Reexamining the Pathways to Reduction in Tobacco-Related Disease

Five years ago, when I last wrote on tobacco policy, my perspective was to offer an assessment of the strengths and weaknesses of a half-century of tobacco control strategies aimed at reducing the health risks associated with cigarette smoking. I began with a discussion of informational strategies; then turned to public place restrictions; and followed with a treatment of excise tax initiatives. In my view, restrictions on advertising and promotion, and resort to tort litigation (the latter, of course, primarily in the privately-initiated common law sphere) had been less effective as control efforts, but nonetheless also warranted consideration. In the ensuing years, there have been a number of significant developments that have altered the course of tobacco control policy. Prominent among these developments has been the emergence of a stronger federal presence under the authority granted the Food & Drug Administration in the Family Smoking Prevention and Tobacco Control Act of 2009; the resort by the industry to litigation in a new guise — particularly reliant on the First Amendment — as an offensive weapon targeting regulatory controls; and the publication of the 2012 Surgeon General’s Report on youth smoking, which makes the case for top-priority attention to underage smoking behavior. These and related measures point to new pathways for breaking through a perceived recent loss of momentum in achieving further reductions in tobacco-related disease — new pathways, without abandoning what has worked in the recent past. I attempt to pull together these multiple fronts in a section focused on youth smoking, assessing the promise of present efforts to reduce the harms associated with tobacco. Finally, I offer some brief thoughts from a broader public health perspective, discussing the framework of tobacco control initiatives from the vantage point of the obesity problem