S3E1: Clearing the Air: How CDC is Protecting Us From Tobacco

Although the United States has made great strides in reducing tobacco-related disparities, commercial tobacco use is still the leading cause of today’s biggest health challenges. 

The Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health (OSH) has been leading tobacco prevention, cessation, and control. The office's director joins us to discuss the progress the team has made in decreasing tobacco use, as well as the challenges and work ahead.  

While CDC has found that smoking and e-cigarette use are down, new nicotine products threaten progress. OSH works to protect future generations by addressing these evolving threats to reduce preventable tobacco-related death and disease in the United States. 

Dr. Deirdre Lawrence Kittner is the director of OSH. She has more than 20 years of public health experience, with a focus on global tobacco control, tobacco and health behavior science, and preventative policy development. Previously, she worked at the National Cancer Institute and served as deputy director of the Food and Drug Administration’s Center for Tobacco Products' Office of Science.  

More Links and Information 

Check out more Fors Marsh Media 

Connect or partner with Fors Marsh 

Read the new Surgeon General report on prevention and control strategies to reduce tobacco-related disparities. 

Find resources to help quit smoking. 

Explore the Empower Vape-Free Youth and Tips From Former Smokers campaigns. 

Transcript

Melissa Sosinski: Tobacco use behaviors have changed significantly over the past century, with adult smoking prevalence rates declining from their peak in 1964. That same year, the U.S. Surgeon General’s Advisory Committee on Smoking and Health also released its first report helping us understand the health risks of smoking. The U.S. Surgeon General is the leading spokesperson on matters of public health, and about two weeks ago, the 35th report was issued.   

Reporter: The major new report from the surgeon general warns about ongoing dangers of cigarettes nationwide.   

Surgeon General: The more we learn, the more we recognize how dangerous tobacco is. So we need to, number one, be preventing people from getting started and using these products in the first place, and second, if they are using them, we have to help people quit.   

MS: While many of y’all may think that smoking still isn’t a major problem, this latest report found that nearly 1 in 5 deaths nationwide—almost 500,000 a year—are still due to cigarette smoking exposure and secondhand smoke. Yeah. It’s a lot if you think about it. 

The CDC’s Office on Smoking and Health is the lead federal agency for comprehensive tobacco prevention and control. OSH saves lives and money by preventing and reducing the use of commercial tobacco products—the leading cause of preventable disease, disability, and death in the United States. 

This is Empathy Affect, Fors Marsh Media’s podcast that explores the human side of government. I’m Melissa Sosinski, and today we’re going to have the opportunity to talk about the lifesaving work that OSH does every day with the office’s director, Dr. Deirdre Lawrence Kittner. 

In her position, Dee provides leadership and direction for scientific, policy, and programmatic strategies to prevent tobacco product initiation, encourage smoking cessation, decrease secondhand smoke exposure, and reduce tobacco-related health disparities. 

MS: Dr. Lawrence Kittner, it’s such a pleasure to have you on Empathy Affect today to talk about you and the Office on Smoking and Health and the important role that the CDC plays in tobacco prevention and cessation. 

Dr. Deirdre Lawrence Kittner: Thank you so much for having me here. 

MS: Okay Dee, so for listeners who aren’t aware, can you briefly introduce the Office on Smoking and Health and the unique role it plays in tobacco prevention and control across our country? 

DLK: Yes, the Office on Smoking and Health, or OSH, is at the Centers for Disease Control and Prevention, or CDC, and it sits in CDC’s National Center for Chronic Disease Prevention and Health Promotion. OSH is the lead federal agency for comprehensive tobacco prevention and control, and we save lives and money by reducing the use of commercial tobacco products. 

I should explain to your listeners that CDC’s use of the word “tobacco” refers to commercial tobacco products, which are products made to be highly addictive, contain harmful chemicals, and are sold for profit. We are not referring to the sacred and traditional use of tobacco by some American Indian communities.  

At OSH, we are a dedicated team of scientific, public health, and health communication professionals. We work with partners to prevent tobacco use, reduce secondhand smoke exposure, and help those who use tobacco to quit. Underlying our work is a deep commitment that everyone deserves to live free from tobacco-related disease, disability, and death. 

I’m often asked, “Why are you still focused on cigarette smoking? Wasn’t this issue solved years ago?” And it is true that cigarette smoking is at its lowest level ever recorded in our country’s history. However, over 28 million adults currently smoke cigarettes, and smoking remains the number one cause of preventable death and disease in the United States. Our office oversees several programs and initiatives to document the problem, educate the public, collaborate with states and communities, and advance the science on core tobacco control solutions such as tobacco-free or smoke-free policies. 

