The Tobacco Control Experience: A Model for Substance Use Prevention?

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Through a combination of governmental and private sector interventions, with an emphasis on policies, tobacco control has dramatically reduced smoking and its burden of preventable premature disease and death. Since publication of the first Surgeon General’s report in 1964, the prevalence of cigarette smoking in the USA has dropped by nearly two-thirds and tobacco control has been credited with averting eight million premature deaths. Extensive research has established which interventions have been effective and which not. For example, cigarette taxation and smoke-free workplace laws both have reduced smoking significantly, while warning labels and school health education have contributed relatively less to population-level impact. The documented impacts of tobacco control interventions offer insights into interventions that might be adopted to combat other forms of substance abuse. For example, based on the evidence that cigarette taxation has reduced initiation of smoking by youth and increased adult cessation, proponents of obesity control are advocating taxation of snack foods and sugary beverages; several jurisdictions have adopted such taxes. Lessons can go in both directions, however. Tobacco control has much to learn from experiences with harm reduction regarding other forms of substance abuse, including, as a notable example, treatment of heroin addiction with methadone. This is relevant to the current divisive debate about the use of electronic cigarettes as a substitute for smoking.