Changing Policies to Change Practices

A look back at CHEST’s advocacy work within tobacco regulation

August 25, 2023

CHEST has played a significant role in changing tobacco use in the US—from policy to cessation. What began more than 60 years ago continues today in the long fight against lung cancer.

In early 1960, Diseases of the CHEST, now called the journal CHEST®, published “Statement on Cancer of the Lung.” The article was among the first to emphasize the need to find the causative agents of lung cancer, with smoking cited as a probable link. The journal became a key source of critical research connecting tobacco use to lung cancer.

vintage no smoking print

Using this evidence-based science, the college actively disseminated the information to the public and worked with the office of the US Surgeon General to make the law requiring warning labels on cigarette packs.

The professional association also led by example when announcing that its annual meeting would have designated smoking areas, with the goal of reducing cigarette use and secondhand exposure to others. Later, a nonsmoking pledge requirement was added as a condition of obtaining Fellow of the American College of Chest Physicians (FCCP) designation.

View a more detailed history of CHEST’s involvement in tobacco »

CHEST is still deeply involved in tobacco use, control, cessation, and regulation, and includes it as one of the organization’s priorities within advocacy. With the introduction of vaping and other innovations, such as flavorings, CHEST advocacy focuses on protecting youth, young adults, and members of marginalized communities, who have been long-time targets of the tobacco industry.

“Over the past years, CHEST has really stepped up and taken a more active role in advocacy,” Frank Leone, Chair of the Tobacco/Vaping Work Group for the CHEST Health Policy and Advocacy Committee, said. “The organization takes responsibility for figuring out what to do, what our members need to do, what they need to know, and what guidance they need in order to be as effective as they can possibly be.

“By prioritizing tobacco as one of the pillars, CHEST actively identifies the foremost experts in the field and brings them together where some of the top minds can brainstorm ways we can be most effective in the evolutionary process for policy.”

“Changes in policy without changes in practice is just half the equation.”

Currently, the committee is working to get menthol and flavored cigarettes removed from retail shelves. In a letter to the commissioner of the US Food and Drug Administration (FDA), CHEST joined Campaign for Tobacco-Free Kids in their call to prohibit menthol as a characterizing flavor in cigarettes. From the letter:

As stated in the FDA’s own scientific analysis and the Tobacco Products Scientific Advisory Committee (TPSAC) report, menthol cigarettes pose a public health risk even greater than that seen with nonmenthol cigarettes.

Studies on menthol cigarettes have repeatedly shown that flavoring increases the initiation of smoking among young people. This preference increases with Black youth smokers, an ongoing disparity, with menthol cigarettes taking a disproportionately high toll of disease and death in the African American community.

Changes in policy without changes in practice is just half the equation. CHEST recently created a physician-facing Tobacco Dependence Treatment Toolkit.

Tobacco Toolkit

Included in the toolkit are comprehensive guidelines on how to better assess a patient’s readiness and willingness to change and begin treatment for tobacco addiction. Topics covered include motivational interviewing, testing/diagnostics, treatment basics (including e-cigarettes/smokeless tobacco), and insurance billing.

The Tobacco Dependence Treatment Toolkit serves as a resource to strengthen the physician approach to guiding patients through breaking a nicotine addiction.

Access the toolkit »

To learn more about CHEST’s recent involvement with tobacco use, control, and cessation, visit the Tobacco and Vaping section of CHEST’s On the Record advocacy page.


The Cancer Moonshot: a CHEST leader’s perspective

The Cancer Moonshot is a White House initiative to bring renewed leadership to the fight against cancer.

Since the initial program launch in 2016, progress has been made toward the three goals: to accelerate scientific discovery, foster greater collaboration, and improve the sharing of cancer data.

Early in 2022, President Biden announced two new goals: to reduce the cancer death rate by half within 25 years and improve the lives of people with cancer and cancer survivors.

When the White House hosted a forum in early June, CHEST leader, Frank Leone, MD, FCCP, Chair of the Tobacco/Vaping Work Group for the CHEST Health Policy and Advocacy Committee, was present for the discussion. The focus was on the largest single driver of cancer deaths in this country: smoking.

“It is great that CHEST is now at the table as active participants in the process of forming and checking in on initiatives related to public health,” Dr. Leone said. “The [Cancer] Moonshot didn't cure cancer like it aimed to—that was sort of an unattainable goal—but it made a lot of big differences in the way the country approaches the problem of cancer, and this served as a checking point for experts from a variety of backgrounds to provide feedback about the good, the bad, and the ugly of their framework.”

Dr. Leone left the forum feeling inspired by the conversation but also aware of the scope and depth of the problem and the tremendous task at hand.

“The federal government is really bringing some very sophisticated resources to try and increase access, accessibility, and effectiveness of interventions around tobacco dependence,” Dr. Leone said. “I see the detrimental impacts of tobacco use in the clinic on a daily basis, but participating in a federal program really drives home the size of the tobacco dependence problem.”

Despite the herculean task of eliminating lung cancer deaths, Dr. Leone is encouraged by the level of commitment from the participants in the room, including administration officials, community and patient advocates, private sector leaders, researchers, public health workers, and health care providers, such as the Center for Black Health & Equity.

View the full recording of the Cancer Moonshot forum »