Dr. Terry F. Pechacek, professor of health management and policy at the School of Public Health at Georgia State University, discusses strategies for tobacco control, including the impact of of e-cigarettes.

1. Accelerating the National
Progress to Reduce Tobacco
Use
Terry F. Pechacek , Ph.D.
Professor of Health Management & Policy
Georgia State University School of Public Health
Retooling and Recommitting:
Policy, Systems, and Environmental Approaches in Tobacco Control
August 19th, 2015 ● Atlanta, Georgia

2. • The current rate of progress in tobacco control
is too slow.
• The tobacco industry continues to position
itself to sustain its sales by:
• recruiting youth and young adults
• Maintaining current smokers as consumers of
all their nicotine-containing products including
cigarettes
Accelerating the National
Progress to Reduce Tobacco
Use

3. Tobacco Product Use by Education Level
NSDUH 2013 Adults aged 18 and older
0
5
10
15
20
25
30
35
40
<HS HS Grad Some College College Grad
Percent Using in Past Month
Any Tobacco Cigarettes Cigars
SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013

4. 5.6 Million Projected Deaths
Key Assumptions
• Initiation rates of smoking among adolescents
and young adults remain high
• Peak birth cohort smoking prevalence in
young adulthood remains high
• Adult cessation rates in young adulthood
remain low
• Tobacco products most commonly used
remain highly lethal

5. Past Year Cigarette Initiates among Persons
Aged 12 or Older, byAge at First Use:
NSDUH 2002-2013
Numbers in Millions Initiated
at Age 18
or Older
Initiated
Prior to
Age 18
SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013

6. Past Month Cigarette Use among
PersonsAged 12 or Older, by Age:
NSDUH 2013
Age in Years
Percent Using in Past Month
SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013

7. Will ENDS be a panacea or peril?
From a clinical
perspective
Using Electronic Nicotine
Delivery Systems could help:
• Smoking combusted
cigarettes is the single
greatest cause of death in
the world.
• Current tobacco control
methods will not achieve
public health objectives.
• Properly regulated, ENDS
have the potential of
providing nicotine at a
much lower level of harm.
From a population
perspective
Electronic Nicotine Delivery
Systems could:
• Increase youth initiation
• Promote dual use
• Delay cessation
• Entice former smokers
back to nicotine
• Re-normalize smoking
• Continue addiction
• Set back progress from
establishing health
promoting social norms

8. Potential Health Impacts of ENDS
• Could have negative and positive individual
and population health impact
Source: 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.
“The impact of the noncombustible
aerosolized forms of nicotine delivery on
population health is much more likely to
be beneficial in an environment where
the appeal, accessibility, promotion, and
use of cigarettes and other combusted
tobacco products are being rapidly
reduced, especially among youth and
young adults.” 2014 SGR, Page 859

9. 2014 SGR Recommendations
 Sustain high-impact media campaigns such as CDC Tips and
FDA youth prevention for 12 months a year for 10+ years
 Raise excise taxes – Average Retail Price of at least $10 per
pack most effective
 Protect 100% of U.S. Population by comprehensive
smokefree indoor air policies
 Fully fund comprehensive statewide tobacco control
programs at CDC-recommended levels
 Expand Smoking Cessation for All Smokers
 Provide access to barrier-free proven tobacco use cessation treatments
 Promote proven tobacco use cessation treatment as a standard of care in
primary and specialty care settings

10. Can novel nicotine products serve as a
disruptive technology and advance
public health?

11. Tobacco Industry in Transition
Industry wants broader nicotine
product market
 Cigarette Target = slow decline in market
 Slow down regulations
 ENDS Market = Keeping Smokers & Recruiting Youth
 Cautious adoption of less-profitable ENDS
 Industry favors tight regulations of innovative “vaping”
 Seek to reverse non-smoking norms
 Defending public health benefits of dual-use
 Non-combustibles & Heat-not-Burn = Growth
 Seek FDA MRTP approvals (e.g., SNUS, then H-n-B)
 Rapidly grow markets (e.g., Marlboro iQOS)

12. Tobacco Industry in Transition
Seeking Public Health Endorsement
 Remember: “When you are dancing with the BEAR,
it is hard to stay in the lead, and when the lights
get low, he will eat you alive!”
 Companies want to manage transition
 Cigarettes have very high profit margins (≈ $1 per pack)
 Disruptive technologies favor innovation NOT
established products
 Regulations can create barriers for innovation
 Financial Analysts Predict Strong Future Tobacco Sales
Volumes (US and Globally)

13. “A defective and
unreasonably dangerous
product”1
End Game scenarios for the U.S. include:
 FDA regulation to:
• Reduce nicotine content to make cigarettes non-
addictive
• Make some or all tobacco products less appealing
• Establish standards for toxicant levels in tobacco
products
 Sales restrictions
• including local and state product category bans
1Proctor RN. Why ban the sale of cigarettes? The case for abolition. Tobacco Control 2013;22:i27-i30

14. End Game Strategies at State/Local Level
• Raise the age of sale to 21
• Decrease access to and visibility of tobacco
products in the community
• decrease density of retail outlets,
• proximity of retail outlets to schools,
• Sales of tobacco products in pharmacies
• Establish Minimum Prices/Prohibit discounting
• Local and state product category bans

15. bit.ly/NoToTobacco

16. Thank You! Questions?
tpechacek@gsu.edu
The Georgia State University
Tobacco Center Of Regulatory
Science