With the June passage of a historic tobacco regulation law, public health workers welcomed a set of new, long-awaited tools in the fight against smoking and its unfortunate death toll.
On June 22, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act, giving the U.S. Food and Drug Administration the authority to regulate tobacco products and marketing. Coming almost five decades after the surgeon general’s first report on the harms of smoking and more than 10 years after Congress’ first attempts to provide FDA with tobacco regulatory authority, the new law will affect how tobacco products are sold, marketed and produced, and will be financed via user fees on tobacco manufacturers. According to the Centers for Disease Control and Prevention, tobacco use is the single most preventable cause of death, disability and disease in the United States, and is tied to more than 440,000 U.S. deaths each year and $96 billion in annual U.S. medical expenditures.
President Barack Obama shakes hands with children after signing the new tobacco regulation law at the White House June 22.
Photo by Saul Loeb, courtesy Getty Images
“It’s a victory for health care reform, as it will reduce some of the billions we spend on tobacco-related health care costs in this country,” Obama said during the bill’s signing in Washington, D.C. “It’s a law that will reduce the number of American children who pick up a cigarette and become adult smokers. And most importantly, it is a law that will save American lives and make Americans healthier.”
With CDC reporting more than 1,000 U.S. youth starting a regular smoking habit every day, the new law is expected to give a major boost to anti-tobacco efforts aimed at young people. The FDA law bans all outdoor tobacco advertising within 1,000 feet of schools and playgrounds, bans all remaining tobacco-brand sponsorships of sports and entertainment events, bans free giveaways of non-tobacco items with the purchase of tobacco, and restricts tobacco vending machines to adult-only venues. The law also limits tobacco advertising in publications with high numbers of young readers to black-and-white text-only ads, and boosts enforcement against retailers who sell tobacco products to minors.
“This is the most important tobacco control legislation that the United States has ever enacted,” Matthew Myers, president of the Campaign for Tobacco-Free Kids, told The Nation’s Health. “It has the potential to bring about fundamental change in how tobacco products are marketed, manufactured and sold. Over the next decade, this should give a boost to efforts to discourage youth from starting smoking and significantly complement efforts to assist and encourage adults to quit.”
In a significant coup for public health advocates, the new law also bans tobacco manufacturers from labeling their products as “light” or “low tar,” and gives FDA the authority to regulate all so-called health claims about tobacco products to ensure such claims are scientifically based. Tobacco manufacturers will also be required to place larger, more graphic health warnings on their products. According to the law, cigarette health warnings must now cover the top 50 percent of the front and rear panels of the product package and FDA must issue rules requiring graphic warning labels on cigarettes within two years. With its new authority, FDA can also require changes in tobacco product ingredients, such as levels of nicotine or menthol. Although FDA gained new authority over tobacco product ingredients, the law stipulates it will not be permitted to require nicotine levels be reduced to zero and cannot ban a class of tobacco products.
Public health advocates are celebrating FDA’s new-found authority, including APHA’s Executive Director Georges Benjamin, MD, FACP, FACEP (E), who attended the bill signing. He noted that “after decades of allowing tobacco companies to market their deadly products to our children and deceive consumers about the harm their products cause, our nation has finally chosen to place public health above profit.” In fact, APHA members sent almost 3,500 messages to Congress in 2009 alone calling on policy-makers to pass the FDA bill. The newly signed law is expected to greatly complement state and local public health activities on the anti-tobacco front, especially as the law does not prohibit states and localities from enacting additional and stricter tobacco control measures, including measures that restrict tobacco advertising.
Cheryl Healton, DrPH, president and chief executive officer of the American Legacy Foundation, which runs the successful “truth” youth anti-smoking campaign, described the expanded state and local authority as one of the most important provisions of the federal law. However, the most significant element in the entire bill, she said, will be the tobacco industry’s inability to continue using terms such as “light” and “low tar” to deceive consumers into thinking certain products are less of a health threat.
“The most rapid decline in smoking anywhere in the world right now is in the United States,” Healton told The Nation’s Health. “(This law) should exert further downward impact on smoking, but much will depend on how it’s implemented.”
Even though the new law is being widely regarded as a public health victory, Healton noted that it is “not perfect,” referring to wording in the law that gives three non-voting seats on the newly established federal Tobacco Products Scientific Advisory Committee to representatives of the tobacco industry and tobacco farmers. APHA member Stan Glantz, PhD, director of the Center for Tobacco Control Research and Education at the University of California-San Francisco, echoed Healton’s concerns, stressing that there is “not a single precedent where compromise with the tobacco industry served public health in the long run.” Glantz added that the new law also has the potential to “muddy up” litigation against the tobacco industry and called on public health workers to continue keeping a watchful eye — “this bill is not the panacea,” he said.
“Public health workers in the field should continue to pursue what they were doing well — to run aggressive media campaigns, fight for large-scale anti-tobacco programs, support clean indoor air policies and tobacco taxes,” Glantz told The Nation’s Health.
Myers at the Campaign for Tobacco-Free Kids said Congress did a “good job” in minimizing the impact of the advisory committee’s tobacco industry members, noting that “there’s no way that the tobacco members will be able to delay action or prevent strong public health action.” In addition, he said the law will only reap maximum impacts if it also serves as a catalyst for increased prevention and cessation efforts.
“(The law) provides us with new tools, but it’s vitally important that public health leaders monitor tobacco marketing to look for the new ways (the industry) is reaching out to youth and the new ways they’re deceiving the American public,” Myers said. “There is no magic bullet in fighting tobacco use.”
FDA is seeking public input on implementing its new tobacco authority. To provide comments, which must be submitted by Sept. 29, visit http://edocket.access.gpo.gov/2009/pdf/E9-15549.pdf. For more information on FDA’s new tobacco authority, visit www.fda.gov/tobacco or www.tobaccofreekids.org.
- Copyright The Nation’s Health, American Public Health Association