Tobacco Product Control
Overview
Tobacco use is the leading preventable cause of death and
illness in the United States, causing more than 480,000
deaths each year1. Most adult tobacco users start before 18
years of age, and use is often instigated by exposure to
parental and peer smoking, smoking in movies and other
media, and advertising that targets children and adolescents2.
The connection between children and tobacco use is so strong
that the Commissioner of the US Food and Drug Administration
(FDA) declared smoking a “pediatric disease” in 19953.
Through creation and enforcement of laws that prevent minors
from gaining access to tobacco, states can reduce not only
adolescent tobacco use rates, but over time, adult tobacco use
rates. State tobacco product control legislation can take many
different forms and includes increasing tobacco excise taxes
(which has been proven to reduce tobacco use), counteradvertising, elimination of tobacco industry sponsorship and
promotions, and restrictions on the sale of tobacco products.
AAP Recommendations
• According to the 2015 AAP Policy Statements, “Public
Policy to Protect Children From Tobacco, Nicotine, and
Tobacco Smoke” and “Electronic Nicotine Delivery
Systems”, youth demand for tobacco should be reduced.
Prices of tobacco products should be raised and costsaving measures like samples, discounts, duty-free sales,
or coupons should be eliminated. Venues for unsupervised
purchase of tobacco products, such as vending machines
and online merchants, should be eliminated. All tobacco
products should be placed behind sales counters to reduce
access to minors.
• Provision of tobacco products to youth by adults is illegal;
significant consequences for noncompliance should be
enforced. The minimum purchase age of tobacco products
should be raised to 21. The National Academy of Medicine
has backed this stance- a recent report found that raising
the tobacco product purchase age to 21 will save lives4.
Pushing back the age of tobacco purchase to 21 helps
keep cigarettes out of the hands of younger potential
smokers- the majority of people who purchase for
distribution to minors are between the ages of 18 and 20,
and younger students likely do not share social circles with
21 year olds.
updated October 2015
• All tobacco products should be labeled to warn users of
the health hazards of tobacco use. Warnings should use
clear wording, in the strongest possible terminology, and
should be prominently displayed on packaging (occupying
more than 50% of the front), on advertisements, and on
displays at tobacco sales facilities. These messages should
be rotated to present a new warning on a regular basis.
• Advertising of tobacco products should be prohibited from
all media, events, and venues, including the Internet.
Products such as t-shirts, sports equipment, and other
items should not bear messages or images that depict
tobacco products or promote tobacco use. Electronic
Nicotine Delivery Systems (ENDS), also known as ecigarettes, should be included in these regulations. The
FDA should regulate all tobacco products. Flavoring agents
(including menthol) should not be used in tobacco
products, as these flavored products are particularly
popular with youth. Tobacco products resembling candy or
mints should be prohibited, as these products can be
mistaken for candy and are a poisoning hazard for children.
New tobacco and nicotine delivery products not already on
the market should be prohibited unless well-designed,
independently conducted research shows that their
introduction to the market would benefit public health.
• Exposure to and depiction of tobacco product use should
be reduced in films, videos, DVDs, video games, and
television programs. The evidence is very strong that
depiction of tobacco use in media is a significant factor in
the uptake of tobacco use by children and youth5. Any new
film that shows or implies tobacco use should be given a
Motion Picture Association of America rating of “R”. The
only exceptions should be when the presentation of
tobacco clearly and unambiguously reflects the risks and
consequences of tobacco use or the depicted tobacco use
is necessary to represent that of a real historical figure that
actually used tobacco. It should be certified that no one
working on or associated with the production received
anything of value (money, gifts, publicity, loans, or anything
else) in exchange for using or displaying tobacco products.
The closing credits of every film depicting tobacco use or
displaying images of tobacco products should contain such
a declaration, and a clear, unambiguous anti-smoking ad
(not funded or produced by a tobacco company) should
appear prior to the start of the film. Tax subsidies should
not be given to films that include smoking.
