Current Cardiovascular Risk Reports

, Volume 7, Issue 6, pp 446–452 | Cite as

Environmental Determinants of Smoking Behaviors: The Role of Policy and Environmental Interventions in Preventing Smoking Initiation and Supporting Cessation

  • William A. CaloEmail author
  • Sarah Krasny
Smoking and Lifestyle (R Huxley, Section Editor)


Tobacco control strategies have contributed to substantial declines in smoking in the United States. However, smoking still remains the single largest preventable cause of disease and premature deaths in the country. Despite the continuing challenges of implementing tobacco control strategies and the pervasive influence of the tobacco industry to undermine such strategies, there are now unprecedented opportunities to prevent smoking initiation, facilitate cessation, and protect nonsmokers from secondhand smoke. In this paper, we briefly review the most recent literature discussing key strategies that have proven effective in tobacco control including regulations on marketing and sales of tobacco products, taxation, and smoke-free legislation. We focused on these 3 tobacco control strategies because of their potential to positively influence the environment of both minors and adults regardless of their smoking status. Although research has identified significant individual and social predictors of tobacco use, environmental influences are also important risk factors for tobacco use.


Tobacco control Smoking prevention Smoke-free policy Tobacco product taxation Tobacco advertising Smoking initiation Built environment Smoking cessation 



WAC was supported by The University of Texas School of Public Health Cancer Education and Career Development Program – National Cancer Institute / NIH Grant R25CA57712. The content is solely the responsibility of the authors and does not necessarily represent the offıcial views of the National Cancer Institute or the NIH.

