Interview with Dr. Brian King: Why Local Tobacco Control Still Matters

On October 21, 2025, the Coalition for a Tobacco-Free Hawai‘i (CTFH) sat down with Dr. Brian King, former Director of the FDA’s Center for Tobacco Products and now Executive Vice President at the Campaign for Tobacco-Free Kids. We spoke with him for his insights on the changes to tobacco prevention and control at the federal level, how it impacts local communities, and opportunities for action. Below is a transcript of our discussion:

CTFH: Aloha Dr. King, welcome to the HIPHI office! We appreciate you coming in for this interview. So just to start things off, can I ask who you are, what your role is, and why you care about this as an issue?

Dr. King: Yes, so I am Dr. Brian King, I am the Executive Vice President for U.S. programs at Campaign For Tobacco-Free Kids, which is the leading advocacy organization for tobacco control globally. Before that, I served many years in the federal government, including Director of the Center for Tobacco Products at FDA, and also Deputy Director in the Office on Smoking and Health at the Centers for Disease Control and Prevention.

CTFH: What got you involved in tobacco prevention work?

Dr. King: Well, it was very early on in my career. I considered going to medical school, and then I realized the power of prevention. When it comes to tobacco use, we know that an ounce of prevention is worth a pound of cure, and so I was very drawn in my graduate school years to tobacco control work, particularly around policy areas. At that time, we were implementing smoke-free policies, we were looking at taxation. Those policies, once implemented, had significant impact very quickly. So it was that opportunity to really optimize prevention, in a way that expeditiously improved public health, that was really alluring to me.

CTFH: What are some facts or figures that stand out to you the most in the tobacco space?

Dr. King: I think the biggest one is the remarkable progress we have made in reducing cigarette smoking in the United States. If you think about it, back in the 1960s, when the first Surgeon General’s Report was released in 1964, thatʻs when we started to see declines in smoking rates. At that point, nearly half of Americans were smoking. Now you look at the estimates, and they are 10% or 11%, so thatʻs a remarkable achievement, which I consider to be one of the greatest public health achievements in the past century, and you’ve seen it also borne out in preventing disease, disability, and death. 

That said, in terms of other alarming numbers, we still have 30 million Americans that are smoking. As the leading cause of preventable disease and death in this country, itʻs still a very important topic. I do think that many people feel that weʻve fully addressed smoking in this country, and that couldnʻt be further from the truth. It’s not just the 30 million adult smokers; we are also seeing the evolution of the marketplace and new products that people are using. Particularly when it comes to kids there are concerns about e-cigarette use, which has increased in recent years, but fortunately, in the last couple of years, it has come down about 70%. This is a good public health achievement, but still, two million kids nationally are using these products, and it’s important for us to continue to address the diversity of products, particularly when it comes to kids.

CTFH: Hawai‘i has been one of the national leaders in tobacco control. For example, we were the first state to raise the age to purchase tobacco to 21, and we have strong smoke-free air laws. What makes local efforts like these important to national progress?

Dr. King: I do want to highlight Hawai‘i, visionary vanguards. When it comes to implementing statewide policies, Hawai‘i has really been remarkable and certainly ahead of the curve on a variety of fronts. I will say when it comes to population-based interventions and efforts to address tobacco control, what we’ve seen over the years is percolation from the bottom up. So local-level policies are really critical. You can address a salient audience, you can deliver messages with key champions at the local level that understand the population. They understand the drivers of use and, importantly, they understand the most impactful and expeditious solutions. 

When it comes to tobacco control, state and local action has really been the bread and butter for many years. We’ve seen it over multiple decades, whether that be in the 1980s when taxation was implemented, the 1990s when smoke-free policies were being implemented, the 2000s and 2010s where we see age of sale policies, and even more recently in the 2020s when weʻre seeing flavor policies. All of those have galvanized from the local level and percolated up. That is why preemption is so problematic. For those who donʻt know, preemption is when a policy is implemented at the federal or at the state level, and it prevents localities from implementing policies. Ultimately, what that does is stifles that ability to do what we know works based on the science, as well as the implementation of local policies that then begin to proliferate over time. As population attitudes change, people see the effect of those local policies and the important public health influence that it has, and then that ultimately leads to more policies, maybe even a state or national policy down the road as a result of it.

