Tobacco Control at MD Anderson

What’s in a name? For MD Anderson’s EndTobacco™ Program, it’s an ambitious commitment to tackling an issue that extends far beyond Texas.

Smoking is linked to up to 30% of all cancer deaths in the United States, according to the National Cancer Institute. This means that ending tobacco use is an integral part of MD Anderson’s mission to end cancer.

Since its launch in 2014, EndTobacco has not only dedicated itself to preventing tobacco-related cancer deaths, but also to improving lives. Its three main goals are to reduce youth tobacco use, lessen secondhand smoke exposure and promote evidence-based tobacco treatment.

Now, to mark EndTobacco’s tenth anniversary, the program’s leaders – Jennifer Cofer, Dr.P.H., Ernest Hawk, M.D., and Mark Moreno – are reflecting on the program’s progress and the challenges still ahead.

Planning for impact

EndTobacco was formed in response to the question ‘How can MD Anderson share information, take action against and limit the harms of tobacco for patients and the public?’

At the program’s inception, a group of experts came up with more than 100 pages of evidence-based recommendations based on findings from MD Anderson and other health entities.

“We thought very carefully about how to organize ourselves to be more impactful in trying to promote a tobacco-free culture at a population level well beyond the walls of MD Anderson,” says Hawk, head of Cancer Prevention and Population Sciences.

Combining tobacco control programming and policy

Since then, the program has taken those recommendations from the page to the public, making progress from the classroom to the Texas Capitol.

For students, MD Anderson offers the ASPIRE initiative, a five-part tobacco education program designed for adolescents and teens. To date, more than 160,000 students across 47 states have enrolled in the program.

At the college level, the Eliminate Tobacco Use Initiative aids universities in creating smoke- and tobacco-free campuses and providing prevention resources and smoking cessation support. Originally launched in Texas, the program expanded nationally in 2018; it has now reached more than 80 colleges.

Training initiatives for health care providers allow the program’s tobacco cessation efforts to reach broader audiences. In 2017, EndTobacco began Texas’ first accredited Tobacco Treatment Training Program, which has since graduated more than 1,300 Tobacco Treatment Specialists. Project TEACH ECHO provides resources for health care providers, while the Tobacco Cessation Clinic Enhancement Program helps clinics improve their existing programming.

EndTobacco also serves as an educational resource to the public and policymakers.

“The cancer and advocacy communities have had a lot of success at the local and state level adopting policies that have had a direct impact on tobacco use,” says Moreno, MD Anderson’s Chief Governmental Relations Officer.

Among these legislative wins are smoke-free workplace ordinances that now protect more than 60% of Texans, and the 2019 Tobacco 21 law, which made it illegal for Texas retailers to sell tobacco products to those under age 21. That policy became a federal law only three months later.

Big wins, new challenges for tobacco control

Between 2011 and 2021, the number of Texas high school students smoking cigarettes dropped from 17.4% to only 3.7%, according to the Centers for Disease Control and Prevention’s High School Youth Risk Behavior Survey.

Cofer, EndTobacco’s executive director, believes that decrease can be attributed to many factors, including EndTobacco. “We are one piece of the puzzle, but we're a strong partner in contributing to that reduction,” she says, noting the importance of both programs and policies in the decline of youth smoking rates.

Unfortunately, ending tobacco means taking aim at a moving target. Today, the EndTobacco team is facing the increasing popularity of products such as e-cigarettes and nicotine pouches. The program is now working to educate youth and young adults about the harms of these products while pushing for policy that drives sweeping change.

The program helped educate policymakers on the legislation that allows the state comptroller to track e-cigarette sales in Texas. Now, it is turning its attention to future policy that will allow the state to tax vape products at the same rate as other tobacco products. It also offers cessation resources that focus on emerging tobacco products, such as the Truth Initiative’s This Is Quitting program, which provides young Texans with free text message support to help them quit vaping.

While newer tobacco products take on different forms and flavors than their predecessors, “nicotine and tobacco are still nicotine and tobacco,” Cofer says. “Our big challenge is to counter what the industry may say and really get the public health and cancer prevention messages out there.”

As it responds to these new challenges, EndTobacco also hopes to continue scaling its initiatives like ASPIRE, the Eliminate Tobacco Use Initiative and the Tobacco Treatment Training Program. The plan is to expand them first throughout Texas, then nationally.

“Taking tobacco use to zero is our ultimate goal,” Hawk says. “We're not there yet, but we've come a long way over the last 10 years partly due to our program and partly due to the myriad of other efforts.”

While much work lies ahead, there is a decade of momentum to build on.

“When we dedicate resources and take intentional steps to identify ways we can address a problem, this is the incredible success that we can achieve,” Moreno says. “It's a wonderful example of teamwork and collaboration culminating in a pretty phenomenal outcome in a very short period of time.”

Learn more about EndTobacco.