacco-related diseases into allocating more of the tobacco settlement funds to help this older adult group?
We’ve already done a pretty good job of that with policymakers. The problem with the settlement money at this point is that, by and large, the money available has by now been allocated for programs. Therefore, in the States where aging programs have gotten some of that money and tobacco control programs have gotten some of that money, the real strategy now is to make sure that this money is not lost to other programs or used to cover budget deficits or things like that. Very little of that money is unclaimed at this point, so with regard to the settlement funds, the real challenge is to make sure that the money going for health programming, including tobacco prevention and cessation, continues to go there, and the money going for aging programs continues to go there. What we’re really looking at is increasing cigarette taxes and seeing if some of that money can be allocated to these very kinds of tobacco control and aging healthcare programs. The same data used to convince legislators that older people deserve and are entitled to some of the settlement funds should be used by aging programs to justify cigarette tax revenues going to them.
Does the tobacco industry have angles or arguments from which to minimize the number of smoking-related deaths among older adults?
Absolutely. It would be mind-boggling to learn how much money the people in the tobacco industry actually spent on research to learn the best ways of doing this. Most frequently, they simply say that this is a matter of personal choice. This is America. Everyone has freedom in this country. Everyone has a right to do what he or she wants, and one of those rights is to smoke. In fact, there is no right to smoke in this country. There was nothing in the Constitution about a right to smoke. There is nothing in any Federal law saying that. With only rare excepts very few States say anything about a right to smoke. There is no such thing, but that’s the argument the tobacco industry constantly uses, that it is a personal choice and a person’s right. Then from that personal choice argument, they say: “It’s not my fault, it’s the person’s fault. It’s the victim’s fault. He or she is the one who made the choice. He or she knew it was hazardous. He or she has known that for years and, therefore, it’s his or her own fault.” That’s their primary argument.
The second argument they make occasionally is one which leads to them getting their hands slapped every time they’ve tried it. The argument is that society is better off economically if older people are smokers because if they’re smokers, on average they do not live as long and, therefore, less money goes out in Social Security, less goes out for Medicare payments, and less goes out for Medicaid. Their argument is that the quicker they die, the better off society is from an economic perspective. That’s a rather callous argument, but they used it most recently in Eastern Europe trying to justify why it was an economic value to the country to have Philip Morris as part of its economy. That report got out and became a smash hit in the news media all around the world, demonstrating the callousness and the uncaring nature of the tobacco companies. Those are the arguments they make.
One amazing thing about the people in the tobacco industry is that each time you think you’ve seen them do something that shocks you, and you think no one could possibly do that or could be that callous, they then top it and do something worse. The people in that industry truly do not know what morality or ethics means, or if they do, they ignore it.
Do you think there may be a limit to this type of strategizing by the tobacco industry, or do you think people are at least becoming more aware of it?
People are waking up to it, but the countervailing pressures are extraordinary, and they come largely from economics. The tobacco industry brings in billions of dollars each year, and that creates tax revenues for the Federal and State governments. Those tax revenues are important because they create jobs. Those economic arguments are very compelling to policymakers, but we have to be able to prove and demonstrate that if that industry declined or didn’t even exist, the money currently spent on cigarettes and other tobacco products would be spent elsewhere, and the money that was spent elsewhere would create jobs elsewhere. The United States does not need an industry like this, nor does anyone else in the world, but the economic argument weighs very heavily against other health arguments.
How do the healthcare expenses of older adult smokers affect the healthcare and Social Security systems?
They have a devastating impact, but less so on Social Security because people are going to be paid out of that fund anyway. Still, they clearly affect the Social Security system through the fact that many people go onto disability because of tobacco-caused diseases. Medicare is hit extremely hard, and former Health, Education, and Welfare Secretary Joe Califano, after conducting some research on this, made the statement that if it were not for tobacco and other substance abuse, we would not have a problem with the Medicare trust fund. Substance abuse has a devastating impact on Medicare and State Medicaid programs. Were it not for those diseases, we would not be looking at deficit problems in Medicaid. We wouldn’t have to worry about a recession in terms of the impact on those programs. The money that is currently going for services, healthcare, and social services for persons with tobacco-caused diseases is so out of line with what would have to be spent that it boggles the mind.