CTFH: That’s one of our key issues with local county control being repealed in 2018, and weʻve been fighting against it ever since. We hear a lot of folks that say vapes are a safe alternative to combustible products. Is this true? Why or why not?

Dr. King: We know based on the available scientific evidence that e-cigarettes, as a general class, have lower risk than a regular cigarette. But it’s important to look at the magnitude of that risk. Cigarettes have 7,000 chemicals and 70 carcinogens, so they’re very risky. That said, just because an e-cigarette as a general class may have lower risk, that doesn’t mean it’s risk-free. We’re particularly concerned about use of these products among youth and young adults because these products contain nicotine. Nicotine is highly addictive. It can harm the developing adolescent brain, and it can prime the brain for addiction to other drugs. That adverse effect isnʻt just among youth, it’s also among young adults, because the brain continues to develop until about age 25 or 26. 

So when it comes to kids, we’re particularly concerned about the use of e-cigarettes. When it comes to adults, if they’re not already using a tobacco product, they definitely shouldnʻt start, and that includes e-cigarettes. When it comes to adult smokers who may be looking for an option to quit smoking, it’s important they use those FDA-approved therapeutics that we know work, such as nicotine patches and nicotine gum. If they do choose to use an e-cigarette, it’s important that they talk to their physician and have a discussion. If they do try to do it, they have to transition completely, because we know that using both a cigarette and an e-cigarette does not meaningfully reduce individual level of risk.

CTFH: We do know many communities are still facing high rates of tobacco use. What approaches are proving most effective in reaching those most impacted?

Dr. King: Comprehensive strategies are key when it comes to tobacco control, and that’s based on decades of science. We have been implementing tobacco control policies for many decades so we know what works. Many of the strategies are what I like to call “bread and butter strategies.” There are those that we’ve been using for many years, and by far the single most effective intervention to reduce tobacco use is price increases. We know that the higher the price, the lower the use, and one key area where thatʻs accomplished is through taxation. Many states, including Hawai‘i, have implemented high taxes that have ultimately led to reductions in use. 

There are also other policies, like smoke-free policies, which when implemented not only protect people from secondhand smoke but they also create an environment that helps reduce the acceptability of these products. That prevents initiation and also promotes cessation. Another type of bread and butter policy is mass reach health communication campaigns. We’ve seen those in many states, and nationally, where you educate people about the risks of tobacco use and provide them with resources to help them quit, such as the Quitline number. All 50 states have Quitlines, which provide the resources needed to quit, including potentially free nicotine replacement therapy, depending on the state. 

More recently, we’ve have seen emerging policies implemented for which the evidence base continues. A good example of that is age-of-sale restrictions. We saw the age increased to 21 for tobacco sales, which is important to prevent use by young people. Other newer types of policies include things like tobacco retail licensing and prohibiting flavors in tobacco products, which we know is a key driver for youth use. 

So ultimately these policies build on that strong foundation of tobacco control, those bread-and-butter strategies like taxation and smoke-free laws, and they address all the different levers that influence tobacco use. That’s why a comprehensive approach is key. 

As you implement these policies, it’s important that you also ask, “Whatʻs the end goal?” You want people to quit using these products and prevent them from starting, and so for cessation, you’ve got to make sure you help people out. You can’t implement a policy, like increasing the price, without making sure you’ve got infrastructure like Quitlines and cessation resources that are going to capitalize on this opportunity and make sure that they provide people the evidence-based information and resources they need to help them quit for good.

CTFH: We know that there have been a lot of federal cuts across the board. Can you share what the landscape is looking like nationally, and how thatʻs going to impact the states?

