An Evaluation of Efficacy of FDA Policies Regarding Cigarette and E-Cigarette

Lung cancer. Cardiovascular disease. Bronchitis. COPD. Heart disease. Respiratory illness. Pregnancy complications. These are just a few of the copious detrimental physical and mental effects that smoking can have on the body (Alberg et al. , 2014). Smoking kills over 5 million people a year and kills up to half of those that use it (Whittaker, 2010). Yet, unfortunately, smoking is still far too prominent across the world. Clearly, something must be done to reduce cigarette and e-cigarette use, and thereby help to improve the health of millions. So how can this harmful habit be discouraged? The FDA has tried to reduce cigarette and e-cigarette use by way of campaigns, taxes, policies, and other methods of the like, with somewhat limited success. The FDA’s policies regarding cigarette smoking have had limited, insufficient efficacy and its policies regarding e-cigarette use have had negligible efficacy; both can be improved in many ways.

The FDA has indeed made efforts in the past to reduce cigarette smoking via use of text-only warnings, to little effect. In 1965 it became required that the Surgeon General’s warning labels be put on cigarette packages, and in 1972 the same became required for cigarette advertising. This had some effect because warning labels helped increase nationwide awareness of the dangers of cigarettes. However, there are many more domains of cigarette smoking behavior that can be reached, and text-only warnings did not have much effect on discouraging people from smoking (Hitchman et al. , 2013).

Graphic labels are in fact a lot more effective and in one study were shown to reduce craving in smokers (Do and Galvan, 2015). Smoking rates did experience a decline of 5% over a 10-year period after the 1965 policy was instated, but this rate was not as rapid as it should have been and plateaued for a few years after 1975 (CDC, 2016). Clearly, more was needed to have a more extensive impact on smoking behavior. In addition to text-only warnings, the FDA later instated policies that restricted cigarette advertising. In 1970, when the Public Health Cigarette Smoking Act was passed it banned cigarette advertising on TV and radio and required stronger health warnings on cigarette packs. Unfortunately, although the lack of cigarette advertisements on radio and TV did help to reduce the reach and prominence of tobacco promotion, cigarette smoking rates remained the same for 5 years after this policy was instated, then only began to very gradually decline at a rate of about 1% a year (CDC, 2016). Another policy change of significance occurred in 1998, when the tobacco industry approved a Master Settlement Agreement that removed all advertising from billboards, prohibited tobacco sponsorship of youth-prominent events, prohibited transit advertising, and created the National Public Education Foundation, among several other things (Paek et al. , 2010). Cigarette advertisements were removed in many public areas, and further education efforts increased awareness of the dangers of cigarettes. However, this policy was arguably not as strict as it should have been on tobacco companies, and there was in fact only a 5% decrease in smoking rates over the 15 years after the policy was instated (CDC, 2016). The MSA was clearly not as effective as was needed.

Although FDA policies were not having the intended impact on smoking rates, nothing more of notability happened until over a decade later. In 2009, the Family Smoking Prevention and Tobacco Control Act was passed. This placed more restrictions on marketing to minors, required heavier regulation of tobacco company operators/owners, larger warning labels, and required that cigarette ingredients are disclosed to the FDA (Paek et al. , 2010). The act does not ban sales of certain classes of tobacco products. Many have argued that this policy is ineffective and more extensive measures must be taken, as it does not do anything to directly reduce nicotine use, only indirectly makes efforts to encourage smoking reduction (CDC, 2016). So far it has not seemed to deter youth, nor have any remarkable effect on reducing smoking rates. Both adults and youth smoking rates did not decrease by more than 1% per year for 5 years after this 2009 act, which is a slower rate than the nation has seen in the past (CDC, 2016). Improved tobacco policies are still needed to reduce smoking. While the FDA has tried to reduce cigarette use, even its strictest policies and efforts have not had as extensive of consequences on reducing smoking as they should. Research has even shown that “health-related information in cigarette advertising leads consumers to underestimate the detrimental health effects of smoking” (Paek et al. , 2010). The FDA’s cigarette warnings must be improved in order to have an effect on people’s mindset about the dangers of smoking. And while smoking rates overall have been gradually reduced in past years, they are still much higher than they should be and have not been declining at an acceptable, fast rate.

