The remarkable decline in smoking rates over the past several decades is a testament to the excellent work of many in the cancer and public health communities. But that does not mean the work on this front is complete. About 21% of US adults were current smokers in 2005 (the latest year for which data are available), but smoking rates were much higher among certain populations, including people with less education and those living in poverty. Tobacco companies, meanwhile, continue to introduce new products, some of which claim to be "reduced harm." And now some of the nation's largest cigarette manufacturers are even moving into the smokeless tobacco (ST) market.
A spit-free ST product has been popular in some Scandinavian countries for several decades; similar products have recently been introduced in the US. Because users don't need to spit, these small, tea bag-like pouches are easier to use and far more discreet than either traditional moist snuff or loose-leaf products. They typically come in small, decorative tins, and several brands available in flavors such as mint and cinnamon are now being test marketed in several US cities.
These recent developments have tobacco control researchers and advocates worried that these important gains in declining smoking rates could be erased. In addition to periodontal problems and cardiovascular disease, ST has been most closely associated with increased risks of oral and pancreatic cancer. There is also concern ST use may be associated with smoking initiation.
It's with that backdrop that the Senate Health, Education, Labor, and Pensions committee earlier this year held a hearing on legislation recently introduced by Senator Edward Kennedy - and cosponsored by senators from both parties - that would grant the Food and Drug Administration (FDA) the authority to regulate tobacco products. In its current form, the legislation would grant FDA the authority to:
- Reinstate a rule promulgated by FDA in 1996 that included significant restrictions on tobacco marketing and sales to youth
- Restrict advertising and promotion of tobacco products to the full extent permitted by the First Amendment
- Require tobacco manufacturers to provide detailed, brand-specific disclosure of ingredients, nicotine, and smoke constituents in their products
- Require changes in current and future tobacco products, including the reduction or elimination of harmful ingredients and constituents
- Strictly regulate products that would be branded "reduced harm"
- Require stronger, more-effective health warnings on tobacco products and advertisements, and ban the use of terms such as "light," "mild," or "low" on labels or in advertising
Important, complex, and unanswered research questions would be raised by additional regulatory authority requirements. Epidemiology and surveillance research would be required to monitor the impact of any modified-risk products introduced into the marketplace, and research would be needed to determine the biological impact of products with lower levels of nicotine and other toxic constituents both on individual and population levels.
NCI's Tobacco Control Research Branch (TCRB) is funding ongoing research on many of the issues raised by tobacco control advocates, including the effects of advertising and promotion on populations most at risk for smoking. In addition, NCI is funding two important efforts that address tobacco products claiming to be reduced harm, one focused on testing such products and the other focused on assessing tobacco use behavior and exposure to toxins among users of such products.
Smoking remains the leading cause of premature, preventable death in the US, accounting for one-third of all cancer deaths. Whatever the outcome of this legislative process, NCI is committed to its ongoing efforts to tackle the scourge of tobacco by funding cutting-edge tobacco control and prevention research.