Compliance with Ethics Guidelines

Conflict of Interest

William A. Calo declares that he has no conflict of interest. Sarah Krasny declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Viswanath K, Herbst RS, Land SR, et al. Tobacco and cancer: an American Association for Cancer Res.earch policy statement. Cancer Res. 2010;70:3419–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Cokkinides V, Bandi P, McMahon C, et al. Tobacco control in the United States–recent progress and opportunities. CA Cancer J Clin. 2009;59:352–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. Morb Mortal Wkly Rep. 2008;57:1226–8.Google Scholar
  4. 4.
    American Cancer Society. Cancer Facts and Figures 2013. Atlanta: American Cancer Society; 2013.Google Scholar
  5. 5.
    Bollyky TJ, Gostin LO. The United States’ engagement in global tobacco control: proposals for comprehensive funding and strategies. JAMA. 2010;304:2637–8.PubMedCrossRefGoogle Scholar
  6. 6.
    • Hyland A, Barnoya J, Corral JE. Smoke-free air policies: past, present and future. Tob Control. 2012;21:154–61. This paper summarizes the evolution of smoke-free policies, highlights the research underlying such policies, and examines factors that have contributed to their adoption. The authors also speculate on what the smoke-free policies of the future may look like. PubMedCrossRefGoogle Scholar
  7. 7.
    Warner KE, Mendez D. Tobacco control policy in developed countries: yesterday, today, and tomorrow. Nicotine Tob Res. 2010;12:876–87.PubMedCrossRefGoogle Scholar
  8. 8.
    Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases. Ann Rev Public Health. 2006;27:341–70.CrossRefGoogle Scholar
  9. 9.
    Smedley BD, Syme SL. Promoting health: intervention strategies from social and behavioral research. Am J Health Promot. 2001;15:149–66.PubMedCrossRefGoogle Scholar
  10. 10.
    Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC: Institute of Medicine; 2007.Google Scholar
  11. 11.
    Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: summary of national findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville: Substance Abuse and Mental Health Services Administration; 2011.Google Scholar
  12. 12.
    Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ. 2012;61:1–162.PubMedGoogle Scholar
  13. 13.
    Centers for Disease Control and Prevention (CDC). Cigarette use among high school students - United States, 1991–2009. Morb Mortal Wkly Rep. 2010;59:797–801.Google Scholar
  14. 14.
    Nasim A, Khader Y, Blank MD, et al. Trends in alternative tobacco use among light, moderate, and heavy smokers in adolescence, 1999-2009. Addict Behav. 2012;37:866–70.PubMedCrossRefGoogle Scholar
  15. 15.
    Wiener RC. Association of smokeless tobacco use and smoking in adolescents in the United States: an analysis of data from the Youth Risk Behavior Surveillance System survey, 2011. J Am Dent Assoc. 2013;144:930–8.PubMedGoogle Scholar
  16. 16.
    Agaku IT, yo-Yusuf OA, Vardavas CI, et al. Use of conventional and novel smokeless tobacco products among US adolescents. Pediatrics. 2013;132:e578–86.Google Scholar
  17. 17.
    U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: 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; 2012.Google Scholar
  18. 18.
    Conklin CA, Robin N, Perkins KA, et al. Proximal vs distal cues to smoke: the effects of environments on smokers’ cue-reactivity. Exp Clin Psychopharmacol. 2008;16:207–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Conklin CA, Perkins KA, Robin N, et al. Bringing the real world into the laboratory: personal smoking and nonsmoking environments. Drug Alcohol Depend. 2010;111:58–63.PubMedCrossRefGoogle Scholar
  20. 20.
    DiFranza JR, Wellman RJ, Sargent JD, et al. Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality. Pediatrics. 2006;117:e1237–48.PubMedCrossRefGoogle Scholar
  21. 21.
    National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco Control Monograph No. 19. Bethesda: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2008. NIH Pub. No. 07-6242.Google Scholar
  22. 22.
    Henriksen L, Feighery EC, Schleicher NC, et al. Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Prev Med. 2008;47:210–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Dewhirst T. POP goes the power wall? Taking aim at tobacco promotional strategies utilized at retail. Tob Control. 2004;13:209–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Duke JC, Allen JA, Pederson LL, et al. Reported exposure to pro-tobacco messages in the media: trends among youth in the United States, 2000-2004. Am J Health Promot. 2009;23:195–202.PubMedCrossRefGoogle Scholar
  25. 25.
    Agaku IT, Adisa AO, Akinyamoju AO, Agboola SO. A cross-country comparison of the prevalence of exposure to tobacco advertisements among adolescents aged 13–15 years in 20 low and middle income countries. Tob Induc Dis. 2013;11:11.PubMedCrossRefGoogle Scholar
  26. 26.
    Henriksen L. Comprehensive tobacco marketing restrictions: promotion, packaging, price and place. Tob Control. 2012;21:147–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Husten CG, Deyton LR. Understanding the Tobacco Control Act: efforts by the US Food and Drug Administration to make tobacco-related morbidity and mortality part of the USA’s past, not its future. Lancet. 2013;381:1570–80.PubMedCrossRefGoogle Scholar
  28. 28.