• Local, state, and federal tax policies should support
tobacco control. Higher taxes have been shown to deter the
purchase and use of tobacco and prompt cessation
attempts6, accordingly, local, state, and federal taxes on
tobacco products should be implemented and/or
increased. The revenue from these taxes should be used to
support evidence-based tobacco control programs. All
tobacco products, including cigarettes, cigars, smokeless
tobacco, and ENDS, should be taxed at the same rates.
• Tobacco farming price supports and subsidies should be
eliminated. Alternative revenue sources should be
developed for and promoted to tobacco farmers, and
children should be protected from the harms of farming
tobacco
Counter-advertising and Tobacco “Prevention” by the Tobacco
Industry
One way to combat the tobacco industry’s powerful influence is
to implement evidence-based counter-advertising programs,
which should include prevention and cessation themes.
Developing message content through formative research
and use of brief, recurring messages that encourage
individuals to remain tobacco free is an effective approach in
mass media campaigns. For instance, advertising campaigns
that reflect the health consequences of tobacco use (eg,
depictions of real people suffering from tobacco use, displays
of graphic pictures of diseased organs, and messages about
the tobacco industry’s tactics) have been shown to be more
effective than humorous or emotionally-neutral campaigns.
Tobacco Control Mechanisms
In developing a counter-marketing program, it is crucial to be
aware of initiatives devised by the tobacco industry. Tobacco
industry prevention programs generally still maintain access to
minors as potential consumers. These programs are ineffective
and more harmful than beneficial10. Often, tobacco industry
prevention programs communicate that smoking is an “adult
choice;” emphasize that youth smoking is against the law;
target parents rather than youth; focus on peer pressure as a
cause of smoking; and target younger teens rather than older
teens (who are at a much higher risk for smoking initiation).
Studies from the American Journal of Public Health11,12 and a
report from the National Cancer Institute13 have determined
that tobacco industry-sponsored anti-tobacco ads are not
preventing youth from smoking or persuading youth to stop
smoking and may have even caused youth to smoke.
Evidence-Based Pricing Strategies
Increasing the unit price of tobacco products through
increasing state tobacco excise taxes is an effective means to
reduce tobacco use among youth7. Such increases make
tobacco use less attractive to youth who typically have limited
amounts of money to spend. Revenues from these taxes
should be used to fund tobacco prevention and cessation
programs.
Media and Advertising Restrictions
In 1998, the Master Settlement Agreement (MSA) imposed
specific limitations and restrictions on the tobacco industry’s
ability to advertise tobacco products to youth, distribute brandname apparel and merchandise, sponsor events using brand
names, and distribute free samples and gifts to minors8. The
Family Smoking Prevention and Tobacco Control Act (FSPTCA),
enacted in 2009, strengthened MSA restrictions and imposed
new restrictions on tobacco advertising and marketing. The
FSPTCA authorizes state and local lawmakers to restrict the
time, place, and manner, but not the content, of cigarette
advertising. States may not regulate content because
commercial speech is protected under the First Amendment,
which requires that any restrictions on commercial speech
must directly advance the government’s substantial interest in
reducing youth and adult tobacco use; must not be more
extensive than necessary to promote these governmental
interests; and will allow tobacco companies to reasonably
communicate with legal tobacco product customers. Under the
FSPTCA, the FDA contracts with states to actively promote
state level enforcement, inspect manufacturers, retailers, and
distributors to identify violations of the law’s restrictions and
limitations9.
updated October 2015
Using authority granted by the FSPTCA, states play an
important role in counteracting the effects of tobacco
advertising. Taking into account First Amendment constraints,
states may restrict commercial displays in retail outlets, with
the exception of text- only informational displays (eg, pricerelated product characteristics). States should also require
tobacco retailers to display and distribute warnings about the
health consequences of tobacco use, information regarding
products and services for cessation, and corrective messages
to offset misstatements about the health effects of tobacco
use.