MS: Yeah, that’s a great overview. And I can’t help but ask a little bit about your history in this space. You yourself have not only worked at the CDC leading OSH, but with the Food and Drug Administration and the National Cancer Institute in tobacco regulation and health research. So, tell me, how did you get into tobacco health and the public health field? And what compelled you to commit so much of your career to this space? And how have you seen it evolve over the time you’ve spent in the field? 

DLK: Getting into this field has been an adventure. Because of my love for science, I chose biology as my undergraduate major at Spelman College. And fortunately, I was also accepted into the UMARC program, Undergraduate Minority Access to Research Careers. UMARC, which taught me research skills, led me to spend two summers at MIT doing research there, where I earned a PhD in toxicology.  

And then you might say I met my destiny at the National Cancer Institute, where I transitioned into public health. I earned a Master of Public Health from Harvard and began analyzing tobacco-related health disparities, first as a postdoc at NCI and then as an epidemiologist at NCI. So, fast-forward to 2009, and I helped set up the Center for Tobacco Products at the Food and Drug Administration, FDA, where I last served as deputy director over regulatory science, and then finally, in 2021, I began my dream job as director of CDC’s Office on Smoking and Health. 

Driving my passion in this work is my Grandma Jean. She was my heart and is my inspiration. She passed away prematurely from a tobacco-related illness and heart attack, after being targeted by tobacco industry marketing and becoming addicted to smoking menthol cigarettes. And I’ve spent more than two decades in tobacco control, a field that has prevented millions of premature deaths and is studied as a model for public health success.  

Yet, a constant challenge and concern in my profession is the ever-changing landscape of tobacco products. You walk into any gas station or convenience store, et cetera, and you’ll see an array of tobacco products in many shapes and sizes that are smoked, smokeless, electronic. Products such as cigarillos or little cigars, nicotine pouches, and so-called “smart vapes” threaten the progress made in decreasing tobacco use among our nation’s youth. And no form of tobacco use is risk-free, and all tobacco products are dangerous to young people. As a society, we must remain steadfast in empowering all communities and protecting a new generation from a lifetime of nicotine addiction.  

MS: Yeah, first, I’m very sorry to hear about your grandmother. I lost my grandfather about 10 years ago to COPD. And while he had quit smoking decades before, it ultimately led to his health complications at the end of his life. But as we’re sort of talking about the challenges today, I know that the new products that you were mentioning are a challenge, but also health disparities.  

We know that while smoking rates have decreased over time, as you were mentioning, there are still populations really impacted by smoking rates. These include Black, Native American, Alaska Native, and LGBTQ+ populations, as well as people in rural areas. And I know that the surgeon general also just released a report that confirms the persistence of disparities in tobacco product use and exposure to secondhand tobacco smoke. So, can you break down why these disparities exist in these populations and why it’s difficult to move the needle across these communities? 

DLK: Yes, it is complicated. Not everyone has benefited from the public health success that we have seen in tobacco control. And as you mentioned, just last week, the surgeon general released a report entitled, Eliminating Tobacco-Related Disease and Death: Addressing Disparities. And the report highlights that tobacco use is far from being a personal choice. Rather, there are powerful economic, social, and structural forces that are at work. For example, factors such as how much money people make, where people live, where they work, or their level of education have been linked to tobacco product use.  

On top of that, for decades, tobacco companies have used promotions, targeted marketing, and other tactics to increase tobacco product access and appeal for certain population groups.  

Another driving factor in disparities is the uneven implementation of strong policy protections. For example, almost 40% of the U.S. population lives in a state where they are not covered by comprehensive smoke-free laws. And then there are barriers to health care access. For example, certain groups are less likely to get advice about quitting from health care providers. And we know that advice from one’s health care provider increases the chances for a successful quit.  

So as a result, the remarkable progress that we’ve made in reducing tobacco use in the U.S. has not been the same across all population groups. American Indian [and] Alaska Native youth and adults experience the highest prevalence of cigarette smoking of any racial and ethnic group. Cigarette smoking is also higher among people with lower incomes, lower levels of education, those that identify as gay, lesbian, or bisexual, people who work in manual labor or service jobs, people living in the South and Midwest, living in rural areas, those with mental health conditions or substance use disorder, and people with disabilities. 

It does not have to be this way. The 2024 Surgeon General’s report outlines what can be done to change this. If we are to create a world where zero lives are harmed by and lost to tobacco, we must combine efforts to eliminate the use of tobacco products and eliminate influences of the tobacco industry with efforts to remove underlying social, structural, and commercial drivers of health disparities. 

MS: Yeah, and just hearing the different populations and the reasons why these disparities exist, I’m sure it’s very complicated and hard to really break through. I was wondering if you can share a story or two about the impact that smoking and tobacco product use has on some of these people. I know it could look different from person to person, community to community, but paint us a picture of what these disparities often look like. 

