Reducing Tobacco Use: A Report of the Surgeon General - Executive Summary

Abstract

This report of the Surgeon General on smoking and health, Reducing Tobacco Use, appears at a time of considerable upheaval in the arena of tobacco use control and prevention. Legal and legislative efforts to protect children from tobacco initiation and to diminish the prevalence of smoking among adults are in a state of flux, with some important gains and some sobering setbacks. Major changes in the public stance of the tobacco industry have evoked a reevaluation of strategies for controlling and preventing tobacco uptake. Enormous monetary settlements have provided the resources to fuel major new comprehensive antitobacco efforts, but the ultimate cost and benefit of these resources are still to be determined. Into this changing landscape, the report introduces an assessment of information about the value and efficacy of the major approaches that have been used--educational, clinical, regulatory, economic, and comprehensive--to reduce tobacco use. The report evaluates the scientific evidence for each approach, attempts to place the approaches in the larger context of tobacco control, and provides a vision of the trajectory for tobacco use prevention and control based on these available tools. Thus, although our knowledge about tobacco control remains imperfect, we know more than enough to act now. Widespread dissemination of the approaches and methods shown to be effective in each modality and especially in combination would substantially reduce the number of young people who will become addicted to tobacco, increase the success rate of young people and adults trying to quit using tobacco, decrease the level of exposure of nonsmokers to environmental tobacco smoke, reduce the disparities related to tobacco use and its health effects among different population groups, and decrease the future health burden of tobacco-related disease and death in this country. These achievable improvements parallel the health objectives set forth in Healthy People 2010, the national action plan for improving the health of all people living in the United States for the first decade of the 21st century (U.S. Department of Health and Human Services [USDHHS] 2000a). Twenty-one specific national health objectives related to tobacco use are listed in Healthy People 2010, including reducing the rates among young people and adults to less than half of the current rate of use. Attaining all of these tobacco-related objectives will almost certainly require significant national commitment to the various successful approaches described in this report. The major conclusions of this report are not formal policy recommendations. Rather, they offer a summary of the scientific literature about what works. In short, this report is intended to offer policymakers, public health professionals, professional and advocacy organizations, researchers, and, most importantly, the American people guidance on how to ensure that efforts to prevent and control tobacco use are commensurate with the harm it causes.