What is the cost-effectiveness of older adults (or even of one older adult) quitting smoking?
The cost-effectiveness can be measured in a number of ways. One method is to determine the direct savings from not spending money on buying cigarettes, so if the average price for a pack of cigarettes today is somewhere around $4, give or take a little, that means a pack-a-day smoker is spending almost $30 a week on cigarettes. Multiply that by 50 weeks, and you have more than $1,500 a year being spent on cigarettes. Those are very direct savings.
Indirect savings can be determined from healthcare costs that older persons incur as a result of tobacco-caused diseases. Currently, Medicare does not cover prescription drugs, but prescription drug costs are rising astronomically. Many States still do not have prescription drug assistance programs for older people, and the ones that do are generally targeted to lower-income persons, so whatever a person has to spend on medications that are needed because of tobacco-caused diseases would not have to be spent were it not for that. This doesn’t include outpatient care or inpatient care that may be incurred because of tobacco-caused diseases.
People living in nursing homes have to pay $40,000 to $50,000 each year, and many of the people are there because of tobacco-caused diseases. Ultimately, those persons end up on Medicaid because virtually no one can afford to spend that kind of money on nursing home care. Once he or she is on Medicaid, the State and the Federal governments are going to pay those costs.
So, a specific figure on the cost benefit varies from person to person, but the direct costs are still significant. That’s money being spent on prescriptions or doctor and hospital care that could have been spent on food, living expenses, or even a vacation. Retirement is supposed to be about having some pleasure after working hard all your life. That’s being taken away from older people.
I don’t think most people know that smoking is related to a number of health problems generally associated with aging, such as hearing loss, vision loss, oral health problems, impotence, wrinkles, dementia, and Alzheimer’s. Would you like to elaborate on any of these points?
Increasingly, the general public understands that smoking largely causes lung cancer. I think most people understand that heart disease and strokes bear some relation to smoking, but I think most people are shocked when you say that many other health problems are also caused by tobacco use and secondhand smoke.. In fact, research now suggests that there may be some causation between smoking and dementia and Alzheimer’s. Loss of vision and hearing may be affected by smoking. Further, oral health problems, cancer of the mouth, and those kinds of diseases are also caused by tobacco use, including chewing tobacco and cigarette and cigar or pipe smoking. Amazingly, impotence seems to be affected by smoking. A study done not too long ago lined up a group of people who had never smoked in their lives next to a group of adults who had smoked throughout their lives, and the researchers asked the people to simply try and identify which were the smokers and which were the non-smokers. People were pretty good at identifying them. The folks who had substantial wrinkles were generally the smokers. As more and more research is done, we’re finding that tobacco affects the body in a variety of ways, all of which are negative. About 90 percent of lung cancer cases are caused by tobacco, and clearly, smoking exacerbates hearing loss, as well as wrinkles and vision loss. It all comes down to one simple thing: You can really mess up your health by continuing to smoke, and you can mess up your health by being near persons who are smoking. Second-hand smoke, while not as dangerous per se as direct smoking, is still very serious. It kills thousands of people every year in this country.
Do you feel that the tobacco control advocates have focused too much on the leading causes of death?
We’ve done too little research on the health effects of tobacco. We’re certainly correcting that now, but we have a ways to go. More importantly, we have focused too little on the effects of tobacco use on chronic disease. We have focused more on mortality than chronic illness, and chronic illness is the most difficult thing for both the victim and the family to deal with. There is a great focus these days on caregiver assistance for older people because chronic illness drains the dignity as well as the life out of individuals, and we really haven’t put enough focus on that. As we’ve done focus groups with older people who are smokers and former smokers, one of the most important issues about smoking for them is clearly illness, which is even more important than death. We need to put much more focus on that.
Can you speak on the issue of longer life for older adults as a result of quitting smoking?
