Tobacco use remains the nation's leading cause of preventable death. The emergence of e-cigarettes and legalized marijuana use, and the increasing concentration of tobacco use among some racial and ethnic groups, poor people, people with mental illness, and young adults are all changing the environment in which tobacco control efforts take place. High quality state and local tobacco control policies and programs not only prevent tobacco use and disease, but can be an important component of health care cost containment, a key concern at all levels of government and in the private sector. The tobacco industry continues to work to stop or blunt these efforts' effectiveness. All tobacco control programs are not equally effective at reducing smoking and health care costs, making it important to quantify the effects of tobacco control policies and programs. Our research will inform the development and implementation of effective tobacco control policies and programs in this rapidly changing environment through three specific aims: 1. Identify and analyze the new challenges to state and local tobacco control policymaking and program implementation to inform the development of effective responses to these challenges. 2. Identify policy and demographic determinants of smoking initiation, progression and cessation, including smokefree policy coverage and cigarette taxes, as well as variation in these determinants by race/ethnicity and socioeconomic status. 3. Quantify the magnitude and quality of tobacco control program spending across states and the relationship between associated changes in smoking behavior and healthcare expenditures. We will pursue Aim 1 through a series of detailed case studies of the development and effects of state tobacco control policies and programs on tobacco use.
For Aim 2 we will merge national datasets, beginning with the National Longitudinal Survey of Youth, with policy data on clean indoor air laws, tobacco taxes, price and demographic variables to develop new models of smoking behavior that will provide a framework for better understanding how these policies affect individual behavior and health disparities. We will pursue Aim 3 using modern econometric methods to quantify the effects of state tobacco control programs, allowing for differences in program effectiveness on smoking behavior and, in turn, the effects of both smoking and tobacco control programs on health care costs. This more sophisticated understanding of what tobacco control policies and programs are most effective, together with understanding the tobacco industry's evolving efforts to block these policies, will help public health professionals develop, implement, and defend effective tobacco control policies and strategies that respond to this changing environment.

Public Health Relevance

(RELEVANCE) Smoking is the leading preventable cause of death, accounting for 1/3 of all cancer deaths and 540,000 deaths annually. Reducing this burden requires understanding the health impact (including on associated healthcare costs) of different tobacco control programs and policies as well as how the tobacco industry works to block these efforts and maintain a favorable environment to promote tobacco use. This research will inform health authorities on how to use increasingly limited resources most efficiently to prevent tobacco use and promote cessation.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA043950-27
Application #
9893866
Study Section
Community Influences on Health Behavior Study Section (CIHB)
Program Officer
Kimmel, Heather L
Project Start
1994-07-01
Project End
2021-06-30
Budget Start
2020-07-01
Budget End
2021-06-30
Support Year
27
Fiscal Year
2020
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
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Kulik, Margarete C; Lisha, Nadra E; Glantz, Stanton A (2018) E-cigarettes Associated With Depressed Smoking Cessation: A Cross-sectional Study of 28 European Union Countries. Am J Prev Med 54:603-609
Cho, Hong-Jun; Dutra, Lauren M; Glantz, Stanton A (2018) Differences in Adolescent E-cigarette and Cigarette Prevalence in Two Policy Environments: South Korea and the United States. Nicotine Tob Res 20:949-953
Chaffee, Benjamin W; Watkins, Shannon Lea; Glantz, Stanton A (2018) Electronic Cigarette Use and Progression From Experimentation to Established Smoking. Pediatrics 141:
Barry, Rachel A; Glantz, Stanton A (2018) Marijuana Regulatory Frameworks in Four US States: An Analysis Against a Public Health Standard. Am J Public Health 108:914-923
Yang, Y Tony; Glantz, Stanton (2018) San Francisco Voters End the Sale of Flavored Tobacco Products Despite Strong Industry Opposition. Ann Intern Med 169:708-709
Jawad, Mohammed; Lee, John Tayu; Glantz, Stanton et al. (2018) Price elasticity of demand of non-cigarette tobacco products: a systematic review and meta-analysis. Tob Control 27:689-695
Dutra, Lauren M; Glantz, Stanton A; Arrazola, René A et al. (2018) Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette Smoking. J Adolesc Health 62:532-538
Orenstein, Daniel G; Glantz, Stanton A (2018) Regulating Cannabis Manufacturing: Applying Public Health Best Practices from Tobacco Control. J Psychoactive Drugs 50:19-32
Glantz, Stanton A; Halpern-Felsher, Bonnie; Springer, Matthew L (2018) Marijuana, Secondhand Smoke, and Social Acceptability. JAMA Intern Med 178:13-14

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