1994 Surgeon General's Report—Preventing
Tobacco Use Among Young People
Disclaimer
Chapter 1: Introduction, Development of the Report, Major Conclustions
Introduction
Previous Surgeon General's reports on tobacco use and health have largely
focused on the epidemiologic, clinical, biologic, and pharmacologic aspects
of adult use of tobacco products. This report on Preventing Tobacco Use
Among Young People provides a more detailed look at adolescence, the time
of life when most tobacco users begin, develop, and establish their behavior.
Because regular use soon results in addiction to nicotine, this behavior
may persist through adulthood, significantly increasing, through the extended
years of use, the risk of long-term, severe health consequences.
Despite three decades of explicit health warnings, large numbers of young
people continue to take up tobacco; currently, over three million adolescents
smoke cigarettes, and over one million adolescent males currently use smokeless
tobacco. Clearly, effective interventions are needed to prevent more young
people from trying tobacco. To achieve significant long-term reductions
in tobacco use and tobacco-related deaths in the United States, we must
examine the nature and scope of adolescent tobacco use, consider the social,
psychological, and marketing factors that influence young people in their
decision to use tobacco products, and evaluate current efforts to prevent
young people from becoming users. This report addresses the crucial problems
of adolescent tobacco use.
Development of the Report
This report of the Surgeon General was prepared by the Office on Smoking
and Health, National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, Public Health Service, U.S.
Department of Health and Human Services, as part of the department's responsibility,
under Public Law 91-222 and Public Law 99-252, to report current information
on the health effects of cigarette smoking and smokeless tobacco use to
the United States Congress. This report is the first to focus on the problem
of tobacco use among young people. Given the continuing onset of use in
adolescence and the growing evidence of health consequences associated with
early use, the report was seen as both needed and timely.
The current report has been produced through the efforts of experts in
the medical, pharmacologic, epidemiologic, developmental, economic, behavioral,
legal, and public health aspects of smoking and smokeless tobacco use among
young people. Initial manuscripts for the report were prepared by 28 scientists
who were selected for their expertise in specific content areas. This material
was consolidated into chapters, each of which underwent peer review. The
entire document was reviewed by a number of experts in the field, as well
as by institutes and agencies within the U.S. Public Health Service. The
final draft of the report was reviewed by the Assistant Secretary for Health
and by the Secretary, Department of Health and Human Services.
Several concerns guided the development of this report. The first, which
is addressed in Chapter 2, is whether tobacco use is associated with health
consequences during the period of adolescence (broadly defined as ages 10
through 18, although research cited in this report varies somewhat in the
ages considered adolescent). The long-term health consequences—that is,
those that emerge in adulthood—have been the subject of extensive review
and are widely acknowledged in the scientific and public literature. The
chapter thus focuses on the serious health consequences, as well as the
increased risk factors for subsequent health consequences, that are evident
early in life among young smokers and smokeless tobacco users. Chapter 3
examines the epidemiologic patterns of tobacco use among the young. National
data on trends in adolescent use are analyzed to determine the extent of
the current problem, as well as to note changes in patterns of initiation
and use. The factors that influence adolescents in their decision to use
tobacco are examined in Chapter 4, which considers psychosocial risk factors,
and Chapter 5, which examines the influence of tobacco advertising and promotion.
The final concern, the focus of Chapter 6, was to assess what has been done—from
the individual level to the legislative level—to prevent tobacco use among
young people.
Major Conclusions
- Nearly all first use of tobacco occurs before high school graduation;
this finding suggests that if adolescents can be kept tobacco-free,
most will never start using tobacco.
- Most adolescent smokers are addicted to nicotine and report that
they want to quit but are unable to do so; they experience relapse rates
and withdrawal symptoms similar to those reported by adults.
- Tobacco is often the first drug used by those young people who use
alcohol, marijuana, and other drugs.
- Adolescents with lower levels of school achievement, with fewer
skills to resist pervasive influences to use tobacco, with friends who
use tobacco, and with lower self-images are more likely than their peers
to use tobacco.
- Cigarette advertising appears to increase young people's risk of
smoking by affecting their perceptions of the pervasiveness, image,
and function of smoking.
- Communitywide efforts that include tobacco tax increases, enforcement
of minors' access laws, youth-oriented mass media campaigns, and school-based
tobacco-use prevention programs are successful in reducing adolescent
use of tobacco.
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 February 24, 1994
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