a better outcome: dr. andrew hyland and dr. danielle smith

In 1950, Dr. Morton Levin published one of the first studies to link smoking tobacco to lung cancer. It would be 15 years before the United States Congress passed the first law requiring a warning be printed on all cigarette packages and another four years before they passed the first laws limiting cigarette advertising. Smoking on domestic flights wasn’t banned until 1989, almost 40 years after Levin’s study, and indoor smoking bans were virtually nonexistent until the 1990s and early 2000s.

The slowness of the march toward a tobacco-free world–or, at least, a world in which awareness of the dangers of using tobacco was mainstream–was largely thanks to the lobbying, litigation, and marketing efforts of massive tobacco companies whose money often spoke louder than empirical, scientific evidence.

In the second half of the 20th century, tobacco companies invested in advertising that sold both their products and the idea that those products were harmless. They made fraudulent and bad-faith claims about efforts to create “healthier” cigarettes, and they poured money into protecting themselves from accountability for their fraud. 

They sustained a culture of ignorance, ambivalence, and outright denial that has only recently fallen from prominence; and they facilitated a form of addiction that can be linked directly to millions of lung cancer deaths and indirectly to immeasurable suffering by generations of Americans. 

Despite the uphill climb, doctors, researchers, and public health advocates stayed the course. We have their voices and work to thank for the fact that cigarette smoking rates in young people and adults have fallen almost 70% since 1965.

But the work continues. Over 30 million Americans still smoke cigarettes today and smoking remains the leading cause of lung cancer, which kills more people every year than colon, breast, and prostate cancers combined. 

Dr. Andrew Hyland’s career has thrust him into a position on the frontlines of the continued fight for better health outcomes through tobacco control. 

His personal story, too, is inextricably tied to the story of tobacco and the harm it inflicts. In the spring of 2022, his mother died of lung cancer. She quit smoking in 1990, some three decades after she picked up her first cigarette as a teenager. Andrew’s memories of cigarette smoke hanging in the air of his childhood home are not so different from the memories of millions of people raised in the 1970s and 80s, when the science was clear on cigarettes and cancer but public awareness hadn’t yet caught up. 

Andrew was born, raised, and educated in Buffalo, New York. He has a bachelor’s degree in mathematics, a master’s degree in statistics, and a doctoral degree in epidemiology and community health from the University at Buffalo.

He recalls finding his path forward as a master’s student, a self-described “math nerd” who, by twists of fate, discovered that he could take his love of numbers and translate it into the work of improving people’s lives through public health.

“Epidemiology is essentially applied mathematics to solve problems related to health,” he says. “Why do people get sick? What are the risk factors? And how can we minimize them, avoid them, address them? So there’s science behind it, and then there’s advocacy, connecting research and outreach.” 

While pursuing his PhD, Andrew took a job with the Department of Health Behavior at Roswell Park Comprehensive Cancer Center, where he began his career working on research and advocacy surrounding tobacco control policies. 

He’s been at Roswell Park ever since, and today serves as Chair of the Department of Health Behavior–the same department where he got his start.

The Department of Health Behavior aims to build communities in Western New York and beyond that are free from tobacco-related diseases, including cancer, through research, outreach, and service.

On the service front, it’s a matter of helping people quit smoking. Andrew himself directs the New York State Smokers’ Quitline and his department houses both Roswell Park Cessation Services, which serves 40,000 community members every year, and Roswell’s Tobacco Treatment Service, which helps cancer patients at Roswell Park quit smoking.

The outreach component of the Department of Health Behavior’s work is about sharing knowledge with communities in the form of education and best practices for tobacco control and cancer prevention. It’s also about informing legislation related to tobacco products by infusing science into policy debates at the local, state, and national levels. 

At the core of everything Andrew and his colleagues do is pure scientific research, looking at all aspects of tobacco and health, from the plant itself to the tobacco industry’s influence on communities to the impact of policy initiatives.

Over its history, the Department of Health Behavior has steadily expanded the scope of its work to address the changing needs of a changing world, from environmental concerns associated with cigarette filters to social justice issues arising from the tobacco industry’s targeting of minority communities with its marketing of menthol-flavored products to rising calls for action surrounding e-cigarettes, flavored vaping products, and their influence on young people’s health. 

