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The announcement came during a news conference at the 11th World Conference on Tobacco or Health in Chicago, where Dr. Satcher released the Surgeon General's report on "Reducing Tobacco Use." It is the first-ever report to provide an in-depth analysis of the effectiveness of various methods to reduce tobacco use -- educational, clinical, regulatory, economic, and social.

"During the past four decades we have made unprecedented gains in preventing and controlling tobacco use," Dr. Satcher said. "However, the sobering reality is that smoking remains the leading cause of preventable death and disease in our nation, and those who suffer the most are poor Americans, minority populations, and young people. Although our knowledge remains imperfect, we know more than enough to address the tobacco control challenges of the 21st century."

Health and Human Services Secretary Donna E. Shalala noted, "This report of the Surgeon General comes at a critical moment in the rapidly changing landscape of tobacco control, both nationally and globally. It offers a science-based blueprint for achieving our Healthy People 2010 objectives to reduce tobacco use and its health impact in this country. We must now work to commit the resources necessary to put this blueprint into action."

The report calls for the widespread use of approaches and methods, especially in combination, that have proven to be effective in substantially reducing the number of people who will become addicted to nicotine; increasing the success rate of young people and adults trying to quit tobacco use; decreasing nonsmokers' exposure to environmental tobacco smoke; reducing disparities related to tobacco use and its health effects among different population groups; and decreasing the future health burden of tobacco-related disease and death.

Although the report was developed by the Centers for Disease Control and Prevention primarily to guide decisions about effective tobacco control programs in the United States, the report's analyses and findings have clear application globally.

"We estimate that the number of smoking-related deaths worldwide will rise to 10 million per year by 2030, with 70 percent of these deaths occurring in developing countries," CDC Director Dr. Jeffrey P. Koplan said. "The CDC is committed to working side-by-side with other nations and international organizations, such as the World Health Organization, to create a broad framework to curb the global epidemic of tobacco-related disease. This report can be an important tool in supporting this global health initiative."

Key actions that Dr. Satcher outlined to reduce tobacco use, supported by evidence in the report, include:

• Implementing effective school-based programs, combined with community and media-based activities, which can prevent or postpone smoking onset in 20 to 40 percent of U.S. adolescents. Unfortunately, fewer than 5 percent of schools nationwide are implementing the major components of school guidelines recommended by the federal Centers for Disease Control and Prevention (CDC).

• Changing physician behavior, medical system procedures, and insurance coverage to encourage widespread use of state-of-the-art treatment of nicotine addiction. The report shows that brief physician advice to quit smoking can double or quadruple normal quit rates, while a combination of behavioral counseling and pharmacological treatment can boost success up to 10 times.

• Passing and enforcing strong clean indoor air regulations, which contribute to changing social norms and may decrease tobacco consumption among smokers and increase smoking cessation. The report calls on states to pass laws that will not restrict local governments from passing even stronger measures to protect their citizens from secondhand smoke.

• Improving tobacco warning labels in the U.S., which are weaker and less prominent than those required in other countries such as Canada and Australia. The report shows that consumers receive very little information regarding the ingredients, additives, and potential toxicity of tobacco products.

• Increasing tobacco prices and excise taxes. Evidence presented in the report suggests that a 10 percent increase in price will reduce overall cigarette consumption by 3 to 5 percent. However, both the average price of cigarettes and the average cigarette excise tax in the United States are well below those in most other industrialized countries.

• Changing many facets of the social environment to reduce the broad cultural acceptability of tobacco use. The report concludes that comprehensive approaches combining community interventions, mass media campaigns, and program policy and regulation are most effective in changing social norms and reducing tobacco use.

"Failure to effectively use every intervention strategy at our disposal could mean turning back the clock on the efforts we've made since the 1960s to reduce cigarette smoking, one of the most notable public health accomplishments of this century," Dr. Satcher said. "We must respond aggressively to the serious challenges we still face: most importantly, the tobacco industry's continuing campaign to advertise and promote tobacco products. We need fair but aggressive measures to regulate these marketing activities, especially those that influence young people." He noted that the industry spent $6.7 billion in 1998 -- or more than $18 million a day -- to market cigarettes, despite the overwhelming evidence of the harm they cause.

A detailed summary of the Surgeon General's report, "Reducing Tobacco Use," and other related information is available on the CDC's web site: www.cdc.gov/tobacco. Copies of the Executive Summary and the report's "At A Glance" can also be ordered via fax by calling 1-800-CDC-1311 or by writing the CDC's Office on Smoking and Health, Mail Stop K-50, 4770 Buford Highway, Atlanta, Georgia 30341.

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