NIH – U.S. Tobacco Control Policies to Reduce Health Disparities (R01, R21)

May 26, 2017 by School of Medicine Webmaster

The following description was taken from the R01 version of this FOA:

This FOA seeks applications for research projects to help address health disparities in tobacco use in the United States through scientific inquiry focused on innovative tobacco control policies including, but not limited to:

  • protecting nonsmokers from secondhand smoke (SHS) exposure,
  • insurance coverage for tobacco dependence treatment, and
  • other promising public and private tobacco control policy approaches.

Applicants may propose projects in which the focus is on reducing health disparities in vulnerable populations by utilizing tobacco prevention and control strategies. The long-term goal of this FOA is to reduce health disparities in health outcomes, thereby reducing the excess disease burden of tobacco use within these groups. Applicants submitting applications related to health economics are encouraged to consult NOT-OD-16-025 to ensure that proposals align with NIH mission priorities in health economics research.

This FOA is proposed in response to the findings of the March 2016 Report to the NCI Board of Scientific Advisors, titled “Tobacco Control Research Priorities for the Next Decade: Working Group Recommendations for 2016-2025.” This report concluded, “research is needed to identify innovative local, state, federal and private sector policy approaches that will advance the goal of eliminating tobacco use and its resultant harms, as well as effective strategies to more completely disseminate these approaches” and that research is needed “to identify and implement tobacco control policies that reduce or eliminate tobacco-related inequalities.”


The landmark 1964 Surgeon General’s report on smoking and health began a process of public education, programmatic and policy intervention, litigation, and social norm change that has revolutionized how most Americans view tobacco use, and in particular cigarette smoking. As a result, over the past five decades, the prevalence of cigarette smoking among U.S. adults has declined by more than half – from 42.4% in 1965 to 16.8% in 2014. Tobacco prevention and control efforts implemented since the 1964 Surgeon General’s report are estimated to have prevented 8 million premature deaths in the United States and to have extended mean life span by 19-20 years, between the years 1964 and 2012.

Despite this progress, tobacco use remains the leading cause of preventable premature death in the U.S., as it does in most other high-income nations. The overall decline in prevalence masks substantial differences in adult cigarette smoking prevalence among different U.S. subpopulations, related to income, level of educational attainment, race/ethnicity, place of residence, health insurance coverage, the presence or absence of co-morbid mental health conditions and/or substance abuse, and other factors. For example, in 2014, cigarette smoking prevalence was 15.2% among those living at or above the federal poverty level, compared with 26.3% among those living below the federal poverty level. Similarly, exposure to SHS has dropped from about 50% of all nonsmokers in 1999-2000 to about 25% in 2011-2012. However, exposure remains especially high among some groups: approximately half of black nonsmokers are exposed to SHS, including 7 in 10 black children; and SHS exposure is more than twice as high among nonsmokers living below the poverty level, compared with those living above the poverty level (43% vs. 21%, respectively).

Health Disparities and Smoking Prevalence

Disparities in smoking prevalence are increasingly reflected in differences in lung cancer incidence and mortality. For example, in 2012, the age-adjusted incidence of lung and bronchus cancer per 100,000 persons ranged from 92.4 in Kentucky to 40.6 in New Mexico. A recent editorial notes the close link between tobacco use rates and overall cancer mortality, stating, “the variation [in overall cancer death rates] across states today is greater than the overall improvement in mortality over the past 40 years: cancer mortality varies as much as 30% across states, and is strongly associated with state-level tobacco use.” Differences in tobacco use are also strongly linked to differences in overall mortality between population subgroups. For example, in the U.S., England, Wales, Canada, and Poland, more

than half the difference in mortality between men of high vs. low social strata is due to differences in the risk of dying from smoking at ages 35-69. A continued focus on tobacco prevention and control efforts at the population level can help reduce tobacco use, as well as the incidence of lung and other cancers. For example, in California, both tobacco use and lung cancer mortality have declined faster than the national average, and this is expected to continue.

