Excise Tax Boosts, Restrictions on Tobacco Marketing, and Federal Regulatory Control Over Tobacco Are Among Steps Needed to Reduce Smoking in the U.S.

A combination of increased excise taxes, nationwide indoor smoking bans, and other measures would significantly lower the U.S. smoking rate, which now hovers at around 21 percent of the adult population, says a new report from the Institute of Medicine.  But to achieve faster, more certain reductions, the U.S. Food and Drug Administration (FDA) should be given broad regulatory authority over tobacco marketing, packaging, and distribution, and other revisions to current tobacco policy should be enacted, said the committee that wrote the report.

Although smoking in the United States has declined by more than 50 percent since 1964, tobacco use still claims about 440,000 lives every year, and secondhand smoke causes another 50,000 deaths annually.  Smoking-related health costs are estimated to be $89 billion a year. 

Ending the Tobacco Problem: A Blueprint for the Nation proposes a two-pronged approach to further reduce tobacco use in the United States.  The first element focuses on strengthening existing tobacco control measures to preserve and enhance the gains already made.  The committee's recommendations include:

• Increasing the federal excise tax on cigarettes substantially, and boosting taxes in states with lower rates to achieve greater parity in prices nationwide and thwart interstate smuggling.
• Dedicating $15 to $20 per capita annually of the proceeds from higher taxes or other resources to fund tobacco control efforts in each state.
• Imposing smoking bans in all nonresidential indoor settings nationwide, including restaurants, bars, malls, prisons, and health care facilities.
• Requiring all public and private health insurance plans to make coverage of smoking cessation programs a lifetime benefit.
• Licensing retail outlets that sell tobacco products.
• Launching additional efforts aimed at curbing youth interest in smoking and access to tobacco, including bans on online sales of tobacco products and direct-to-consumer shipments.

These measures focus on reducing demand for cigarettes, but do not address the addictive aspects of tobacco or constrain manufacturers' incentives to attract more smokers.  The committee expressed concern that overall smoking rates may not drop significantly below 15 percent and that youth smoking rates may not fall permanently below 20 percent unless the basic legal framework of the tobacco market is changed.  Therefore, it proposed a second set of further-reaching recommendations.  Specifically, the committee called for:

• Changing federal law to give FDA authority to regulate tobacco products, including powers to restrict how they can be marketed.
• Removing federal restrictions on state laws so that states are free to supplement federal regulations with more stringent measures to suppress smoking.
• Limiting tobacco advertising and promotional displays to text-only, black-and-white formats.
• Prohibiting tobacco companies from using misleading terms such as "mild" and "light."
• Requiring new, large pictorial warnings on the harmful effects of smoking -- similar to those required in Canada -- on all cigarette packs and cartons.
• Requiring manufacturers to correct false or misleading information on products and at the point of sale.
• Restricting the type or number of outlets that can sell tobacco products, and requiring them to display warnings and give a proportional amount of space to cessation aids.
• Prohibiting tobacco companies from targeting youth for any purpose and urging them to redirect money they now spend on prevention to independent public health organizations.
• Developing a plan for gradually reducing the allowable nicotine content of cigarettes.

The study was sponsored by the American Legacy Foundation.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.