Dr. King: Unfortunately, we have seen a devastation of the federal tobacco control infrastructure. This has occurred across multiple agencies. One key agency is the U.S. Food and Drug Administration, which is responsible for regulating the manufacture, sale, and distribution of these products at the federal level. Several staff were fired because they were probationary employees who hadnʻt been working longer than a year when cuts were made in February. Then we saw another round of cuts in April that reduced the size of the Center for Tobacco Products. Fortunately, some of those people have been brought back, but not all of them. Ultimately, without those subject matter experts–particularly the scientists who know how to review applications and do what’s necessary to make sure we obey the law that Congress has mandated of the agency–that could have a detrimental impact on public health. 

We’ve also seen adverse cuts to the Centers for Disease Control and Prevention (CDC), and this includes the Office on Smoking and Health (OSH), which is the lead agency for comprehensive tobacco prevention and control. They do a lot of important things, including surveillance. They monitor youth use nationally, including conducting the National Youth Tobacco Survey. This has been very important to keep a pulse on trends in youth tobacco use, including when things are getting alarming, like the spike in e-cigarette use we saw back in 2017 to 2019. It also shows when we’re making progress, such as that 70% decline in youth use. If you don’t have the data, you donʻt know if you’re in public health peril or promise, so thatʻs a key area of concern with the elimination of OSH. 

The CDC also conducts the Tips from Former Smokers Campaign, which is an award-winning campaign that has helped over a million adult smokers quit smoking over a ten-year period, and has saved billions of dollars in averted smoking-related costs. With the removal of OSH, we see removal of that campaign, which is helping many people quit and also driving people to Quitlines across the country to get that evidence-based resource. 

Finally, and particularly relevant to states, OSH led the National Tobacco Control Program. The bulk of OSH’s dollars were going out the doors to states and communities to fund evidence-based tobacco prevention and control strategies. Typically, the states have done five-year grants where they receive funding, and we saw slashing of the entire Office on Smoking and Health’s budget. Right now, Congress is proposing to gut it completely in the long term. This would be absolutely cataclysmic to state and local action on tobacco control, and we know that’s critically important as we’ve previously discussed. 

State and local action is essential to make sure we’re providing evidence-based support and resources at the local and state level to help prevent what is the leading cause of preventable disease and death in this country. At present, it’s a very perilous time for tobacco control in this country. Thereʻs still an opportunity to reverse course if Congress makes the right decision and continues to fund the CDC’s Office on Smoking and Health. Without those resources it would be detrimental to the public health of this country and to states across the country, including their tobacco control and public health programs. 

CTFH: If we have these cuts, is there anything you think the states should do now to act?

Dr. King: I think it’s really important to have a plan B, and maybe even a plan C. In times where there may be budget cuts, it’s important to understand what the necessary resources and infrastructure are that are needed. We should make sure that we proactively prioritize what is most essential so that those resources will be available as needed. It’s important that we also make sure we’re maintaining and building relationships, maybe looking for new partners that continue to help promote this area. This could include non-government partners or even efficiencies within government, such as chronic disease programs or communicable disease programs, to identify if there are people that can help support the broader infrastructure and continue the important work, even if there may be less dollars.

CTFH: What are some things the tobacco industry has done, or hasn’t done, that lead to the need to regulate them?

Dr. King: We know from available evidence, including decades of industry documents that were turned over as a result of court cases, that the tobacco industry has deceived the American public on a multitude of occasions over the years. In fact, they have been convicted in federal court for being racketeers and for misleading the American public on the risks of smoking. That said, I think it’s important to consider that history in terms of engaging with the industry and understanding their underlying motives. 

When it comes to tobacco products, the ultimate goal of industry is to make money. You see heavy promotion of these products–there’s about a million dollars an hour spent in this country advertising cigarette smoking, which is a factor driving people to use those products. So when it comes to tobacco control it’s important to consider that, although there’s a preponderance of evidence about the adverse health risks, thereʻs also an industry that’s working actively–on an hourly basis–to promote these products and to make money. This is important to consider as we implement policies, which are litigated by the industry nearly instantaneously upon implementation. We need to make sure that we consider these things as the industry continues to create front groups, continues to challenge actions in court, and continues to provide misinformation in many cases to the public on key issues.