Key Challenges

Science-based policy approaches to tobacco prevention and control have the potential to further decrease the health and economic burdens of tobacco use and to reduce the wide disparities in tobacco use and tobacco-caused cancers across various subpopulations in the U.S. Policy interventions target population-level outcomes by seeking to change the social-environmental context in which decisions about tobacco use are made. They may be especially valuable for reducing health disparities in tobacco use because of their broad reach, ability to change social norms, and because they can be implemented at much lower cost than interventions that target individuals. However, gaps in our understanding of tobacco control policies remain, especially as they relate to the ability of existing and new policies to reduce health disparities in tobacco use.

The nation’s tobacco control environment and policy landscape is increasingly complex and rapidly changing. Key challenges include the following:

  • The significant advances in reducing tobacco use were achieved when cigarettes were the product of choice for the vast majority of Americans. Today, consumers are exposed to – and are increasingly using – a wider variety of tobacco products, including cigars, little cigars and cigarillos, smokeless tobacco products, Electronic Nicotine Delivery Systems (ENDS), and waterpipes. Many of these tobacco products are relatively inexpensive, easy to obtain, and some are specifically targeted toward youth, young adults, or certain racial/ethnic groups. These products also pose new challenges to comprehensive smoke-free policies, which may differ between population subgroups.
  • State and local marijuana laws are changing rapidly. As of March 2016, four states and Washington, DC, allow for personal possession and consumption of marijuana by adults, and 23 states, Guam, and Washington, DC, have passed some type of “medical marijuana” measure. In addition, some tobacco products, especially cigars, cigarillos and ENDS, are now commonly used together with marijuana (cannabis) or cannabis oil. More liberal marijuana laws are widely expected to influence tobacco use patterns and may influence population subgroups differently.
  • The 2009 Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration (FDA) the authority to regulate the manufacture, marketing, and distribution of tobacco products and expanded the ability of state and local governments to regulate tobacco product advertising. As a result, states and localities have now begun to implement innovative policies in this area, such as measures that restrict point-of-sale tobacco advertising. These efforts hold promise to reduce tobacco use, including among populations with higher prevalence. State and local policy interventions may allow for more targeted approaches to reducing disparities in tobacco use.
  • The communication and media landscape is complex and rapidly changing, and online user-generated content and social networking sites (such as Facebook, Instagram, and Twitter) have become an integral part of the communication landscape. Social media interactions may promote tobacco control, but may also have adverse effects on tobacco use, through the spread of inaccurate health information, the emergence of online communities with norms that support tobacco use, through tobacco industry promotional efforts, and through other means. Although levels of computer ownership and high-speed internet access are lower among older Americans, Blacks, Hispanics, low-SES persons, and those living outside metropolitan areas, than other groups, levels are substantial for all groups, and are expected to continue to rise. Mobile technologies also offer the potential to reach rural populations, people with limited contact with the health care system, and other vulnerable groups.
Specific Research Objective and Scope of this FOA

The central charge of the FOA is to understand how to improve the effectiveness of existing tobacco control policy strategies to reduce health disparities in tobacco use, as well as studying new policy approaches to reducing health disparities in tobacco use.

Research topics of interest include, but are not limited to the following:

  1. Comprehensive smoke-free polices (e.g. how to increase adoption and implementation of comprehensive smoke-free policies in workplaces, homes, vehicles etc.);
  2. Policies related to coverage for tobacco dependence treatment (e.g. state, local and/or federal policies affect access to, affordability, and use of cessation services among vulnerable populations, and the impact of surcharges on tobacco users);
  3. Overarching policy environment (e.g. studies that examine the dynamic interplay of different tobacco control policies on tobacco use, how tobacco control policies may work together to reduce tobacco use among both youth and adults, focusing on how to accelerate progress in communities that have experienced slower declines in tobacco use, etc.); and
  4. Dissemination and implementation of research findings.

Deadlines:  October 11, 2017; June 13, 2018; October 11, 2018; June 13, 2019; October 11, 2019; June 15, 2020 (full proposals; letters of intent are due 30 days prior to the deadline)


Filed Under: Funding Opportunities