Brand-Name Sponsorships
While the MSA prohibits tobacco company sponsorship of team
sports, events with a large youth audience, and events with
underage participants, the Regulations Restricting the Sale
and Distribution of Cigarettes and Smokeless Tobacco to
Protect Children and Adolescents, within the FSPTCA, go
further. Whether or not underage participants are present, the
FSPTCA Regulations prohibit brand name sponsorship of any
athletic, musical, or other social or cultural event, or
sponsorship of any team or other entries involved in those
events13. States contracting with the FDA can inspect retailers
to ensure there is no brand name sponsorship of such events.
Advocacy Considerations
Promotional Items, Samples, and Point of Sale Restrictions
The Regulations Restricting the Sale and Distribution of
Cigarettes and Smokeless Tobacco to Protect Children and
Adolescents also provide for restrictions, with some limitations,
on tobacco promotional items and prizes, free samples,
labeling, and point of sale advertising (subject to commercial
speech limitations under the First Amendment). Free samples
of smokeless tobacco may only be distributed in qualified
adult-only facilities, where each person present in the facility
must present a government-issued photo identification to a law
enforcement officer or security guard14. Again, states that
contract with the FDA can inspect retailers to ensure
compliance with the FSPTCA.
• Encourage effective counter-advertising. States should
consider promoting programs that contribute to the
prevention and decrease of tobacco use by youth, including
programs that discourage tobacco use.
Sales Restrictions
Under the Regulations Restricting the Sale and Distribution of
Cigarettes and Smokeless Tobacco to Protect Children and
Adolescents, a retailer must: not sell cigarettes to anyone
younger than the age of 18; verify age through photo
identification (but no verification is required for individuals
older than the age of 26); not sell cigarettes in packages of
less than 20; sell tobacco in only a direct face-to- face manner,
with some exceptions; and prohibit the sale of cigarettes and
smokeless tobacco products via vending machines and selfservice displays (except in facilities where minors younger than
the age of 18 are not present or permitted to enter at any
time).
With the recent introduction of a wide variety of tobacco
products, minors are at an even greater risk of acquiring an
addiction to tobacco, meaning that states should consider
strengthening existing retail laws to cover newer,
nontraditional tobacco products. These products include, but
are not limited to, electronic cigarettes, rolling paper,
dissolvable products, and flavored tobacco14. Flavored
cigarettes and smokeless tobacco products are especially
attractive to children because they come in a variety of fruit
and/or candy flavors. Tobacco companies are notorious for
deliberately marketing such products to a younger population
so that they may develop a lifelong addiction at an early age15.
Eliminating the sale of such products to minors is one
mechanism states may use to prevent youth from using
tobacco.
updated October 2015
• Tobacco addiction is a children’s health issue. Close to
90% of adult smokers smoke their first cigarette prior to age
182. Strengthening barriers to youth tobacco access is the
best opportunity for decreasing tobacco use and improving
health outcomes over time.
• Raising tobacco taxes should be considered. A recent
analysis by the Congressional Budget Office found that a
mere 50 cent increase in federal excise tax per cigarette
pack would lead to roughly 10,000 adult lives saved by
202116. These improvements in health would lead to
increased payroll tax and income tax amounts from people
who were able to work longer, or be more productive16. This
would increase revenues by $700 million, and contribute
.003% of the U.S. Gross Domestic Product (GDP) by 202116.
Between 2013 and 2021, the tobacco tax would save
federal taxpayers nearly a billion dollars ($730 million)
because of lower health care expenditures16.
• Effective, comprehensive counter-marketing programs
must: be long-term; consist of integrated components; be
integrated into a larger tobacco control program; be
culturally relevant; be strategic; be evaluated; and be
adequately funded17.
• Emphasize the broad public support for laws aimed at
adolescent smoking prevention. Laws aimed at preventing
youth from smoking have high public opinion ratings.
According to a 2013 public opinion poll by the Mellman
Group, 76% of voters favor the law passed in 2009
(FSPTCA) that gives the FDA “authority to regulate tobacco
products, including restrictions on sales and marketing
towards children”18.
• Require businesses to obtain a license to sell tobacco
products over the counter and/or in vending machines.
Retailers required to obtain a license in order to sell
tobacco products have a strong incentive to comply with
laws governing tobacco sales for fear of license suspension
or revocation. License suspension or revocation can
constitute a painful loss since sales from tobacco products
often generate major revenues.
