Tobacco Regulation in the United States

Public Health: Regulation of Tobacco Use in the US

Public health efforts to regulate tobacco use in the US due to the associated morbidity and mortality date from way back in history (Tam et al., 2018). Interventions such as advertisement restrictions, counter-marketing campaigns, smoke-free policies, and increasing the price of tobacco products have helped to reduce the prevalence of smoking among youth and adults. The US regulatory authority has also attempted to regulate the marketing, distribution, and sale of tobacco products through enforcement of the Tobacco Control Act of 2009 (Tam et al., 2018). However, there is still a lot that needs to be done since tobacco use remains to be a significant problem affecting both adolescents and adults in the US and a leading cause of preventable deaths. Besides, the health gains resulting from reduced smoking are unequally distributed across the US creating disproportionate public health problems among some populations (Tam et al., 2018). Therefore, this analysis seeks to investigate the effectiveness of tobacco regulation policies by answering questions regarding their impact at the public/social health level. The evaluation also intends to provide recommendations to improve the interventions aimed at reducing cigarette use.

Background

The burden of tobacco consumption in the US is overwhelmingly caused by cigarette smoking. Approximately 480,000 deaths every year, and many more illnesses are attributed to active and passive smoking of cigarettes (Jamal et al., 2018). Although the prevalence of smoking is higher among men aged from 25-64years, the problem exists irrespective of age and gender. The result is not only health issues but also an economic burden on individuals and families following the high cost of cigarettes, lost productivity as well as the associated healthcare expenses (Jamal et al., 2018). Tobacco regulation laws with a focus on population-based interventions are essential to address the massive problem of smoking.

The existing policy addressing the issue is the Tobacco Control Act. Ever since its initiation, cigarette taxes in the US have increased by between $0.5 and $6 depending on the brand, the target market, and the state (Tam et al., 2018). Additionally, according to the policy, the minimum legal age of tobacco access is 21years. Therefore, any underage individual cannot access cigarettes or other tobacco products unless through illegitimate means. The act also provides guidelines for designated smoking zones by making provisions for smoke-free air laws to be applied in public places such as restaurants, workplaces, and bars.

Whereas the Tobacco Control Act has helped to lessen the number of illnesses and deaths related to smoking in the US, it has its share of strengths and weaknesses. The most noteworthy strength is in how the policy comprehensively addresses different scenarios related to tobacco use and provides suggestions to help reduce smoking among populations (Tam et al., 2018). Nonetheless, the provisions of the act are reliable as extensive research using credible methods informs them. However, the law needs some amendments as it lacks sufficient details on the implementation of the tobacco control programs mentioned therein (Tam et al., 2018). Besides, there are assumptions regarding the effect of inflation on cigarette prices and whether or not the introduced taxes will be felt directly by the consumers.

The key stakeholders affected by the policies include cigarette smokers following increased taxes and restrictions regarding the acceptable smoking areas. The manufacturers and distributors of cigarettes and other tobacco products are also affected due to the price increase as well as changes in the legal age of consumers. Following the implementation of the act, vendors have to be cautious about the age of their customers to avoid breaking the law (Jamal et al., 2018). Furthermore, the government and non-governmental organizations also feel the impact of the policy as they are the main contributors to the implementation of tobacco control programs, as highlighted in the act.

Analysis

In a bid to achieve the objective of regulation of tobacco use, in 2011, the US Congress passed an alternative policy titled the Tobacco Products Regulation Act (Green, 2019). Unlike the Tobacco Control Act that mainly focused on cigarette use, this legislation sought to regulate all tobacco products. The Food and Drug Administration (FDA) agency was given the responsibility to ensure the successful implementation of the act (Green, 2019). A further alternative policy is the Contraband Cigarette Trafficking Act of 2003. The legislation made it illegal for any individual apart from the exempt person to carry out the business of contraband cigarettes. The aim was to reduce the number of cigarettes distributed at both the state and local levels.

While both of these policies are valuable as they address different aspects of the problem of increased use of tobacco, the best one will be selected based on its effectiveness and coverage. The Tobacco Products Regulation act covers a wide range of smoking options, including new products such as cigars, nicotine gel, and dissolvable tobacco (Green, 2019). It is also useful in regulating tobacco use through reduced marketing and sensitization of the harmful effects. On the contrary, the Contraband Cigarette Trafficking act has less coverage as it provides regulations for cigarettes and smokeless tobacco only (Williams, Derrick & Phillips, 2017). Even so, it is useful in minimizing cigarette sales to minors who mainly purchase from illicit traders due to their low prices and non-compliance to age restrictions.

