ENDING THE

TOBACCO EPIDEMIC

A Tobacco Control Strategic

Action Plan for the

U.S. Department of Health

and Human Services

ENDING THE TOBACCO EPIDEMIC

A Tobacco Control Strategic

Action Plan for the

U.S. Department of Health

and Human Services

November 10, 2010
Suggested Citation:

U.S. Department of Health and Human Services. Ending the Tobacco Epidemic:

A Tobacco Control Strategic Action Plan for the U.S. Department of Health and Human Services.

Washington, DC: Office of the Assistant Secretary for Health, November 2010.

3

Table of Contents

Introduction 5

The Vision and Charges 7

Challenges: The Burden of Tobacco Use and Barriers to Progress 10

Opportunities: What Works in Tobacco Control 14

Major Tobacco Control Activities at the

U.S. Department of Health and Human Services 17

Strategic Actions 19

1. Improve the Public’s Health: Strengthen the implementation of evidence-based

tobacco control interventions and policies in states and communities . . . . 19

2. Engage the Public: Change social norms around tobacco use 20

3. Lead by Example: Leverage HHS systems and resources to create

a society free of tobacco-related disease and death 21

4. Advance Knowledge: Accelerate research to expand the science base

and monitor progress 23

Create Synergy: Future steps for sustainable progress 25

Conclusion 26

Endnotes 27

References . . . . . . . . . . . . . . .32

Appendices 37
Introduction

“Our work to protect our children and improve the public’s 

health is not complete. Today, tobacco is the leading

preventable cause of death not just in America, but also

in the world.”

President Barack Obama

June 22, 2009

Cigarette smoking and exposure to secondhand smoke kill an estimated 443,000 people in 

the United States each year.1 For every smoker who dies from a smoking-attributable disease, 

another 20 live with a serious smoking-related disease.2 Smoking costs the United States $96 

billion in medical costs and $97 billion in lost productivity each year.3 Despite progress in 

reducing tobacco use, one in five U.S. high school students and adults still smoke.4,5

These statistics reflect a legacy of millions of lives prematurely lost from tobacco use, reflecting a tragic public health history. Before the introduction of the modern mass-marketed cigarette in the late 1800s, lung cancer was rare. In stark contrast, lung cancer is now this nation’s 

leading cause of cancer death among both men and women, killing an estimated 160,000 

people in the United States each year.6 The dramatic rise in smoking in the 20th century 

prompted a prominent historian to refer to that time period as “The Cigarette Century.”7

But the 21st century has witnessed a convergence of public attitudes and political support 

that creates an unprecedented opportunity for the United States. On June 22, 2009,

President Obama signed into law historic legislation granting the U.S. Food and Drug

Administration (FDA) authority to regulate tobacco products to protect the public health.

In reviewing the need to accelerate progress in tobacco control and announcing the new

FDA regulations restricting tobacco marketing to children on March 19, 2010, Kathleen

Sebelius, Secretary of Health and Human Services, stated, “This needs to be a national effort.

The lesson that we should take from the successes of the past 50 years is not that progress

is inevitable. It’s that saving lives and reducing health costs is possible, but only if we pursue 

an aggressive policy agenda.”
5

On March 23, 2010, President Obama signed into law historic health insurance reform

legislation, the Patient Protection and Affordable Care Act (Affordable Care Act). As noted 

by Secretary Sebelius in testimony before the U.S. House of Representatives on April 21, 

2010, the law creates a new Prevention and Public Health Fund that will provide a significant 

investment to “allow HHS to expand and sustain prevention, wellness, and public health 

programs to improve the health of the nation and help restrain health care costs.” The law 

also specifically expands smoking cessation coverage now for pregnant Medicaid beneficiaries 

and enhances prevention initiatives in 2013 by offering financial incentives to States

to provide optional services that encourage healthy behaviors by Medicaid beneficiaries.

The U.S. Department of Health and Human Services (HHS) can leverage this historic

moment to launch a new chapter to end tobacco-related suffering and death.

This strategic action plan proposes a comprehensive approach designed to mobilize HHS’s 

expertise and resources in support of proven, pragmatic, achievable interventions that can

be aggressively implemented not only at the federal level, but also within states and communities. The activities described in the plan are meant to serve as a guideline for future development, are conditional, and are subject to the availability of resources. Implementing the 

strategic actions in this plan can enable the United States to meet the Healthy People objective 

of reducing the adult smoking rate to 12%.8 Together, the recommended actions offer

an historic opportunity to accelerate our efforts to end the tobacco problem.
6

The Vision and Charges

In November 2009, Secretary of Health and Human Services

Kathleen Sebelius charged HHS to develop a Department-wide 

strategic action plan for tobacco control. The Secretary named 

Assistant Secretary for Health Howard K. Koh, MD, MPH, as chair 

of the working group that would develop the plan.

The Tobacco Control Working Group (“Working Group”) committed to realizing the

following vision:

A society free of tobacco-related death and disease

During its review, the Working Group noted that the Institute of Medicine’s (IOM’s) 2007 

Ending the Tobacco Problem: A Blueprint for the Nation argued persuasively that “aggressive 

policy initiatives will be necessary to end the tobacco problem. Any slackening of the public health response may reverse decades of progress in reducing tobacco-related disease and 

death.”9

 IOM concluded that the ultimate goal of ending the tobacco problem in the United 

States can be achieved with a two-pronged strategy:

•	 Strengthening and fully implementing traditional tobacco control measures

•	 Changing the regulatory landscape to permit policy innovations

Echoing the IOM, the President’s Cancer Panel (PCP), in its 2007–2008 Annual Report, set 

forth as one of its primary goals to “End the scourge of tobacco in the United States.”

As stated by the PCP, “ridding the nation of tobacco is the single most important action 

needed to dramatically reduce cancer mortality and morbidity. There is no substitute for this 

action if we are to eliminate the sickness and death caused by tobacco use. For the health and 

future strength of our nation, this preventable epidemic of disease must be brought to the 

most rapid end possible.”10
7

The Working Group therefore based its work on two ambitious charges:

1. Develop and implement a Department-wide strategic action plan framed around four

of the Healthy People 2020 tobacco control objectives:

•	 Reduce tobacco use by adults and adolescents.

•	 Reduce the initiation of tobacco use among children, adolescents, and young adults.

•	 Increase successful cessation attempts by smokers.

•	 Reduce the proportion of nonsmokers exposed to secondhand smoke.

2. Support the Food and Drug Administration’s (FDA’s) newly acquired role to regulate the 

manufacture, marketing, and distribution of tobacco products.

The Working Group included the substantial and unprecedented participation

of public health experts from across HHS, representing the following agencies 

and offices:

•	 Administration for Children and Families (ACF)

•	 Administration on Aging (AoA)

•	 Agency for Healthcare Research and Quality (AHRQ)

•	 Assistant Secretary for Administration (ASA)

•	 Assistant Secretary for Financial Resources (ASFR)

•	 Assistant Secretary for Health (OASH)

•	 Assistant Secretary for Legislation (ASL)

•	 Assistant Secretary for Planning and Evaluation (ASPE)

•	 Assistant Secretary for Public Affairs (ASPA)

•	 Centers for Disease Control and Prevention (CDC)

•	 Center for Faith-Based and Neighborhood Partnerships (Partnership Center)

•	 Centers for Medicare and Medicaid Services (CMS)

•	 Food and Drug Administration (FDA)

•	 Health Resources and Services Administration (HRSA)

•	 Indian Health Service (IHS)

•	 National Institutes of Health (NIH)

•	 Office for Civil Rights (OCR)

•	 Office of the Secretary (OS)

•	 Office of the Surgeon General (OSG)

•	 Substance Abuse and Mental Health Services Administration (SAMHSA)
8

The Working Group organized around four subcommittees:

•	 Tobacco Use Cessation and Treatment

•	 Prevention Policies, Education, and Communication

•	 Surveillance and Monitoring

•	 Tobacco Regulation

The Working Group agreed that the plan should:

•	 Accelerate progress in reducing tobacco use.

•	 Be bold and innovative.

•	 Be evidence-based and achieve a large-scale public health impact.

•	 Engage all HHS agencies in a collaborative, Department-wide strategy.

•	 Be operationally feasible, starting immediately.

•	 Bolster and support tobacco control plans at the local, state, federal, and

international levels.

International tobacco control efforts were deemed especially important, given the vast scale 

of the worldwide tobacco epidemic and the fact that 168 nations have now ratified the World 

Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the 

world’s first public health treaty, which fashions a global approach to combating the tobacco 

epidemic.

This plan begins by describing the challenges and opportunities in tobacco control.

It concludes by presenting specific strategic actions whereby HHS can achieve the vision

of a society free from tobacco-related death and disease.
9

Challenges: The Burden of Tobacco Use and Barriers

to Progress

The United States has made historic progress in combating the epidemic of tobacco-caused 

illness and death since the landmark 1964 Surgeon General’s Report on the health effects of 

cigarette smoking. Since then, adult smoking rates in the United States have been cut in half 

(from 42.4% in 1965 to 20.6% in 2008). More than half of all adults who have ever smoked 

have quit.11 This substantial decline has been characterized as one of the 10 greatest achievements in public health in the 20th century.12

Despite this progress, tobacco use remains the leading cause of premature and preventable 

death in our society.13 Worldwide, the tobacco epidemic killed 100 million people in the 

20th century and is projected to kill one billion people worldwide in the 21st century. Each 

year, smoking kills more than five million people around the globe.14

In the United States, smoking kills an estimated 443,000 people each year, with secondhand 

smoke responsible for 50,000 of those deaths.15 The list of diseases caused by smoking has 

been expanded to include abdominal aortic aneurysm, acute myeloid leukemia, cataract,

cervical cancer, kidney cancer, pancreatic cancer, pneumonia, periodontitis, and stomach 

cancer.These are in addition to previously known diseases, including bladder, esophageal, 

laryngeal, lung, oral, and throat cancers; chronic lung diseases; coronary heart and cardiovascular diseases; reproductive effects; and sudden infant death syndrome (SIDS).16 Tobacco

use causes more deaths than HIV/AIDS, alcohol use, cocaine use, heroin use, homicides, 

suicides, motor vehicle crashes, and fires combined.17

Secondhand smoke exposure also causes serious disease and death in adults and children, 

including heart disease, lung cancer, SIDS, acute respiratory infections, ear problems, and 

asthma attacks.18

Approximately 8,600,000 people in the United States have chronic illnesses related

to smoking.19 Cigarette smoking also costs the nation $193 billion in health care costs and 

lost productivity each year. Of those costs, private and public health care expenditures for 

smoking-related health conditions are estimated at $96 billion.20

While smoking among U.S. adults is down significantly from a decade ago, the decline

in the adult smoking rate has now stalled, with virtually no change in prevalence since 2004.