CTFH: What are the next best practices that states can do to make sure their residents are protected?

Dr. King: One thing to consider is that even with all the federal cuts, including the Food and Drug Administrationʻs Center for Tobacco Products, the underlying Tobacco Control Act that gave FDA authority does not preempt states and communities from acting. So indeed that’s been a key area where there’s been a variety of activities and meaningful public health actions for many years. That has to continue. That has been the hallmark of tobacco control for decades. I can’t reinforce enough that, despite the current chaos in the federal realm, I believe there is a key opportunity for states and communities to continue to advance evidence-based policy. We can’t abandon our tried and true strategies, like smoke-free policies, taxation, mass reach health communications, and cessation resources, but we can also look to the future to other policies after those baseline policies have been implemented. This includes things like tobacco retail licensure, addressing the use of flavors in tobacco products, including menthol cigarettes, and really taking that next step in terms of building upon that foundation of the existing suite of policies, and then looking forward to continuing advancing actions that will further reduce tobacco-related disease and death. 

CTFH: You mentioned banning flavors. Why would that be an important policy to implement?

Dr. King: Well, we know that flavors are a key influencer of use, and one key flavor when it comes to cigarettes is menthol. So when the Tobacco Control Act was implemented federally back in 2009, menthol cigarettes were excluded, and following that, the agency was tasked with conducting continued research and exploration over potentially prohibiting menthol cigarette sales in the future. The agency did that. They proposed a policy, and a final policy, and it got to the very final stages and ultimately the White House decided not to pursue that policy. But ultimately we know that based on the evidence, it would be highly effective because we know menthol cigarettes were heavily promoted particularly to African American communities across the country, but also other populations. Menthol cigarettes increase the appeal and mask the harshness of cigarettes, but they also can make it harder for people who are smoking to quit. So if you were to prohibit that last bastion of flavors in cigarettes, you would have strong potential to reduce tobacco-related disease and death both nationally, if the national policy were to proceed, but also importantly at the state level. There have been many states that have implemented policies prohibiting flavors, including menthol cigarettes, and that definitely would help prevent the tobacco-related disease and death associated with smoking. 

CTFH: Are there any key specifics on allowing counties or localities this authority? Examples on why that is so important, or some efforts that have been done in other places that have been successful?

Dr. King: The preemption issue is really problematic when it comes to tobacco control. We know through many decades of public health practice and data that the ability to engage at the local level is absolutely critical in terms of helping to educate the public, helping to educate stakeholders, helping to build evidence base around the impact of these policies. So having the ability to do that in an environment where you can easily relate with the public, easily relate with the decision-makers, and then implement a policy is really critical. Ultimately, what we’ve seen over time is things galvanize from the bottom up. A good example is Tobacco 21–policies that prohibited the sale of tobacco to anyone under 21. Those started in the 1990s in Massachusetts, and you started to see them galvanize at the local level. Years later in the 2010s and on you see states implement these policies at the statewide level, including Hawai‘i, and then we saw the federal policy in 2019. I think that’s a classic example of the importance of local action, because you started at the lower level, you develop that implementation and evidence base, and then in turn you use that as social norms change, public attitudes change, and you educate people about the benefits of these policies. Then they grow and they ultimately protect more people in the end. 

CTFH: Would you say our residents across the board, within the state, are going to be at more risk from the tobacco industry harming people if our individual counties arenʻt allowed to respond?

Dr. King: Absolutely, without a question. There’s a profound history. It’s a lot easier for industry to fight one battle at the state level than to fight multiple battles at the local level in any given jurisdiction. So it behooves industry to have preemption, because it prevents them from having to litigate in multiple areas of a state at multiple points in time. That is one factor that you see when these preemption bills are promoted–the industry has heavily supported them for that very reason because if they can get a law that preempts any type of action that’s going to prevent adverse effects to their bottom line, they’re going to do it. So that said, without a question, preemption is something thatʻs going to inhibit the advancement of meaningful tobacco control interventions.