Clearly in today’s society, older people generally are living longer. As I mentioned earlier, one of the important things we’re seeing is that quitting smoking at any age, on average, increases the life span. But more importantly, it improves the quality of life for the years that person has to live. Interestingly, only about a third of the smokers die prematurely, while about two-thirds don’t. No one knows why that is, whether it is genetic or something else. It just happens to be a fact. One of the posters we’ve done is of a pistol and state that, as a smoker, you’re playing Russian roulette by putting two bullets in a six-bullet chamber and spinning it. You’re going to lose one-third of the time in terms of dying prematurely, but a lot of people look at George Burns, who smoked cigars every day until he was 100 years old, and they say: “Well, you know, I know him, or I knew family members who smoked all their lives, and they lived until they were 80 or 90. That’s where I’ll be.” No, that’s not necessarily true. And if you live that long, if you’ve been a smoker, the quality of your life is going to be less than that of somebody who was not a smoker. You’re going to have more chronic illness, and living to 90 years of age when you’ve had emphysema for 30 years is not a pleasure. Having emphysema means you take three steps, start puffing, and have to stop because you don’t have enough breath. The same thing happens with other chronic obstructive pulmonary diseases. That is not a good quality of life, not the kind of life one looks forward to when a person is in his or her 20s, 30s, 40s, or 50s.
What we need to do is get people to realize that quitting not only lengthens the life span, but more importantly, it improves the quality of that lifetime. That’s what people really want, a healthy life. Remember that old line: “If you’ve got your health, you’ve got everything.” When you don’t have your health, you don’t have a quality of life in many cases.
What kind of impact do you think the two posters created by The Center for Social Gerontology have made?
They’ve had a very powerful effect. We’ve only made a few thousand of them, but as we travel around the country working with aging programs, we invariably walk into an office, a senior center, or something like that and see those posters hanging there. We walked into an office in Honolulu, and the first thing I saw was one of our posters. I’ve been to a senior center in Arkansas, and the same thing happened there. I think they’re having an impact because they raise people’s consciousness about how tobacco harms older people and the need to quit. Those are the things we want to emphasize.
How accessible are smoking cessation treatment programs to older adults who want to quit, and are these covered by Medicare?
Smoking cessation programs are accessible, but they’re not usually targeted toward older people. Very few are run in senior centers or other facilities that older people frequent, and there has been very little impetus on the part of the healthcare community to try and set up smoking cessation programs that are easy for older people to go to and use. A lot more needs to be done in that way.
As for Medicare covering the cost of taking part in a smoking cessation program, it currently does not. In a small number of States, a pilot program is being conducted to test whether people would make greater use of smoking cessation programs or nicotine replacement therapies if Medicare paid for them. In fact, smoking cessation programs tend to have low success rates and low usage. Generally, people are much more successful in quitting if they combine a smoking cessation program with some form of nicotine replacement therapy, whether it is the patch, Zyban, inhalers, or something else. Through their Medicaid program, many States pay for nicotine replacement therapies, but a much greater number of States do not pay for it that way. Some insurance policies pay for nicotine replacement therapies, but many do not. Many of the “MediGap” policies people pay for to supplement Medicare also do not cover this. We have a ways to go to make it easier for older persons, as well as younger people, to be able to access nicotine replacement therapies and smoking cessation programs. Until we do that, we’re going to rely very much on individuals to do it by will power. Now, will power is absolutely crucial, but will power with a nicotine replacement therapy or a smoking cessation program is much more successful. Healthcare providers and aging programs need to do much more to identify older smokers and work much more with those persons to encourage them to quit. That means the healthcare community has a ways to go here as well.
Regarding the ageism I talked about earlier, physicians and other healthcare providers need to look inward about why they’re not talking to their older patients who are smokers about nicotine replacement therapies and quitting smoking.
Did you mention that the NCTFOP is working on a smoking cessation program for older adults?
We’ve done a very careful review of the literature and are trying in southeastern Michigan to work with aging programs and healthcare providers to set up some pilot programs and see what works best. Is it better to have smoking cessation programs in senior centers? Is it better to have the medical community begin to track older smokers who are in the hospital, and, before those patients are discharged, give them a nicotine patch or some other nicotine replacement therapy. Later, when a home health worker follows up with them, he or she could encourage them to continue to try quitting. We’re testing a number of things to see what works best and how it can fit into the healthcare delivery and aging services systems.
