Tobacco Policy

Tobacco Policy

In the decades since the landmark 1964 Surgeon General’s report on smoking and health, the prevalence of cigarette smoking among United States (US) adults has more than halved, falling from 42% in 1965 to less than 12% in 2021.^1,2 Declines in smoking and tobacco use are largely due to the successful implementation of evidence-based tobacco prevention and control policies at the federal, state, or local level (e.g., smoke-free environments, excise tax increases, marketing restrictions, and insurance coverage for tobacco dependence treatment) that have revolutionized how most Americans view tobacco use, making tobacco products less acceptable, desirable, and accessible.^3,4 In the US, tobacco prevention and control efforts implemented between 1964 and 2012 are estimated to have prevented 8 million premature deaths and extended the mean life span by 19-20 years.⁵ Yet, despite decades of decline, tobacco use remains the number one preventable cause of death in the US, leading to over 160,000 premature deaths due to cancer and 480,000 premature deaths overall each year.⁶

Tobacco, Alcohol, and Cannabis Policies

Tobacco, alcohol, and cannabis are the three most commonly used substances in the US.⁷ Although the health effects of cannabis are still emerging,⁸ tobacco products cause nearly 30% of all cancer deaths in the US annually, and alcohol use causes over 4%.⁹ Federal, state, and local policies have the potential to reduce substance use, yet the policy environment surrounding tobacco, cannabis, and alcohol is constantly evolving. For instance, the Alcohol Policy Information System (APIS) has identified more than 950 alcohol-related policy changes in the US since 2003¹⁰ and, although cannabis is illegal federally, an increasing number of US states and territories allow for both medical and non-medical cannabis use.¹¹ Given that use and co-use of tobacco, alcohol, and cannabis is common in the US – among individuals who currently smoke cigarettes, over half report currently using alcohol¹² and 30% report currently using cannabis¹³ – it is essential to consider the direct and indirect effects of policies that target one of these substances on the use of the other substances. Research is therefore needed to assess the impact of federal, state, and local tobacco, alcohol, and cannabis policies on the use of or secondhand exposure to all three substances.

Tobacco Policy and Health Equity

The overall decline in tobacco use masks substantial differences in tobacco use and tobacco-related diseases among certain groups in the US, including racial and ethnic minorities, rural communities, individuals with low socioeconomic status, military veterans, LGBTQIA+ individuals, uninsured individuals, and those living with a disability or mental health condition.¹⁴ Evidence-based policy approaches to tobacco prevention and control have the potential to reduce tobacco use and eliminate tobacco related inequities in these groups due to their broad reach, ability to change social norms, and because they can be implemented at much lower cost than interventions that target individuals. However, while evidence-based policies rooted in public health may prevent or mitigate inequities, policies could also, through unanticipated effects or otherwise, exacerbate existing inequities or create new ones. Gaps in our understanding of tobacco prevention and control policies remain, particularly as they relate to the ability of new and existing policies to reduce health inequities in tobacco use and related substance use behaviors (i.e., alcohol and cannabis use). Research aimed at understanding how federal, state, and local policies impact use, co-use, and secondhand exposure in populations experiencing health disparities is an important step toward achieving health equity.

The National Cancer Institute (NCI) is funding research to advance the science in these areas. Information on relevant funding opportunities, NCI-funded grants, and resources for researchers interested in studying policy approaches to the prevention and control of tobacco are listed below.

Recent Funding Opportunities in Tobacco Prevention and Control Policy Research

To achieve the long-term goal of eliminating disparities in tobacco use and tobacco-related cancers, NCI is funding research focused on the impact of tobacco control policies on tobacco use and secondhand smoke (SHS) exposure in the US. Under the PARs Tobacco Control Policies to Improve Health Equity (PAR-20-302, PAR-20-303) and Tobacco Control Policies to Reduce Health Disparities (PAR-17-217, PAR-17-218, PAR-18-674, PAR-18-675), NCI awarded 16 grants (11 R01s, 3 R21s, 2 R37s) to support observational or interventional research aimed at reducing disparities in tobacco use and SHS exposure through state- and local-level tobacco prevention and control policies. The overarching goal of the funded research was to improve the effectiveness of existing tobacco prevention and control policy strategies, as well as to study new policy approaches to reducing disparities in commercial tobacco use and SHS exposure.

In February 2024, the NCI convened a meeting of grantees funded by the PARs Tobacco Control Policies to Improve Health Equity and Tobacco Control Policies to Reduce Health Disparities. The purpose of this meeting was to discuss and disseminate findings from funded projects, identify remaining gaps in knowledge, and discuss plans to enhance the translation of current and future research to policymakers and community partners and further engage them going forward. 

NCI recently published two companion notices of funding opportunity (NOFOs) on Tobacco, Alcohol, and Cannabis Policy Research for Health Equity (R01, R21). The funding opportunities aim to support policy research projects that focus on populations experiencing disparities in tobacco, alcohol, and cannabis use or secondhand exposure by examining new or adapted policies pertaining to tobacco, alcohol, and/or cannabis in the US. The results of funded projects will advance equitable tobacco, alcohol, and cannabis policies.

Pre-Application Webinar (November 21, 2024).