The current smoking rate of 1 in every 5 adults far exceeds the national goal set by Healthy 

People, which aimed to reduce adult prevalence to less than 12%. If the current trend

continues, the adult smoking rate likely will remain considerably higher than this target.21
10

Members of certain racial/ethnic minority groups,22,23,24,25 individuals of low socioeconomic 

status (SES),26 pregnant women,27 and other groups carry a disproportionate burden of risk 

for tobacco use and tobacco-related illness and death. Smoking rates are highest among 

American Indians/Alaska Natives (32.4%).28 Subpopulations such as Korean, Vietnamese, 

and Puerto Rican men also have very high smoking rates compared with the overall population. Although African Americans have lower smoking rates compared with American 

Indians/Alaska Natives and whites (21.3%, 32.4%, and 22%, respectively),29 they bear the 

greatest burden of tobacco-caused cancer.30,31,32,33 Thirty-one percent of persons living in 

poverty smoke, and the challenges continue to be greatest among adults with low educational 

attainment.34 In 2008, an estimated 36% of adults with 9 to 11 years of education and 41% 

of adults with a general equivalency diploma smoked.35 Tobacco use exerts a huge toll on 

persons with mental illnesses and substance abuse disorders, accounting for 200,000 of the 

annual 443,000 annual tobacco-related deaths in the United States. Persons with chronic 

mental illness die 25 years earlier than the general population does, and smoking is the major 

contributor to that premature mortality. This population consumes 44% of all cigarettes,

reflecting very high prevalence rates plus heavy smoking by users.36 Available evidence also 

reports very high smoking rates among lesbian, gay, bisexual and transgender populations; 

however, these populations remain underrepresented in current surveillance systems used

to monitor tobacco use.
11

Significant tobacco-related disparities also exist by geographic area, with higher smoking rates 

typically in states with few smoke-free protections, lower tobacco taxes, and limited tobacco 

control program funding. Enormous disparities exist by race/ethnicity, age, and socioeconomic

status in secondhand smoke exposure. Among the highest exposed are:

•	 71% of African Americans

•	 63% of low-income individuals

•	 61% of children aged 4-11 years37

The use of tobacco products by the nation’s children is a pediatric disease of considerable proportion. Every day, nearly 4,000 young people under 18 try their first cigarette, and approximately 1,000 become daily smokers.38 Most adult smokers tried their first cigarette before age 

18.39 Smokeless tobacco use among youth is also a major problem, with an estimated 13% of 

high school males using smokeless tobacco products in 2007.40 An estimated six million

of today’s youth will eventually die

prematurely from smoking.41
12

Mass marketing has special appeal for children and adolescents. In 2006, the major U.S. 

cigarette manufacturers spent approximately $12.5 billion—or more than $34 million every 

day—to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking and tobacco use.42 Advertising, marketing, and promotion of 

tobacco products have been especially directed to attract young people.43 Data demonstrate 

that the depiction of cigarette smoking in movies glamorizes

its use for young people and substantially increases smoking initiation by youth.44

There is also a growing concern regarding new tobacco products that are being marketed

to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and 

smokeless tobacco can maintain tobacco addiction, encouraging continued tobacco use 

among smokers who might otherwise quit.45,46 The marketing of smokeless tobacco and

other purported reduced-risk products, as well as manufacturers’ related health claims, may 

increase overall tobacco use. Consumer perceptions of the “safety” of these products may 

pose a continuing obstacle for tobacco prevention and control strategies. Tobacco use will 

remain the leading cause of preventable death and disease in this nation and elsewhere unless 

prevention and control efforts become commensurate with the harm.
13

Opportunities: What Works in Tobacco Control

We know how to end the tobacco epidemic. A number of authoritative scientific publications

have identified interventions that are effective in reducing tobacco use and, when fully

implemented, will dramatically reduce tobacco use. Four publications in particular form

the central foundation for understanding and executing the most effective tobacco control 

interventions:

•	 Best Practices for Comprehensive Tobacco Control Programs—2007

•	 Guide to Community Preventive 

Services

•	 Treating Tobacco Use and Dependence: 2008 Update

•	 Report on the Global Tobacco 

Epidemic, 2008: The MPOWER 

Package

All four publications conclude that tobacco control programs that are comprehensive,

sustained, and accountable are far more 

effective in reducing tobacco use and 

tobacco-attributable death and disease 

than piecemeal efforts. These publications also provide the evidence base 

for the Institute of Medicine’s (IOM’s) 

Ending the Tobacco Problem: A Blueprint 

for the Nation and its call for the implementation and intensification of effective 

tobacco control interventions that have 

proven to be effective.

First, the Centers for Disease Control 

and Prevention’s (CDC’s) Best Practices 

for Comprehensive Tobacco Control Programs, fully updated in 2007, provides 

concrete, detailed, programmatic guidance for implementing many of the recommendations 

of the IOM report. Second, the Task Force for Community Preventive Services’ Guide to 

Community Preventive Services, updated in 2005, similarly identifies a number of evidencebased, effective tobacco control interventions and helped inform CDC’s Best Practices publication as well as the technical guidance that CDC provides to state tobacco control programs. Third, the U.S. Public Health Service Clinical Practice Guideline Treating Tobacco Use 

and Dependence: 2008 Update identifies effective, experimentally validated tobacco dependence treatments and practices.

Fourth, at the global level, the World Health Organization’s (WHO’s) Report on the Global 

Tobacco Epidemic, 2008: The MPOWER Package mirrors the recommendations of the foregoing publications by presenting a strategic framework of six evidence-based, high-impact 

Every Day in the 

United States

The tobacco industry spends over 

$34 million to market and promote 

its products.

Almost 4,000 adolescents start smoking.

Approximately 1,200 current and 

former smokers die prematurely from 

tobacco-related diseases.

The nation spends more than 

$260 million in direct medical costs 

related to smoking.

The nation experiences nearly 

$270 million in lost productivity 

due to premature deaths from 

tobacco-related diseases.

CDC’s Best Practices for Comprehensive 

Tobacco Control Programs—2007
14

tobacco control interventions that have proved effective:

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce restrictions on tobacco advertising, promotion, and sponsorship

Raise taxes on tobacco

These four publications referenced above endorse a number of evidence-based tobacco

control interventions that collectively reduce tobacco use:

•	 Youth-targeted mass-media countermarketing campaigns. Tobacco use prevalence 

declines when adequately funded mass-media countermarketing campaigns are combined with other strategies in multicomponent tobacco control programs. The most 

prominent of these efforts is the national truth® campaign (February 2000–2004),

which resulted in approximately 450,000 fewer adolescents initiating smoking in

the United States.47 During 2000–2002, the truth® campaign spent $324 million

on media, research, public relations, and related expenditures. A cost-utility analysis 

found that the campaign recouped its costs and that just under $1.9 billion in medical

costs were averted for society over the lifetimes of the youth who did not become 

smokers.48

•	 Adoption of comprehensive smoke-free laws. Smoke-free policies improve indoor 

air quality, reduce negative health outcomes among nonsmokers, decrease cigarette 

consumption, encourage smokers to quit, and change social norms regarding the 

acceptability of smoking.49 A 2009 IOM report, Secondhand Smoke Exposure and 

Cardiovascular Effects: Making Sense of the Evidence, confirmed a strong causal relationship between implementation of smoke-free laws and decreases in heart attacks.50

Elimination of secondhand smoke exposure also reduces lung cancer and other

pulmonary diseases.51

•	 Availability of accessible, affordable tobacco cessation options. Tobacco dependence is a chronic disease that often requires repeated interventions and multiple 

quit attempts. The U.S. Public Health Service Clinical Practice Guideline, Treating 

Tobacco Use and Dependence: 2008 Update, notes that tobacco dependence treatments, such as counseling and use of medications, are effective across a broad range 

of populations. The combined use of medication and counseling almost doubles the 

smoking abstinence rate compared with either medication or counseling alone.

Quitlines are among the most cost-effective clinical preventive services and can reach 

large numbers of smokers with proper promotion and clinical referral.52

•	 Raising the retail price of tobacco products through excise tax increases. For 

every 10% increase in the price of tobacco products, consumption falls by approximately 4% overall, with a greater reduction among youth.53,54 The 2009 enactment 
15

of the 62-cent federal cigarette excise tax increase to fund an expansion of the State 

Children’s Health Insurance Program is projected to prevent initiation of smoking by 

nearly two million children. The tax increase will also have the projected benefits of 

causing more than one million adult smokers to quit, averting nearly 900,000 smoking-attributed deaths, and producing $44.5 billion in long-term health care savings 

by reducing tobacco-related health care costs. Similar effects are found when states 

raise tobacco excise taxes.55

•	 Restricting advertising and promotion. The National Cancer Institute 2008 

monograph, The Role of the Media in Promoting and Reducing Tobacco Use, documents

that tobacco advertising and promotion increase tobacco use. It concludes that 

countries that have implemented comprehensive tobacco advertising bans have been 

successful in reducing tobacco consumption by as much as 5.4%.
16

On a population level, combining these interventions through comprehensive, multicomponent, sustained tobacco control programs markedly reduces tobacco use, prevents heart

attacks, lowers cancer rates, and ameliorates the incidence of chronic disease. States and 

locales that have made significant investments in comprehensive tobacco control programs 

have seen cigarette sales drop more than twice as much as in the entire United States. Smoking prevalence among adults and youth decline faster with increased spending for tobacco 

control programs.56,57,58 The 2007 CDC Best Practices recommends an investment of $9 to 

$18 dollars per capita for optimal tobacco control outcomes. Prominent examples include:

•	 California: As a result of the efforts of the California Tobacco Control Program, 

smoking rates among adults declined from 22.7% (1988) to 13.8% (2007).59

In the first decade of its program, California reduced lung cancer rates among men 

more rapidly than in other parts of the country and reduced lung cancer rates among 

women while these rates continued to increase elsewhere. Overall, this constituted

a drop of 6%—or 11,000 fewer cases—most of which would have been fatal.60

•	 Florida: Between 1998 and 2002, a comprehensive prevention program, anchored 

by an aggressive youth-oriented health communications campaign, reduced smoking 

rates among middle school students by 50% and among high school students

by 35%.61

•	 Massachusetts: Comprehensive tobacco control program efforts, which included

a mass media campaign and tobacco tax increases, reduced statewide consumption

by 48% in the first decade (1993–2003) before the program was stripped of nearly

all funding.62 In July 2006, Massachusetts health care reform provided tobacco

cessation coverage for all MassHealth (Medicaid) populations, including behavioral

counseling and all FDA-approved treatments. Subsequently, the number of 

MassHealth members who smoked dropped from 38% to 28%, representing a 26% 

decrease (July 2006–December 2008).63

•	 Other states: Maine, New York, and Washington have seen 45% to 60% reductions

in youth smoking rates with sustained comprehensive statewide programs. For

example, between 2000 and 2006, the New York State Tobacco Control Program

reported that adult smoking prevalence declined 16% and smoking among high 

school students declined by 40%, resulting in more than 600,000 fewer smokers

in the state over the 7-year intervention period.64

•	 New York City: Beginning in 2002, a comprehensive effort to reduce tobacco use 

included 1) increasing tobacco taxes, 2) establishing a strong smoke-free policy,

3) implementing aggressive media campaigns, 4) providing free cessation services

to smokers, and 5) conducting rigorous evaluation to measure the results. As a result, 

youth smoking rates were reduced by about 50% and adult smoking rates decreased 

from 21.6% (2002) to 15.8% (2008).65
17

Major Tobacco Control Activities at the U.S. Department

of Health and Human Services

HHS has provided national leadership for comprehensive tobacco prevention and control. 

Current programs constitute a critical foundation from which to launch this strategic plan. 

The following is a succinct inventory of activities, with a more detailed overview provided

in Appendix C. Efforts include programs to:

•	 Expand the science base for effective tobacco control; conduct surveillance and 

monitoring of tobacco use and the effectiveness of tobacco control efforts. The 

National Institutes of Health (NIH) and Centers for Disease Control and Prevention

(CDC) lead HHS’s efforts on research and disseminate evidence-based findings

to prevent, treat, and control tobacco use. HHS maintains surveillance and evaluation systems—such as the Behavioral Risk Factor Surveillance System, the National 

Health and Nutrition Examination Survey, National Health Interview Survey,

National Survey on Drug Use and Health, Monitoring the Future, and the National 

Youth Tobacco Survey—that monitor the prevalence of tobacco use; the knowledge, 

attitudes, and behaviors related to tobacco use; exposure to tobacco/tobacco smoke 

constituents; and the effectiveness of tobacco prevention and control interventions

at both the national and state levels. The Agency for Healthcare Research and Quality 

led a consortium of federal and nonfederal groups that sponsored the development 

and release of the U.S. Public Health Service Clinical Practice Guideline Treating 

Tobacco Use and Dependence: 2008 Update, which is the gold standard for effective 

clinical treatments for tobacco dependence.

•	 Build sustainable capacity and infrastructure for comprehensive tobacco control 

programs. Through the National Tobacco Control Program (NTCP), CDC provides 

coordinated national efforts to reduce tobacco-related diseases and deaths. NTCP 

funds all 50 states, the District of Columbia, 8 U.S. territories, 7 tribal support 

centers, as well as 6 national networks devoted to reducing tobacco-related morbidity 

and mortality and tobacco-related disparities among priority populations. The funding leverages significant state investments to implement comprehensive, evidencebased tobacco control interventions. The National Network of Tobacco Cessation 

Quitlines, a collaborative effort between the National Cancer Institute (NCI) and 

states that is supported and funded through NTCP and state funding, makes free 

telephone cessation counseling available in the United States.

•	 Regulate the manufacture, marketing, and distribution of tobacco products.

The 2009 Family Smoking Prevention and Tobacco Control Act provides the Food 

and Drug Administration (FDA) with the authority to regulate the manufacture, 

distribution, advertising, and promotion of tobacco products. Some of FDA’s responsibilities under the law include setting tobacco product standards, reviewing premarket applications for new and modified-risk tobacco products, requiring new health 

warnings, and establishing and enforcing advertising and promotion restrictions. 

