Truth Initiative's Proposals for Getting Tobacco Out of U.S. Society

The American organization Truth Initiative has just published a report[1] calling on the United States to adopt comprehensive anti-smoking measures and to denormalize the use of tobacco and related products with a view to eliminating tobacco from society. To this end, Truth supports a set of measures including banning flavors, increasing taxes, reducing the number of points of sale, improving access to cessation treatments and applying the measures to all tobacco products in the strict sense as well as non-medical nicotine.

Despite significant progress in reducing and denormalizing tobacco use in the United States, tobacco use remains the leading cause of preventable premature death and disease in the country. Tobacco use still accounts for more than 480,000 deaths in the country each year and costs more than $240 billion annually in health care costs and nearly $185 billion in lost productivity due to tobacco-related diseases.

In 2021, 35.65 million (14.5 %) adults reported using combustible tobacco products and 11.1 million (4.5 %) reported using vaping products. Among youth, 1 million (3.7 %) reported using a combustible tobacco product, and over 2.5 million (9.4 %) reported using vaping products.

A tobacco-free generation, a public health objective

Truth reminds us that to achieve a tobacco exit in a society – or endgame – strong measures are necessary. These measures include reducing access to products, reducing the appeal and addictive nature of tobacco and nicotine products, facilitating access for smokers to proven smoking cessation treatments and denormalizing the consumption of any tobacco product, whatever it may be, including new products put on the market, ultimately relegating this consumption to a behavior of the past. This strong commitment to a tobacco exit from society is gaining momentum in light of the favorable developments in many countries that have managed to massively reduce their tobacco consumption but are faced with the need to continue the effort and design new provisions. Thus, more and more public health experts and policy makers supported by public support are committing to this path. And several countries are well on the way to achieving this End Game (New Zealand, Australia, Canada).

The goal of a tobacco-free generation is to save thousands of lives from premature mortality and many diseases and to greatly reduce the health disparities caused by tobacco use.

The United States is increasingly adopting strong local measures

Public support for achieving a tobacco-free generation has resulted in the recent adoption of several strong policies in the United States, at the local, state, and even federal levels. For example, many localities have adopted flavor bans. Some counties and cities, such as San Francisco and Philadelphia, have reduced the number of tobacco retailers in their jurisdictions. At the federal level, the Food and Drug Administration is considering regulations aimed at reducing nicotine levels in cigarettes to non-addictive levels.

While measures implemented in recent years have significantly reduced tobacco prevalence in the country, Truth wants state and local governments to redouble their efforts to implement the most appropriate policies for their communities and to move towards quitting smoking. In addition, proven measures such as strong and consistent tax policies, the establishment of smoke-free spaces, better access to cessation treatments, the reduction of the number of points of sale, etc. are essential.

According to Truth Initiative, at the federal level, the FDA must act quickly to finalize regulations on menthol cigarettes and flavored cigars in order to remove these products from the market. The organization also mentions regulations aimed at reducing nicotine levels in cigarettes and vaping products. For the latter, Truth Initiative recalls that levels are currently limited to 20 mg/ml in other countries such as in the member states of the European Union and Canada. In addition, the FDA should better monitor its process for verifying vaping products placed on the market. Finally, it is called upon to adopt new rules to remove from the market all flavored tobacco and nicotine products, with the exception of cessation products subject to specific authorization from the public agency.

The adoption of strong measures is supported by a majority of the American population since a recent poll by the Centers for Disease Control and Prevention (CDC) showed that 62.3% of adults were in favor of a policy ending the sale of menthol cigarettes and that more than 57.3% of adults were in favor of a policy ending the sale of all tobacco and nicotine products.

An approach that must include new tobacco and nicotine products

For Truth, it is not only necessary to denormalize tobacco consumption but also any other product containing nicotine such as vaping products, nicotine pouches, etc. with the exception of drugs approved by the Food and Drug Administration.

The tobacco industry's strategy to win back markets through the launch of new tobacco and nicotine products, presented by the manufacturers as safer, has sparked much debate. According to Truth Initiative, attention has ultimately been diverted from the dangers of these products as such and also from the tobacco industry's responsibility in maintaining the tobacco epidemic.

Holding the tobacco industry accountable for the tobacco epidemic and protecting against its interference

The tobacco industry must be held accountable for its role in perpetuating smoking, particularly among youth and young adults, through its continued opposition to tobacco control measures and the development of its new products that are aggressively and targeted at youth. The organization notes that tobacco companies continue to fail to comply with existing regulations. E-cigarette maker Juul has been held accountable by multiple local governments in the United States for its blatant actions to mislead consumers and market its products to youth. In another area, a tobacco company has been found guilty by the U.S. government for violating U.S. sanctions and selling cigarettes and other tobacco products to North Korea.

Truth Initiative finally warns policy makers and the public health community about the tobacco industry's strong interference. The organization recommends developing research, actions, communication and funding to counter the industry's misinformation around the policies to be implemented. It warns about the tobacco industry's promotion of a "risk reduction" discourse. According to the organization, we are witnessing real misinformation whose sole purpose is to develop the nicotine market and increase the profits of tobacco manufacturers. It is necessary for health professionals and tobacco control experts to re-appropriate the subject of risk reduction. According to the organization, public health must adopt a long-term vision and implement policies protected from the cigarette lobby whose interests are irreconcilable.

Keywords: Truth Initiative, United States, End Game, tobacco-free generation, smoking, misinformation, nicotine, tobacco industry

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[1] Report, Gamechanger: Shifting from Tobacco Control to Ending the Industry's Influence for Good, Truth Initiative, published July 12, 2023, accessed July 13, 2023