An NIH State-of-the-Science Conference on "Tobacco Use: Prevention, Cessation, and Control" issued a draft statement at the conclusion of its June 12-14 meeting that identifies the research, programs, and policies necessary to achieve further progress in reducing the individual and societal burdens of tobacco-related illnesses.

Dr. Mark Clanton, NCI deputy director and deputy director for Cancer Care Delivery Systems, stated, "We're here for this important and timely conference because tobacco prevention, treatment, and control research are so important to improving the nation's health. The purpose is to facilitate an objective review of the evidence: to clarify what is known and to identify what research gaps remain."

Panel Chairman Dr. David F. Ransohoff, of the University of North Carolina at Chapel Hill, stated that tobacco use remains the nation's leading preventable cause of premature death and that cigarette smoking alone is responsible for more than 30 percent of cancer deaths annually. Despite declines in tobacco use in recent decades, Dr. Ransohoff noted that "it is unlikely that the Healthy People 2010 objectives of reducing smoking prevalence to 12 percent or less in adults and 16 percent or less in youth will be reached on schedule."

About 70 percent of the nation's 44.5 million adult smokers want to quit, but fewer than 5 percent succeed in a given year. "Despite strong evidence that a variety of pharmacologic and behavioral interventions are effective for tobacco cessation, only a small proportion of tobacco users receive them," the draft report notes. "This gap represents a major national quality-of-care problem."

The conference panel addressed several key questions, including: "What are the effective strategies for increasing the implementation of proven, population-level, tobacco-use cessation strategies, particularly by health care systems and communities?" Evidence suggests that media campaigns, telephone-counseling programs (quitlines), and increases in tobacco pricing and taxation are effective.

"Although some approaches are promising, considerable heterogeneity exists within each approach type," the draft report notes. "For example, telephone counseling programs vary in intensity, referral sources, and inclusion of pharmacotherapy." The panel recommended research to examine the effectiveness of different components of telephone-based counseling, including "population quitlines vs. provider-associated programs, self-referral vs. provider referral to telephone-based counseling, and bundling of services within programs."

The panel also addressed the question, "What research is needed to make the most progress and greatest public health gains nationally and internationally?" Their recommendations include determining the effectiveness of incorporating social context in interventions and evaluating approaches to reduce tobacco use in populations that "are particularly vulnerable or where tobacco has a disproportionately adverse effect, including people who have co-occurring conditions."

Dr. Clanton commented, "While tobacco use is decreasing in developed countries like the United States, it is increasing in developing countries. A better understanding of how effective strategies for tobacco prevention and treatment can be developed and implemented across diverse populations, as well as better methods to reduce health disparities, is crucial to accelerate progress to reduce tobacco use both in the United States and worldwide."

By Bill Robinson