DLK: Mm-hmm. Yes, the impact of commercial tobacco is devastating. Smoking causes harm to nearly every organ of the body. Millions live with a serious smoking-related illness from diabetes and rheumatoid arthritis to heart disease, stroke, and 12 types of cancer. Every year, cigarette smoking and secondhand smoking exposure cause the deaths of nearly a half million people in our country. So, it’s about 1300 deaths a day. And that amounts to nearly 1 in 5 of all deaths being caused by smoking every year in the United States. These are our loved ones. Yes, and I’m sorry that you lost your granddad. These are our loved ones, friends, coworkers, patients, neighbors, caregivers, storytellers.  

And one of our signature programs at OSH, which is celebrating its 25th year, is the National and State Tobacco Control Program. It’s the only nationwide initiative that provides direct funding and technical assistance to every state, DC, Guam, and Puerto Rico, and more than two dozen tribal organizations to reduce tobacco-related disease and death. 

We support a network of partner organizations to reduce tobacco- and cancer-related disparities in specific population groups across the country. And in every state, we help support tobacco cessation and quitlines, which are a critical component of the Tips From Former Smokers national education campaign. 

MS: If you’ve ever seen one of the Tips campaign ads, it’s probably stuck with you. These messages feature real people living with serious long-term effects from smoking and secondhand smoking exposure. The bottom-line goal is to encourage people who smoke to quit—and to date, Tips has helped more than 1 million U.S. adults quit smoking. While Tips has been running since 2012, this year, OSH included testimonies that focused on menthol tobacco products. 

Tips Ad Audio: I used to think menthol cigarettes weren’t as bad as other cigarettes because they didn’t seem as harsh. Here’s a tip: heart attacks caused by smoking menthols are just as harsh. Trust me, I had one at the age of 36. For free help, visit CDC.gov/Tips. 

MS: Notably, some of the disproportionately impacted populations we mentioned often consume menthol cigarettes. So, I asked Dee why OSH focused on menthols this year and what results her team has seen so far.  

DLK: So, while cigarette smoking has decreased substantially among people who currently smoke, we have seen an increase in the proportion of adults who smoke menthol cigarettes. This should come as no surprise because tobacco companies add menthol to cigarettes to make them seem less harsh and aggressively market menthol-flavored tobacco products to specific population groups. 

Many of this year’s new Tips ads include messaging about the harms of menthol cigarettes to help educate the public on the dangers of these products and encourage people who smoke to quit for good. 

Preliminary results for the 2024 campaign showed that calls to 1-800-QUIT-NOW increased while the Tips campaign was on air, and this is consistent with what we’ve seen in previous years. Menthol cigarettes are easier to start smoking and can be harder to quit, but the Tips campaign lets people know that quitting is possible. 

MS: Absolutely. While efforts like Tips have focused on cigarette smoking cessation, you were mentioning before that new products are entering the market, which makes things a little bit more complicated. There are e-cigarettes and nicotine pouches like you were mentioning before. So how is OSH handling the emergence of these new products in your prevention and cessation efforts? 

DLK: Yes, at CDC, we collect, study, and share information on tobacco use among youth and adults and its effect on health, as well as sales data related to many tobacco products, including new tobacco products. Recently, we were excited to release with FDA the results from our joint annual flagship study, the National Youth Tobacco Survey. The survey is unique in that it’s the only nationally representative survey of tobacco use among U.S. middle and high school students.  

And 2024 data show that youth e-cigarette use is down to its lowest level in a decade. From 2023 to 2024, the number of U.S. students who reported current use of e-cigarettes decreased substantially—by half a million youth. And this is incredible news for the nation and for families.  

However, for the first time, nicotine pouches were the second most commonly used tobacco product among U.S. youth. And this is exactly the kind of data that states, partners, and policymakers expect and need. And surveillance data guide our actions. They’re critical to informing prevention and cessation efforts. 

MS: Yeah, I mean, as the different products enter the market, even though e-cigarette use is down, but there’s the rise of tobacco pouches, how do you shift your prevention efforts to better reach young people as they opt for these products? 

DLK: You are right, youth tobacco use is of great concern because no tobacco products, including e-cigarettes, are safe, especially for children, teens, and young adults. Most e-cigarettes contain nicotine, which is highly addictive. Nicotine can harm the parts of an adolescent’s brain that control attention, learning, mood, and impulse control. 

Furthermore, as you stated, most tobacco use begins in youth. And for these reasons, youth are a primary focus at the Office on Smoking and Health. For example, we support national and state data collection to understand tobacco use patterns among youth. We work with the Truth Initiative to identify how youth exposure to tobacco product imagery in movies, television, and social media impacts tobacco initiation and use. 

