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Growing Up Tobacco-Free:
Preventing Nicotine Addiction in Children and Youths

 Contents

Report in Brief
The High Price of Addiction
Nicotine and Young People
Public Opinion
Recommendations for Action
Strategies for the Long Term

September 13, 1994, the Institute of Medicine (IOM) at the National Academy of Sciences released the report, Growing Up Tobacco-Free: Preventing Nicotine Addiction in Children and Youths. The report reinforces and complements the findings in the Surgeon General's report, Preventing Tobacco Use Among Young People, and makes specific policy recommendations regarding tobacco advertising and promotion, access issues, licensure, and excise taxes. The following summary of the report was prepared by IOM.

Report in Brief

September 13, 1994

National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council

Use of tobacco products is the nation's deadliest addiction, and a youth-centered prevention strategy is the nation's best response. Every day, researchers estimate, 3,000 young people become regular smokers. Every year more than 400,000 people die from diseases caused by tobacco use.

A new report from a committee of the Institute of Medicine sets forth a blueprint to help prevent such deaths and reduce tobacco-related health care costs. The report, Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, calls for immediate action to prevent tobacco use where it usually starts, among young people.

The report recommends a higher tax on tobacco products, tougher regulation of tobacco ads that appeal to youngsters, and increased support for other policies designed to curtail tobacco use by children and adolescents. Tobacco products should be regulated as part of consumer safety, food, and drug legislation, the report concludes. It proposes continued support for programs (such as smoke-free zones) that help make tobacco use socially unacceptable, and youth-centered tobacco research.
 

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The High Price of Addiction

"Tobacco use is not a choice like jogging or a habit like eating chocolate," the report notes, "it is an addiction that is fueled by nicotine." A single cigarette delivers up to 3 milligrams (mg) of nicotine directly to the smoker's bloodstream, producing immediate, sometimes pleasurable, physiological effects. Smokeless tobacco products , including snuff and chewing tobacco, pack an even more powerful punch, providing up to 4.5 mg of nicotine in a single 'pinch.' When blood/nicotine levels begin to dwindle, withdrawal symptoms, ranging from excessive hunger to headaches and dizziness, prompt the smoker to reach for yet another dose of nicotine, and the cycle continues.

One of every five deaths is linked to nicotine addiction. In 1990, the U.S. Office of Technology Assessment estimated that tobacco use cost $68 billion in health care expenses and lost productivity.

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Nicotine and Young People

Nicotine addiction almost always begins at an early age: 89 percent of adult daily smokers tried their first cigarette by age 18. Nearly three-fourths of this group were addicted before they were old enough to vote.

Among U.S. adults, the prevalence of smoking declined steadily from 40.4 percent in 1965 to 25.7 percent in 1991, but has now leveled off. Similarly, after a decline, tobacco use by young people "has remained stubbornly high" and now hovers near 30 percent. Between 1992 and 1993, in fact, regular smoking among high-school seniors actually increased by 1.8 percent. Meanwhile, the popularity of snuff and chewing tobacco is growing at an alarming rate.

As tobacco companies compete for shares of a shrinking domestic market, advertisements and promotions have intensified. In 1991, for instance, the industry spent $4.6 billion on ads and promos,13 percent more than the previous year. The ubiquity of pro-tobacco messages and their appealing images "convey the message that tobacco use is a desirable, socially approved, safe and healthful, and widely practiced behavior among young adults, whom children and youths want to emulate," the report notes.

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Public Opinion

Health officials and the general public favor strong measures to reduce underage smoking. In a recent national survey of adults, 73 percent said they probably would support a higher cigarette tax if revenues were used to discourage smoking by youths. Another 76 percent favored restricting cigarette ads that appeal to children. Because young people often tend to not recognize the relevance of the long-term consequences of tobacco use to their own well-being, the report says, a youth-centered tobacco control policy has "a strong ethical foundation."
 

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Recommendations for Action

Though school-based anti-smoking programs can be effective, more aggressive measures are needed. The committee urged Congress to take three immediate steps:

  • Increase tobacco taxes. By boosting the tax added to each pack of cigarettes, the United States could make tobacco less accessible to youths while also raising money for tobacco control, health care, and other uses. "A reasonable target would be to increase the tax by $2 per pack, with proportional increases for smokeless tobacco products," the report says.
  • Regulate ads and promos. By the end of 1995, Congress should repeal a federal law that currently prevents state and local governments from regulating tobacco advertisements and promotions, such as billboards, point- of-sale advertising, and storefront displays.
  • Boost support for state and local initiatives. Through technical assistance, grants, and cooperative agreements, federal lawmakers should help state and local governments and coalitions pursue youth-centered tobacco control policies.

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Strategies for the Long Term

The committee also recommended four longer-term steps to sustain progress toward reducing the adverse health consequences of tobacco use.

First, Congress should authorize an appropriate agency within the U.S. Public Health Service to regulate tobacco packaging, labeling, and contents. Regulations should encompass tougher warning labels as well as a possible cap on tar and nicotine content.

In addition, all features of advertisements and promotions that tend to appeal to youths and influence them to use tobacco should be eliminated. Ads and packages, for example, might be limited to an image-free format with product information only. At the same time, governments and private organizations should reinforce the emerging view of smoking as an unaccepted behavior. Social programs, such as paid anti-smoking advertisements and smoke- free zones in schools and workplaces, help generate a "tobacco-free norm."

Finally, support for policy research on tobacco use by children and adolescents should be increased. Smoking trends among different ethnic groups should be studied more closely. Researchers need to know, for example, why tobacco use among African-American youngsters has declined and if recent data presage an upward trend in smoking among all teens as a group.

Funding for the study was provided by the Robert Wood Johnson Foundation, Metropolitan Life, American Heart Association, Tobacco- Related Disease Research Program of California, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, Indian Health Service, W.K. Kellogg Endowment Fund, Center for Substance Abuse Prevention, and the Agency for Health Care Policy and Research.

Copyright: Institute of Medicine
Permission is granted to reproduce this report brief in its entirety, with no additions or alterations. 9/94

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