2000 Surgeon General's Report—Reducing Tobacco Use
A Call for Action
Disclaimer
If the recommendations in this report were fully implemented,
the Healthy People 2010 objectives related to tobacco use could be met,
including cutting in half the rates of tobacco use among young people and
adults.
–David Satcher, MD, PhD, U.S. Surgeon General
Tobacco use, particularly cigarette smoking, is the leading cause of
preventable illness and death in the United States. Each year, more than
400,000 Americans die too young because of smoking-related diseases. Today,
nearly one in four U.S. adults and one in three teenagers smoke. Tragically,
if current trends continue, an estimated 25 million people (including 5
million of today’s children) will die prematurely of a smoking-related disease.
A major challenge to our nation’s public health leaders and policy makers
in the new millennium is to provide the support and resources necessary
to carry out tobacco control programs that work.
The Surgeon General’s report on Reducing Tobacco Use will give the nation
a blueprint for preventing tobacco use and improving our citizens’ quality
of life. Each type of activity described in this report—educational, clinical,
regulatory, economic, and comprehensive—has proven to be effective. Although
our knowledge about tobacco control remains imperfect, we already know more
than enough to take action now. If we start today, we can greatly ease the
future burden of tobacco-related disease and death in our country.
Educational Interventions
- Increase the number of schools that fully implement the CDC’s
Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.
Less than 5% of schools nationwide currently use these guidelines, even
though full implementation could help 20% to 40% of U.S. adolescents
postpone or never start smoking.
- Establish a smoke-free and tobacco-free environment in schools,
including all school facilities, property, vehicles, and school events,
as called for in Healthy People 2010. In 1994 only 37% of middle, junior
high, and senior high schools were free of smoke and tobacco. Fully
implementing the Pro-Children’s Act of 1994, which prohibits smoking
in facilities that receive any federal funding for children’s services,
will bring us closer to the Healthy People 2010 target of 100% smoke-free
schools.
Clinical Interventions
- Begin providing universal insurance coverage of evidence-based treatment
for nicotine dependency as called for in Healthy People 2010. It is
estimated that smoking cessation programs are more cost-effective than
other commonly provided clinical preventive services, including screening
for cervical, breast, and colon cancer; treatment of mild to moderate
high blood pressure; and treatment of high cholesterol.
- Encourage more physicians to advise their patients to quit smoking.
This simple intervention could produce quit rates of 5% to 10% per year.
- Combine behavioral counseling with pharmacologic treatments such
as nicotine gum or nicotine patches. A combination of counseling and
treatment can produce 20% to 25% quit rates after one year.
Regulatory Interventions
- Increase smoking bans to reduce people’s exposure to environmental
tobacco smoke (ETS). ETS contains more than 4,000 chemicals; of these,
at least 43 are known carcinogens. ETS is still a common public health
hazard that can be easily eliminated, and smoking bans are the most
effective method for reducing ETS exposure. Healthy People 2010 calls
for an increase in laws that prohibit smoking or limit it to separately
ventilated areas in public places and worksites.
- Strengthen warning labels on tobacco products sold in the United
States. Current U.S. labels are weaker and less conspicuous than those
in other countries.
- Better regulate the advertising, promotion, and sale of tobacco
products in the United States. Tobacco marketing here is considerably
less restricted than in several other countries, notably Canada and
New Zealand. U.S. youth have easy access to tobacco. A high proportion
of underage smokers across the country continue to be able to purchase
their own tobacco. Healthy People 2010 calls for more states to suspend
or revoke retail licenses for violating laws that prohibit the sale
of tobacco to minors. Stricter regulation of selling and promoting tobacco
products is needed to keep young people from starting to smoke.
- To protect young people around the world, make exported tobacco
products subject to the same laws as domestic tobacco products. Federal
laws and regulations concerning the packaging and advertising of domestic
cigarettes do not apply to tobacco products exported from the United
States.
Economic Interventions
Raise tobacco prices to Healthy People 2010 target levels by increasing
the average federal and state tax on tobacco products to $2.00 for both
cigarettes and spit tobacco products. Research shows that increasing the
price of tobacco products would decrease the prevalence of tobacco use,
particularly among minors and young adults. However, both the average price
of cigarettes and the average cigarette excise tax in this country are well
below those in most other industrialized countries, and the taxes on smokeless
tobacco products are well below those on cigarettes.
Comprehensive Interventions
- Allocate more Master Settlement Agreement funds to tobacco control.
The National Conference of State Legislatures reported that less than
10% of tobacco settlement funds appropriated by state legislatures in
fiscal year 2000 were allocated for tobacco prevention and control programs.
- Reduce the cultural acceptability of tobacco use. By carrying out
a comprehensive program that includes educational, clinical, regulatory,
and economic interventions, we can change the social environment that
makes tobacco use acceptable.
- Finally, while putting all these activities into motion, we must
focus on making the elimination of tobacco-related health disparities
a priority. Cultural, ethnic, religious, and socioeconomic differences
clearly are important in understanding patterns of tobacco use. For
example, the average smoking rate among American adults is 24%, but
among Native American adults is 34%. People with 16 or more years of
education smoke much less than people with 9 to 11 years of education—11%
and 36%, respectively. Achieving the goal of eliminating tobacco-related
health disparities will require stronger research efforts to find new
and more effective interventions for our nation’s diverse population
groups.
Disclaimer: Data and findings provided on this page reflect the content of
this particular Surgeon General's Report. More recent information may exist
elsewhere on the Smoking & Tobacco Use Web site (for example, in fact sheets,
frequently asked questions, or other materials that are reviewed on a regular
basis and updated accordingly).
Page last updated August 9, 2000