The Substance Abuse and Mental Health Services Administration enforces the Synar 

Amendment, which requires states, the District of Columbia, and the 8 U.S. jurisdictions to enact and enforce laws prohibiting the sale of tobacco products to individuals 

younger than 18 years of age.
18

•	 Communicate timely, relevant information about tobacco issues to policymakers, health professionals, business leaders, partners, and the public. HHS, 

through its agencies and offices, conducts a national public affairs program and

provides guidance for public affairs activities (including Web, new media, and broadcast communications) on the risks of tobacco use and the benefits of quitting. Key 

elements include the Surgeon General’s Reports on tobacco, considered to be the 

most authoritative scientific publications produced by the federal government regarding tobacco and health, and NCI’s Tobacco Control Monograph series, which

provides ongoing and timely information about emerging public health issues

in tobacco control.

•	 Deliver tobacco cessation treatment through direct health care services and 

health insurance. CMS includes coverage for smoking and tobacco cessation counseling for certain beneficiaries. Medicare coverage involves all beneficiaries who use 

tobacco. Under Medicaid, tobacco cessation counseling and likewise the provision

of tobacco cessation pharmaceuticals are optional benefits for all individuals should 

the State elect to provide them. The Indian Health Service Cancer Program seeks

to reduce tobacco use by promoting clinical cessation efforts, encouraging community-based education and policy interventions, and providing technical assistance

to existing surveillance efforts. The Health Resources and Services Administration’s 

Bureau of Primary Health Care health center grantees have begun to implement 

tobacco cessation counseling services that have the potential to affect more than 17 

million persons, the majority of whom are children and women of childbearing age.

•	 Foster global tobacco control through surveillance, capacity building, and 

information exchange. For more than 10 years, CDC, the World Health Organization (WHO), and the Canadian Public Health Association have collaborated on 

the Global Tobacco Surveillance System (GTSS) to assist countries in establishing 

tobacco control surveillance and monitoring programs. Currently, 14 countries are 

implementing the Global Adult Tobacco Survey (GATS), and 163 countries have 

implemented the Global Youth Tobacco Survey—two data collection mechanisms 

within GTSS. GATS is funded by the Bloomberg Initiative to Reduce Tobacco Use 

(partners include the Campaign for Tobacco-Free Kids, CDC, CDC Foundation, 

Johns Hopkins Bloomberg School of Public Health, WHO, and the World Lung 

Foundation). CDC has also provided global leadership in the development of laboratory capacity to measure human exposure to tobacco and its constituents though its 

support of the WHO Tobacco Laboratory Network. And since 2002, the Fogarty 

International Center, together with other institutes within NIH, has administered an 

innovative research and training program to reduce the burden of tobacco consumption on low- and middle-income nations.
19

Strategic Actions

The following strategic actions are based on scientific evidence and extensive real-world 

experience. Some of these actions require significant financial investment while others can be 

taken at little or no cost. Some actions will occur quickly and demonstrate almost immediate 

results; others will take more time. As a whole, all actions are meant to serve as a guideline 

for future development, are conditional, and are subject to the availability of resources.

These actions are high-impact interventions that include smoke-free air for everyone, tobacco 

price increases, and adequately funded mass-media educational campaign, and full access

to comprehensive tobacco cessation services. The most current and authoritative model of the 

effect of comprehensive tobacco control measures concludes that, with all of these interventions implemented simultaneously, the Healthy People objective of reducing the adult

smoking rate to 12% can be reached by 2020.66

1. Improve the Public’s Health: Strengthen the implementation of evidence-based 

tobacco control interventions and policies in states and communities

•	 Expand evidence-based comprehensive tobacco control programs. These interventions include implementing smoke-free policies, increasing the price of tobacco 

products, and restricting youth access to tobacco products. While state and community tobacco prevention efforts have recently been aided by funding under ARRA, 

few states meet CDC’s Best Practices funding recommendations. Based on availability 

of resources, HHS plans to increase funding to states to accelerate the implementation of population-based policy interventions.

•	 Enhance comprehensive cessation services in the states. Tobacco users anywhere 

in the United States can access cessation assistance by dialing 1-800-QUIT-NOW, 

a national portal that links to state quitlines. Only 1% to 2% of tobacco users take 

advantage of the national quitline network because they are unaware of its availability 

and the services it offers.67 While quitlines are partially supported by CDC funding, many states lack resources to promote these services or to handle increased call 

volume, even with the recent infusion of funds from ARRA. Based on the availability 

of resources, HHS proposes to increase support for the National Network of State 

Quitlines and enable states to expand comprehensive cessation services and conduct 

promotional activities to a larger population, including outreach to pregnant women 

and parents of young children.

•	 Reduce tobacco-related disparities through targeted interventions in locations 

serving high-risk populations (e.g., public housing, substance abuse facilities, 

mental health facilities, correctional institutions, community health centers, 

Ryan White clinics, rural health clinics, critical access hospitals). Reducing 

smoking prevalence will require greater attention to populations carrying a disproportionate burden of use and dependence (e.g., adults and youth with mental illness 

and substance abuse disorders, prison inmates, homeless individuals). A way to reach 

such groups is through efforts that directly affect the scope of services and facilities 

serving those populations. Such efforts include tobacco-free policies; quitline promotion; and counseling and cessation services in sites such as public housing, substance 
20

abuse facilities, mental health facilities, and correctional institutions. A number

of HHS agencies—such as IHS, HRSA, and SAMHSA—can reach populations

at these sites but are not yet fully integrating tobacco control policies and effective 

cessation interventions. HHS plans to institute and promote tobacco-free policies 

and implement comprehensive cessation services tailored for and targeted to high-risk 

populations.

•	 Accelerate adoption of comprehensive smoke-free laws in every state. As of 

March 2010, with the addition of Kansas, 24 states, the District of Columbia, and 

Puerto Rico had enacted comprehensive smoke-free laws that prohibit smoking

in workplaces, restaurants, bars, and most other public places.68 However, 100 million Americans in 26 states are still unprotected by comprehensive laws.69 Populations disproportionately affected include those in blue collar jobs, hospitality workers 

such as bar and casino employees, and individuals with lower socioeconomic status. 

In collaboration with state and community tobacco control programs and partners, 

HHS plans to provide technical assistance and promote the public health benefits 

and effectiveness of comprehensive smoke-free laws.

•	 Increase local, state, and tribal enforcement of tobacco regulation. Currently

several HHS agencies—including CDC, SAMHSA, and IHS—collaborate with state,

local, and tribal governments to provide technical assistance, research on effective 

practices, and surveillance to enhance enforcement capacity. In support of its

enforcement of federal tobacco regulations, FDA is contracting with states and

territories to carry out tobacco retailer inspections and investigations. HHS plans to 

use existing expertise, resources, and linkages as additional regulations are considered. 

HHS, under the auspices of IHS, plans to foster improved collaboration with tribal 

governments.

2. Engage the Public: Change social norms around tobacco use

•	 Conduct a mass media campaign designed to prevent initiation among youth, 

promote cessation among adults, and inform the public about the health consequences and toll of tobacco. Effective media campaigns increase support for tobacco 

cessation; decrease the social acceptability of tobacco use; build public support for 

smoke-free policies and other proven, population-based policies; and maximize the 

impact of state and community tobacco prevention and control programs. As evidenced in the recently released Tobacco Control State Highlights 2010,

70 state tobacco 

control media campaigns have been cut substantially in recent years due to severe 

state budget constraints. While state and community tobacco prevention efforts have 

recently been aided by funding under ARRA, the budget gap remains large. Based 

on the availability of resources, HHS proposes to conduct a hard-hitting mass media 

campaign that will prevent tobacco use initiation, promote and facilitate cessation, 

and shape social norms related to tobacco use.

•	 Develop a multilevel communication and education campaign that is recognizable and employed consistently across HHS agencies (e.g., unified Departmentwide Web presence). Opportunities for better coordination exist for HHS to provide 

consistent and informative messages regarding, for example, the harmful effects
21

of tobacco use, effective interventions for reducing tobacco use, and the elimination 

of exposure to secondhand smoke. HHS currently has several hundred tobaccorelated Web sites. By unifying the Department-wide Web presence, HHS plans

to effectively communicate reliable, updated, and consistent information in an

accessible, user-friendly format.

•	 Institute effective Department-wide messages about the impact of regulation 

on the public perception of the risk of tobacco products. Many aspects of FDA’s 

new regulation of tobacco products are complex. FDA is charged, for example, with 

regulating “modified-risk” products, which are products sold or distributed for use to 

reduce harm or the risk associated with tobacco products. New communications tools 

and strategies need to be developed to discourage public perceptions about “safe” 

tobacco products and to convey easily understandable information about the ongoing 

risk of tobacco use and the impact of regulation on that risk. These messages can be 

developed and disseminated by leveraging existing agency resources, coordinated with 

the release of upcoming FDA regulatory actions and integrated into a comprehensive 

HHS communication strategy.

•	 Promote reductions in youth exposure to onscreen smoking. Smoking onscreen 

in movies increases the risk of youth smoking. Films rated PG and PG-13 account 

for 60% of audience exposure to onscreen smoking. Decreasing onscreen smoking, 

showing antitobacco ads before movies that depict smoking, and imposing parental 

restrictions will help to change social norms and reduce the acceptability of smoking. 

Widely endorsed steps to reduce youth exposure to onscreen smoking include applying an R rating to new movies that depict smoking, requiring strong antitobacco ads 

preceding movies that depict smoking, certifying no payoffs for depicting tobacco 

use, and removing depiction of tobacco brands.71,72,73 HHS plans to promote the

science related to the effectiveness of eliminating depictions of smoking in youthrated films in its communications to the movie industry, the public, decision-makers, 

and opinion leaders.

3. Lead by Example: Leverage HHS systems and resources to create a society free 

of tobacco-related disease and death

•	 Implement tobacco-free campus policies, provide comprehensive cessation treatment across all HHS facilities, and require HHS-funded programs to provide

a plan for implementing tobacco-free campus policies. Tobacco-free campus

policies reduce tobacco use and tobacco-related health care costs and project a positive,

pro-health message.74 Under a tobacco-free campus policy, no employee or member 

of the public may use any tobacco product anywhere on facility grounds. On January 1, 2005, the HHS Secretary called for all agency campuses to be tobacco-free.75

While agencies such as CDC and NIH have implemented tobacco-free policies, full 

implementation has not yet been achieved. HHS plans to complete the implementation of tobacco-free campuses in all its owned facilities. HHS also plans to require 

funded programs (e.g., grants, contracts, cooperative agreements) to have or provide

a plan for implementing tobacco-free campus policies. (Guidelines will be determined

in implementation and will consider relevant federal law and applicable grants policies.)
22

•	 Implement policies across all HHS agencies requiring conferences to be held 

in jurisdictions with smoke-free laws. Smoke-free conference policies protect 

government employees and other conference participants from the health effects 

of secondhand smoke. Currently, CDC, NCI, NIDA, SAMHSA, and at least 23 

nongovernmental organizations, such as the American Public Health Association and 

American Academy of Pediatrics, have smoke-free meeting policies.76 HHS plans to 

require conferences sponsored by the Department to be held in jurisdictions that are 

covered by state or local laws making enclosed workplaces and public places, including meeting facilities and restaurants (but not bars or casinos), completely smoke-free,

as applicable federal law allows. Communities in 44 states currently meet the criteria 

of this smoke-free conference policy either through statewide or local smoke-free 

laws. (See NCI’s smoke-free meeting locator at http://meetings.smokefree.gov/.)

•	 Expand Medicaid and Medicare health insurance coverage to include comprehensive, evidence-based cessation treatment. As of 2009, 45 Medicaid programs 

cover some form of tobacco-dependence treatment in their fee-for-service coverage, 

but all but two of these states have barriers to obtain such treatment (e.g., copayments, limited treatment courses, not covering combined treatments).77 The Patient 

Protection and Affordable Care Act (Affordable Care Act) will require states to 

provide comprehensive tobacco cessation services to pregnant women. The Affordable 

Care Act offers future incentives for states to expand this coverage beyond pregnant 

women enrolled in Medicaid. Medicare provides comprehensive cessation benefits to 

all its enrollees who use tobacco. Building on these opportunities and in partnership 

with states, HHS plans to work to expand access to comprehensive cessation benefits 

and to increase use of these benefits (including both medications and counseling) 

based on the availability of resources.

•	 Ensure that all HHS health care delivery sites implement evidence-based, 

system-wide changes that prompt the identification of and clinical intervention 

with all tobacco users. Successfully integrating tobacco use screening, documentation, and cessation-treatment referral into the health care delivery system would 

significantly reduce tobacco-related deaths and disease. The U.S. Public Health 

Service Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 

Update describes five evidence-based systems-level strategies that can institutionalize 

and increase the delivery of tobacco dependence treatments. Currently, HHS service 

providers offer limited tobacco cessation advice and referral. A complete inventory 

of the current status is necessary. Once a baseline is determined and based on the 

availability of resources, HHS health care service providers can expand their efforts to 

fully implement the recommendations of the Clinical Practice Guideline and provide 

advice and referral to cessation treatment, thereby serving as a model for all HHSfunded programs.

