The Associated Press has announced the iconic Marlboro Man, Eric Lawson, has passed away. This handsome outdoorsman helped turn Marlboro into the world’s most popular brand. He died at age 72 from chronic obstructive pulmonary disease. Lawson had been speaking out about the health hazards of smoking which was really brought to light 50 years ago. Have we been waging a war against tobacco for 50 years?

It was fifty years ago that U.S. Surgeon General Luther Terry announced that cigarette smoking causes lung cancer and is associated with other deadly illnesses. This was in 1964 and at that time about 43% of adults smoked. Warning labels (1965), advertising bands (1971), and forbidden areas for tobacco products followed, and by 2012 the adult smokers in America had decreased to 18%. The AMA estimated that the decline had saved 8 million lives and extended life by two years. It appeared that after 50 years progress was being made, but the story doesn’t end here.

With sales decreasing in the United States and other high-income nations, poorer countries have been the marketing targets and today, there are now 1 billion, yes, that is one in every three adults in the world, smoke. The estimated loss of life will be 1 billion this century. We are not winning the war. The battleground has shifted. Fifty million Americans are still using some form of tobacco. This is too many. Just as we are making progress with the combustible forms of tobacco, a new product has emerged, the electronic cigarette.

The e-cigarette is a non-combustible and is being marketed as a quit smoking aid and as a “less harmful vehicle.” More than 20% of smokers have now tried the e-cigarettes. The e-cigarettes give a feel of smoking and vaporize a liquid solution like propylene glycol. Sales are projected to reach 1.7 billion in the United States in 2013. Marketing campaigns threaten to undermine the successful public health campaign on combustibles as they are now showing up on television. Young people are experimenting with this new product. Many suspect the next step will be to move to the combustible products. Nicotine is especially addictive to the young who are still developing their brains. At this point the war is not being won as we have new battlefields – The world’s increasing rates as well as e-cigarettes.

What can I do? I can tell people lovingly that combustibles are dangerous and still take life, damage quality, and if the smoke is inhaled by others, especially the young, harm is done. The number one cause of childhood asthma is caused by being exposed to second-hand smoke. If those who smoke say they definitely will not try to quit, they should at least be encouraged to smoke away from others and decrease the number they are smoking. Of course our first concern would be to help them quit. There are many behavioral strategies available, but a person must want to try. We can also speak out of the potential dangers of e-cigarettes and “vaping,” especially in the young as I suspect this could easily be a gateway product. 90% of adult smokers report that if they could start all over, they would not smoke. Smoking is the most addictive habit known. We must do everything we can to protect our youth.

With 6 million deaths globally a year related to tobacco and 400,000 in the States, we must love our neighbor enough to help them anyway we can. The war is far from over. Reinforcements are needed right away.