[Federal Register Volume 85, Number 13 (Tuesday, January 21, 2020)]
[Notices]
[Pages 3382-3383]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-00819]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket No. CDC-2020-0005]


Achieving Health Equity in the Advancement of Tobacco Control 
Practices To Prevent Initiation of Tobacco Use Among Youth and Young 
Adults, Eliminate Exposure to Secondhand Tobacco Product Emissions, and 
Identify and Eliminate Disparities in Tobacco Use and Secondhand 
Exposure Among Population Groups; 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 tobacco product emissions 
(e.g., secondhand smoke and aerosol); help current smokers quit; and 
identify and eliminate tobacco-related disparities. From 2017 to late 
2018, CDC solicited input from the public through a Federal Register 
Notice (FRN Docket Number: CDC-2017-0103); regarding these 
comprehensive prevention efforts. CDC has reviewed these comments, 
posted to www.regulations.gov, and received helpful feedback. Now, CDC 
is seeking additional information to inform future activities that 
assist in achieving health equity in tobacco prevention and control by 
eliminating differences in tobacco use and dependency and exposure to 
secondhand tobacco product emissions (e.g., secondhand smoke and 
aerosol) among certain population groups.

DATES: Electronic or written comments must be received by March 23, 
2020.

ADDRESSES: You may submit comments, identified by CDC-2020-0005 by any 
one of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov, 
Please follow the directions on the site to submit comments; or
     Mail: Karena Sapsis, Office on Smoking and Health, Centers 
for Disease Control and Prevention, 4770 Buford Hwy., Mail Stop S107-7, 
Atlanta, GA 30341.
    Instructions: All information received in response to this notice 
must include the agency name and docket number (CDC-2020-0005). All 
relevant comments received will be posted without change to http://www.regulations.gov, including any personal information provided.

FOR FURTHER INFORMATION CONTACT: Karena Sapsis, Office on Smoking and 
Health, Centers for Disease Control and Prevention, 4770 Buford Hwy., 
Mail Stop S107-7, Atlanta, GA 30341; Telephone (770) 488-3080; Email: 
[email protected].

SUPPLEMENTARY INFORMATION: 

Scope of Problem

    Tobacco use is the leading cause of preventable disease, 
disability, and death in the United States (Ref. 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 (Refs. 1 
and 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.
    Tobacco product use among youth, irrespective of whether it is 
smoked, smokeless, or electronic, is also a public health concern (Ref. 
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 (Ref. 3). The use of e-cigarettes may also lead to future 
cigarette smoking among some youth (Ref. 4). In addition to e-
cigarettes, youth also use several other types of tobacco products 
(e.g., cigarettes, flavored hookahs, smokeless tobacco, cigars, tobacco 
in pipes), and disparities in use of these products (e.g., menthol 
cigarette use among non-Hispanic blacks) exist across population groups 
(Ref. 5).
    In addition to concerns regarding the safety of tobacco product 
use, exposure to secondhand tobacco product emissions (e.g., secondhand 
smoke and aerosol) can also be harmful. 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 (Refs. 6 and 7). 
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 (Ref. 8).

Achieve Health Equity and Identify and Eliminate Tobacco-Related 
Disparities

    Health Equity in tobacco prevention and control is an opportunity 
for all people to live a ``healthy, tobacco-free life, regardless of 
their race or ethnicity, level of education, gender identity, sexual 
orientation, the job they have, the neighborhood they live in, or 
whether or not they have a disability'' (Ref. 9). Advancing health 
equity is rooted in addressing social determinants of health, which are 
the conditions in which people are born, grow, live, work and age, and 
include the wider set of forces and systems shaping the conditions of 
daily life (Ref. 10). Although progress has been made in reducing 
tobacco use and dependency in the general population, tobacco use and 
dependency and exposure to tobacco product emissions (e.g., secondhand 
smoke and aerosol) is still higher among certain population groups 
(Ref. 9). Persistent disparities can affect populations on the basis of 
certain factors, including but not limited to: (Refs. 9, 11, and 12).

 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
 Housing instability
 Incarceration status

    Addressing the social and environmental factors that influence 
tobacco use and exposure to secondhand tobacco product emissions can 
advance equity in tobacco prevention and control, and reduce tobacco-
related disparities among populations disproportionately impacted by 
tobacco use (Refs. 10 and 13). These efforts can help reduce the 
overall prevalence of tobacco use in addition to the prevalence of 
tobacco use within one or across several population groups.

