Despite strong reductions in smoking prevalence, cigarette smoking remains the leading preventable cause of death in the US, and lung cancer is the leading cause of smoking-attributable deaths. Prior to 2009, marketing, manufacture and sale of tobacco products was not under the purview of the Food and Drug Administration (FDA). The 2009 Family Smoking Prevention and Control Act gave the FDA authority over tobacco products, under a new regulatory standard of protection of the public health. FDA actions regarding tobacco must take into account population level impacts of proposed regulation on the public health, considering users and non-users of tobacco alike. In response to changes in both smoking patterns and tobacco regulation, new, non-cigarette tobacco products have been introduced which are marketed as substitutes for or complements to cigarettes. At the population level, these products have the potential to improve public health by reducing cigarette consumption, or to decrease public health by reducing smoking cessation and encouraging smoking initiation. There is thus an urgent need for quantitative population-level estimates of cigarette smoking behavior, including cessation rates, consumption levels, and initiation rates. These estimates must be detailed enough to incorporate important predictors of cigarette smoking which might be impacted either by FDA regulation or by marketing and use of new tobacco products. There is also an urgent need to quantify the effect of changes in cigarette smoking behaviors on lung cancer mortality, also at the population level. This proposal is for secondary data analysis of the publicly available, federally-sponsored surveys of tobacco use, including the Tobacco Use Supplement to the Current Population survey; the National Health Interview Surveys (NHIS) and their Mortality Linked Files; and the National Survey on Drug Use and Health. The large sample sizes and representative nature of these surveys enable detailed estimates of smoking behavior at the state and regional level, by gender, age, and within race/ethnic groups.
The specific aims of the grant are : 1) to quantify US population rates of smoking cessation, including success rates per quit attempt; 2) to identify important associations between use of other tobacco products and cigarette smoking behavior; and 3) to quantify the population impact of cigarette consumption level and quitting history on subsequent lung cancer mortality, within birth cohorts. The UCSD team has a successful history of conducting and analyzing national and state population surveys of tobacco use. The team has broad experience in tobacco control studies, in epidemiology and statistics, and in behavioral intervention trials, including smoking cessation trials. The study team is thus well poised to conduct population-level tobacco control studies relevant to new regulatory issues surrounding tobacco.
Despite reductions in smoking prevalence, cigarette smoking remains the leading preventable cause of death in the US, and lung cancer is the leading cause of smoking-attributable deaths. New, non-cigarette tobacco products are being marketed as complements to cigarettes, for example to avoid smoking restrictions, and these have the potential to increase or decrease cigarette smoking rates at the population level. We propose to use the large federally-sponsored surveys of tobacco use to quantify changes in cigarette smoking behaviors which may be associated with marketing and use of new tobacco products, and to quantify the effect of changes in cigarette smoking behavior on population-level lung cancer mortality rates.
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