    •• Ribisl KM. Research gaps related to tobacco product marketing and sales in the Family Smoking Prevention and Tobacco Control Act. Nicotine Tob Res. 2012;14:43–53. This paper examined several provisions in the FSPTCA related to the sales and marketing of tobacco products. The author provided a description and brief history of key regulations, what is known about these regulatory strategies, and research opportunities. Of the ideas presented, the author highlighted the following 5 areas of policy opportunity: curtailing cigarette price promotions and discounts, reducing tobacco retailer density, reducing youth exposure to tobacco marketing online and at the point of sale, reducing tax avoidance, and restricting advertising and promotion at the state level with the lifting of federal preemption. PubMedCrossRefGoogle Scholar
  29. 29.
    • Dube SR, Arrazola RA, Lee J, et al. Pro-tobacco influences and susceptibility to smoking cigarettes among middle and high school students–United States, 2011. J Adolesc Health. 2013;52:S45–51. This study assesses the proportion of susceptible middle and high school students who are exposed to pro-tobacco advertisements through stores, magazines, and the Internet. Despite provisions from the FSPTCA that seek to limit the exposure to and appeal of tobacco advertisements among youth, the study found that middle and high school students continue to be exposed to pro-tobacco advertisements in stores, magazines, and the Internet. PubMedCrossRefGoogle Scholar
  30. 30.
    Rose SW, Myers AE, D'Angelo H, Ribisl KM. Retailer adherence to Family Smoking Prevention and Tobacco Control Act, North Carolina, 2011. Prev Chronic Dis. 2013;10:E47.PubMedCrossRefGoogle Scholar
  31. 31.
    Frick RG, Klein EG, Ferketich AK, Wewers ME. Tobacco advertising and sales practices in licensed retail outlets after the Food and Drug Administration regulations. J Community Health. 2012;37:963–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Klein EG, Ferketich AK, bdel-Rasoul M, et al. Smokeless tobacco marketing and sales practices in Appalachian Ohio following federal regulations. Nicotine Tob Res. 2012;14:880–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Lovato C, Watts A, Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviors. Cochrane Database Syst Rev. 2011;10, CD003439.PubMedGoogle Scholar
  34. 34.
    Morgenstern M, Sargent JD, Isensee B, Hanewinkel R. From never to daily smoking in 30 months: the predictive value of tobacco and non-tobacco advertising exposure. BMJ Open. 2013;3:e002907.Google Scholar
  35. 35.
    Supreme Court lets FDA move forward with graphic cigarette warnings and other tobacco regulations. Available at Accessed August 2013.
  36. 36.
    •• Luke DA, Ribisl KM, Smith C, Sorg AA. Family Smoking Prevention and Tobacco Control Act: banning outdoor tobacco advertising near schools and playgrounds. Am J Prev Med. 2011;40:295–302. This study uses spatial analyses to examine how the FSPTCA rules banning outdoor tobacco advertising near schools and playgrounds would affect tobacco retailers in New York and Missouri given different tobacco free buffer zones (350-, 500- and 1000- feet). Given that similar rules on tobacco-free buffer zones around schools and playgrounds have been deemed unconstitutional, this analysis is important because it gives the FDA reliable data on which to base the new rules that it issues. PubMedCrossRefGoogle Scholar
  37. 37.
    American Nonsmokers’ Rights Foundation. Overview List – How many smokefree laws? Available at Accessed August 2013.
  38. 38.
    Leung R, Mallya G, Dean LT, et al. Instituting a smoke-free policy for city recreation centers and playgrounds, Philadelphia, Pennsylvania, 2010. Prev Chronic Dis. 2013;10:E116.PubMedCrossRefGoogle Scholar
  39. 39.
    Siegel M, Albers AB, Cheng DM, et al. Effect of local restaurant smoking regulations on progression to established smoking among youths. Tob Control. 2005;14:300–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Hyland A, Travers MJ, Cummings KM, et al. Tobacco outlet density and demographics in Erie County, New York. Am J Public Health. 2003;93:1075–6.PubMedCrossRefGoogle Scholar
  41. 41.
    West JH, Blumberg EJ, Kelley NJ, et al. Does proximity to retailers influence alcohol and tobacco use among Latino adolescents? J Immigr Minor Health. 2010;12:626–33.PubMedCrossRefGoogle Scholar
  42. 42.
    Johns M, Sacks R, Rane M, Kansagra SM. Exposure to tobacco retail outlets and smoking initiation among New York City adolescents. J Urban Health. 2013; [In press].Google Scholar
  43. 43.
    Centers for Disease Control and Prevention (CDC). State cigarette excise taxes - United States, 2010–2011. Morb Mortal Wkly Rep. 2012;61:201–4.Google Scholar
  44. 44.
    • Chaloupka FJ, Yurekli A, Fong GT. Tobacco taxes as a tobacco control strategy. Tob Control. 2012;21:172–80. This review presents an overview of the different types of tobacco taxes and tax structures used by governments around the world, and discusses how these taxes impact on the prices of tobacco products. The authors also discussed “best practices” for using tobacco taxes for tobacco control. PubMedCrossRefGoogle Scholar
  45. 45.
    Chaloupka FJ, Straif K, Leon ME. Effectiveness of tax and price policies in tobacco control. Tob Control. 2011;20:235–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Levy DT, Cummings KM, Hyland A. Increasing taxes as a strategy to reduce cigarette use and deaths: results of a simulation model. Prev Med. 2000;31:279–86.PubMedCrossRefGoogle Scholar
