The results of this study show that most adult smokers were unaware of the FDA's authority to regulate tobacco products, but were generally supportive of efforts to better inform the public about health risks and to make tobacco products less addictive.
These findings from a nationally representative sample of smokers provide an indication of support for the specific provisions of the FSPTCA. The study is limited since it only includes adult smokers and because this supplemental survey wave was conducted shortly after the passage of FSPTCA and prior to the implementation of any of the components of the regulations. Thus, it is not surprising that awareness of these new regulatory measures was low. Future waves of the ITC United States Survey will continue to monitor how smokers' beliefs and attitudes related to FDA regulation of tobacco products may change over time.
Support for potential regulations foreshadowed in the FDA legislation was generally stronger than for some of the more novel possibilities. Support for many FDA proposals was consistent among all smoker subgroups examined, including heavy smokers. Of the small number of statistically significant comparisons, most were related to age. When compared to older participants, 18-24 year olds were less likely to believe that their brand has been evaluated by the government, more likely to support a ban on tobacco company promotions, and were more likely to believe that light cigarettes are just as dangerous as regular strength cigarettes. This suggests a need to better target educational campaigns toward older smokers.
The finding that support is generally strong among heavy smokers, and comparable to that of light smokers, could be particularly important because it suggests that the degree of nicotine dependence is not motivating opposition to regulation.
For some measures there was markedly less support for specific policies than for the general proposition under which the specific proposal logically falls. For example, there was much stronger support for removing promotional activities than the specific measure of requiring cigarettes to be sold in only plain packaging. In these cases, it is important to understand whether this is because smokers do not believe the policy will achieve the general aim or whether they think it is an inappropriate means of achieving it.
Strong support was found among smokers for banning cigarette promotion as long as adults who want to smoke could still purchase cigarettes. Smokers also indicated some level of support (33%) for restricting the number of places where cigarettes could be sold.
Support for banning additives and flavorings was generally low. About one-fifth of current smokers (19%) and 9% of current menthol smokers supported banning menthol. Support for banning menthol was unrelated to interest in quitting, which may suggest that smokers don't link flavoring and ease of quitting. These findings are similar to another nationally representative survey conducted in November 2009. Respondents were asked whether they strongly agree, agree, disagree, or strongly disagree with the statement: "Menthol cigarettes should be prohibited just like other flavored cigarettes." Winickoff et al. found that 28% of current smokers supported banning menthol cigarettes [8].
Data from this study suggest that smokers are supportive of actions that they see as better enabling them to make free choices about the use of cigarettes. Nicotine addiction and a lack of knowledge about these products are two critical constraints now placed on consumers that limit their ability to freely choose when and how to use cigarettes. That said, they still want the experience of smoking to be as pleasant as possible, something not consistent with this desire.
The data presented here show that smokers are generally supportive of decreasing the addictiveness of the product and the level of support is dependent on the array of alternatives that were offered to them. Few supported banning cigarettes or tobacco products altogether, an action not permitted under the FSPTCA. Given that approximately 90% of smokers regret smoking and most want to quit [9], reducing nicotine levels in cigarettes has the potential to make it easier for smokers to quit. These data suggest that reducing nicotine levels to make cigarettes less addictive is a potentially viable strategy the FDA can take to improve public health. However, we do not know how smokers would respond to a specific measure where they might have a stronger sense of how the regulation would impact them directly.
It is clear from this study that smokers need to be better informed about the implications of FDA regulation. A large scale public education campaign from the FDA about the dangers of tobacco use and the regulatory powers they now have that is coordinated with other national, state, and local partners would be useful. Because reducing nicotine levels has the potential to reduce addictiveness, thereby increasing consumer autonomy, such efforts to educate the public about this possible regulatory action would be important.
These baseline data were collected shortly after the passage of the FSPTCA and prior to the enactment of any specific regulatory measures. These initial levels of support or opposition for specific policy measures can be used by the FDA to inform policy development and the need to educate smokers and the public at large about the purpose behind the regulation and of the kinds of regulatory controls the public are looking for. As specific regulatory measures of the FSPTCA are enacted, it will be important to assess any changes in knowledge and attitudes related to specific components of the regulations.
