U.S. federal tobacco control policy from 1964 to 2013: Were punctuated and significant public health reforms enacted?

Abstract

Currently, an academic controversy exists regarding whether U.S. tobacco control policy has been punctuated and rapid, primarily driven by federal policymaking or a combination of federal, state, and local policymaking, and has substantially reduced tobacco consumption. An analysis of U.S. tobacco control policy from 1964 to 2013 indicates federal policy change was not rapid and punctuated and some limited progress occurred in improving the public health. Asserting all U.S. tobacco control policy is purportedly punctuated because of federal tobacco control efforts also ignores discretionary policy output and outcome legislation and regulations operating solely at the state or local levels of government. Analyses of punctuated policy change trends must include operationalized policy outputs and outcomes grounded in scholarly historical and scientific research that analyzes all key policy issues such as clean indoor air linked to a general policy area, like tobacco control, to determine whether punctuation has occurred or not. In the case of federal, but not state tobacco policy, punctuation did not occur. Instead, there were some moderate and incremental advances in tobacco control contradicted by federal tobacco consumption and support policies.