Political impediments to a tobacco endgame.

Any serious consideration of exploring a tobacco endgame in the USA must build upon the enviable track record of reducing tobacco use through a mixture of federal and state policies. This foundation may pose particular challenges in approaching an endgame, including questions of national political feasibility, public support, limitations of sub-federal experimentation and recruitment of future political champions. Advocates must demonstrate a compelling need for a dramatic expansion beyond existing efforts, amid competition from alternative issues and little apparent public appetite for such an initiative.