Cancer prevention through stealth: science, policy advocacy, and multilevel governance in the establishment of a ‘National Tobacco Control Regime’ in the United States

The role of the US federal government in developing tobacco control through a cooperative, interactive program with state and local private and public organizations has been underestimated. This article investigates how the government initiated and sustained a program of “capacity building” through the scientific authority of the National Cancer Institute, beginning in the 1980s. There are several major questions to be answered: (1) How did this program manage to be adopted and sustained despite the well-documented hindrances to effective tobacco control policy at the federal level? (2) How did a tobacco control policy program become incorporated into the scientific research agenda of the National Cancer Institute? (3) How have science, social factors, and government at various levels interacted in this capacity-building program? The study emphasizes how the US federal government, blocked by a tobacco-friendly Congress from enacting effective tobacco control legislation, utilized its scientific research role and, with the cooperation of other levels of government and large, private antitobacco organizations, established an ongoing policy effort.