•	 Enhance health care professionals’ knowledge and adoption of effective tobacco 

cessation treatments through HHS provider-education training programs.

Recommendations from the Task Force on Community Preventive Services indicate 

that reminder systems that prompt health care providers to identify and intervene 

with patients who use tobacco are effective at increasing provider delivery of quit 

advice and increasing cessation among patients. HHS plans to 1) promote provider 
23

education programs designed to increase delivery of cessation advice and counseling

to decrease exposure to secondhand smoke and 2) implement reminder systems

that prompt health care providers to identify and intervene with patients who use 

tobacco.

•	 Enhance health care provider incentives to promote tobacco cessation treatment 

efforts. Given the challenges of addiction, many patients need to be supported in 

multiple quit attempts with a variety of interventions. The combined use of medication and counseling nearly doubles the smoking abstinence rate compared with either 

medication or counseling alone.78 HHS plans to take advantage of the opportunities 

presented by the Affordable Care Act to motivate health care providers and encourage 

states to offer effective cessation treatments that will result in maximal provision

of evidence-based treatments and required reporting on the interventions.

4. Advance Knowledge: Accelerate research to expand the science base and

monitor progress

•	 Develop and implement a Department-wide research plan to support FDA’s 

regulatory authority over tobacco. FDA regulation of tobacco products, including

the complex category of modified-risk tobacco products, will require significant

expansion of the science base that underlies FDA’s new regulatory authority.

Currently, HHS conducts research on both individual and population exposures

to the chemicals in tobacco products, measuring toxic and addictive substances in

tobacco products, in smoke and other emissions, and in people who use tobacco 

products or are exposed to secondhand smoke. HHS plans to leverage and expand 

this research capacity by creating an HHS-wide regulation research working group 

led by the Assistant Secretary for Health. This new research working group will 

ensure that cutting-edge knowledge about tobacco generated throughout HHS can 

inform and support FDA’s regulatory actions.

•	 Develop innovative, rapid-response surveillance systems for assessing quickly 

evolving changes in products, exposure, tobacco industry practices, and public 

perception. Tobacco manufacturing and marketing practices—which are a focus of 

FDA’s new regulatory authority, as well as the target of state and local tobacco control 

policy initiatives—continue to evolve. Public attitudes similarly continue to evolve, 

in part in direct response to tobacco industry product changes and marketing efforts. 

The breadth and complexity of existing surveillance systems limits rapid response

capacity. Based on availability of resources, HHS plans to expand existing partnerships to ensure that surveillance systems are in place to meet these needs. Office

of Management and Budget approval will also be sought for expedited Paperwork

Reduction Act review to ensure that surveillance-generated data can be readily

employed to enhance tobacco control policy and regulatory efforts.

•	 Expand research and surveillance related to high-risk populations (e.g., American Indians/Alaska Natives and other minority racial/ethnic groups; lesbian, 

gay, bisexual and transgender populations; individuals with mental disorders; 

those of low socioeconomic status) to identify effective approaches to prevention 

and cessation. A better understanding of effective approaches to prevent and
24

control tobacco use and reduce secondhand smoke exposure will contribute to reducing tobacco-related disparities. Although current data-collection efforts—such as the 

National Health Interview Survey, the Behavioral Risk Factor Surveillance System, 

and the National Survey on Drug Use and Health—provide tobacco use prevalence 

for some subpopulations, additional targeted surveillance is needed. HHS proposes 

to develop alternative data-collection options and analytic techniques, such as

incorporating tobacco use questions in the U.S Department of Commerce’s

American Community Survey.

•	 Expand research and surveillance that promote the effectiveness of both

population- and individual-based cessation interventions and tobacco

dependence treatments. Research is required to better understand from a national 

perspective which tobacco users will eventually take steps to quit, who will be

successful at quitting, and how long tobacco use abstinence is sustained. In addition, 

there is a need for more evidence of effective cessation interventions for populations 

such as youth; young adults; pregnant women; low-income smokers; racial/ethnic 

minorities; lesbian, gay, bisexual and transgender smokers; light or intermittent 

smokers, and those with comorbidities (particularly mental health and substance

use disorders). To fill this need, HHS proposes to create stronger research and

surveillance systems to better identify tobacco users, support the development

of new tobacco cessation treatments, promote delivery of evidence-based cessation 

treatments, and track the delivery and outcome of cessation efforts.

•	 Expand monitoring, surveillance, and research activities globally through 

technical assistance to help achieve the goals of the Framework Convention on 

Tobacco Control (FCTC). The effective implementation of the FCTC will reduce 

tobacco-induced death and disease worldwide. HHS plans to continue to build the 

knowledge base and share scientific information on tobacco use and to monitor the 

impact of tobacco control programs through the Global Tobacco Surveillance System.

HHS will collaborate through bilateral or multilateral partnerships, particularly in 

low- and middle-income nations, to implement effective and sustainable programs.

•	 Create an HHS annual progress report on tobacco data showing progress

towards the Healthy People 2020 objectives. Timely and accurate data regarding

progress toward the Healthy People 2020 objectives are an important component

in understanding the effectiveness of efforts to combat the tobacco epidemic. HHS 

plans to develop a report highlighting progress and challenges based on key

indicators. This annual assessment will support HHS’s commitment to achieving the 

Healthy People objectives.
25

Create Synergy: Future steps for sustainable progress

With this strategic plan, HHS can serve to mobilize and integrate tobacco control

efforts across the federal government, with state and local leaders, and with

partners in the international community.

Federal Government: By creating an ambitious tobacco control agenda for the immediate 

future, HHS will be in a position to collaborate with other federal agencies, such as the

Office of Personnel Management (OPM), Department of Defense (DOD), the Veterans

Administration (VA), Department of Housing and Urban Development, the General

Services Administration (GSA), and the Environmental Protection Agency (EPA), as well

as other public and private partners. Envisioned collaborations could include:

•	 Working with OPM to ensure that all federal employees have access to evidencebased cessation treatments, including counseling and FDA-approved medications, 

with no or minimal barriers.

•	 Supporting DOD in its efforts to implement the recommendations of the Institute

of Medicine’s 2009 report Combating Tobacco in Military and Veteran Populations.

•	 Collaborating with GSA to fully implement tobacco-free campus policies across the 

federal government.

•	 Partnering with the EPA to reduce the number of children exposed to secondhand 

smoke in homes and cars.

•	 Supporting the VA in its efforts to implement tobacco-free campuses and provide 

comprehensive tobacco-use cessation treatment consistent with the recommendations 

of the U.S. Public Health Service Clinical Practice Guideline Treating Tobacco Use 

and Dependence: 2008 Update.

Nongovernmental Organizations and State and Local Leaders: National and state

partners play a critical role in tobacco prevention and control efforts. To achieve its vision, 

HHS must build on its longstanding practice of working closely with national and state 

nongovernmental public health organizations. HHS will work to strengthen its existing 

collaborations and establish new partnerships to implement this plan. State and local community action is essential to ensure the success of the tobacco control interventions called for 

in this plan. It is the policies, partnerships, and intervention activities that occur at the state 

and local levels that will ultimately lead to social norm and behavior change. HHS will work 

closely with and support these key stakeholders, as allowed under applicable federal law, and 

the essential and unique roles that they play in tobacco control efforts.

International Community: Though this plan’s primary function is to address domestic 

tobacco control, integration of U.S. tobacco control efforts with worldwide tobacco control 

efforts benefits both domestic and global citizens by protecting them from the dangers of 

tobacco use and secondhand smoke. To address the worldwide epidemic of disease and death 

caused by tobacco use, HHS will continue to work with its many partners to foster global

tobacco control initiatives. HHS activities in the global arena support expansion of the

science base through surveillance and research; the building of country capacity for data

collection, analysis, and reporting; and assistance to countries and regions in linking surveillance data to tobacco control efforts. HHS will expand these efforts to implement effective 

and sustainable programs through bilateral or multilateral partnerships with health ministries 

and international agencies throughout the world.
26

Conclusion

The overriding objective of this strategic action plan is to reinvigorate national momentum 

toward tobacco prevention and control by applying proven methods for reducing the burden 

of tobacco dependence. HHS will lead this transformative national endeavor by example, 

leveraging existing resources and expertise and making new investments to the furthest extent 

possible to maximize the nation’s tobacco prevention and control efforts. The recommendations set forth here, when fully implemented, will markedly accelerate our nation’s effort

to defeat the tobacco epidemic.

This HHS strategic action plan builds upon existing blueprints and uses robust, scientific 

evidence as its foundation to set forth a comprehensive proposal for specific, concrete actions 

that can be taken by the Secretary and the agencies within HHS. The recommended actions 

in the plan are meant to serve as a guideline for future development, are conditional, and 

are subject to the availability of resources. Additionally, a number of the actions will provide 

key Department-wide support for the new tobacco regulatory mission of FDA whose new 

Center for Tobacco Products is now overseeing implementation of the 2009 Family Smoking 

Prevention and Tobacco Control Act. Implementing this plan will bring the country closer 

to meeting the overarching Healthy People 2020 goals: to achieve health equity, eliminate 

disparities, and improve the health of all groups.

With implementation of the strategic actions in this plan, the country can achieve the 

Healthy People objective of reducing the adult smoking rate to 12%, resulting in millions

of fewer smokers in the United States. Implementing these actions would bring us closer

to a world where tobacco-related illness is uncommon and lung cancer, the leading cause

of cancer death in the country, is rare. It could also begin to recoup the billions of dollars lost 

in societal productivity and medical costs associated with tobacco use.

HHS can lead the way in transforming the nation by implementing proven tobacco prevention and treatment interventions recommended in this strategic action plan. The convergence 

of public attitudes supporting tobacco control and political support offers an historical

opportunity to rekindle the momentum of previous decades and achieve the vision of

a society free from tobacco-related death and disease.

“If we do not act decisively today, a hundred years from now our grandchildren and their children will look back and seriously question how people 

claiming to be committed to public health and social justice allowed the 

tobacco epidemic to unfold unchecked.”

Former WHO Director-General Gro Harlem Brundtland, MD, MPH
27

Endnotes

1. Centers for Disease Control and Prevention. Smoking-attributable mortality, years of potential life 

lost, and productivity losses—United States, 2000–2004. Morbidity and Mortality Weekly Report

2008;57(45):1226–1228.

2. Centers for Disease Control and Prevention. Cigarette smoking-attributable morbidity—United States, 

2000. Morbidity and Mortality Weekly Report 2003;52(35):842–844.

3. See note 1 above.

4. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2007. 

Morbidity and Mortality Weekly Report Surveillance Summaries 2008;57(SS-4):1–136.

5. Centers for Disease Control and Prevention. Cigarette smoking among adults and trends in smoking 

cessation—United States, 2008. Morbidity and Mortality Weekly Report 2009;58(44):1227–1232.

6. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the 

Surgeon General. Atlanta: 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; 2004.

7. Brandt AM. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined 

America. New York: Basic Books; 2007.

8. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving 

Health and Objectives for Improving Health. 2nd ed. 2 vols. Washington, DC: U.S. Government Printing 

Office, November 2000. The Healthy Weight 2010 objective is to reduce adult smoking to 12 percent. 

The Healthy Weight 2020 objectives are still in draft form, but this tobacco use objective will likely 

remain unchanged.

9. Institute of Medicine. Ending the Tobacco Problem: A Blueprint for the Nation. Washington: National 

Academies Press; 2007.

10. President’s Cancer Panel. Our Nation’s Investment in Cancer: Three Crucial Actions for America’s 

Health. Washington: U.S. Department of Health and Human Services, National Institutes of Health, 

National Cancer Institute; 2008.

11. See note 5 above.

12. See note 9 above.

13. See note 6 above.

14. Campaign for Tobacco-Free Kids. Global Tobacco Epidemic: Key Facts. Campaign for Tobacco-Free 

Kids Web site. Available at http://www.tobaccofreecenter.org/tobacco_epidemic/key_facts.

15. See note 1 above.

16. See note 6 above.

17. See note 9 above.

18. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to 

Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National 

Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
28

19. See note 2 above.

20. See note 1 above.

21. National Center for Health Statistics. National Health Interview Survey. Hyattsville (MD): Centers for 

Disease Control and Prevention, National Center for Health Statistics; 1965–2008.

22. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority

Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific 

Islanders, and Hispanics: A Report of the Surgeon General. Atlanta: 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; 1998.

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nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010;116(3):544–573. 

24. Haiman CA, Stram DO, Wilkens LR, Pike MC, Kolonel LN, Henderson BE, et al. Ethnic and

racial differences in the smoking-related risk of lung cancer. New England Journal of Medicine

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25. American Cancer Society. Cancer Facts and Figures for African Americans, 2007–2008. Atlanta: 

American Cancer Society; 2007.

26. Singh GK, Miller BA, Hankey BF, Edwards BK. Area Socioeconomic Variations in U.S. Cancer

Incidence, Mortality, Stage, Treatment, and Survival, 1975–1999. NCI Cancer Surveillance Monograph 

Series Number 4. Bethesda (MD): U.S. Department of Health and Human Services, National Institutes 

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27. See note 6 above.

28. See note 5 above.

29. Ibid.

30. See note 23 above.

31. See note 25 above.

32. See note 24 above.

33. See note 22 above.

34. See note 5 above.

35. Ibid.

36. Schroeder, SA and Morris C. Tobacco use in those with mental health and substance abuse problems: 

Neglected epidemic. Annual Review of Public Health, 2010 31:16.1-16.18

37. Centers for Disease Control and Prevention. Disparities in secondhand smoke exposure—United States, 

1988–1994 and 1994–2004. Morbidity and Mortality Weekly Report 2008;57(27):744–747.

38. Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey 

on Drug Use and Health: Detailed Tables. U.S. Department of Health and Human Services, SAMHSA, 

Office of Applied Studies Web site. Available at http://oas.samhsa.gov/NSDUH/2K8NSDUH/tabs/

Sect4peTabs10to11.pdf.
29

39. Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on 

Drug Use and Health: National Findings. U.S. Department of Health and Human Services, SAMHSA, 

Office of Applied Studies Web site. Available at http://oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.pdf.

40. Centers for Disease Control and Prevention. National Youth Tobacco Survey and Key Prevalence

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41. Campaign for Tobacco-Free Kids. Toll of Tobacco in the United States of America. Campaign for 

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42. Federal Trade Commission. Cigarette Report for 2006. Washington: Federal Trade Commission; 2009.

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43. National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco 

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44. Ibid.

45. Wetter DW, McClure JB, de Moor C, Cofta-Gunn L, Cummings S, Cinciripini PM, et al. Concomitant 

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49. See note 9 above.

50. Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the 

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51. See note 18 above.

52. Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and 

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55. Campaign for Tobacco-Free Kids. Public Health Benefits and Healthcare Cost Savings from the

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56. Farrelly MC, Pechacek TF, Chaloupka FJ. The impact of tobacco control program expenditures

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30

57. Tauras JA, Chaloupka FJ, Farrelly MC, Giovino GA, Wakefield M, Johnston LD, et al. State tobacco 

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60. Centers for Disease Control and Prevention. Declines in lung cancer rates—California, 1988–1997. 

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73. See note 9 above.
31

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77. Centers for Disease Control and Prevention. State Medicaid coverage for tobacco-dependence

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78. See note 52 above.
32

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Appendices
38

Appendix A: List of Acronyms

ACF Administration for Children and Families

AHRQ Agency for Healthcare Research and Quality

AoA Administration on Aging

ARRA American Recovery and Reinvestment Act

ASA Assistant Secretary for Administration

ASFR Assistant Secretary for Financial Resources

ASH Assistant Secretary for Health

ASL Assistant Secretary for Legislation

ASPA Assistant Secretary for Public Affairs

ASPE Assistant Secretary for Planning and Evaluation

BPHC Bureau of Primary Health Care

CDC Centers for Disease Control and Prevention

CMS Centers for Medicare and Medicaid Services

CTP Center for Tobacco Products

CSAP Center for Substance Abuse Prevention

DoD Department of Defense

EPA Environmental Protection Agency

FCTC Framework Convention on Tobacco Control

FDA Food and Drug Administration

FDCA Federal Food, Drug, and Cosmetic Act

GATS Global Adult Tobacco Survey

GSA U.S. General Services Administration

GTSS Global Tobacco Surveillance System

GYTS Global Youth Tobacco Survey

HAB HIV/AIDS Bureau

HHS U.S. Department of Health and Human Services

HINTS Health Information National Trends Survey

HRSA Health Resources and Services Administration

HUD U.S. Department of Housing and Urban Development

ICSH Interagency Committee on Smoking and Health

IHS Indian Health Service

IOM Institute of Medicine

MCHB Maternal and Child Health Bureau

MPOWER Monitor tobacco use and prevention polices; protect people from tobacco smoke;

offer to help quit tobacco use; warn about dangers of tobacco; enforce bans on tobacco 

advertising, promotion, and sponsorship; and raise taxes on tobacco
39

MSSP Medicare Stop Smoking Program

MTF Monitoring the Future

NCA National coverage analysis

NCEH National Center for Environmental Health

NCI National Cancer Institute

NHANES National Health and Nutrition Examination Survey

NHLBI National Heart, Lung, and Blood Institute

NICHD National Institute of Child Health and Human Development

NIDA National Institute on Drug Abuse

NIH National Institutes of Health

NRT Nicotine replacement therapy

NSDUH National Survey on Drug Use and Health

NTCP National Tobacco Control Program

OASH Office of the Assistant Secretary for Health

OBSSR Office of Behavioral and Social Sciences Research

OCR Office for Civil Rights

OGC Office of the General Counsel

OGHA Office of Global Health Affairs

OHE Office of Health Equity

OHITQ Office of Health Information Technology and Quality

OPA Office of Pharmacy Affairs

OPHS Office of Public Health and Science

OPM Office of Personnel Management

OS Office of the Secretary [of Health and Human Services]

OSG Office of the Surgeon General

OSH Office on Smoking and Health

OTP Opioid Treatment Program

PCP President’s Cancer Panel

SAMHSA Substance Abuse and Mental Health Services Administration

SBIRT Screening, Brief Intervention, and Referral to Treatment

SSA State substance use authority

TCA Family Smoking Prevention and Tobacco Control Act

TCRB Tobacco Control Research Branch

TUS-CPS Tobacco Use Supplement to the Current Population Survey

VA U.S. Department of Veterans Affairs

WHO World Health Organization 
40

Appendix B: Healthy People 2020 – Draft Tobacco Use Objectives

Topic

2010 

Number 2020 Number Objective

Tobacco Use 27-1 TU HP2020–5: Reduce tobacco use by adults.

a. Cigarette smoking 

b. Smokeless tobacco products 

c. Cigars

Tobacco Use 27-2 TU HP2020–6: Reduce tobacco use by adolescents.

a. Tobacco products (past month) 

b. Cigarettes (past month) 

c. Smokeless tobacco products (past month) 

d. Cigars (past month) 

Tobacco Use 27-3 TU HP2020–7:

Reduce the initiation of tobacco use among children, adolescents, and young 

adults.

a. Children and adolescents aged 12 to 17 years—Tobacco products 

b. Children and adolescents aged 12 to 17 years—Cigarettes 

c. Children and adolescents aged 12 to 17 years—Smokeless tobacco products

d. Children and adolescents aged 12 to 17 years—Cigars 

e. Young adults aged 18 to 25 years—Tobacco products 

f. Young adults aged 18 to 25 years—Cigarettes 

g. Young adults aged 18 to 25 years—Smokeless tobacco products 

h. Young adults aged 18 to 25 years—Cigars 

Health Systems 

Changes 27-5 TU HP2020–8: Increase smoking cessation attempts by adult smokers.

a. Increase smoking cessation attempts by adult smokers. 

b. Increase smoking cessation attempts using evidence-based strategies by adult 

smokers.

Health Systems 

Changes New TU HP2020–18: Increase recent smoking cessation success by adult smokers.

a. Increase recent smoking cessation success by adult smoker. 

b. Increase recent smoking cessation success using evidence-based strategies

by adult smokers.

Health Systems 

Changes 27-6 TU HP2020–1: Increase smoking cessation during pregnancy.

Health Systems 

Changes 27-7 TU HP2020–9: Increase smoking cessation attempts by adolescent smokers.

Health Systems 

Changes New TU HP2020–19: Increase tobacco screening in health care settings. 

a. Increase tobacco screening in office-based ambulatory care settings. 

b. Increase tobacco screening in hospital ambulatory care settings. 

c. (Developmental) Increase tobacco screening in dental care settings. 

d. (Developmental) Increase tobacco screening in substance abuse care settings. 
41

Health Systems 

Changes New TU HP2020–17: Increase tobacco cessation counseling in health care settings.

a. Increase tobacco cessation counseling in office-based ambulatory care settings. 

b. Increase tobacco cessation counseling in hospital ambulatory care settings. 

c. (Developmental) Increase tobacco cessation counseling in dental care settings.

d. (Developmental) Increase tobacco cessation counseling in substance abuse care 

settings.

Health Systems 

Changes 27-8b TU HP2020–10:

Increase comprehensive Medicaid insurance coverage of evidence-based treatment for nicotine dependency in States and the District of Columbia. 

Social and 

Environmental 

Changes 27-9 TU HP2020–11: Reduce the proportion of nonsmokers exposed to secondhand smoke.

a. Children aged 3 to 11 years 

b. Adolescents aged 12 to 17 years 

c. Adults aged 18 years and older

Social and 

Environmental 

Changes New TU HP2020–20: Increase the proportion of smoke-free homes.

Social and 

Environmental 

Changes 27-12 TU HP2020–2:

Increase the proportion of persons covered by indoor worksite policies that prohibit smoking.

Social and 

Environmental 

Changes 27-18 TU HP2020–4:

Increase the number of States and the District of Columbia, Territories, and Tribes 

with sustainable and comprehensive evidence-based tobacco control programs.

a. States and the District of Columbia 

b. Territories 

c. Tribes 

Social and 

Environmental 

Changes 27-11 TU HP2020–12:

Increase tobacco-free environments in schools, including all school facilities, 

property, vehicles, and school events.

a. Junior high school 

b. Middle school 

c. High school 

d. (Developmental) Head Start

Social and 

Environmental 

Changes 27-13 TU HP2020–13:

Establish laws in States, District of Columbia, Territories, and Tribes on smokefree indoor air that prohibit smoking in public places and worksites.

a. Private workplaces 

b. Public workplaces 

c. Restaurants 

d. Bars 

e. (Developmental) Gaming halls 
42

f. Commercial daycare centers 

g. Home-based daycare centers 

h. Public transportation 

i. Hotels and motels 

j. Multiunit housing 

k. Vehicles with children 

l. Prisons/correctional facilities 

m. (Developmental) Substance abuse treatment facilities 

n. (Developmental) Mental health treatment facilities 

o. (Developmental) Entrances/exits of all public places 

p. (Developmental) Hospital campuses 

q. (Developmental) College/university campuses

Social and 

Environmental 

Changes 27-19 TU HP2020–15: Eliminate State laws that preempt stronger local tobacco control laws.

New a. Preemption on smoke-free indoor air 

New b. Preemption in advertising 

New c. Preemption on youth access

Social and 

Environmental 

Changes 27-14 TU HP2020–3:

Reduce the illegal sales rate to minors through enforcement of laws prohibiting 

the sale of tobacco products to minors.

a. States and the District of Columbia 

b. Territories 

Social and 

Environmental 

Changes 27-16 TU HP2020–14:

Reduce the proportion of adolescents and young adults who are exposed to tobacco advertising and promotion—reduction in the proportion of adolescents grades 6 

through 12 exposed to tobacco advertising and promotion.

a. Internet advertising and promotion 

b. Magazine and newspaper advertising and promotion 

New c. (Developmental) Movies 

New

d. (Developmental) Point of purchase (convenience store, supermarket,

or gas station

Social and 

Environmental 

Changes 27-21 TU HP2020–16: Increase the Federal and State tax on tobacco products.

a. Cigarettes 

b. Smokeless tobacco products 

New c. Other smoked tobacco products

Product New TU HP2020–21:

Reduce levels of tobacco exposure biomarkers, including NNAL, in cigarette 

smokers.
43

Appendix C: Comprehensive HHS Tobacco Inventory

The Administration for Children and Families (ACF)

ACF integrates tobacco control and prevention into its programs that promote the economic and social well being of families,

children, individuals, and communities. ACF, through the Office of Head Start, conducts the “Care for Their Air” outreach campaign 

to deliver health risk-reduction messages related to secondhand smoke and other environmental asthma triggers.

