Highlights: United States

The lack of federal government action in 2012 was a stark difference from the past few years when the Obama Administration aggressively implemented policies to reduce the burden of tobacco use, the leading cause of preventable death.

The lack of action by the FDA was particularly noteworthy. As a result of the 2009 Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), FDA was given authority over all tobacco products, but it has failed to assert its jurisdiction and to begin to regulate tobacco products other than cigarettes and smokeless tobacco products, including cigars and e-cigarettes.

In the absence of FDA asserting its authority over other tobacco products, the tobacco industry moved swiftly to capitalize on this void. There has been a proliferation of e-cigarette marketing and sales, as well as claims that the products will help smokers quit. The cigar industry has also capitalized, with the introduction of bills in the House and Senate that would take away future FDA oversight of most cigars. Manufacturers have also released new tobacco products, maneuvering their way around the poorly executed substantial equivalence provision, which is supposed to prohibit manufacturers from introducing new products without FDA's prior authorization. FDA has even failed to act on the recommendations of the expert Tobacco Products Scientific Advisory Committee, making no effort to remove menthol cigarettes from the market.

The Administration has not taken advantage of opportunities to help smokers quit. In a proposed rule released in November 2012, the Department of Health and Human Services (HHS) indicated it would allow each state to pick its own benchmark insurance plan, which will then serve as the standard for plans in that state's health insurance exchange. While preventive services, including tobacco cessation, must be covered in every state's benchmark plan, HHS does not guarantee that states will offer a comprehensive cessation benefit. The Lung Association has called for HHS to specifically define a comprehensive cessation benefit.

In April 2012, the Government Accountability Office issued a report that found "significant market shifts" had occurred as a result of the 2009 federal cigarette tax increase and recommended that Congress equalize tax rates across all tobacco products (i.e. increase the tax on other tobacco products to the level of cigarettes) and consider other measures to reduce tax avoidance. The Lung Association has encouraged Congress to consider tobacco tax increases and parity as part of its negotiations on sequestration.

There is one notable exception to the federal government's shortcomings of 2012: the "Tips from Former Smokers" mass media campaign. This campaign, which features testimonials from real former smokers living with disease caused by tobacco use, served as an avenue to discourage smoking and encourage quitting, by featuring the federal government's tobacco cessation resources, 1-800-QUIT-NOW and www.smokefree.gov. Both 1-800-QUIT-NOW and www.smokefree.gov saw a significant increase in callers and visitors during the 12 week campaign. Given the tremendous impact, the Lung Association urges this or similar media campaigns to continue in 2013.