We’re also reaching young people through our National and State Tobacco Control Program. All 50 states and DC are working to address e-cigarettes and emerging products. For example, states are working to add e-cigarettes to smoke-free indoor air policies in schools, colleges, and universities. They’re engaging youth to educate other youth on the dangers of tobacco use and dependence, including e-cigarettes. 

States are partnering with pediatricians and others to screen youth for tobacco use dependence and increase access to cessation treatment services. 

And just last year, our office launched a campaign called Empower Vape-Free Youth. The Empower Vape-Free Youth campaign helps middle and high school educators speak with students about the risks of e-cigarettes and to encourage them to avoid or quit vaping. 

MS: Yeah, that’s fabulous. It’s so great to hear about the different initiatives that you have going on to reach these younger people. I just want to stress again: a majority of tobacco use begins in youth, like you were saying, so being able to reach through is so important.  

I want to go back to your background in science and research for a second again. Given this background, are there any promising innovations that you’ve seen in tobacco prevention or cessation? And how do you apply your background in tobacco research to the work you do today at OSH? 

DLK: Fortunately, tobacco control has the luxury of 60 years of scientific evidence. My training in toxicology helped me to understand just how harmful commercial tobacco is and how it damages our health. My public health training and experience give me hope because we have proven tobacco prevention strategies in our toolbox that help create societal conditions for tobacco-free success. 

These strategies include policies that prohibit smoking, e-cigarettes, and other tobacco products in public places, tobacco product price increases, which is proven to be the single most effective strategy in reducing consumption, particularly among youth, cessation support that has no barriers, is widely promoted, and is evidence-based, and media—mass media campaigns that educate people about the harmful effects of tobacco product use and promote quitting and quit resources. These strategies work best when implemented fully and equitably for everyone, everywhere, and to the extent needed.  

The newly released Surgeon General’s report on disparities highlights that to end tobacco-related disease and death, we must work together. This extends beyond CDC. There’s an active role, not only for government, health care, public health, and research organizations, but just as importantly for funding entities, schools and academic institutions, businesses, and members of the public. All of us can help build a world in which zero lives are harmed by or lost to tobacco use.  

MS: We’ve talked so much about OSH and what you’re doing and how you’re creating these partnerships and working together with communities to prevent the harms of tobacco across our country. But say I’m a listener who smokes or has a family member or friend who smokes and wants to quit. Where should they start and what are some of the best practices they can take to stay committed to cessation? 

DLK: First and foremost, awesome. This is the best time to quit. Now is the best time to quit. And it is one of the most important things they can do to improve and protect their health.  

And I’d ask your Empathy Affect listeners to be generous with their empathy. Tobacco use is a chronic relapsing condition driven by addiction to nicotine. If you know someone that wants to quit using tobacco, encourage them to visit CDC.gov/QUIT or call 1-800-QUIT-NOW for free and confidential help.  

The CDC website has a wealth of resources to support a loved one’s quit journey. For example, tips on making a quit plan and managing withdrawal symptoms. You could also emphasize to your family member or friend that counseling combined with medication is the most effective way to quit smoking. And loved ones should speak with their doctor or other health care professional to find out which of the seven FDA-approved quit-smoking medications are a better fit for their personal circumstances.  

And tell them again: quitting is one of the best things that you can do for your health, no matter how old you are or how long you’ve smoked. Even if someone has tried before, the key to success is to keep trying. Don’t give up. 

MS: Thank you so, so much, Dee—to you and for the work that you and your colleagues at the CDC and across the country do to address tobacco use. While we’ve made a lot of progress in reducing tobacco use, I think today has been a great opportunity to learn about the work we still have ahead and how you’re helping us get there. So, thank you again. 

DLK: Thank you so much for this wonderful opportunity and conversation. I truly believe everyone could play a part in creating a society where every community, once and for all, breaks the cycle of disease, disability, and death caused by commercial tobacco use. Thank you. 

MS: I hope we can break that cycle too, Dee. Today has been a great reminder that commercial tobacco use still contributes to so many health problems in America. I just keep thinking about that one stat from the Surgeon General’s report—that 1 in 5 of all deaths in the U.S. are caused by smoking. 

If you want to read more about the report, visit CDC.gov/endtobaccodisparities. And if you want to quit smoking or help folks in your community quit, you can also visit CDC.gov/quit to find resources and tips to do so. 

Thank you for tuning into today’s episode of Empathy Affect. If you enjoyed the conversation, please subscribe, follow, and share the show with a friend. And don’t forget to rate us on your podcast platform of choice. I hope you’ll join me next time. Thanks, y’all.