Tobacco control policy in developed countries: Yesterday, today, and tomorrow

Tobacco control policies have contributed to dramatic declines in smoking in the developed nations. However, the circumstances under which these policies altered the smoking landscape have changed and are likely to change further. As well, decreases in smoking prevalence may have "stalled" at current levels. Because today's smokers differ significantly from yesterday's and the environment in which smokers consume their cigarettes has changed, it is plausible that several of the evidence-based tobacco control policies soon will have run their course in the most advanced tobacco control environments. We ask, therefore, what developed nations can expect of these policies in the future and what novel policy measures may be needed to continue the assault on tobacco. After summarizing tobacco control success in the United States and the findings from tobacco control policy research, we consider the remaining problem focusing on the characteristics of remaining smokers and their circumstances. We then examine constraints on the continuing effectiveness of evidence-based policy interventions. We employ a model to project U.S. smoking prevalence decades into the future, with and without improvements in initiation and cessation rates. We then speculate about novel policy directions that will be needed to further move the needle of tobacco control. Without substantial innovation in tobacco control policy, further reductions in smoking in developed nations will come frustratingly slowly. Needed policy innovations might be quite radical, such as legislating entirely smoke-free outdoor environments or regulators reducing allowable nicotine in cigarettes to non-addicting levels.