Are you running any focus groups with older adults to see what kind of approach to cessation they might prefer?
We ran some focus groups just a few months ago. As far as we know, they are the first time anyone in the country has conducted focus groups specifically looking at older smokers and former smokers. We found that the fear of illnesses caused by tobacco clearly appears to be one of the major factors in people deciding to quit smoking. This suggests healthcare providers are a major starting point that is likely to be more successful than somewhere else to get older persons to quit. Also, we asked the persons in the focus groups: “When you tried to quit or when you quit successfully, how did you do it?” Their answer invariably was: “I made the decision to do it myself. It was my will power, and I didn’t use anything to assist me.” Less than 20 percent of the people said they had used some form of nicotine replacement therapy or smoking cessation program, which means that most people were doing it on their own, and if they were successful, it was because of their own will power. That’s positive. On the other hand, the healthcare, aging, and tobacco control communities have not done a good job making assistance available for older persons in the format and manner that would help them make use of it.
The message came through loud and clear that we are not targeting this population, and even when we do, we’re not targeting them effectively. If we did, we would increase our chances of getting older persons to quit smoking.
We also learned from those focus groups that older people are not necessarily hard-core smokers. There are people who have smoked for many years. Does that make them hard-core smokers? I don’t think so. These people have tried to quit on a number of occasions. They just haven’t been successful. Very few of these folks have not tried to quit. That’s true of the general population as well. It usually takes four or five attempts for a person to succeed in quitting smoking, so I’m not at all convinced that the idea of older people being hard-core smokers is anything other than a myth. There is probably a group of hard-core smokers, but a very high percentage of older smokers are not; they simply haven’t been successful so far. Almost to a person, they want to try and quit.
How has your professional background helped you become a leader in efforts to eliminate the dangers of tobacco use and environmental tobacco smoke for older adults?
My background both as a lawyer and someone who has worked in the aging field for over 30 years means that I have a fairly good understanding of what it means to be an old person in America. I also have a very good knowledge of the aging network and the tobacco control community, but probably most importantly, I have a sense of justice. I don’t know whether you are born with a sense of justice, whether you learn it, or whether it is both, but having a sense of justice means that I am extremely troubled?and at times extremely angered?when I see unethical behavior that hurts other people. The Golden Rule guides my whole life. If something shouldn’t be done to me, then I shouldn’t do it to somebody else. The executives in the tobacco companies generally don’t smoke. They generally don’t want their kids to smoke, either. But they have no problem at all taking the highly unethical action of advertising as heavily as they can to addict young people and keep people hooked into old age. My background?not as a lawyer but as someone who believes in justice?is probably the most important thing that makes me a leader in this field.
Do you feel that youth can play a role in helping alleviate the situation for older adults? Would some kind of an intergenerational effort be helpful in this case?
There really is a role for youth to play, and it works both ways. Older people tend to like their grandchildren as much or more than their children. They’ve had a lot of interaction with their children over the years?some good, some bad. With grandchildren, there isn’t that much bad interaction. Intergenerational programs through which children try to work with older people to quit or encourage them to quit could possibly be successful.
Likewise, older people talking to youngsters about the health effects and damage of tobacco could have quite an impact. An older person can walk into a school classroom or any other youth group and talk about what it is like to have emphysema that was caused by tobacco use or to have a hole in his or her throat so he or she can breathe. The visual impact on the young people could be quite substantial. Intergenerational programs involving tobacco use could work to help older people and children, and too few of those have been done.
Would you give any other advice to individuals and coalitions in their efforts to prevent substance use and abuse?
It is absolutely crucial that older people not be excluded from tobacco control efforts, whether it has to do with smoking cessation or second-hand smoke. Also, older people can bring so much to the table when it comes to smoke-free environment issues. Older people vote much more heavily and frequently than younger people, and politicians know that. Older people involved in efforts to get smoke-free environment laws passed in this country, whether on the local, State, or national level, can be extraordinarily effective. And older peoples’ groups are among the best organized lobbying organizations in the country. Tobacco control groups need to take another look at whether older people should be involved in their efforts.
Thank you so much for your time, Jim Bergman. Your interview will be posted on ePrevco in August.
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