National Cancer Institute NCI Cancer Bulletin: A Trusted Source for Cancer Research News
November 16, 2010 • Volume 7 / Number 22

Featured Article

HHS Releases New Tobacco Control Strategy for the Nation

DHHS Secretary Kathleen Sebelius announced proposed graphic warning labels that will appear on cigarette packs and in advertisements. At a press conference on November 10, HHS Secretary Kathleen Sebelius announced proposed graphic warning labels that will appear on cigarette packs and in advertisements. [Enlarge]

The U.S. Department of Health and Human Services (HHS) last week unveiled a new comprehensive tobacco control strategy that seeks to help smokers quit and stop others from starting to use tobacco. One high profile piece of the plan will result in bolder health warnings that must cover the upper half of the front and back of cigarette packages and at least 20 percent of tobacco product advertisements beginning in 2012.

“We want to make sure that every person who picks up a pack of cigarettes knows exactly what the risk is they are taking,” said HHS Secretary Kathleen Sebelius during a November 10 press conference at George Washington University in Washington, DC, an event that also featured FDA Commissioner Dr. Margaret A. Hamburg and HHS Assistant Secretary for Health Dr. Howard Koh.

“This will be the most significant change to health warnings on cigarettes and in cigarette advertisements in more than 25 years,” said Dr. Hamburg. The Family Smoking Prevention and Tobacco Control Act, passed in 2009, granted the FDA authority to regulate the manufacture, marketing, and distribution of tobacco products, and the new warnings provide a concrete example of how that regulation can benefit public health, she added.

Other countries have implemented similar graphic warning labels on cigarette packages, noted Dr. Cathy Backinger, chief of NCI’s Tobacco Control Research Branch (TCRB) in the Division of Cancer Control and Population Sciences (DCCPS), and, based on research findings in recent years, Americans can expect that the new U.S. warning labels will help drive down smoking rates. “The data show that depicting the nature and magnitude of the harms of tobacco use in a realistic manner motivates smokers to quit,” she said.

Using the Evidence Base

The warnings are one part of what Secretary Sebelius called the first-ever comprehensive new strategy designed to help tobacco users quit and keep nonusers from starting. “The strategy rests on four pillars of strategic action,” added Dr. Koh, who co-chaired the working group that developed the plan. (See the sidebar.)

Proposed cigarette warning label with a graphic of a baby and the phrase, 'Warning: Tobacco Smoke Can Harm Your Children.' One of the proposed cigarette warning labels
Unpacking the Plan’s Actions

HHS Assistant Secretary for Health Dr. Howard Koh described the four pillars of strategic action that HHS would undertake as “high-impact interventions.”

Engage the public to change social norms around tobacco use. This effort will include a mass media campaign necessary to counteract the $34 million spent each day by major tobacco manufacturers on marketing. Department-wide messages and a multilevel communication and education campaign will be part of this initiative.

Improve the public’s health. By implementing and expanding evidence-based tobacco control interventions and policies at the state and community level, the goal is to enhance comprehensive cessation services, reduce tobacco-related disparities, increase the enforcement of current regulations, and accelerate the adoption of comprehensive smoke-free laws in every state.

Lead by example and leverage all possible resources. By maximizing all internal resources throughout the department, HHS will model tobacco-free campuses and facilities, including all conferences, as well as comprehensive cessation treatment, provider-education and training, and incentives for employees.

Advance knowledge, accelerate research, and expand the science base. This is especially critical given the FDA’s new authority to regulate tobacco. “The Department looks forward to working with partners around the country to make this vision come alive,” Dr. Koh said.

The objectives described in Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan, revolve around a major metric––reducing the current rate of adult smokers from around 20 percent to 12 percent over the next decade by reducing the initiation of tobacco use by children, adolescents, and young adults, and helping current smokers successfully quit. The plan also includes reducing the exposure of nonsmokers to secondhand smoke and supporting the FDA’s role in regulating the manufacture, marketing, and distribution of tobacco products.

The plan outlines the following key actions: accelerating state and community tobacco control efforts, engaging the public by changing social norms with national media and communications, leading by example to implement model tobacco control policies within HHS, and advancing knowledge by expanding the science base and monitoring progress.

NCI scientists are involved in all four key action areas and DCCPS Director Dr. Robert Croyle represented NIH as co-chair of the steering committee that developed the plan. “We are gratified that NCI’s tobacco control research contributed to the Secretary’s new plan,” said Dr. Debbie Winn, deputy director of DCCPS. “As fewer Americans smoke, we will see fewer deaths from lung cancer and other diseases caused by tobacco use.”

NCI is one of a number of federal agencies contributing to both the implementation of the plan’s activities and building the research base on which it is founded. Dr. Backinger, whose branch has been funding tobacco control programs at the state and community level for years, will serve as co-chair of the subcommittee that monitors research and surveillance as the plan is implemented.

The Time Is Now

“We are truly at an unprecedented time in our nation’s public health history,” said Dr. Koh, who pointed out that the consequences of tobacco are epidemic. Whereas a million people died from tobacco-related causes in the 20th century, “the tobacco epidemic is projected to kill one billion people [worldwide] in the 21st century,” he said.

Lung cancer should be an uncommon disease in this country, he stressed, not the nation’s leading cause of cancer deaths. “This is all preventable,” he added. “For too long, the nation has been forced to tolerate the intolerable and accept the unacceptable.”

Dr. Michael Fiore, director of the University of Wisconsin’s Center for Tobacco Research and Intervention and one of many experts who helped craft the plan, explained why he agrees that this is an unprecedented time and opportunity for making advances in American public health.

“Among the most important public health achievements in the latter half of the 20th century was halving tobacco dependence in America from about 42 percent in the mid-1960s to just over 20 percent today,” he said. But that progress has been uneven, he added, because “tobacco has become concentrated among some of the members of our society with the least resources to overcome it, such as the poor, the least educated, and those with other mental and physical health conditions. There are enormous opportunities now to make a difference with these populations––including people who are on Medicare and Medicaid, for example.”

Dr. Fiore added that it will take more than the federal government to make full use of these opportunities. “HHS and the whole government can provide leadership,” he said, “but it will require a full partnership with the research and private-sector communities in order to make the objectives in this plan a reality.”

—Addison Greenwood

To Learn More

HHS has posted a full copy of the strategic plan, along with the related press release and a Webcast of the press announcement, online.

Examples of each of the proposed cigarette warning labels can be found on the FDA Web site.

NCI has many resources to help people quit smoking, including a Web page with links to fact sheets, quit guides, and other tools and information, and the NCI Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).