Major Activity Description Reach 

Program instruction

on smoke-free

environments in Head 

Start programs

Written guidance to Head Start and Early Head Start programs to ensure that all centers 

remain smoke-free

National

“Care for Their Air” 

Web page

Through the Head Start Early Childhood Knowledge and Learning Center, information 

on how to protect children from exposure to environmental tobacco smoke in the home 

and the car is available to Head Start grantees

National

Conference presentations and workshopsWorkshops at Head Start training conferences on the “Care For Their Air” outreach 

campaign and strategies to reduce children’s exposure to secondhand smoke

National

The Agency for Healthcare Research and Quality (AHRQ)

AHRQ supports health services research that will improve the quality, safety, efficiency, and effectiveness of health care for all 

Americans and promotes evidence-based approaches, including tobacco cessation and prevention. AHRQ led a consortium of federal 

and nonfederal groups that sponsored the development and release of the U.S. Public Health Service Clinical Practice Guideline 

Treating Tobacco Use and Dependence: 2008 Update, which includes new, effective clinical treatments for tobacco dependence.

Major Activity Description Reach 

U.S. Public Health 

Service Clinical 

Practice Guideline 

Treating Tobacco Use 

and Dependence: 2008 

Update

The U.S. Public Health Service Clinical Practice Guideline Treating Tobacco Use and 

Dependence: 2008 Update contains strategies and recommendations designed to assist 

clinicians, tobacco-dependence treatment specialists, health care administrators, insurers,

and purchasers in delivering and supporting effective treatment for tobacco use and 

dependence. The guideline has been adopted globally.

National

U.S. Preventive 

Services Task Force 

Reaffirmation

of Recommendation

on Counseling for 

Tobacco Use

The U.S. Preventive Services Task Force will again issue a statement reaffirming its 

recommendation supporting information found in the Public Health Service Clinical 

Practice Guideline Treating Tobacco Use and Dependence: 2008 Update. The recommendation will note that the net benefits of tobacco cessation interventions in adults and 

pregnant women remain well established.

National

Published research AHRQ sponsors research papers and case studies on effective tobacco control treatments and interventions, e.g., “Electronic Health Record-based Intervention to Improve 

Tobacco Treatment in Primary Care: A Cluster Randomized Controlled Trial” (Archives 

of Internal Medicine, 2009).

National
44

The Centers for Disease Control and Prevention (CDC)

CDC provides national leadership for a comprehensive, broad-based approach to reducing tobacco use. Essential elements of this 

approach include state-based, community-based, and health system-based interventions; cessation services; countermarketing; 

policy development and implementation; tobacco product research; surveillance; and evaluation.

Major Activity Description Reach

National Tobacco Control 

Program (NTCP)

Through NTCP, CDC provides coordinated, national efforts to reduce 

tobacco-related diseases and deaths. NTCP, established in 1999, funds all 

50 states, the District of Columbia, 8 U.S. territories, 7 tribal support centers, and 6 national networks devoted to reducing tobacco-related morbidity and mortality and tobacco-related disparities among priority populations. The funding leverages significant state investments to implement 

comprehensive, evidence-based, effective tobacco control interventions. 

The National Network of Tobacco Cessation Quitlines, a collaborative 

effort between the National Cancer Institute (NCI) and states that is supported and funded through NTCP and state funding, makes free telephone 

cessation counseling available in the United States. 

State and national

Surveillance and evaluation CDC maintains surveillance and evaluation systems that monitor the 

prevalence of tobacco use; the knowledge, attitudes, and behaviors related 

to tobacco use; and the effectiveness of tobacco prevention and control 

interventions at both the national and state levels. These systems include 

the National Health Interview Survey (with the periodic Cancer Control 

Supplements), the National Youth Tobacco Survey, state Youth Tobacco 

Surveys, the National Adult Tobacco Survey, state Adult Tobacco Surveys,

the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior

Surveillance System, the National Ambulatory Medical Care Survey,

and the and the National Hospital Ambulatory Medical Care Survey. Key 

Outcome Indicators for Evaluating Comprehensive Tobacco Control

Programs helps states monitor progress toward expected outcomes and 

refine program activities as needed. CDC also analyzes tobacco-related 

data from other agencies for evaluation and surveillance purposes, including the National Survey on Drug Use and Health (SAMSHA), Tobacco 

Use Supplement to the Current Population Survey (NCI), and Monitoring 

the Future (NIDA).

CDC’s National Health and Nutrition Examination Survey (NHANES) 

combines interviews and physical examinations to assess the health and 

nutritional status of adults and children in the United States. NHANES 

includes tobacco-specific (cotinine and tobacco-specific nitrosamine) 

laboratory data as well as extensive adult and youth tobacco use questionnaire data that can be used to assess tobacco use and secondhand smoke 

exposure. NHANES also collects information on the brand/sub-brand of 

cigarette smoked using the 12-digit universal product code on the participant’s pack.

National
45

Major Activity Description Reach

Interagency Committee on 

Smoking and Health (ICSH)

ICSH, which is chaired by the Surgeon General, coordinates research, 

educational programs, and other activities across the federal government 

that relate to the effect of smoking on human health. Recent ICSH meetings have explored tobacco-related disparities, global tobacco control, 

secondhand smoke, and nicotine addiction. CDC’s Office on Smoking and 

Health (OSH) serves as the Executive Secretary of ICSH.

Federal

Surgeon General’s Reports Working closely with the Office of the Surgeon General, OSH develops 

and produces Surgeon General’s Reports on the health consequences of 

smoking. For more than four decades, these reports have been considered the most authoritative scientific publications on tobacco use and its 

consequences produced by the federal government. These reports provide 

detailed evidence of health effects in particular populations, the connection between smoking and specific diseases, and broader perspectives on 

health consequences. The most recent report, The Health Consequences of 

Involuntary Exposure to Tobacco Smoke, was released in 2006. Currently, 

How Tobacco Causes Disease: The Biology and Behavioral Basis for 

Smoking-Attributable Disease is in production. 

National

Tobacco product and tobacco biomonitoring researchCDC’s tobacco product research is a joint activity of the National Center 

for Environmental Health’s (NCEH’s) Division of Laboratory Sciences 

and OSH. NCEH houses the Tobacco Laboratory, which investigates both 

individual and population exposures to the chemicals in tobacco products. 

The laboratory is unique because it measures toxic and addictive substances in tobacco products, in smoke and other emissions, and in people 

who use tobacco products or who are exposed to secondhand smoke. No 

other laboratory in the federal government has these capabilities. OSH 

conducts research into the toxicity of tobacco products, smoking behavior, 

consumer attitudes, and risk perceptions regarding tobacco products and 

collaborates with other CDC researchers to investigate gene-environment 

interactions underlying tobacco-related disease.

National

Global tobacco control For more than 10 years, CDC, the World Health Organization (WHO), 

and the Canadian Public Health Association have collaborated on the 

Global Tobacco Surveillance System (GTSS) to assist countries in 

establishing tobacco control surveillance and monitoring programs. 

GTSS involves the collection of data through three school-based surveys 

(the Global Youth Tobacco Survey [GYTS], the Global School Personnel Survey, and the Global Health Professions Student Survey) and one 

household survey (the Global Adult Tobacco Survey [GATS]). GTSS 

provides countries with data to monitor and evaluate the magnitude, 

patterns, determinants, and consequences of tobacco use within country, 

across countries, and over time. Funding from the Bloomberg Initiative to 

Reduce Tobacco Use supports GATS. Other GATS partners are WHO, the 

CDC Foundation, the Johns Hopkins Bloomberg School of Public Health, 

the World Lung Foundation, the Campaign for Tobacco-Free Kids, and 

RTI International. GATS and GYTS data will be used to monitor and 

track key articles of WHO’s Framework Convention on Tobacco Control 

and will enable countries to develop, implement, and evaluate comprehensive national tobacco control programs, policies, and action plans.

International
46

The Centers for Medicare and Medicaid Services (CMS)

CMS includes coverage for smoking and tobacco cessation counseling for certain beneficiaries. Medicare coverage involves all

beneficiaries who use tobacco. Under Medicaid, tobacco cessation counseling and likewise the provision of tobacco cessation 

pharmaceuticals are optional benefits for all individuals should the State elect to provide them. Beginning 10/1/10, Medicaid must 

provide those services to pregnant women. 

Major Activity Description Reach 

Medicare Part B: smoking and 

tobacco use cessation counseling

This benefit provides for treatment of individuals who use

tobacco.

National

Medicaid mandatory benefit

to provide tobacco cessation 

counseling to pregnant women

The new Affordable Care Act benefit requires that States provide 

tobacco cessation services including counseling and pharmacotherapy to pregnant women effective 10/01/2010.

National

Preventive Services: Medicaid 

optional coverage of cessation 

services

Beginning in 2013, the Affordable Care Act encourages States

to provide coverage of preventive services rated A or B by the 

US Preventive Services Task Force by offering a 1% increase

in Federal financial participation for States covering these

services without cost-sharing for the beneficiary.

National

Pharmacotherapy: Medicaid

optional coverage of cessation 

drugs

Currently, if States elect the optional Medicaid drug benefit,

they can also elect to exclude smoking cessation drugs from that 

benefit package. Beginning in 2014, the Affordable Care Act

requires that States electing to provide the optional Medicaid 

drug benefit must include cessation drugs.

National

Medicaid coverage of evidencebased tobacco cessation telephone 

quitlines

Medicaid will cover tobacco cessation quitlines as an optional 

administrative activity. Therefore, States can receive 50%

Federal financial participation for the costs of their quitlines 

which are allocated to Medicaid beneficiaries.

National
47

The Food and Drug Administration’s Center for Tobacco Products (CTP)

FDA is responsible for implementing the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), which gives 

the agency the authority to regulate the manufacture, marketing, and distribution of tobacco products as provided by statute and as 

appropriate for the protection of public health. Some of the agency’s responsibilities under the law include setting tobacco product 

standards, reviewing premarket applications for new and modified-risk tobacco products, requiring new health warnings, and establishing and enforcing advertising and promotion restrictions. It should be noted that this is not a comprehensive list of all requirements and actions under the Tobacco Control Act.

Major Activity Description Reach

Tobacco Products Scientific 

Advisory Committee

(FDCA Sec. 917)

The Tobacco Products Scientific Advisory Committee provides advice, 

information, and recommendations to the Secretary on a variety of 

topics, including:

•	 The impact on the public health of the use of menthol in 

cigarettes, including such use among children, African Americans, 

Hispanics, and other racial and ethnic minorities

•	 The nature and impact of the use of dissolvable tobacco products on the public health, including such use among children

•	 The effects of the alteration of nicotine yields from tobacco 

products and whether there is a threshold level below which 

nicotine yields do not produce dependence on the tobacco 

product involved

•	 Applications submitted by a manufacturer for a new or 

modified-risk tobacco product 

National

Flavor ban [FDCA Sec. 

907(a)(1)(A)]

Effective September 22, 2009, this section places a ban on all cigarettes 

containing certain characterizing flavors (except for menthol as required by 

the statute).

National

Registration and listing 

(FDCA Sec. 905)

This section requires that every person who owns or operates any domestic 

establishment engaged in the manufacture, preparation, compounding, or 

processing of tobacco products must register those establishments with FDA 

by December 31 of each year. All registrants must also submit a list of all 

tobacco products that are being manufactured by that person for commercial 

distribution, along with certain accompanying information, including all 

labeling.

National 
48

Major Activity Description Reach

Reporting of ingredient and 

constituent data [FDCA 

Sec. 904(a)(1)] 

This section requires each tobacco product manufacturer, importer,

or agent thereof to submit a listing of all ingredients, including tobacco 

substances, compounds, and additives, that are added by the manufacturer to the tobacco, paper, filter, or other part of each regulated

tobacco product by brand and by quantity in each brand and sub-brand.

National

Reissuance of the 1996 

Final Rule on Cigarettes and 

Smokeless Tobacco (TCA 

Sec.102; 21 CFR Part 1140)

This section establishes regulations restricting the sale, distribution, advertising, and promotion of cigarettes and smokeless tobacco products to children 

and adolescents. 