CTFH: If you were designing an advocacy campaign to tackle Big Tobacco, what would some top line activities be?

Dr. King: Gotta stick to the facts. So I think we know that tobacco product use is the leading cause of preventable disease and death in this country, so sticking to “what are the risks of these products,” which we know are particularly profound when it comes to smoking. If you think about it, these products, when used as intended by the manufacturer, kill half of their users. These products are also highly addictive, and when it comes to the adverse health risks, there are a myriad when it comes to smoking in particular. So I think it’s important to stick to the facts, identify the risks, and then reinforce what the causes of these use patterns are, including drivers such as industry promotion and various other factors. Then, importantly, have a solution and what it is we need to do about it. Thatʻs where policy interventions are key. It’s not only just raising information and awareness about the risks and the people responsible, but also having that important solution. When it comes to tobacco control the good news is we have an arsenal of solutions, we know what works, weʻve just got to implement. 

CTFH: At some point you would like to retire. What would the tobacco landscape look like to you? Where you would say, “We’ve done it. This has been a success.” What does that picture look like? 

Dr. King: Unfortunately, I think that’s many years in our future, but the thing that gets me up every day, which I always am mindful of–if people always say what keeps you up at night, I say nothing keeps me up at night–but I’ll tell you what gets me up in the morning, and that’s the considerable progress we’ve made in reducing smoking rates in this country, and also reducing other product use, particularly among kids.You look at e-cigarettes alone since 2019, we’ve seen a 70% reduction in use. To me that’s a good thing.We’ve seen youth tobacco product use is at a 25-year low, e-cigarette use among kids is at a 10-year low, and cigarette smoking is at the lowest level we’ve ever seen among adults in half a century. The numbers are heading in the direction, but theyʻre still too high. So for me, the key is to drive those rates down as much as possible, particularly cigarette smoking. We’re headed in the right direction, but there’s still 30 million Americans smoking and there’s more work to do. Same thing with kids, we still have well over two million kids that are using tobacco products. In a perfect scenario, I would love to be out of a job in the end. I yearn for the day when we’ve effectively reduced tobacco-related disease and death, but the problem is we’ve still got some ways to go and that’s why itʻs important that in an environment where weʻre seeing cuts to federal infrastructure and decimation of infrastructure at the state and local level, we’ve got to redouble our efforts and galvanize and continue to act. I remind folks the pendulum will always continue to swing. As a federal civil servant for 15 years, the pendulum always swings. I’m very hopeful that we’re going to continue to see important, meaningful action to address not only a variety of public health factors, but particularly tobacco use in the years to come.

CTFH: In your experience what factors do policy makers consider when deciding whether to take action on tobacco control?

Dr. King: I’d like to think that it’s the public health angle. I’ll say that for some people that does work, but ultimately money talks. What Iʻve found over my career as a scientist is that it’s always critical that we relay the facts. I think that we have a strong preponderance of evidence around the health risks of tobacco use and the health savings in terms of implementing evidence-based policies, but I think the financial costs are also a very important angle when it comes to educating key decision makers. So when it comes to smoking in particular, there’s astronomical costs for society. For the United States as a whole, it’s $600 billion a year–billion, with a B–that’s an astronomical amount of dollars. If you’re implementing a strategy to address that, that’s going to save a lot of money, since a lot of those costs are from direct healthcare that’s being subsidized by government agencies at the state and federal levels. So ultimately, these types of population-based tobacco control policies are not just saving lives, but it’s saving money. We know that it makes good dollars and cents in many scenarios, so I think it’s important that we continue to reinforce the important health benefits, but also we understand those financial benefits as well, particularly as we’re considering policies, and the net gain from implementing them in the long term.

CTFH: Any final thoughts or messages?

Dr. King: My message to folks is to keep on trucking. I know that we’re at a very perilous time, particularly for public health, but I remain hopeful weʻll continue to make important progress, and now is not the time to let up. Now is the time to continue to keep our foot on the accelerator, and I remain hopeful that we’ll continue to implement policies and relay evidence-based information at the local, state, and federal levels for many years to come.