Regulations grounded in research are saving lives by adding restrictions to tobacco

According to Health Canada, about 48,000 people in Canada die from tobacco use each year. Research has shown that tobacco use is a leading cause of preventable diseases and deaths worldwide and efforts to reduce tobacco consumption through regulation and policy measures have significantly contributed to public health improvements.

Strategies supported by science, like the work carried out by David Hammond and Geoffrey Fong here at the University of Waterloo, aim to save lives by reducing tobacco-related diseases and promoting public health.

Increased taxes on tobacco products makes them less affordable, reducing consumption. Bans on smoking in public places protects non-smokers from second-hand smoke and encourage smokers to quit. Restrictions on tobacco advertising and promotion have successfully reduced the appeal of tobacco products, particularly among young people. And mandating graphic health warnings on tobacco packaging informs consumers about smoking risks, discouraging use.

These policies have all been informed by research projects around the world, led by prominent clinicians, researchers and policymakers.  Fong is the founder and chief principal investigator of the International Tobacco Control (ITC) Policy Evaluation Project, a collaborative research program that brought together these experts from more than 30 countries to focus on the impact of tobacco control policies.

Hammond, a professor in the School of Public Health Sciences, is one of these experts focused on youth nicotine use and national-level tobacco restriction interventions and has conducted surveys across Canada, the United States, England, New Zealand and soon Australia. His research explores the unpredictable trends in smoking, vaping and new products like nicotine pouches.

Hammond’s research has identified significant shifts in youth tobacco use, particularly the rapid adoption of disposable e-cigarettes and concerns over nicotine pouches attracting non-smoking youth.

"We’re in a phase where the tobacco industry is expanding its product lines, ostensibly to offer less harmful alternatives to smoking," Hammond says. "However, these products also pose risks, especially if they attract young non-smokers."

His findings also explore the diverse regulatory strategies across countries to counter this trend. Australia’s unique policy requiring prescriptions for vaping products offers a natural experiment in controlling the market. New Zealand’s bold moves to reduce smoking by increasing the legal purchase age annually and removing nicotine from cigarettes were reversed by the new government, but the legwork on those policies has the United Kingdom and Canada considering similar measures.

A persistent challenge is the ongoing innovation by tobacco companies, introducing products such as heated tobacco and recreational nicotine gum, which contribute to higher nicotine consumption among young non-smokers.

Hammond stresses the importance of evidence-based policies that balance harm reduction for adult smokers with youth protection, informing legal and public health decisions globally. His interdisciplinary approach engages students in impactful research aimed at influencing drug regulation debates and addressing critical public health challenges.

The ITC project has also investigated the influence of banning menthol cigarettes, highlighting the effects of regulatory measures on smoking cessation and illicit trade.

Fong, a professor in the Department of Psychology and the principal investigator of the ITC Project, integrates psychological theories with epidemiological survey methods to assess their impact on populations worldwide. His recent research has centered on evaluating Canada’s menthol cigarette ban and its relevance to potential policies in other nations, notably the United States. Using data from the ITC survey, researchers examined smoking habits among menthol and non-menthol cigarette users across various Canadian provinces.

"By focusing on the ban’s localized impact within Canada, we were able to conduct a rigorous evaluation, controlling for various confounding factors such as existing policies," Fong explains. "Our findings indicated a 7.3 per cent greater likelihood of menthol smokers quitting compared to non-menthol smokers."

Moreover, the study projected substantial benefits for the United States, where the prevalence of menthol smokers is significantly higher.

"Based on our data, we estimated that a similar ban in the U.S. could lead to approximately 1.33 million smokers quitting, marking it as potentially the most impactful tobacco control policy in U.S. history," Fong says.

The study’s credibility was bolstered by collaboration with the University of Toronto, where similar findings were replicated, providing a robust sample size and reinforcing the study’s conclusions.

Addressing concerns about illicit trade, another significant aspect of the study was the absence of any detectable increase in illicit menthol cigarette purchases post-ban. "Our research in Canada and the Netherlands found no rise in illicit trade following the ban, reassuring regulators about the ban’s efficacy," Fong says.

The study comes amid global efforts towards tobacco endgame policies aimed at significantly reducing smoking rates.

"These findings underscore the importance of targeted policy interventions like menthol bans in accelerating the decline of smoking-related deaths," Fong adds.

As the research gains attention, it has influenced ongoing discussions with the FDA regarding potential menthol bans in the U.S.

"Our collaboration with regulatory bodies aims to provide evidence-based support for impactful tobacco control measures," Fong says.

For over 20 years, the ITC Project has made many global contributions to advancing policies to reduce the massive toll of tobacco use, a toll that was estimated by WHO to be economic losses of $1.4 trillion USD annually.

The ITC Project has been honoured with many Canadian and international awards, including the Governor General’s Innovation Award , given to Hammond, Fong and their ITC Waterloo colleague Mary Thompson. It has also received awards from the Canadian Cancer Society, Canadian Institutes of Health Research and WHO. In 2021, Fong was appointed as an Officer of the Order of Canada.

Waterloo’s research showcases the transformative potential of regulatory measures in combatting tobacco use and achieving public health goals around the globe.

Banner image generated by Midjourney
Jordan Flemming