Specific Requirements Include:

•	 Prohibits the sale of cigarettes or smokeless tobacco to people younger 

than 18 years of age

•	 Prohibits the sale of cigarette packages with fewer than 20 cigarettes

•	 Prohibits the sale of cigarettes and smokeless tobacco in vending

machines, self-service displays, or other impersonal modes of sales, 

except in very limited situations

•	 Prohibits free samples of cigarettes and restricts free samples

of smokeless tobacco products

•	 Prohibits tobacco brand-name sponsorship of any athletic, musical,

or other social or cultural event or any team or entry in those events

•	 Prohibits gifts or other items in exchange for buying cigarettes

or smokeless tobacco products

•	 Requires that audio ads use only words with no music or sound effects

•	 Prohibits the sale or distribution of items or services that bear brand 

names, logos, or other indicia of product identification identical

to, similar to, or identifiable with those used for any brand of cigarettes 

or smokeless tobacco

FDA will, where feasible, contract with states to carry out inspections 

of retailers.

National
49

Major Activity Description Reach 

Smokeless tobacco label

and advertising warnings 

(TCA Sec. 204) 

Cigarette label and

advertising warnings

(TCA Sec. 201)

This section amends the Comprehensive Smokeless Tobacco Health

Education Act to require four rotational health warning statements that 

must appear on smokeless tobacco packaging and in advertising. New 

health warnings are larger and more prominent. For packages, the

warning must comprise at least 30% of the two principal display panels 

of the package. For press and poster advertisements, the warning must 

comprise at least 20% of the area of the ad.

This section amends the Federal Cigarette Labeling and Advertising Act 

to require nine new rotational health warning statements that must appear 

on cigarette packaging and in advertising. New warnings are larger and 

more prominent and will include, through FDA final regulations, color 

graphics depicting the negative health consequences of smoking. For 

packages, the warnings must appear in the top 50% of the front and rear 

panels of the package. For press and poster advertisements, the warning 

must comprise at least 20% of the area of the ad.

National

Bans the use of the descriptors (FDCA Sec. 911)

This section prohibits the introduction into interstate commerce of any 

tobacco product labeled or advertised with the descriptors “light,” “mild,” 

“low,” or similar descriptors that were manufactured after June 22, 2010, 

unless an FDA marketing order is in effect with respect to such product. 

This section also prohibits tobacco product manufacturers, without an 

FDA order in effect, from introducing any such product into the domestic 

commerce of the United States after July 22, 2010, irrespective of the 

date of manufacture.

National

Premarket review (FDCA 

Sec. 910)

FDA will conduct a premarket review of applications for tobacco products not commercially marketed in the United States as of February 15, 

2007, unless those products are exempt for certain reasons outlined in 

the Tobacco Control Act. For those products requiring premarket review, 

FDA will review information submitted regarding, among other things, 

the health risks of the tobacco product, ingredients, and methods used for 

manufacture, and labeling.

National

Tobacco product standards 

(FDCA Sec. 907)

This section grants FDA authority to create tobacco product standards 

appropriate for protecting the public’s health, including standards for 

nicotine yields and reduction or elimination of other constituents.

National

Public education and

outreach

The Tobacco Control Act encourages the agency to promote cessation to 

reduce disease risk and the healthcare and productivity costs associated 

with tobacco products and to provide information about the contents of 

tobacco products and consequences of tobacco use. Implementation of 

the Tobacco Control Act is furthered by outreach to stakeholders, which 

include members of the general public (consumers, patients, caregivers); 

organizations representing consumers; patients; smokers; tobacco control 

advocates; regulated industry; health professionals; and federal, state,

local, tribal, and international health agencies and organizations.

National
50

The Health Resources and Services Administration (HRSA)

HRSA has a coordinated approach to tobacco-related activities through its Office of Health Equity (OHE) which leads the agencywide effort to collect data; provide resources; and develop and expand initiatives related to tobacco initiation, prevention, and cessation. One major focus is to help the Bureau of Primary Health Care (BPHC) reach its goal of 100% of their grantees having a formal 

tobacco prevention of initiation and cessation program. OHE also represents HRSA in a variety of cross-Departmental tobacco 

initiatives and oversees a small Tobacco Cessation and Education Learning Collaborative.

Major Activity Description Reach 

Bureau of Primary 

Health Care (BPHC)

Fifty-seven percent of BPHC’s health center grantees have adopted a formal tobacco 

cessation program. The health centers serve approximately 16 million persons; the 

majority of those served are women of childbearing age and children. Almost 28% 

are served in languages other than English. Ten BPHC primary care associations were 

funded to implement cancer and tobacco control programs, in part through support 

from the Offices of Women’s Health at HHS and FDA. One initiative also targets 

secondhand smoke exposure amongst women of childbearing age, their children, and 

families.

Local and national

Healthcare Systems 

Bureau/Office of 

Pharmacy Affairs 

(OPA)

This bureau oversees the 340B Prime Vendor Program, which provides medication

for tobacco cessation at a discounted fee. HRSA’s BPHC is collaborating with OPA

to inform its health center providers that prescription and over-the-counter tobacco

cessation medications are available at discounted fees. 

Local and national

HIV/AIDS Bureau 

(HAB)

Numerous HAB grantees (under the Ryan White HIV/AIDS Program – Parts A, B, 

C, and D) have tobacco cessation programs. Several models used include pharmacotherapy, social services counseling, and clinician interventions.

Local and national

Office of Planning, 

Analysis and Evaluation/Office of Health 

Information

Technology and

Quality (OHITQ)

OHITQ has proposed two nationally aligned tobacco screening performance measures 

that bureaus and offices can use for their service delivery and/or outreach programs. 

The measures also can be used by HRSA’s grantees to assess their overall quality

performance and/or continuous quality improvement efforts in this area.

Local and national

Maternal and Child 

Health Bureau 

(MCHB)

HRSA’s Healthy Start Initiative is designed to reduce infant mortality and disparities 

in perinatal health in high-risk communities by improving the quality of health care 

for women and infants. The 2006 Healthy Start Evaluation revealed 73% of MCHB’s 

Healthy Start Programs had formal smoking cessation activities. Additionally, Healthy 

Start staff provides individual and group counseling to prevent tobacco initiation, 

adolescent and youth tobacco related interventions as well as exposure to secondhand 

smoke

HRSA, MCHB, and the American Academy of Pediatrics’ Bright Futures Health

Supervision Guidelines for infants, children, and adolescents include specific

risk-reduction recommendations to prevent and assess tobacco use and exposure.

http://mchb.hrsa.gov/programs/training/brightfutures.htm

Local and national
51

The Indian Health Service (IHS)

The IHS Cancer Program seeks to reduce tobacco use by promoting clinical cessation efforts, encouraging community-based

education and policy interventions, and providing technical assistance to existing surveillance efforts.

Major Activity Description Reach 

Tobacco Control Task 

Force

Multidisciplinary group that does strategic planning for IHS tobacco 

control efforts

National, tribal, and federal 

health care

Establish cessation clinics National effort to establish nicotine dependence treatment in every 

IHS and tribal health care facility

National (IHS and tribes)

Surveillance Involves collecting and monitoring data on tobacco use among 

American Indians and Alaska Natives

National

Education and materials Development of programs and materials to educate providers and 

patients through a contract with the University of Arizona

National

The National Cancer Institute’s Tobacco Control Research Branch (TCRB)

The National Cancer Institute (NCI) has identified research to prevent and control tobacco use and tobacco-related cancers as a 

public health priority. Its Tobacco Control Research Branch (TCRB) leads and collaborates on research and disseminates evidencebased findings to prevent, treat, and control tobacco use. Branch activities include funding research grants and contracts, sponsoring 

conferences and symposia, and disseminating tobacco control science. Additionally, branch scientists conduct research and participate in diverse scientific and programmatic activities in support of national and international tobacco control efforts.

Major Activity Description Reach 

Research grants and 

contracts

Provide funds to scientists to conduct research in tobacco control, including 

etiology, prevention, cessation, and policy research The majority of the TCRB 

grant portfolio is investigator-initiated proposals. In addition, the portfolio 

currently includes the following major research initiatives: Improving Effectiveness of Smoking Cessation Interventions and Programs in Low-Income 

Adult Populations; Smokeless Tobacco Use, Prevention, and Cessation; State 

and Community Tobacco Control Policy and Media Research; Testing Tobacco 

Products Promoted to Reduce Harm; and Laboratory Assessment of Tobacco 

Use Behavior and Exposure to Toxins Among Users of New Tobacco Products 

Promoted to Reduce Harm.

National and

international

Surveillance Fund tobacco use behavior and health awareness surveillance through the 

Tobacco Use Supplement to the Current Population Survey (TUS-CPS), Health 

Information National Trends Survey (HINTS), and others. TUS-CPS is a key 

source of national, state, and substate level data on smoking and other tobacco 

use in the U.S. household population. The 2003 TUS-CPS has a special focus on 

tobacco cessation. HINTS was created to monitor changes in the rapidly evolving field of health communication. The survey data can be used to understand 

how adults use different communication channels to obtain health information 

for themselves and their loved ones and to create more effective health communication strategies across populations. 

National

Information dissemination Disseminate research findings and smoking and health information through NCI 

Tobacco Control Monographs, the NCI Cancer Bulletin, the Cancer Information 

Service, and other mechanisms. The NCI Tobacco Control Monograph Series 

provides ongoing and timely information about emerging public health issues 

in smoking and tobacco control. The most recent volumes in the series are The 

Role of the Media in Promoting and Reducing Tobacco Use (2008) and Phenotypes and Endophenotypes Foundations for Genetic Studies of Nicotine Use and 

Dependence (2009).

National and

international
52

Major Activity Description Reach

Cessation services Provide cessation services to the general public through Smokefree.gov, Women.Smokefree.gov, 1-800-QUIT-NOW, and 1-877-44U-QUIT. The Smokefree.

gov Web site offers a variety of resources designed to help people quit smoking. 

The site and all resources are free to the public. In 2009, a major expansion of 

the site was unveiled that highlighted new resources and interactive features, 

including assessments and support materials for depression and withdrawal 

symptoms. Web 2.0 technologies were incorporated into the site and content 

was tailored to women smokers (Women.Smokefree.gov). TCRB collaborates 

with the North American Quitline Consortium.

National

Collaborative projects Engage in collaborative research, dissemination, and public health tobacco 

control projects with diverse public and private organizations. TCRB scientists 

regularly participate in WHO-sponsored activities, including those of the Study 

Group for Tobacco Regulation and the Tobacco Laboratory Network. TCRB 

scientists have also collaborated with the International Agency for Research

on Cancer. TCRB is working with the NCI Office of the Director to further

enhance the availability of cessation services for employees and their dependants. TCRB is also developing evaluation metrics to help Gold Standard

organizations measure the health impact of their efforts. (Note that NCI is a 

CEO Cancer Gold Standard organization.) TCRB organizes and cosponsors

research conferences and knowledge syntheses to disseminate scientific

findings, generate new knowledge, encourage collaborative projects, and help 

ensure research efficiency.

National and

international

Support tobacco control 

infrastructure

Provide funding, leadership, and collaboration to a wide range of networks and 

activities in support of tobacco control research and public health infrastructure. 

Examples include Tobacco Research Network on Disparities, Youth Tobacco 

Cessation Collaborative, National Tobacco Cessation Tobacco Collaborative, 

Tobacco Surveillance Epidemiology and Evaluation Network, and Tobacco 

Harm Reduction Network.

National and

international
53

The National Heart, Lung, and Blood Institute (NHLBI)

NHLBI supports smoking-related research, including epidemiology and treatment research related to smoking cessation

in patients with cardiovascular disease and chronic obstructive pulmonary disease. 

Major Activity Description Reach 

Grant funding Supports research on smoking prevention and control National

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NICHD supports tobacco-related research activities that include basic, clinical, and epidemiological studies of the reproductive, 

neurobiological, developmental, and behavioral processes that determine and maintain the health of children, adolescents, and adults 

affected by tobacco use and or exposure. Research programs include both domestic and international populations. 

Major Activity Description Reach 

Summary of ongoing

research activities

Basic research activities include clarifying the processes by which 

tobacco exposure may lead to sudden infant death syndrome, fetal 

growth restriction, birth defects, or developmental delays; also, how 

exposure may affect ovarian health and fertility. Clinical studies 

include testing interventions designed to help women stop smoking 

during pregnancy and after having given birth. Among the epidemiologic studies that the institute supports, researchers are examining the 

patterns of risk behaviors among adolescents, which include factors 

related to access to tobacco and exposure to tobacco use. 

National

Recent science advances 

from the Global Network 

for Women’s and Children’s 

Health Research

As indicated in the document “Tobacco Use and Secondhand Smoke 

Exposure During Pregnancy May Threaten Health of Women and Children in Developing Nations,” pregnant women are a priority population for tobacco prevention efforts because tobacco use poses 

serious risks to fetal and maternal health. Findings from a study 

conducted by NICHD and NCI indicate that rates of tobacco 

use during pregnancy, as well as exposure of pregnant women 

and their young children to secondhand smoke, are significant 

threats to health in several low- and middle-income countries. 

