ATS policy highlights recommendations to reduce tobacco use, improve health

The American Thoracic Society Tobacco Action Committee released a new policy with recommendations created to reduce tobacco use, and increase research, treatment and tobacco treatment program implementation.

“More robust tobacco control policies are urgently needed,” Michelle N. Eakin, PhD, associate professor in the division of pulmonary and critical care medicine at Johns Hopkins University, and colleagues wrote. “It is important to have a multipronged approach of policy initiatives that target prevention, tobacco product control, treatment and research.”

Recommendations

In partnership with the American Lung Association, the ATS Tobacco Action Committee identified areas of improvement in tobacco control, treatment and research and developed four recommendations.

The four recommendations developed were to:

• strengthen policies to restrict tobacco manufacturing, sales and marketing;
• increase federal investment in tobacco control;
• increase access and funding for nicotine and tobacco dependency treatment; and
• increase tobacco health effects research, treatment and tobacco treatment program implementation.

Although there have been important reductions in tobacco use, failing to prohibit menthol cigarettes, scaling back on the regulation of other flavored tobacco products, delaying FDA reviews of new tobacco products and continuing to allow single use and refillable flavored tobacco products were considered missed opportunities to progress in tobacco cessation efforts. To improve this, the ATS Tobacco Action Committee recommended removing flavored tobacco from the marketplace, increasing taxes on all tobacco products and closely regulate all forms of tobacco or nicotine advertisements.

Increasing federal investment in tobacco control can increase fundings for the CDC’s Office on Smoking and Health to invest in tobacco control, media campaigns and data collection. The authors also highlighted the need for federal investment in youth tobacco prevention, including education campaigns and investing in research through increasing NIH funding for programs and policies to regulate e-cigarette components and/or devices.

The committee also recommended several important tasks to increase access and funding for nicotine and tobacco dependency treatment such as recommending Congress pass the Quit Because of COVID-19 Act. This may enhance the comprehensive tobacco dependence benefit for Medicaid plans as individuals with Medicaid insurance smoke at higher rates compared with those on private health insurances. In addition, removing co-payments and requirements for prior authorization for individuals seeking evidence-based treatment and allowing certified tobacco treatment specialists to bill for tobacco dependence counseling for all insurance types will also aid in tobacco reduction across the U.S.

To better identify individuals at risk for e-cigarette dependence, understand what causes tobacco initiation, sustained use, e-cigarette cessation and how to treat nicotine dependence and addiction, more research is required. The ATS Tobacco Action Committee also recommends establishing codes for e-cigarette and other electronic nicotine delivery systems to aid in informing clinical care and allow studies to obtain data on health outcomes, long-term effects and prevention and cessation interventions.

Looking ahead

“We advocate for continued innovations in policy to reduce economic dependence on tobacco production, such as promoting economically sustainable alternatives for tobacco workers, growers and sellers, both in the U.S. and internationally,” the authors wrote.

According to the authors, there has been a significant reduction in tobacco use, mainly due to robust policy and treatment programs in the past 50 years. To reach the more disproportionately affected populations, prevent use among youths and respond to newer novel tobacco products, these programs require continued investments.

“We need stronger international collaborations to advance tobacco control globally,” the authors wrote. “Given varying international regulatory environments after the introduction of new products (eg, restrictions on advertising and requirements on packaging), U.S. decisions on tobacco control policies could have significant implications for internal policies and programs.”