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U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.
Use of trade names is for identification only and does not constitute endorsement by the Public Health Service or the U.S. Department of Health and Human Services.
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 percent 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
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
Chapter 1. Introduction, Summary, and Chapter Conclusions
Chapter 2. The Health Consequences of Tobacco Use by Young People
Chapter 3. Epidemiology of Tobacco Use Among Young People in the United States
Chapter 4. Psychosocial Risk Factors for Initiating Tobacco Use
Chapter 5. Tobacco Advertising and Promotional Activities
Chapter 6. Efforts to Prevent Tobacco Use Among Young People
List of Tables and Figures
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Efforts to Prevent the Onset of Tobacco UseMost of the U.S. public strongly favors policies that might prevent tobacco use among young people. These policies include mandated tobacco education in schools, a complete ban on smoking by anyone on school grounds, further restrictions on tobacco advertising and promotional activities, stronger prohibitions on the sale of tobacco products to minors, and increases in earmarked taxes on tobacco products. Interventions to prevent initiation among young people—even actions that involve restrictions on adult smoking or increased taxes—have received strong support among smoking and nonsmoking adults. Numerous research studies over the past 15 years suggest that organized interventions can help prevent the onset of smoking and smokeless tobacco use. School-based smoking-prevention programs, based on a model of identifying social influences on smoking and providing skills to resist those influences, have demonstrated consistent and significant reductions in adolescent smoking prevalence; these program effects have lasted one to three years. Programs to prevent smokeless tobacco use have used a similar model to achieve modest reductions in initiation of use. The effectiveness of these school-based programs appears to be enhanced and sustained, at least until high school graduation, by adding coordinated communitywide programs that involve parents, youth-oriented mass media and counteradvertising, community organizations, or other elements of adolescents' social environments. A crucial element of prevention is access: adolescents should not be able
to purchase tobacco products in their communities. Active enforcement of
age-at-sale policies by public officials and community members appears
necessary to prevent minors' access to tobacco. Communities that have
adopted tighter restrictions have achieved reductions in purchases by
minors. At the state and national levels, price increases have significantly
reduced cigarette smoking; the young have been at least as responsive as
adults to these price changes. Maintaining higher real prices of cigarettes
provides a barrier to adolescent tobacco use but depends on further tax
increases to offset the effects of inflation. The results of this review
thus suggest that a coordinated, multicomponent campaign involving policy
changes, taxation, mass media, and behavioral education can effectively
reduce the onset of tobacco use among adolescents. SummarySmoking and smokeless tobacco use are almost always initiated and established in adolescence. Besides its long-term effects on adults, tobacco use produces specific health problems for adolescents. Since nicotine addiction also occurs during adolescence, adolescent tobacco users are likely to become adult tobacco users. Smoking and smokeless tobacco use are associated with other problem behaviors and occur early in the sequence of these behaviors. The outcomes of adolescent smoking and smokeless tobacco use continue to be of great public health importance, since one out of three U.S. adolescents uses tobacco by age 18. The social environment of adolescents, including the functions, meanings, and images of smoking that are conveyed through cigarette advertising, sets the stage for adolescents to begin using tobacco. As tobacco products are available and as peers begin to try them, these factors become personalized and relevant, and tobacco use may begin. This process most affects adolescents who, compared with their peers, have lower self-esteem and self-images, are less involved with school and academic achievement, have fewer skills to resist the offers of peers, and come from homes with lower socioeconomic status. Tobacco-use prevention programs that target the larger social environment of adolescents are both efficacious and warranted. Chapter ConclusionsFollowing are the specific conclusions for each chapter of this report: Chapter 2. The Health Consequences of Tobacco Use by Young People
Chapter 3. Epidemiology of Tobacco Use Among Young People in the United States
Chapter 4. Psychosocial Risk Factors for Initiating Tobacco Use
Chapter 5. Tobacco Advertising and Promotional Activities
Chapter 6. Efforts to Prevent Tobacco Use Among Young People
ReferencesUS DEPARTMENT OF HEALTH AND HUMAN SERVICES. The health consequences of using smokeless tobacco. A report of the advisory committee to the Surgeon General. US Department of Health and Human Services, Public Health Services, National Institutes of Health. NIH Publication No. 86-2874, 1986. US DEPARTMENT OF HEALTH AND HUMAN SERVICES. The health consequences of smoking: nicotine addiction. A report of the Surgeon General, 1988. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health. DHHS Publication No. (CDC) 88-8406, 1988. US DEPARTMENT OF HEALTH AND HUMAN SERVICES. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411, 1989. AcknowledgmentsThis report was prepared by the Department of Health and Human Services under the general direction of the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
The complete version of "Preventing Tobacco Use Among Young People - A Report of the Surgeon General" provides scientific and technical details about the six major conclusions. It is more than 300 pages long, and is available for purchase through the Government Printing Office (GPO). To order from GPO: Phone Number for the GPO: SGR Home |
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