Both alternatives also have significant impacts on healthcare and patient outcomes. Overall, tobacco products have no known health benefits. However, the Tobacco Products Regulation act requires cigarette manufacturers to meet a given standard to ensure the goods do not cause additional harm other than the long-term effects of smoking (Green, 2019). The manufacturers also have to submit health information to the FDA and include the adverse effects of cigarettes and other products on the packaging before distribution. Conversely, the Contraband Cigarette Trafficking Act helps to reduce illicit trade of tobacco; hence, minimizing instances whereby traders sell counterfeit products (Williams, Derrick & Phillips, 2017). The use of safe cigarettes lessens the threat to the health and the odds of adverse patient outcomes. Generally, the trade-off between alternatives creates a compromise on the most effective policy with more significant strengths and lesser shortcomings.  

Recommendations

Based on the analysis above, the Tobacco Products Regulation Act is the best alternative to address the current issue and policy situation. Its coverage and effectiveness not only cuts across all tobacco products but also addresses all age-groups. Nevertheless, the guidelines in the policy are such that an individual is allowed to make an informed decision on whether or not to use tobacco based on the information provided without curtailing their freedom of choice. Whereas trafficking can be combated, without appropriate education and regulation of the legal tobacco products, smoking will continue to be a menace in the US (Williams, Derrick & Phillips, 2017). The probable strategy for implementing this alternative entails the sensitization of populations and working closely with the producers of tobacco products to regulate the manufacture, distribution, and sale. An expected barrier is how to effectively combine the components of research, communication, and education to implement successful tobacco control programs at the national and community levels (Tam et al., 2018). Methods to evaluate policy implementation include measuring the achievement of pre-set targets and assessing the impact on populations, for instance, how many premature smoking-related deaths have been averted.  

Discussion

Research shows that since the implementation of the Tobacco Control Act, there was no significant reduction in the morbidity and mortality rates attributable to smoking (Tam et al., 2018). The Tobacco Products Regulation Act sought to address its shortcomings, particularly those related to the range of regulated products and implementation of successful interventions. The recommendations stemming from the analysis will solve the public health problem of increased tobacco use and help reduce the occurrence of resultant issues. The limitation of this analysis lies in the over-reliance on secondary data following limited primary research on the effectiveness of the policy. Such creates concerns in the validity of data, which the evaluation negated by using credible secondary sources. Nevertheless, the implications of this alternative policy will encourage education and research to enhance the fill in the gaps in knowledge and consequently inform the further decisions relating to tobacco regulation.

Trade-offs Between Alternatives

Conclusion

Tobacco regulation in the US requires combined efforts from policy-makers, government agencies such as FDA, citizens, and non-governmental organizations. Implementing the guidelines in the Tobacco Control Act and its alternative, the Tobacco Product Regulation Act, is likely to be easier with co-operation across states and among relevant stakeholders. Nonetheless, future policy analysis should address the effect of the assumptions presented by the tobacco control laws. For instance, while they do not account for the differences in socioeconomic status, they assume that increasing taxes will reduce tobacco consumption across all states. Overall, the goal to reduce tobacco use in the US can be achieved if the efforts of different stakeholders persist.

References

Green, V. R. (2019). FDA Regulation of Tobacco Products. Congressional Research Service, 1–39.

Jamal, A., Phillips, E., Gentzke, A. S., Homa, D. M., Babb, S. D., King, B. A., & Neff, L. J. (2018). Current cigarette smoking among adults—United States, 2016. Morbidity and Mortality Weekly Report, 67(2), 53-59. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772802/pdf/mm6702a1.pdf

Tam, J., Levy, D. T., Jeon, J., Clarke, J., Gilkeson, S., Hall, T., ... & Meza, R. (2018). Projecting the effects of tobacco control policies in the USA through microsimulation: A study protocol. BMJ Open, 8(3), 1-13. doi:10.1136/bmjopen-2017-019169

Williams, R. S., Derrick, J., & Phillips, K. J. (2017). Cigarette sales to minors via the internet: how the story has changed in the wake of federal regulation. Tobacco Control, 26(4), 415-420. doi:10.1136/tobaccocontrol-2015-052844