The Center for Disease Control (CDC) recently released polling results from 2021 claiming the majority of US adults are in favor of banning all tobacco products, however, the validity of the results is questionable due to multiple factors.

1. The data is based on a single survey (SpringStyles 2021) that CDC acknowledged did NOT meet the standard for a representative sample of US adults, exposing the survey to bias.
2. The survey itself was drafted with confounding factors, including the wording of the questions and limited response options, both of which influenced the participants’ responses and the analysis of the results.
3. The purpose of the survey was to motivate people to take political action, not to inform or make determinations about public health.

SAMPLE BIAS

According to the CDC, “SpringStyles is a web panel survey and is not representative of the US adult population.”

Respondents were recruited by mail and asked to participate in the online survey. There are multiple factors determining why specific demographics or political dispositions are generally under- or over-represented in this type of survey. This is problematic because the participants’ age, location, and employment type all affect whether they have access to a permanent address and internet. Another key factor is their interest (or disinterest) in the subject matter. In this survey, 40.9% of those contacted chose NOT to complete the survey at all. Combine that with the 43% of respondents who oppose a tobacco prohibition and one could infer that an overwhelming majority likely sees no need to further regulate tobacco.

WEIGHTING OF THE DATA

When there are biases present in the data due to non-responsiveness or other factors, a process called “weighting” is used to make the results appear more in line with a broad representation. CDC admits that these mathematical adjustments were employed and that these limit the accuracy of the data. Essentially, this is an admission that the survey is NOT accurate, and some answers are counted more than once to make up for the lack of participation from people with certain backgrounds.

LEADING QUESTIONS AND LIMITED RESPONSE OPTIONS

The way questions were asked may have also influenced participants’ responses, due to the limited context in which they were provided. Similarly, by limiting respondents to yes/no answers or other binary responses, the survey forced respondents to take sides on an issue in which they likely had no opinion.

For example, one question asked: “To what extent would you support a policy to prohibit the sale of all tobacco products?” The answer choices were limited to a range from “Strongly support” to “strongly oppose”, with no neutral or “no opinion” option even offered! Thus, respondents were forced to choose a side even if they held no opinion on the matter.

LACK OF CONSIDERATION OF OTHER FACTORS

• The data collected was self-reported, which increases the possibility of underreporting of certain variables.
• The study did not assess the respondents’ residency in areas that had already banned menthol cigarette sales or all tobacco product sales.
• The study did not separate tobacco product categories and over-generalized the “tobacco” product category.
• The survey did not ask questions regarding support for policies at specific levels of government (e.g., local, state, or federal).
• The survey had no controls in place for potentially confounding variables, such as previous exposure to anti-tobacco campaigns or personal beliefs about the perceived risks of specific tobacco product use, which could have influenced participants’ responses.
• Possible measurement bias in defining current non-cigarette and cigarette use: The definition of current non-cigarette and cigarette use is limited to the past 30 days, which does not accurately capture long-term smoking.

In reviewing the reference section of the study, you would likely notice some questionable sources. Specifically, the author cites the Campaign for Tobacco Free Kids, and the Truth Initiative, two politically motivated organizations. The Campaign for Tobacco Free Kids has spent $8,071,000.00 on anti-tobacco marketing and lobbying over the past decade.[2] With this in mind, such sources do not represent the most reliable, unbiased sources for inclusion.

AUTHOR BIAS

According to the CDC website, their mission is as follows: “CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.” [3] The CDC further states that it will “Base all public health decisions on the highest quality scientific data that is derived openly and objectively.”[3]

Considering the CDC’s 2021 study in relation to their mission statement, the study is in direct contrast with their claims to base conclusions on the ‘highest quality scientific data’. Did the study allow for any complex opinions? No. Did it allow any considerations for specific tobacco product exclusions from survey participants’ sweeping statements? No.

So, what was the purpose?

The CDC acknowledges that it had a political goal in mind, “Moreover, these findings can inform federal, state, and local efforts to prohibit all tobacco product sales, including menthol cigarettes, reduce tobacco use and tobacco-related disparities, and advance health equity.”

The CDC would be wise to keep its focus on real issues threatening public health. By allowing itself to be used as a political tool for the tobacco-free movement, the CDC is endorsing the blatant disregard these groups have for small family-owned businesses, and the hundreds of thousands of farmers, factory workers, distributors and retailers who rely on the tobacco industry to support their families in the United States and abroad. The CDC will be used to justify regulatory actions that threaten dozens of countries’ economies—issues that will affect Americans at the border and through international trade.

With tobacco use at an all-time low, and continuing to decline, the CDC’s survey is not supporting public health. Instead, it is extending the lifespan of billionaire special interests by falsely fabricating a public outcry for prohibition. It’s no coincidence that their 2021 survey is only now being released as the Center for Tobacco Products receives heavy criticism from community activists, law enforcement and small businesses for its’ ill-conceived attempt to target the tobacco products “allegedly” preferred in communities of color. The CDC should focus its efforts and resources elsewhere and stop propping up junk polls to create a shock-and-awe factor with the general public or galvanizing cheerleader organizations to further their attacks on small business owners and adult consumers.

[1] Al-Shawaf M, Grooms KN, Mahoney M, Buchanan Lunsford N, Lawrence Kittner D. Support for Policies to Prohibit the Sale of Menthol Cigarettes and All Tobacco Products Among Adults, 2021. Prev Chronic Dis 2023;20:220128. DOI: http://dx.doi.org/10.5888/pcd20.220128

[2] “Campaign for Tobacco-Free Kids Lobbying Profile.” OpenSecrets. Accessed February 3, 2023. https://www.opensecrets.org/federal-lobbying/clients/summary?cycle=2022&id=D000048229.

[3] “Mission, Role and Pledge.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, April 29, 2022. https://www.cdc.gov/about/organization/mission.htm#:~:text=CDC%20works%2024%2F7%20to,citizens%20to%20do%20the%20same.