Comprehensive Nicotine Regulation to End the Combustible Tobacco Epidemic
Authors: Neal L. Benowitz
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions21 November 2017Comprehensive Nicotine Regulation to End the Combustible Tobacco EpidemicNeal L. Benowitz, MDNeal L. Benowitz, MDFrom University of California, San Francisco, San Francisco, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2071 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Cigarette smoking, the leading cause of preventable disease and death in the United States, is sustained by nicotine addiction. Most of the harm from smoking derives from products of combustion, with nicotine playing a minor role in causing direct harm. In 1994, the U.S. Food and Drug Administration (FDA) declared that nicotine in cigarettes was a drug—because use is intended to affect the structure and function of the body—and announced its intention to consider regulating cigarettes.At that time, it was recognized that most smokers begin to smoke as children or adolescents. Yong persons experiment with cigarettes in a social ...References1. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Washington, DC: US Gov Pr Office; 1994. Google Scholar2. Benowitz NL, Henningfield JE. Establishing a nicotine threshold for addiction. The implications for tobacco regulation. N Engl J Med. 1994;331:123-5. [PMID: 7818638] CrossrefMedlineGoogle Scholar3. Family Smoking Prevention and Tobacco Control Act, Pub. L. 111-31, 123 Stat. 1776 (2009). Google Scholar4. Benowitz NL, Dains KM, Hall SM, Stewart S, Wilson M, Dempsey D, et al. Smoking behavior and exposure to tobacco toxicants during 6 months of smoking progressively reduced nicotine content cigarettes. Cancer Epidemiol Biomarkers Prev. 2012;21:761-9. [PMID: 22354905] doi:10.1158/1055-9965.EPI-11-0644 CrossrefMedlineGoogle Scholar5. Donny EC, Denlinger RL, Tidey JW, Koopmeiners JS, Benowitz NL, Vandrey RG, et al. Randomized trial of reduced-nicotine standards for cigarettes. N Engl J Med. 2015;373:1340-9. [PMID: 26422724] doi:10.1056/NEJMsa1502403 CrossrefMedlineGoogle Scholar6. Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ. 2016;354:i4645. [PMID: 27624188] doi:10.1136/bmj.i4645 CrossrefMedlineGoogle Scholar7. Zhu SH, Zhuang YL, Wong S, Cummins SE, Tedeschi GJ. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. BMJ. 2017;358:j3262. [PMID: 28747333] doi:10.1136/bmj.j3262 CrossrefMedlineGoogle Scholar8. Food and Drug Administration, HHS. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. Final rule. Fed Regist. 2016;81:28973-9106. [PMID: 27192730] MedlineGoogle Scholar9. U.S. Food and Drug Administration. FDA announces comprehensive regulatory plan to shift trajectory of tobacco-related disease, death [press release]. 28 July 2017. Accessed at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm on 3 August 2017. Google Scholar10. Tengs TO, Ahmad S, Savage JM, Moore R, Gage E. The AMA proposal to mandate nicotine reduction in cigarettes: a simulation of the population health impacts. Prev Med. 2005;40:170-80. [PMID: 15533526] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, California.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2071.Corresponding Author: Neal L. Benowitz, MD, Chief, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, Box 1220, San Francisco, CA 94143-1220; e-mail, Neal.[email protected]edu.Author Contributions: Conception and design: N.L. Benowitz.Analysis and interpretation of the data: N.L. Benowitz.Drafting of the article: N.L. Benowitz.Critical revision of the article for important intellectual content: N.L. Benowitz.Final approval of the article: N.L. Benowitz.Provision of study materials or patients: N.L. Benowitz.Administrative, technical, or logistic support: N.L. Benowitz.Collection and assembly of data: N.L. Benowitz.This article was published at Annals.org on 15 August 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySwitching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical TrialNational Initiatives to Prevent Myocardial Infarction and StrokeWe Must Fix US Health and Public Health PolicyFDA's regulatory shift on tobacco control 21 November 2017Volume 167, Issue 10Page: 736-737KeywordsAdolescentsChildrenClinical trialsDisclosureFood and Drug AdministrationNicotineNicotine addictionPrevention, policy, and public healthPublic policyTobacco control ePublished: 15 August 2017 Issue Published: 21 November 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...