WHAT YOU CAN DO TO ACHIEVE EFFECTIVE
TOBACCO CONTROL IN YOUR STATE
Share these advocacy considerations and your
concerns about tobacco control issues with your state’s
AAP chapter. Communicating with your state’s AAP
chapter is an excellent way to voice your opinion, build
coalitions and relationships with pediatricians and
other physicians, increase statewide awareness of the
issue, and ultimately motivate state lawmakers to
strive for adequate tobacco control during legislative
sessions.
AAP Resources
AAP Julius B. Richmond Center of Excellence
http://www.aap.org/richmondcenter/
AAP Tobacco Policy Statements
• Public Policy to Protect Children From Tobacco,
Nicotine, and Tobacco Smoke
• Electronic Nicotine Delivery Systems
http://www2.aap.org/richmondcenter/AAPPolicyAdvocacy.htm
l
AAP Tobacco Prevention Policy Tool
http://www2.aap.org/richmondcenter/TobaccoPreventionPolic
yTool/index.html
Other Resources
American Lung Association– State Legislated Action on
Tobacco Issues (SLATI)- Smoking Restrictions
http://www.lungusa2.org/slati/search.php
American Lung Association– State of Tobacco Control
www.stateoftobaccocontrol.org/
Americans for Nonsmokers’ Rights– Tobacco Industry
“Prevention” Programs
http://no-smoke.org/document.php?id=276
Campaign for Tobacco-Free Kids– The Impact of the New FDA
Tobacco Law on State Tobacco Control Efforts
www.tobaccofreekids.org/research/factsheets/pdf/0360.pdf
Centers for Disease Control and Prevention– Designing and
Implementing an Effective Tobacco Counter-marketing
Campaign
http://www.cdc.gov/tobacco/stateandcommunity/counter_ma
rketing/manual/pdfs/tobacco_cm_manual.pdf.
Chaloupka, Frank J. Macro-Social Influences– The Effects of
Price and Tobacco Control Policies on the Demand for Tobacco
Products. Nicotine Tob Res. 1999; S1: S77- S81.
updated October 2015
Department of Health and Human Services– Ending the
Tobacco Epidemic: A Tobacco Control Strategic Action Plan for
the US Department of Health and Human Services
http://www.hhs.gov/ash/initiatives/tobacco/tobaccostrategic
plan2010.pdf
Use and Secondhand Smoke Exposure: Mass-Reach Health
Communication Interventions
http://www.thecommunityguide.org/tobacco/massreach.html.
Institute of Medicine Report– “Ending the Tobacco Problem: A
Blueprint for the Nation” (2007) – Recommendation 1
http://www2.aap.org/richmondcenter/pdfs/IOMReport_Bluepr
intforNation.pdf.
Tobacco Control Legal Consortium– Placement of Tobacco
Products
http://publichealthlawcenter.org/sites/default/files/resources
/tclc-guide-placementoftobprods-2011.pdf.
Tobacco Control Legal Consortium– Restricting Tobacco
Advertising
http://publichealthlawcenter.org/sites/default/files/resources
/tclc-guide-restricttobadvert-2011.pdf.
US Food and Drug Administration– Office of Compliance &
Enforcement, Center for Tobacco Products - Enforcement
Action Plan for Promotion and Advertising Restrictions: October
2010
www.fda.gov/downloads/TobaccoProducts/GuidanceComplian
ceRegulatoryInformation/UCM227882.pdf.
Citations
1) U.S. Department of Health and Human Services. The Health
Consequences of Smoking—50 Years of Progress: A Report of
the Surgeon General. Atlanta, GA: U.S. Department of Health
and Human Services, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health, 2014.
2) U.S. Department of Health and Human Services. Preventing
Tobacco Use Among Youth and Young Adults: A Report of the
Surgeon General. Atlanta, GA: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2012.
3) Kessler D. et al. Nicotine Addiction: A Pediatric Disease.
Journal of Pediatrics. 1997; 130(4): 518-524.