Furthermore, smoking uptake among adolescents in the US has increased across high school classes from 1976 to 2005 (Terry-McElrath et al. , 2015), and as of 2014 according to the CDC youth smoking rates were higher in high school students than adults. Policies have not had the efficacy that is needed in reducing smoking; many more efforts, such as stricter policies and smarter health warnings, are needed to reduce smoking and cigarette use. There is another relatively recent and extremely prominent tobacco epidemic that cannot be ignored: use of e-cigarettes. Unfortunately, FDA policies regarding these products have had negligible effects. Use of these unhealthy and damaging products has skyrocketed in past years, especially among youth. From 2013 to 2015, the percentage of youth who had used e-cigarettes in the past month quadrupled from 4% to 16% (CDC, 2016). This is disturbing, because considering the makeup of the adolescent brain, youth are a group of great importance to discourage smoking and teach the dangers of nicotine to. During adolescence the frontolimbic circuitry, which has been implicated in craving and addiction, is ever-changing. What’s more, neurological systems that have importance in regulating craving are especially susceptible during the adolescent years (Do and Galvan, 2015).

Thus, adolescents are a group of great importance to be educated and targeted in terms of campaigns and policies. In the past couple years, the FDA has instated policies and campaigns designed to reduce e-cigarette use and increase awareness of its dangers. It expanded its “The Real Cost” campaign in September 2017 to include e-cigarette messages, and in April and May of 2018 it began to request information from prominent e-cigarette retailers like JUUL about their marketing relationship with youth (FDA, 2018). While these policies are relatively new, and more time is needed in order to securely determine their efficacy, they thus far have not made sufficient headway and have not seemed to deter e-cigarette use (CDC, 2016). Use of e-cigarettes has done nothing but increase, and furthermore many people, especially youth, think that e-cigarettes are significantly healthier than cigarettes; there seems to be something of an underestimation about just how dangerous e-cigarette use is. Clearly, more and better policies must be implemented in order to change this detrimental smoking behavior.

There is a clear limit on the efficacy of the FDA’s policies regarding cigarette and e-cigarette smoking, so why is this? One of the reasons is that there is a plain lack of public awareness that the FDA even regulates tobacco. In a study by Schmidt et al. (2017), it was found that less than half of their study respondents knew that the FDA regulated how cigarettes and e-cigarettes are sold, made, and advertised. If the FDA made its authority more known to the public, it may increase the public’s perception of its credibility and its willingness to listen to and accept its messages and policies. In a study by Schmidt et al. (2017), it was found that “public knowledge of and beliefs about the credibility of an organization can impact the overall effectiveness of communication activities in changing attitudes and behavior and can enhance support for and compliance with recommendations and regulations”. Thus, a factor in the ineffectiveness of FDA policies may be a simple lack of public awareness of its authority.

Another factor affecting cigarette use reduction has been the fact that warning labels on cigarette packs didn’t change for 25 years, from 1985 to 2016 (Rubin, 2010). This is a huge issue, as the efficacy and currency of health warnings declines over time. In a study by Hitchman et al. (2013), smokers and nonsmokers were interviewed about these warning labels and asked questions such as “do the warning labels make you think about the health risks of smoking?. . . think about quitting?. . . stopped you from having a cigarette?” to evaluate how effective health warnings were over time in discouraging smoking. They found that there were “significant linear declines from 2002 to 2011 in smokers’ reports of thinking about the health risks of smoking because of the health warnings” (Hitchman et al. , 2013). Evidently, when the same warning labels are used for years and years, their effects wear off, which is a massive problem considering the FDA’s sameness with cigarette health warnings.

Thus, major contributing factors to the ineffectiveness of the FDA’s regulations have been the fact that the public seems to be somewhat unaware that the FDA has any control of cigarette regulation, and that the same warning label, which was ineffective from the start, was in place for far too long, It is undeniable that the FDA needs to do more and improve the efficacy of their policies in order to reduce the detrimental effect of smoking. Smoking rates are declining at a very slow speed and have been on this trend for the last 10 years. What’s more, rates are declining at a more gradual pace than they have in previous decades. The FDA’s policies have not had the efficacy that is necessary, despite past and present efforts by government entities.

Luckily, there are many possibilities for implementing policies that would have improved efficacy on reducing smoking. Having multiple campaigns in place at once could be effective in decreasing smoking. Graphic, pictorial warning labels could also be more effective in discouraging people from buying cigarettes rather than text-only warnings, as well as frequently changing warning labels to maintain people’s attention. A further effort that could help reduce smoking is if the FDA were to accept feedback from the public about its policies and increase transparency about its regulation processes. A final aspect that could be valuable is if the FDA teamed up with other relevant groups such as smaller campaign groups, health professionals’ groups, or activists, to strengthen their policy efficacy. Overall, smarter approaches and policies need to be put in place to reduce smoking and improve public health.