10 Years of Protecting Public Health Through Tobacco Regulatory Research

Posted on May 9th, 2023 by David M. Murray, Ph.D., NIH Office of Disease Prevention

“Kids are flocking to flavored, disposable e-cigarettes, study finds” – The Washington Post

“New ‘candy’ e-cigs catch fire after U.S. regulators stamp out Juul’s flavors” – Reuters

Headlines like these highlight a real challenge for people who want to protect kids from the harms of using tobacco products. While flavors, such as mint, menthol, watermelon, and apple pie are safe to consume in food products, inhaling them in tobacco products can be harmful and put the health of our kids at risk.+

A special kind of research is needed to help public health authorities keep up with the latest changes and trends in tobacco products. That includes studying how these flavored tobacco products are attractively marketed to children and how quickly many started using them.

In 2013, NIH and the Food and Drug Administration (FDA) launched a unique interagency partnership called the Tobacco Regulatory Science Program (TRSP), directed by Helen Meissner. It aims to reduce the public health impact of tobacco product use across the country. The NIH administers the research program through the Office of Disease Prevention (ODP), which I lead, to help inform FDA’s tobacco regulatory priorities.

This unique partnership also represents a new field of study called tobacco regulatory research. It informs proposed regulations for tobacco products based on strong scientific evidence. The TRSP brings together scientists from diverse fields, such as epidemiology, chemistry, toxicology, addiction, and psychology, to shed light on why people try and continue to use tobacco, how tobacco use affects health, and which policies might help reduce the risk of harm.

Now celebrating its 10th anniversary, this extremely productive partnership has resulted in more than 400 research grants, all peer-reviewed and designed to increase our understanding of existing and emerging tobacco products and their associated health risks.

Our research includes studies showing that menthol in cigarettes makes it easier to start smoking by reducing the harshness of tobacco [1]. People who smoke menthol cigarettes also show more signs of nicotine dependence and, therefore, are less likely to successfully quit. The research shows this is because menthol interacts with nicotine in the brain, making nicotine even more addictive.

Additionally, researchers have explored how marketing and promotion of menthol and flavored tobacco products have targeted Black and LGBTQ+ people, socioeconomically disadvantaged populations, and people with mental health challenges. These studies show that this direct marketing has contributed to the burden of tobacco-related disease among these groups and widened health inequities [2].

The TRSP also has a real-world impact on shaping tobacco policy. In April 2022, the program’s sponsored research was cited in FDA-proposed rules to prohibit menthol as a characterizing flavor in cigarettes and ban all characterizing flavors (other than tobacco) in cigars [3]. These tobacco product standards will have a huge impact on public health by reducing youth experimentation with products like cigarettes, cigars, and cigarillos and increasing the number of people who quit smoking.

Many jurisdictions have already banned flavored tobacco products. Through our partnership with the FDA, TRSP-funded researchers have started evaluating the impact of these policies on tobacco use and public health. The need for research continues as we seek to understand how new tobacco products affect people’s use, attitudes, and health.

However, tobacco products that have the potential to addict a new generation to nicotine continue to be marketed. For example, new products that use “ice-hybrid” flavors which combine cooling and fruity/sweet properties, such as raspberry ice, are being used more often than either fruity/sweet or menthol/mint among young adult e-cigarette users [4]. Illegally marketed, but novel, flavored oral nicotine products, such as gummies and pouches, also are gaining appeal among young people. The dynamic nature of the tobacco market emphasizes the importance of TRSP to support research on tobacco products, directly informing tobacco regulation.

The success of TRSP over the past 10 years demonstrates how establishing a research pipeline that directly informs regulation can lead to effective, evidence-based health policies. The high output of research on the effects of new and emerging tobacco products, such as the appeal and addictiveness of flavored e-cigarettes, provides FDA with data to inform regulatory actions. This partnership is truly helping regulators and policymakers turn scientific discovery into actions designed to protect public health.

References:

[1] Use of menthol cigarettes, smoking frequency, and nicotine dependence among US youth. Leas EC, Benmarhnia T, Strong DR, Pierce JP. JAMA Netw Open. 2022 Jun 1;5(6):e2217144.

[2] Menthol smoking and related health disparities. Centers for Disease Control and Prevention, June 27, 2022.

[3] FDA proposes rules prohibiting menthol cigarettes and flavored cigars to prevent youth initiation, significantly reduce tobacco-related disease and death. FDA News Release, April 28, 2022.

[4] ‘Ice’ flavoured e-cigarette use among young adults. Leventhal A, Dai H, Barrington-Trimis J, Sussman S. Tob Control. 2023 Jan;32(1):114-117.

Links:

Smokefree.gov (U.S. Department of Health and Human Services, Washington, D.C.)

Office of Disease Prevention (NIH)

Tobacco Regulatory Science Program (ODP)

Director’s Messages (ODP)

Note: Dr. Lawrence Tabak, who performs the duties of the NIH Director, has asked the heads of NIH’s Institutes, Centers, and Offices to contribute occasional guest posts to the blog to highlight some of the interesting science that they support and conduct. This is the 29th in the series of NIH guest posts that will run until a new permanent NIH director is in place.