4) U.S. National Academy of Medicine. Public Health
Implications of Raising the Minimum Age of Legal Access to
Tobacco Products. http://www.iom.edu/Reports/2015/
TobaccoMinimumAgeReport.aspx. Accessed October 15,
2015.
5) Wellman R. et al. The Extent to Which Tobacco Marketing
and Tobacco Use in Films Contribute to Children’s Use of
Tobacco. Arch Pediatr Adolesc Med. 2006; 160: 1285- 1296.
16) Baumgardner J., et al. Cigarette Taxes and the Federal
Budget — Report from the CBO. N Engl J Med. 2012; 367:
2068-2070.
6) Tobacco Control Legal Consortium: Tobacco Tax Basics: An
Introduction to Key Considerations for States. February 2012.
Available at http://publichealthlawcenter.org/sites/default
/files/resources/tclc-fs-tobaccotax-basics-2012.pdf. Accessed
October 15, 2015.
17) Centers for Disease Control and Prevention– Best
Practices for Comprehensive Tobacco Control Programs
2014. Available at http://www.cdc.gov/tobacco/
stateandcommunity/best_practices/index.htm. Accessed
October 15, 2015.
7) Chaloupka F, Pacula R. The impact of Price on Youth
Tobacco Use. Changing Adolescent Smoking Prevalence:
Where It Is and Why. Tobacco Control Monograph No. 14.
Bethesda, MD: US Department of Health and Human Services;
2001.
18) Campaign for Tobacco-Free Kids: The Mellman Group- FDA
Regulation of Tobacco Products. Available at
http://www.tobaccofreekids.org/content/press_office/2013/2
013_06_survey/Pollster Memo for Release.pdf Accessed
October 15, 2015.
8) State of California Department of Justice – Office of the
Attorney General: Tobacco Master Settlement Agreement
Highlights. Available at http://oag.ca.gov/tobacco/highlights.
Accessed October 15, 2015.
9) US Food and Drug Administration: Overview of the Family
Smoking Prevention and Tobacco Control Act. Available at
http://www.fda.gov/downloads/TobaccoProducts/GuidanceCo
mplianceRegulatoryInformation/UCM336940.pdf. Accessed
October 15, 2015.
10) Campaign for Tobacco-Free Kids: Big Surprise: Tobacco
Company Prevention Campaigns Don’t Work; Maybe It’s
Because They Are Not Supposed To. Available at
http://www.tobaccofreekids.org/research/
factsheets/pdf/0302.pdf. Accessed October 15, 2015.
11) Landman A., et al. Tobacco Industry Youth Smoking
Prevention Programs: Protecting the Industry and Hurting
Tobacco Control. Am J Public Health. 2002; 92: 917–930.
12) Ibrahim J., et al. The Rise and Fall of Tobacco Control
Media Campaigns, 1967-2006. Am J Public Health. 2007;
97(8): 1383-1396.
13) National Cancer Institute. The Role of the Media in
Promoting and Reducing Tobacco Use. Tobacco Control
Monograph No. 19. Bethesda, MD: U.S. Department of Health
and Human Services, National Institutes of Health, National
Cancer Institute. NIH Pub. No. 07-6242, June 2008.
14) US Food and Drug Administration: Regulations Restricting
the Sale and Distribution of Cigarettes and Smokeless
Tobacco. Available at http://www.fda.gov/tobaccoproducts/
labeling/rulesregulationsguidance/ucm360573.htm.
Accessed October 15, 2015.
15) Campaign for Tobacco-Free Kids: Not your Grandfather’s
Cigar. Available at http://www.tobaccofreekids.org/
what_we_do/industry_watch/cigar_report/. Accessed October
15, 2015.
updated October 2015
CONNECTING WITH YOUR STATE AAP CHAPTER IS EASY
This brief provides an introduction to state
government issues and additional background
information that can be used when communicating
about tobacco product control. To locate your state’s
AAP chapter, please visit the AAP Chapter Contacts
Listing page on the AAP Web site:
http://www.aap.org/member/chapters/chaplist.cfm