Today, one of the fastest-growing areas of interest in the public health and scientific communities is cannabis.

“Our program was built historically on cigarettes,” Andrew says. “But going forward, there’s an opportunity in the cannabis area to take the lessons that we’ve learned from tobacco and the policy environment to ensure a better outcome.”

Dr. Danielle Smith is one of the leading forces behind Roswell Park’s effort to build a robust base of knowledge around cannabis and the ways in which cannabis use might impact individual and community health outcomes.

She’s taken on a leadership role within Roswell Park’s Center for Translational Research on Cannabis and Cancer (CTRCC), an initiative of the Department of Public Health that launched in 2021.

Like Andrew, Danielle is all too familiar with tobacco’s impact on the people who use it and the people around them. When she was 19 years old, she lost her mother to lung cancer.

“That’s an experience that really sticks with you,” Danielle says, “seeing and feeling the effect that smoking has on someone close to you, the effect it has on families.”

She began working at Roswell Park in 2007, assisting in data collection for tobacco policy studies within the Department of Health Behavior while she completed her undergraduate degree in psychology and sociology at the University at Buffalo. She kept working there as she continued on at the University at Buffalo for her Master of Public Health, and later her doctorate in community health and health behavior.

In 2013, Danielle happened upon a study concerning the interrelationships between tobacco and cannabis–the idea that co-use of the two can lead to greater nicotine dependence, heavier cigarette use, and reduced odds of smoking cessation–that piqued her interest enough that she began looking for more information.

She was surprised to find only a handful of published studies exploring the subject.

“At the time, we were just beginning to see cannabis legalization take hold,” Danielle says. “I started to think about the implications of that shift, about cannabis legalization and cancer prevention.”

This became central to Danielle’s PhD research, and it continues to be the focus of her work with the CTRCC at Roswell Park today. 

The CTRCC’s mission is to understand cannabis as it relates to both cancer treatment and cancer prevention–as well as to public health more broadly–and to minimize the potential health risks associated with it.

CTRCC faculty are concerned with therapeutic applications of cannabis–looking at the use of cannabis to mitigate the side effects of cancer treatments, for example – but they are also interested in answering a myriad of other questions about cannabis. While Danielle specializes in issues of co-use of cannabis and tobacco, other faculty members focus on how cannabis use affects young people, how recreational markets will impact communities, and what the social justice implications of legalization are.

They’re taking the same multi-faceted approach used by the Department of Health Behavior at large.

“We want to use the infrastructure that Andrew and others over the years have developed,” Danielle explains, “applying the model of ‘science, outreach, service’ in a new context.”

“We’re coming at the issue from different perspectives,” Andrew elaborates. “We have a center that covers clinical work, and Danielle is leading population studies. We’re addressing it as an issue not only concerning cancer patients, but the general public.”

In the years since Danielle first began her research on the relationships between cannabis and tobacco, there’s been an expansion of the knowledge available on cannabis and related issues.

But there’s still so much unknown, and both Andrew and Danielle point to the importance of filling in that knowledge gap as legalization becomes more mainstream and an industry emerges around cannabis.

There are reasons to be optimistic – Danielle points to the many promising clinical applications of cannabis, and to the CTRCC itself, which represents a recognition by research institutions that the issue matters.

But there are reasons to worry, too. She points to the challenges researchers pursuing the subject face in accessing resources given the stigma that persists around cannabis. And she points to a rise in the same tobacco corporations that once sought to silence those speaking up about the harmful effects of their products taking stakes in emerging cannabis companies. 

It was not so long ago that the link between smoking and lung cancer was an unknown reality, and that our lack of knowledge about tobacco’s impact on health outcomes left the world unprepared to address the issue with the urgency it required. 

By taking a proactive approach to cannabis, Andrew, Danielle, and their colleagues aim to make sure history doesn’t repeat itself.

“I’m hopeful,” Danielle says. “I’m cautiously optimistic that folks in the public health area, that policymakers and other leaders have learned from the mistakes of the past, learned from what we’ve seen with tobacco. And that we can apply those lessons, and tell a different story.”