The researchers found that as many as 18% of pregnant women 

currently smoked cigarettes, up to one-third used smokeless 

tobacco, and as many as half were regularly exposed to secondhand smoke in the nations studied. Whereas tobacco use 

rates are still low, there is the opportunity to avert an increase in 

tobacco use among women, especially pregnant women, in the 

developing world. The data highlight the urgent need to adopt 

proven measures not only to prevent exposure of women and 

girls worldwide to secondhand smoke but also to prevent and 

control tobacco use. 

International
54

The National Institute on Drug Abuse (NIDA)

NIDA supports a broad portfolio of tobacco-related research, including epidemiology, etiology, basic neuroscience, neuropsychology, prevention and treatment research, medication development, and assessing the potential impact of new tobacco products on 

public health. During fiscal year 2008, NIDA funded 290 tobacco-related projects ($82.8 million).

Major Activity Description Reach 

Prevention, epidemiology, 

and services research

NIDA supports research on the epidemiology of tobacco use, including the 

Monitoring the Future (MTF) survey conducted annually by the University of 

Michigan. MTF assesses cigarette, drug, and alcohol use and related attitudes in 

grades 8, 10, and 12. NIDA also funds research to develop and improve tobacco 

prevention programs and services. 

National

Nicotine addiction and

neuroscience research

Research focuses on the neurobiological mechanisms of nicotine activity,

genetic and environmental risk factors for tobacco use and addiction, and

adverse outcomes of tobacco use. Recent discoveries include a genetic variant 

that doubles the risk for nicotine dependence among smokers and is linked

to increased risk for lung cancer. 

National

Dissemination of tobaccorelated research findings 

and health information

NIDA disseminates tobacco-related information to the public through publications like the Research Report: Tobacco Addiction and InfoFacts: Cigarettes 

and Other Tobacco Products. NIDA also supports tobacco-focused sessions and 

presentations at national and international meetings for researchers, tobacco 

control personnel, and health care practitioners, such as the annual meeting

of the Society for Research on Nicotine and Tobacco and the World Conference 

on Tobacco or Health.

Local, national, 

and international

Treatment research

(including medication

development)

NIDA supports research to develop and improve behavioral and pharmacological

smoking cessation therapies, including a nicotine vaccine. Priorities also include 

pharmacogenomics, an emerging field that promises to harness addiction science to personalize cessation treatments. NIDA also partners with other agencies

in the National Cooperative Drug Discovery Group to develop specifically

targeted medications for treating nicotine addiction. 

National

Clinical trials National Drug Abuse Treatment Clinical Trials Network teams regional research 

centers with community drug treatment providers to conduct studies on the 

safety and effectiveness of smoking cessation treatments in a variety of clinical 

settings and patient populations.

Local and

national
55

The Office of Behavioral and Social Sciences Research (OBSSR) at NIH

OBSSR’s mission is to stimulate and integrate behavioral and social sciences research across all 27 institutes and centers that NIH 

comprises, thereby improving the understanding, treatment, and prevention of disease. This mission encompasses a broad range of 

topics, including tobacco control research. OBSSR does not have congressional authority to make grants, but the office does support 

tobacco-related research by partnering with NIH institutes and centers and/or HHS agencies on grants and other activities. The items 

below are examples only; OBSSR contributes to other types of activities that are not listed.

Major Activity Description Reach 

Grant co-funding OBSSR routinely co-funds grants issued by NIH’s institutes and centers.

OBSSR is currently co-funding tobacco-related grants with NIDA and NCI.

Local, state and/or 

federal, depending 

on the grant

Conference co-funding and 

in-kind support

OBSSR provides co-funding and in-kind support in the form of staff time to 

help plan and conduct tobacco-related meetings, conferences, and workshops. 

For example, OBSSR contributed to the multiagency-sponsored Innovations 

in Building Consumer Demand for Tobacco Cessation Products and Services 

Roundtables and Conference, to the National Heart Lung and Blood Institute-led 

2008 Working Group on Smoking Cessation in Hospitalized Patients, and to the 

NCI-led Tobacco Modelers Conference series. 

National

Publication co-funding, 

guest editing, and manuscript preparation

OBSSR co-funds and intellectually contributes to tobacco-related publications. 

Recent and pending publications to which OBSSR has contributed include a 

special issue of the American Journal of Public Health (“Tobacco Modeling to 

Advance Tobacco Control Policy”), American Journal of Preventive Medicine

supplement (“Innovations in Building Consumer Demand for Tobacco Cessation 

Products and Services”), and a special issue of Nicotine and Tobacco Research

(“Light and Intermittent Smoking”).

National
56

The Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA supports a variety of tobacco prevention and treatment activities. These activities include enforcement of the Synar 

Amendment, which focuses on reducing the sale of tobacco products to minors and creating partnerships to implement or enhance 

current tobacco cessation programs. Activities within the SAMHSA’s Center for Substance Abuse Prevention (CSAP) include

collaborating with states on the treatment of tobacco dependence and the essential involvement of tobacco cessation as a portion

of larger treatment programs. 

Major Activity Description Reach 

Synar regulation Requires states, the District of Columbia, and the 8 U.S. jurisdictions to enact and enforce laws prohibiting the sale of tobacco 

products to individuals under the age of 18; to conduct annual, 

random, unannounced inspections of retail tobacco outlets to 

ensure compliance with the law; and to submit an annual report on 

progress. SAMHSA, through CSAP, annually reviews each state’s 

Synar survey and results and provides technical assistance to help 

states comply with the requirements.

State and national

100 Pioneers for Smoking 

Cessation Virtual Leadership 

Academy

Open to current SAMHSA grantees, this program is a partnership 

with the Smoking Cessation Leadership Center to provide $1,000 

to grantees to implement or enhance existing tobacco cessation 

services using evidence-based practices, to implement smoke-free 

environments, to ensure that consumers and staff have access to 

smoking cessation services and support to promote health and 

wellness, and to establish partnerships between behavioral health 

and nicotine cessation organizations to increase available tobacco 

cessation resources in communities.

Community, state, and national

Monitor state substance use 

authorities’ (SSAs’) involvement

Several SSAs are responsible for the treatment of tobacco

dependence. To respond to the states’ needs for sharing of clinical 

interventions and administrative rules, CSAT monitors and shares 

information of interest to state policymakers on the treatment

of tobacco dependence.

National

Opioid Treatment Program 

(OTP) accreditation and 

certification program

The program is the process by which OTPs receive accreditation 

and certification in order to meet state and federal guidelines. 

OTPs address smoking and tobacco cessation with their clients

as an integral part of treatment.

Patients at the OTPs—state and 

national
57

Major Activity Description Reach

Surveillance and

Epidemiology

SAMHSA conducts the National Survey on Drug Use and Health 

(NSDUH), an annual survey of the civilian, noninstitutional population aged 12 years and older. The survey provides detailed information on tobacco use each year, including data on the overall 

prevalence of use among youth and adults, brands used, quantity 

and frequency of use, initiation of use, and co-occurring alcohol 

and illicit drug use and mental disorders. Tobacco questions cover 

cigarettes, smokeless products, cigars, and pipes. The sample is 

stratified by state, providing estimates for every state based on an 

overall sample of 67,500 respondents each year, including 22,500 

youth (aged 12–17 years) and 22,500 young adults (aged 18–25 

years). SAMSHA produces a variety of analytic reports based on 

the NSDUH data addressing the epidemiology of tobacco use.

SAMHSA’s recently revised National Survey of Substance Abuse 

Treatment Services, which collects data from all private and 

public substance abuse treatment facilities in the United States, 

now collects data on whether the facility offers smoking cessation 

programs as an ancillary service and whether the facility provides 

nicotine replacement and/or non-nicotine smoking cessation medications to its clients.

State and national

Screening, Brief Intervention, 

and Referral to Treatment 

(SBIRT) Program

The SBIRT program is a comprehensive, integrated, public health 

approach to the delivery of early intervention and treatment 

services for persons with substance use disorders as well as those 

who are at risk of developing these disorders. SBIRT programs 

are conducted in primary care and community health centers, 

hospital emergency rooms, trauma centers, and other community 

settings. SBIRT programs utilize a tool that screens for alcohol, 

substance abuse, and tobacco use. Individuals scoring positive on 

the screenings are referred to tobacco cessation programs or to 

local quitlines.

State
58

Appendix D: List of Participants

Howard Koh, MD, MPH – Assistant Secretary of Health

Rosemarie Henson – Working Group Co-Chair

Clifford Douglas – Working Group Co-Chair

Gregory Goldstein – Working Group Staff

Anand Parekh – Working Group Staff

Simon McNabb – Working Group Staff

Sharon Kohout – Working Group Staff

Amanda Shriwise – Working Group Staff

Mahak Nayyar – Working Group Staff

Patti Seikus – Editor
59

HHS Tobacco Prevention and Control Working Group

Tobacco Use Cessation and Treatment Subcommittee

Cathy Backinger – Co-Chair NIH

Deborah Willis-Fillinger – Co-Chair HRSA

Shenena Armstrong HRSA

Erik Augustson NIH

Ron Banks OPHS

Priscilla Callahan-Lyon FDA

Emerson Carvalho CMS

Amina Chaudhry SAMHSA

Gail Cherry-Peppers HRSA

Jillian Curtis ASFR

Mark Delowery OS

Paolo Delvecchio SAMHSA

Michael Fiore NIH

Allison Hoffman NIH

Annette Levey OS

Ann Malarcher CDC

Ivan Montoya NIH

Glen Morgan NIH

Juleigh Nowinski OS

Susan Sanders OPHS

Priti Shah AoA

Daiva Shetty FDA

Christine Williams AHRQ

Lee Wilson ASPE

Celia Winchell FDA

Megan Wohr IHS
60

Seiji Hayashi – Co-Chair HRSA

Dana Shelton – Co-Chair CDC

Vicki Rivas-Vasquez – Co-Chair ASPA

Mary Beth Bigley OSG

Matt Brown CMS

Amanda Bryans ACF

Patsy Buida ACF

Jennifer Buschick ASPA

Susie Butler CMS

Emerson Carvalho CMS

Clara Cobb OPHS

Rosaly Correa-de-Araujo OS

Paolo Delvecchio SAMHSA

Pebbles Fagan NIH

James Galloway OPHS

Diane Gianelli ASPA

Prudence Goforth ASPA

Greg Goldstein OPHS

Eileen Hanrahan OCR

Frances Harding SAMHSA

Catherine Heath ACF

Corinne Husten FDA

Jeffrey Kelman CMS

Lauren Kidwell ASL

Sharon Kohout CDC

Kimberly Konkel Partnership 

Center

Roger McClung ASL

Patty McLean CDC

Gene Migliaccio ASA

Cindy Miner NIH

Andrea Palm ASL

Terry Pechacek CDC

Jessica Santillo ASPA

Priti Shah AoA

Julia Spencer ASPE

Joanna Stettner OGC

Mimi Toomey AoA

LeBretia White ACF

Christine Williams AHRQ

Megan Wohr IHS

Prevention Policies, Education, and Communication Subcommittee
61

Surveillance Subcommittee

Wilson Compton – Co-Chair NIH

Dale Hitchcock – Co-Chair ASPE

Lisa Barsoomian OS

Ahmed Calvo HRSA

Nathaniel Cobb IHS

Rosaly Correa-de-Araujo OS

Rashida Dorsey ASPE

Shanta Dube CDC

Martha Engstrom CDC

Erika Fulmer CDC

Joe Gfroerer SAMHSA

Anne Hartman NIH

Corinne Husten FDA

Laura Kann CDC

Annette McClave CDC

Anand Parekh OPHS

Terry Pechacek CDC

Charlotte Schoenborn CDC

Zachary Taylor OPHS

Louise Wideroff NIH
62

Tobacco Regulation Subcommittee

David Ashley – Co-Chair CDC

Catherine Lorraine – Co-Chair FDA

Nathaniel Cobb IHS

Megan Clark Velez FDA

Elizabeth Cusumano ASFR

Nathan Doty FDA

Clifford Douglas OPHS

Allison Hoffman NIH

Amber Jessup ASPE

Susan Marsiglia SAMHSA

Simon McNabb CDC

Sheila Newton NIH

Andrea Palm ASL

Mark Parascandola NIH

Dalton Paxman OPHS

Patricia Richter CDC

Douglas Tipperman SAMHSA

Samuel Wu HRSA