Questions and Answers on NCI's Tobacco Research Implementation Plan

National Cancer Institute
Thursday, 19 November 1998

1. How was the Tobacco Research Implementation Plan created and why?
Tobacco-related disease exacts a huge toll on the nation's public health, causing over 450,000 deaths each year, including 170,000 cancer deaths. To take advantage of an unprecedented opportunity to dramatically reduce tobacco use, the National Cancer Institute (NCI) brought together leading scientists to establish tobacco-related research priorities for the next five to seven years.

This Tobacco Research Implementation Group (TRIG) identified and prioritized a set of nine overarching research opportunities. Two immediate initiatives are the Transdisciplinary Tobacco Research Centers and the State and Community Tobacco Control Interventions. The NCI is committing $122 million over five years to support the initiatives, and the National Institute on Drug Abuse (NIDA) is committing $20 million.

2. How will the Transdisciplinary Tobacco Research Centers work?
NCI and NIDA will fund a series of Transdisciplinary Tobacco Research Centers that will study the prevention of tobacco use, initiation of tobacco use, addiction to tobacco, and/or treatment of tobacco addiction and tobacco-related cancers. Because tobacco control research must rely upon scientists with expertise in diverse areas, these centers will facilitate collaboration between researchers in areas ranging from molecular biology, genetics, neuroscience, and epidemiology to imaging, primary care, behavioral science, communication, health policy, economics, and marketing.

The centers will focus thematically on areas where there are gaps in knowledge, such as adolescent smoking and the use of non-cigarette tobacco products. The centers will also serve as training grounds for the next generation of tobacco researchers. These centers should lead the nation and the world in conducting tobacco research and in discovering new ways to combat tobacco use and its consequences. NCI will commit $50 million and NIDA will commit $20 million to these centers over five years.

3. Why are state and community tobacco use interventions being studied?
Communities are the final "laboratories" where tobacco control interventions are tested to determine if and how they work in the real world. New tobacco control programs are under way in almost ever state, and each program raises new research questions and opportunities to discover useful information that can improve the effectiveness of the tobacco interventions. Several states now invest millions of dollars annually in tobacco control intervention programs, funded by either dedicated tobacco excise taxes or state settlements with the tobacco companies. To boost the effectiveness of these programs, NCI will award $72 million over four years beginning in fiscal year 2000 to study these interventions. Researchers will look at policies that influence behavior, including excise taxes, advertising restrictions, clean indoor air policies, and restrictions on sales to minors.

4. Why is NCI providing support for policy research when there are other agencies and institutes that have projects in this area?
The information gleaned from these studies will help strengthen the nation's large tobacco control programs at the community and state levels. After decades of efforts to help individual smokers, tobacco control research is now focusing on the social environment that surrounds smokers and potential smokers and influences their behavior. Smaller studies have shown the importance of mass media as part of a tobacco control program, but the impact of mass media in large state programs has not received sufficient attention. The impact of national or state media programs on subpopulations, such as youths, is much less certain.

5. How much does NCI spend now on tobacco use research and what kinds of research does the institute currently support?
NCI spent an estimated $80 million on tobacco research in fiscal year 1998. In fiscal year 1997, NCI supported a wide spectrum of tobacco-related research with a budget of $76 million. Support was provided for 176 projects, with community and state intervention research accounting for the largest number of projects. Other current categories of research include: epidemiology, treatment of tobacco addiction, basic biobehavioral, prevention, treatment of nicotine dependence, policy, basic biological, and chemoprevention. The TRIG concluded that because of tobacco's cancer burden, tobacco research should be expanded.

6. How much does NIDA spend now on tobacco use research and what kinds of research does the institute currently support?
NIDA spent $160 million in fiscal year 1997 and $173 million in fiscal year 1998 for research related to tobacco use and nicotine addiction, spanning the epidemiology and prevention of tobacco use and nicotine addiction among young people; basic and clinical research on the addictive properties and biobehavioral effects of nicotine; and research on pharmacological and behavioral treatment.

During fiscal year 1998, NIDA sponsored a national research conference, Addicted to Nicotine, which featured Vice President Gore as closing speaker.

7. How does the NCI plan fit in with the recently announced tobacco company settlement between the companies and states?
The TRIG recommended that NCI launch a concerted, comprehensive research effort over the next five to seven years so that the results of that research could be used by states and communities to improve their efforts to reduce tobacco use and stop the epidemic of tobacco-related diseases. This effort will put in place a national structure with overarching research priorities by 2000 in order to leverage and inform the many state programs that are expected to burgeon over the next several years.

8. What are the recommendations of the implementation group?
The high-priority areas recommended by the Tobacco Research Implementation Group are:

Transdisciplinary Tobacco Research Centers to study the initiation of tobacco use, prevention of tobacco use, addiction to tobacco, and treatment of addiction and tobacco-related cancers.

Basic biobehavioral research to understand the sociocultural, psychological, physiological, and genetic factors that influence the initiative of tobacco, addition, and smoking cessation among children, adolescents, and adults. This area is partially addressed by the Transdiciplinary Tobacco Research Centers and will also be addressed by subsequent initiatives.

Research to find the best ways to tailor tobacco cessation interventions to specific sociocultural, psychological, physiological, and genetic subgroups. This area is also addressed by the Tobacco Research Centers as well as by ongoing grants. Another initiative may be added in fiscal year 2001, if needed.

Research to improve community and state tobacco control programs and to increase the effectiveness of these programs for populations at disproportionate risk. This is the purpose of the State and Community Tobacco Control Interventions initiative, slated to begin in 2000.

Research to identify mechanisms for optimal dissemination of proven prevention and treatment interventions at the community and state levels. This is being addressed in the State and Community Tobacco Control Interventions grants, which begin in fiscal year 2000. Another initiative may be added in fiscal year 2001, if needed.

Research to understand the impact of tobacco policies, including taxation and pricing, clean indoor air policies, marketing restrictions, youth access restrictions, and tobacco product and nicotine replacement regulation. This is being addressed by the State and Community Tobacco Control Interventions initiative, which begins in fiscal year 2000, and other ongoing grants.

Basic biological research to identify and validate biomarkers of tobacco exposure and tobacco-induced cellular events as they relate to the different stages of carcinogenesis. Ongoing grants are addressing this area, and additional initiatives may be undertaken in fiscal year 2000 or fiscal year 2001.

Research to understand genetic and environmental interactions in susceptibility to tobacco-related cancers in order to identify subgroups at risk. This is being addressed by ongoing grants.

Research on expanded surveillance systems to monitor tobacco use behaviors, the implementation and fidelity of tobacco-related interventions, and other factors that influence tobacco use. This area is being coordinated with another group to improve NCI surveillance activities and the timing is yet to be determined.

For more information, or to contact National Cancer Institute, see their website at: www.cancer.gov