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From the Centers for Disease Control and Prevention
September 20, 2000

Publication of Surgeon General's Report on Smoking and Health

JAMA. 2000;284(11):1375-1376. doi:10.1001/jama.284.11.1375-JWR0920-3-1

MMWR. 2000;49:718,727

The Surgeon General's report Reducing Tobacco Use1 was released on August 9, 2000. This report is the first in the series to offer a composite review of the various methods used to reduce and prevent tobacco use.

The six major conclusions of the report are:

1. Efforts to prevent the onset or continuance of tobacco use face the pervasive, countervailing influence of tobacco promotion by the tobacco industry, a promotion that takes place despite overwhelming evidence of adverse health effects from tobacco use.

2. The available approaches to reducing tobacco use-educational, clinical, regulatory, economic, and comprehensive-differ substantially in their techniques and in the metric by which success can be measured. A hierarchy of effectiveness is difficult to construct.

3. Approaches with the largest span of impact (economic, regulatory, and comprehensive) are likely to have the greatest long-term population impact. Those with a smaller span of impact (educational and clinical) are of greater importance in helping persons resist or abandon the use of tobacco.

4. Each of the modalities reviewed provides evidence of effectiveness.

• Educational strategies, conducted in conjunction with community- and media-based activities, can postpone or prevent smoking onset in 20% to 40% of adolescents.

• Pharmacologic treatment of nicotine addiction, combined with behavioral support, will enable 20% to 25% of users to remain abstinent at 1 year posttreatment. Even less intense measures, such as physicians advising their patients to quit smoking, can produce cessation proportions of 5% to 10%.

• Regulation of advertising and promotion, particularly that directed at young persons, is very likely to reduce both prevalence and uptake of smoking.

• Clean air regulations and restriction of minors' access to tobacco products contribute to a changing social norm with regard to smoking and may influence prevalence directly.

• An optimal level of excise taxation on tobacco products will reduce the prevalence of smoking, the consumption of tobacco, and the long-term health consequences of tobacco use.

5. The impact of these various efforts, as measured with a variety of techniques, is likely to be underestimated because of the synergistic effect of these modalities. The potential for combined effects underscores the need for comprehensive approaches.

6. State tobacco control programs, funded by excise taxes on tobacco products and settlements with the tobacco industry, have produced early, encouraging evidence of the efficacy of the comprehensive approach to reducing tobacco use.

Additional information about the report or a free copy of the executive summary is available from the CDC's Office on Smoking and Health, National Center for chronic Disease Prevention and Health Promotion, CDC, MailstopK-50, 4770 Buford Highway, NE, Atlanta, Georgia 30341-3724; telephone (770) 488-5705. Copies of the full report (stock no. 017-001-00544-4) can be purchased for $43 from the Superintendent of Documents, U. S. Government Printing Office, Washington, DC 20402-9328; fax (202) 512-1650. The executive summary of the report will be published as an MMWR Recommendations and Reports. Copies of the full report, the executive summary, and At A Glance also may be downloaded from CDC's World-Wide Web site, http://www.cdc.gov/tobacco.

US Department of Health and Human Services, Reducing tobacco use: a report of the Surgeon General.  Atlanta, Georgia US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health2000;