1994 Surgeon General's Report—Preventing
Tobacco Use Among Young People
Disclaimer
Foreword
This Surgeon General's report on smoking and health is the twenty-third
in a series that was begun in 1964 and mandated by federal law in 1969.
This report is the first in this series to focus on young people. It underscores
the seriousness of tobacco use, its relationship to other adolescent problem
behaviors, and the responsibility of all citizens to protect the health
of our children.
Since 1964, substantial changes have occurred in scientific knowledge
of the health consequences of smoking and smokeless tobacco use. Much more
is also known about programs and policies that encourage nonsmoking behavior
among adults and protect nonsmokers from exposure to environmental tobacco
smoke. Although considerable gains have been made against smoking among
U.S. adults, this progress has not been realized with young people. Onset
rates of cigarette smoking among our youth have not declined over the past
decade, and 28% of the nation's high school seniors are currently
cigarette smokers.
The onset of tobacco use occurs primarily in early adolescence, a developmental
stage that is several decades removed from the death and disability that
are associated with smoking and smokeless tobacco use in adulthood. Currently,
very few people begin to use tobacco as adults; almost all first use has
occurred by the time people graduate from high school. The earlier young
people begin using tobacco, the more heavily they are likely to use it as
adults, and the longer potential time they have to be users. Both the duration
and the amount of tobacco use are related to eventual chronic health problems.
The processes of nicotine addiction further ensure that many of today's
adolescent smokers will regularly use tobacco when they are adults.
Preventing smoking and smokeless tobacco use among young people is critical
to ending the epidemic of tobacco use in the United States. This report
examines the past few decades' extensive scientific literature on the factors
that influence the onset of use among young people and on strategies to
prevent this onset. To better understand adolescent tobacco use, this report
draws not only on medical and epidemiologic research but also on behavioral
and social investigations. The resulting examination of the advertising
and promotional activities of the tobacco industry, as well as the review
of research on the effects of these activities on young people, marks an
important contribution to our understanding of the epidemic of tobacco use
in the United States and elsewhere. In particular, this research on the
social environment of young people identifies key risk factors that encourage
tobacco use. The careful targeting of these risk factors—on a community
wide basis—has proven successful in preventing the onset and development
of tobacco use among young people.
Philip R. Lee, M.D.
Assistant Secretary for Health
Public Health Service
David Satcher, M.D., Ph.D.
Director
Centers for Disease Control
and Prevention
Preface
From the Surgeon General,
U.S. Department of Health and Human Services
The public health movement against tobacco use will be successful when
young people no longer want to smoke. We are not there yet. Despite 30 years
of decline in overall smoking prevalence, despite widespread dissemination
of information about smoking, despite a continuing decline in the social
acceptability of smoking, substantial numbers of young men and women begin
to smoke and become addicted. These current and future smokers are new recruits
in the continuing epidemic of disease, disability, and death attributable
to tobacco use. When young people no longer want to smoke, the epidemic
itself will die.
This report of the Surgeon General, Preventing Tobacco Use Among Young
People, delineates the problem in no uncertain terms. The direct effects
of tobacco use on the health of young people have been greatly underestimated.
The long-term effects are, of course, well established. The addictive nature
of tobacco use is also well known, but it is perhaps less appreciated that
early addiction is the chief mechanism for renewing the pool of smokers.
Most people who are going to smoke are hooked by the time they are 20 years
old.
Young people face enormous pressures to smoke. The tobacco industry devotes
an annual budget of nearly $4 billion to advertising and promoting cigarettes.
As this report so well describes, there has been a continuing shift from
advertising to promotion, largely because of banning cigarette ads from
broadcast media. The effect of the ban is dubious, however, since the use
of promotional materials, the sponsoring of sports events, and the use of
logos in nontraditional venues may actually be more effective in reaching
target audiences. Clearly, young people are being indoctrinated with tobacco
promotion at a susceptible time in their lives.
A misguided debate has arisen about whether tobacco promotion "causes"
young people to smoke—misguided because single-source causation is probably
too simple an explanation for any social phenomenon. The more important
issue is what effect tobacco promotion might have. Current research suggests
that pervasive tobacco promotion has two major effects: it creates the perception
that more people smoke than actually do, and it provides a conduit between
actual self-image and ideal self-image--in other words, smoking is made
to look cool. Whether causal or not, these effects foster the uptake of
smoking, initiating for many a dismal and relentless chain of events.
On the brighter side, a large portion of this report is devoted to countervailing
influences. We have the justification: there is a substantial scientific
basis for primary prevention of cigarette smoking and smokeless tobacco
use. A number of successful prevention programs, based on the psychological
and behavioral factors that create susceptibility to smoking, are available.
We have the means: the report defines a coordinated, effective, nonsmoking
public health program for young people. And we have the will: schools, communities,
legislatures, and public opinion all testify to the growing support for
encouraging young people to avoid tobacco use.
The task is by no means easy. This report underscores the commitment
all of us must have to the health of young people in the United States.
Substantial work will be required to translate the justification, the means,
and the will into a world in which young people no longer want to smoke.
I, for one, relish the task.
M. Joycelyn Elders, M.D.
Surgeon General
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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