Approach

    Health equity is achieved when every person has the opportunity to 
attain his or her ``highest level of health'' and everyone is ``valued 
equally with focused and ongoing societal efforts to address avoidable 
inequalities, historical and contemporary injustices, and the 
elimination of health and healthcare disparities'' (Ref. 14). CDC is

[[Page 3383]]

seeking input to inform future activities to achieve health equity in 
the advancement of tobacco control practices to prevent initiation of 
tobacco use among youth and young adults; eliminate exposure to 
secondhand tobacco product emissions; and identify and eliminate 
tobacco-related disparities. The information gathered will be used to 
inform activities that support or are otherwise related to state 
tobacco control programming (e.g., mass media campaigns; cessation; 
recommending policies related to smoke-free and tobacco pricing) 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 tobacco 
product emissions; and identify and eliminate tobacco-related 
disparities.
    CDC is specifically interested in receiving information on the 
following issues:
    (1) What evidence-based or well-evaluated approaches/strategies, 
specifically addressing the social determinants of health, are being 
used to advance health equity goals related to tobacco use, dependency, 
and exposure to secondhand tobacco product emissions (e.g., secondhand 
smoke and aerosol) in states, intra-state regions, counties, cities 
and/or communities/neighborhoods? Please provide the following 
information: (1) A description of indicated approaches/strategies; (2) 
where or from whom can CDC find additional information on identified 
approaches/strategies; and (3) the places (e.g., state, region, city 
name) and populations covered by any identified approaches/strategies.
    (2) What logic models, indicators, and measurement tools have been 
used to evaluate the effectiveness and efficacy of health equity 
strategies implemented in states or intra-state regions, counties, 
cities, and/or communities/neighborhoods (process and outcomes), 
including but not limited to those regarding tobacco prevention and 
control? Please provide a description for each logic model, indicator 
and measurement tool identified, including where it has been utilized 
and how it can be accessed (e.g., publication reference, website 
address).
    (3) What promising practices are working in states or intra-state 
regions, counties, cities, and/or communities/neighborhoods to advance 
health equity goals: (1) Related to tobacco use, dependency, and 
exposure to secondhand tobacco product emissions (e.g., secondhand 
smoke and aerosol); (2) specifically among population groups with the 
greatest burden of tobacco use, dependency and exposure to secondhand 
tobacco product emissions, or (3) both?
    (4) What science, tools, or resources on health equity would be 
useful to enhance and sustain tobacco prevention and control efforts 
among different population groups?
    (5) In addition to building workforce capacity, are there other 
ways through which CDC may support state and local health departments 
and their partners to advance health equity related to tobacco use, 
dependency, and secondhand tobacco product emissions?
    (6) What partners and stakeholders might CDC seek to engage to 
advance tobacco related health equity? Please list partners in the 
following sectors whose work is related to or can affect tobacco use, 
dependency, and secondhand tobacco product emissions:

 Public health
 Business (e.g., Agriculture, Industry, Production, 
Manufacturing, Transport, Advertising)
 Healthcare
 Research/academic institutions
 Government
 Other

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: U.S. Department of Health and Human Services, CDC; 2016 
[Accessed 2019 Sept 17].
4. 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.
5. 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 2019 Sept 17].
6. 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 2019 Sept 17].
7. 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 2019 Sept 17].
8. 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 2019 Sept 17].
9. 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.
10. World Health Organization. Social Determinants of Health. http://www.who.int/social_determinants/en/. [Accessed on September 26, 
2019].
11. Centers for Disease Control and Prevention. Cigarette smoking--
United States, 1965-2008. Morbidity and Mortality Weekly Report. 
2011;60(01):109-3. [Accessed 2019 Sept 17].
12. 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 
2019 Sept 17].
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 2019 
Sept 17].
14. U.S. Department of Health and Human Services. National 
stakeholder strategy for achieving health equity. April 8, 2011. 
Available at: http://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286 [Accessed 2019 Sept17].

    Dated: January 15, 2020.
Sandra Cashman,
Executive Secretary, Centers for Disease Control and Prevention.
[FR Doc. 2020-00819 Filed 1-17-20; 8:45 am]
 BILLING CODE 4163-18-P