[Federal Register Volume 83, Number 237 (Tuesday, December 11, 2018)]
[Notices]
[Pages 63645-63646]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-26708]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket No. CDC-2018-0115]


Advancing Tobacco Control Practices To Prevent Initiation of 
Tobacco Use Among Youth and Young Adults, Eliminate Exposure to 
Secondhand Smoke, and Identify and Eliminate Tobacco-Related 
Disparities; Request for Information

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Request for information.

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SUMMARY: The Centers for Disease Control and Prevention (CDC) within 
the Department of Health and Human Services (HHS) leads comprehensive 
efforts to prevent the initiation of tobacco use among youth and young 
adults; eliminate exposure to secondhand smoke; help current smokers 
quit; and identify and eliminate tobacco-related disparities. In late 
2017, CDC solicited input from the public in the Federal Register 
Notice 82 FR 50428 regarding nationwide priorities for cessation. CDC 
is currently reviewing and compiling public comments to inform future 
activities that could efficiently and cost effectively help people quit 
using tobacco by employing evidence-based treatment options. CDC will 
share the outcome of this request for information with the public on a 
date to be determined. Now, CDC is seeking information to inform future 
activities to advance tobacco control practices that prevent initiation 
of tobacco use among youth and young adults; eliminate exposure to 
secondhand smoke; and identify and eliminate tobacco-related 
disparities.

DATES: Written comments must be received on or before February 11, 
2019.

ADDRESSES: Submit comments by any one of the following methods:
     Internet: Electronic comments may be sent via http://www.regulations.gov, docket control number CDC-2018-0115. Please follow 
the directions on the site to submit comments; or
    Mail: Comments may also be sent by mail to the attention of Randi 
Frank, Office on Smoking and Health, Centers for Disease Control and 
Prevention, 4770 Buford Hwy, Mail Stop S107-7, Atlanta, GA 30341.
    Instructions: All submissions received must include the agency name 
and Docket Number. All relevant comments received will be posted 
without change to, including any personal information provided. For 
access to the docket to read background documents or comments received, 
go to http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Randi Frank, Office on Smoking and 
Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, 
Mail Stop S107-7, Atlanta, GA 30341; Telephone (770) 488-5114; Email: 
[email protected].

SUPPLEMENTARY INFORMATION:

Scope of Problem

    Tobacco use is the leading cause of preventable disease, 
disability, and death in the United States.\1\ The burden of death and 
disease from tobacco use in the United States is overwhelmingly caused 
by cigarettes and other combusted tobacco products; therefore, rapid 
elimination of their use will dramatically reduce this burden.\1\
    Cigarette smoking alone causes more than 480,000 deaths each year, 
including more than 41,000 secondhand smoke related deaths, and costs 
the country over $300 billion annually in health care spending and lost 
productivity.\1 2\ Cigarette smoking is causally linked to numerous 
types of cancer, respiratory and cardiovascular diseases, diabetes, eye 
disease, complications to pregnancy and reproduction, and compromises 
the immune system.

Prevent Initiation of Tobacco Use Among Youth and Young Adults

    Any form of tobacco product use is unsafe for youth, irrespective 
of whether it is smoked, smokeless, or electronic. Since brain 
development continues through the early to mid-20s, the use of products 
containing nicotine, including e-cigarettes, can be harmful to youth 
and young adults. Specifically, the use of these products can disrupt 
the growth of brain circuits that control attention, learning, and 
susceptibility to addiction.\3\ In 2018, nearly 4.9 million United 
States middle and high school students currently used (>=1 day in past 
30 days) at least one type of tobacco product, with e-cigarettes being 
the most commonly used tobacco product.\4\ Flavors are a major factor 
contributing to the use of these products among young people; 85% of 
youth e-cigarette users report using flavors.\5\ The use of e-
cigarettes may also lead to future cigarette smoking among some 
youth.\6\ In addition to e-cigarettes, youth also use several other 
types of tobacco products, and disparities in use of these products 
exist across population groups.\14\

[[Page 63646]]

Eliminate Exposure to Secondhand Smoke

    The U.S. Surgeon General has concluded that there is no risk-free 
level of secondhand smoke exposure; even brief exposure can be harmful 
to health.7 8 During 2011-2012, about 58 million nonsmokers 
in the United States were exposed to secondhand smoke, and exposure 
remains higher among children, non-Hispanic blacks, those living in 
poverty, and those who rent their housing.\9\ Secondhand smoke exposure 
can cause heart disease, lung cancer, and stroke among adults, as well 
as the following in children: 1 7 8

 Ear infections
 More frequent and severe asthma
 Respiratory symptoms (for example, coughing, sneezing, and 
shortness of breath)
 Respiratory infections (bronchitis and pneumonia)
 Sudden unexplained infant death syndrome (SUIDS)

Identify and Eliminate Tobacco-Related Disparities

    Although progress has been made in reducing tobacco use in the 
general population, disparities persist across population groups.\1\ 
These disparities can affect populations on the basis of certain 
factors, including but not limited to: 10 11
 Age
 Disability
 Educational attainment
 Geographic location (e.g., rural/urban)
 Income
 Mental health and substance abuse conditions
 Employment status
 Race/ethnicity
 Sex
 Sexual orientation and gender identity
 Veteran and military status

