National Cancer Institute's leadership role in promoting State and Community Tobacco Control research

Abstract

The National Cancer Institute (NCI) has been at the vanguard of funding tobacco control research for decades with major efforts such as the Community Intervention Trial for Smoking Cessation (COMMIT) in 1988 and the American Stop Smoking Intervention Study (ASSIST) in 1991, followed by the Tobacco Research Initiative for State and Community Interventions in 1999. Most recently, in 2011, the NCI launched the State and Community Tobacco Control (SCTC) Research Initiative to address gaps in secondhand smoke policies, tax and pricing policies, mass media countermeasures, community and social norms and tobacco marketing. The initiative supported large scale research projects and time-sensitive ancillary pilot studies in response to expressed needs of state and community partners. This special issue of Tobacco Control showcases exciting findings from the SCTC. In this introductory article, we provide a brief account of NCI's historical commitment to promoting research to inform tobacco control policy.

The 1964 Surgeon General's report on Smoking and Health spurred education, programmatic and policy intervention, litigation and social norm changes that revolutionised how Americans view tobacco. Cigarette smoking prevalence among US adults has declined from 42.4% in 1965 to 16.8% in 2014.¹ Tobacco control efforts since 1964 have prevented an estimated 8 million US deaths and extended mean life span by 19–20 years.² Still, tobacco use remains the leading cause of preventable, premature death in the USA, including mortality from lung and other cancers.³ High tobacco use persists based on many factors such as income, education and comorbid mental health conditions. For example, in 2014, cigarette smoking was at 15.2% for people above the federal poverty level versus 26.3% for those below.^{3 4} In addition, while secondhand smoke (SHS) exposure dropped from 50% among non-smokers in 1999–2000 to 25% in 2011–2012, exposure remains high among many groups including poor people and non-smoker African-American adults and children.⁵ These high rates of smoking prevalence and SHS exposure translate into significant inequalities in lung cancer incidence and mortality.^{6 7} Redoubled tobacco control is needed to reverse these disparities and reduce cancer incidence. In particular, science-based policy approaches hold great promise to further decrease the health, social and economic burdens of tobacco use, and narrow the observed disparities across subpopulations.³

State and community-level tobacco control policies and programmes attempt to change social-environmental contexts, which in turn influence tobacco-related attitudes and behaviours. Policy is effective because of its broad reach, ability to change social norms and because it can be implemented at lower cost than individual interventions.^{8 9} Policies that increase taxes, establish smoke-free workplaces and restrict marketing are highly effective for reducing tobacco use, and for increasing support for tobacco-free environments.¹⁰

The National Cancer Institute (NCI) has been at the vanguard of funding tobacco control research with major efforts such as the Community Intervention Trial for Smoking Cessation (COMMIT) in 1988,¹¹ the American Stop Smoking Intervention Study (ASSIST) in 1991,^{12 13} and the Tobacco Research Initiative for State and Community Interventions in 1999.¹⁴ In 2011, the NCI launched the State and Community Tobacco Control (SCTC) Research Initiative to address policy research gaps, with large-scale studies and time-sensitive pilot investigations based on state and community needs.¹⁵ Grantees were also charged with developing effective strategies to disseminate their research findings to a wide array of audiences, including tobacco control programmes, public health practitioners, researchers, and federal, state and local policymakers. A full description of the SCTC Research Initiative is available at http://sctcresearch.org/PublicHome. Over 100 publications and 285 conference presentations have been authored so far, and this special issue of Tobacco Control showcases additional findings.

Return on research investment has been significant, but further inquiry will be critical for continued progress. Consumers are now exposed to and are increasingly using a wider variety of products, including cigars, little cigars and cigarillos, smokeless tobacco products, electronic nicotine delivery systems (ENDS) and waterpipes.¹⁶ As of March 2016, 4 states and Washington, DC, allow marijuana consumption and 23 States, Guam and Washington, DC, have passed medical marijuana laws.^{17 18} Marijuana and cannabis oil are often combined with cigars, cigarillos and ENDS.^{19 20} Increased alternative product and marijuana use may influence tobacco use patterns, and may also threaten implementation and enforcement of smoke-free policies. Legislated definitions of ENDS may affect whether existing sales, marketing, youth access and taxation laws for cigarettes will apply to ENDS, and thus complicate policy-making.²¹ Synergistic opportunities between local tobacco control and federal regulation are forthcoming.²² For example, the 2009 Family Smoking Prevention and Tobacco Control Act expanded local governments' ability to curtail tobacco product advertising, and, as a result, states and localities have started implementing innovative strategies such as new community point-of-sale marketing restrictions.²³ Clearly, future state and community tobacco control policy research will need to adapt in order to study this increasingly complex and dynamic product and policy landscape while also striving to complement Federal regulatory authority.