  47. 47.
    Hyland A, Bauer JE, Li Q, et al. Higher cigarette prices influence cigarette purchase patterns. Tob Control. 2005;14:86–92.PubMedCrossRefGoogle Scholar
  48. 48.
    Levy DT, Chaloupka F, Gitchell J. The effects of tobacco control policies on smoking rates: a tobacco control scorecard. J Public Health Manag Pract. 2004;10:338–53.PubMedCrossRefGoogle Scholar
  49. 49.
    Farrelly MC, Pechacek TF, Chaloupka FJ. The impact of tobacco control program expenditures on aggregate cigarette sales: 1981–2000. J Health Econ. 2003;22:843–59.PubMedCrossRefGoogle Scholar
  50. 50.
    Licht AS, Hyland AJ, O’Connor RJ, et al. How do price minimizing behaviors impact smoking cessation? Findings from the international tobacco control (ITC) 4 country survey. Int J Environ Res Public Health. 2011;8:1671–91.PubMedCrossRefGoogle Scholar
  51. 51.
    Pesko MF, Kruger J, Hyland A. Cigarette price minimization strategies used by adults. Am J Public Health. 2012;102:e19–21.PubMedCrossRefGoogle Scholar
  52. 52.
    •• Xu X, Pesko MF, Tynan MA, et al. Cigarette price-minimization strategies by U.S. smokers. Am J Prev Med. 2013;44:472–6. This research found that cigarette price minimization strategies are practiced widely (prevalence of 55.4%) among current adult smokers in the United States and resulting price reductions are relatively large (a reduction of $1.27 per pack or 22.0%). The authors also provide these estimates for all 50 states and DC.PubMedCrossRefGoogle Scholar
  53. 53.
    Pesko MF, Licht AS, Kruger JM. Cigarette price minimization strategies in the United States: price reductions and responsiveness to excise taxes. Nicotine Tob Res. 2013; [In press].Google Scholar
  54. 54.
    Coady MH, Chan CA, Sacks R, et al. The impact of cigarette excise tax increases on purchasing behaviors among New York city smokers. Am J Public Health. 2013;103:e54–60.PubMedCrossRefGoogle Scholar
  55. 55.
    Fix BV, Hyland A, O’Connor RJ, et al. A novel approach to estimating the prevalence of untaxed cigarettes in the USA: findings from the 2009 and 2010 international tobacco control surveys. Tob Control. 2013; [In press].Google Scholar
  56. 56.
    Chriqui JF, Ribisl KM, Wallace RM, et al. A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States. Nicotine Tob Res. 2008;10:253–65.PubMedCrossRefGoogle Scholar
  57. 57.
    Ribisl KM, Williams RS, Gizlice Z, Herring AH. Effectiveness of state and federal government agreements with major credit card and shipping companies to block illegal Internet cigarette sales. PLoS One. 2011;6:e16754.PubMedCrossRefGoogle Scholar
  58. 58.
    Choi K, Hennrikus DJ, Forster JL, Moilanen M. Receipt and redemption of cigarette coupons, perceptions of cigarette companies and smoking cessation. Tob Control. 2012; [In press].Google Scholar
  59. 59.
    Samuel KA, Ribisl KM, Williams RS. Internet cigarette sales and Native American sovereignty: political and public health contexts. J Public Health Policy. 2012;33:173–87.PubMedCrossRefGoogle Scholar
  60. 60.
    Hahn EJ. Smokefree legislation: a review of health and economic outcomes research. Am J Prev Med. 2010;39:S66–76.PubMedCrossRefGoogle Scholar
  61. 61.
    U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General—Executive Summary. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2006.Google Scholar
  62. 62.
    Brownson RC, Hopkins DP, Wakefield MA. Effects of smoking restrictions in the workplace. Ann Rev Public Health. 2002;23:333–48.CrossRefGoogle Scholar
  63. 63.
    Hahn EJ, Rayens MK, Butler KM, et al. Smoke-free laws and adult smoking prevalence. Prev Med. 2008;47:206–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Hopkins DP, Razi S, Leeks KD, et al. Smokefree policies to reduce tobacco use. A systematic review. Am J Prev Med. 2010;38:S275–89.PubMedCrossRefGoogle Scholar
  65. 65.
    Bauer JE, Hyland A, Li Q, Steger C, Cummings KM. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. Am J Public Health. 2005;95:1024–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Hahn EJ, Rayens MK, Langley RE, et al. Time since smoke-free law and smoking cessation behaviors. Nicotine Tob Res. 2009;11:1011–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009;54:1249–55.PubMedCrossRefGoogle Scholar
  68. 68.
    Been JV, Nurmatov U, van Schayck CP, Sheikh A. The impact of smoke-free legislation on fetal, infant and child health: a systematic review and meta-analysis protocol. BMJ Open. 2013;3:e002261.PubMedCrossRefGoogle Scholar
  69. 69.
    Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis. Circulation. 2012;126:2177–83.PubMedCrossRefGoogle Scholar
  70. 70.
    Centers for Disease Control and Prevention (CDC). State preemption of local smoke-free laws in government work sites, private work sites, and restaurants - United States, 2005–2009. Morb Mortal Wkly Rep. 2010;59:105–8.Google Scholar
  71. 71.
    Centers for Disease Control and Prevention (CDC). CDC grand rounds: current opportunities in tobacco control. Morb Mortal Wkly Rep. 2010;59:487–92.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Management, Policy and Community HealthThe University of Texas School of Public HealthHoustonUSA
  2. 2.Division of Health Promotion and Behavioral SciencesThe University of Texas School of Public HealthHoustonUSA

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