    Addressing the social and environmental factors that influence 
tobacco use can advance equity in tobacco prevention and control, and 
reduce tobacco-related disparities among populations disproportionately 
impacted by tobacco use.\12\ These efforts can help reduce the overall 
prevalence of tobacco use.\13\
    Approach: CDC is seeking input to inform future activities to 
advance tobacco control practices to prevent initiation of tobacco use 
among youth and young adults; eliminate exposure to secondhand smoke; 
and identify and eliminate tobacco-related disparities. The information 
gathered will be used to inform activities that encompass technical 
assistance and guidance to state tobacco control programs and 
collaborative work with national governmental and nongovernmental 
partners, who share CDC's goals to prevent initiation of tobacco use 
among youth and young adults; eliminate exposure to secondhand smoke; 
and identify and eliminate tobacco-related disparities.
    CDC is specifically interested in receiving information on the 
following issues:
    (1) What innovative strategies are working in communities to 
prevent tobacco use among youth, especially in terms of flavored 
tobacco products and e-cigarettes?
    (2) How can CDC best educate all community members about the 
harmful effects of secondhand smoke exposure?
    (3) How can CDC support state and local health departments and 
their partners to improve community engagement with populations most at 
risk for tobacco use?
    (4) What innovative strategies are effective in communities to 
decrease tobacco use in population groups that have the greatest burden 
of tobacco use and secondhand smoke exposure?
    (5) What science, tools, or resources does the public health sector 
need CDC to develop in order to enhance and sustain tobacco prevention 
and control efforts?

References
    1. U.S. Department of Health and Human Services. The Health 
Consequences of Smoking--50 Years of Progress: A Report of the 
Surgeon General. Atlanta: U.S. Department of Health and Human 
Services, Centers for Disease Control and Prevention, National 
Center for Chronic Disease Prevention and Health Promotion, Office 
on Smoking and Health, 2014.
    2. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual 
Healthcare Spending Attributable to Cigarette Smoking: An Update. 
American Journal of Preventive Medicine 2014;48(3):326-33.
    3. U.S. Department of Health and Human Services. E-cigarette use 
among youth and young adults: a report of the Surgeon General. 
Atlanta, GA: US Department of Health and Human Services, CDC; 2016 
[accessed 2018 Oct 18].
    4. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King 
BA. Notes from the Field: Increase in e-cigarette use and any 
tobacco product use among middle and high school students--United 
States, 2011-2018. Morbidity and Mortality Weekly Report. 
2018;67(45);1276-1277.
    5. Ambrose BK, Day HR, Rostron B, et al. Flavored Tobacco 
Product Use Among US Youth Aged 12-17 Years, 2013-2014. JAMA. 
2015;314(17):1871-1873.doi:10.1001/jama.2015.13802U.S.
    6. National Academies of Sciences, Engineering, and Medicine. 
2018. Public health consequences of e-cigarettes. Washington, DC: 
The National Academies Press. doi: https://doi.org/10.17226/24952.
    7. Department of Health and Human Services. A Report of the 
Surgeon General: How Tobacco Smoke Causes Disease: What It Means to 
You. Atlanta: U.S. Department of Health and Human Services, Centers 
for Disease Control and Prevention, National Center for Chronic 
Disease Prevention and Health Promotion, Office on Smoking and 
Health, 2010 [accessed 2018 Oct 10].
    8. U.S. Department of Health and Human Services. The Health 
Consequences of Involuntary Exposure to Tobacco Smoke: A Report of 
the Surgeon General. Atlanta: U.S. Department of Health and Human 
Services, Centers for Disease Control and Prevention, National 
Center for Chronic Disease Prevention and Health Promotion, Office 
on Smoking and Health, 2006 [accessed 2018 Oct 10].
    9. Centers for Disease Control and Prevention. Vital signs: 
Disparities in nonsmokers' exposure to secondhand smoke--United 
States, 1999-2012. Morbidity and Mortality Weekly Report. 
2015;64:103-108.[accessed 2018 Oct 22].
    10. Centers for Disease Control and Prevention. Cigarette 
smoking--United States, 1965-2008. Morbidity and Mortality Weekly 
Report. 2011;60(01):109-3. [accessed 2018 Oct 22].
    11. King BA, Dube SR, Tynan MA. Current tobacco use among adults 
in the United States: findings from the National Adult Tobacco 
Survey. American Journal of Public Health 2012;102(11):e93-e100. 
[accessed 2018 Oct 23].
    12. Centers for Disease Control and Prevention. Best Practices 
User Guide: Health Equity in Tobacco Prevention and Control. 
Atlanta: U.S. Department of Health and Human Services, Centers for 
Disease Control and Prevention, National Center for Chronic Disease 
Prevention and Health Promotion, Office on Smoking and Health, 2015.
    13. Centers for Disease Control and Prevention. Best Practices 
for Comprehensive Tobacco Control Programs--2014. Atlanta: U.S. 
Department of Health and Human Services, Centers for Disease Control 
and Prevention, National Center for Chronic Disease Prevention and 
Health Promotion, Office on Smoking and Health, 2014 [accessed 2018 
Oct 18].
    14. Centers for Disease Control and Prevention. Flavored Tobacco 
Product Use Among Middle and High School Students--United States, 
2014. Morbidity and Mortality Weekly Report. 2015;64(38);1066-1070. 
[accessed 2018 Nov 16].

    Dated: December 4, 2018.
Sandra Cashman,
Executive Secretary, Centers for Disease Control and Prevention.
[FR Doc. 2018-26708 Filed 12-10-18; 8:45 am]
BILLING CODE 4163-18-P