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April 24, 1996


JAMA. 1996;275(16):1285. doi:10.1001/jama.1996.03530400073041

Thirty-one years after the surgeon general targeted tobacco use as a major health threat, about one million teenagers in the United States take up the habit each year. That just about matches the number of older Americans who quit smoking, keeping the smoking rate at about 25% of the population aged 16 years and older. This is far better than the 46% cigarette smoking rate of 1964, but it is one of the most humbling failures of US health policy in the final third of the 20th century.

Because documentation that smoking causes more than 400 000 deaths a year, about 20% of the total deaths in the United States, has failed to lower smoking rates among teenagers in the past decade, it makes sense to try a new strategy by focusing on nicotine, the addictive chemical. Perhaps fear of addiction can do what the fear of death could not: