|
|
|
A
CALL
FOR
ACTION:
SURGEON
GENERAL’S
REPORT
REDUCING
TOBACCO
USE
"If
the
recommendations
in
this
report
were
fully
implemented,
the
Healthy
People
2010
objectives
related
to
tobacco
use
could
be
met,
including
cutting
in
half
the
rates
of
tobacco
use
among
young
people
and
adults."
-David
Satcher,
MD,
PhD,
U.S.
Surgeon
General
Tobacco
use,
particularly
cigarette
smoking,
is
the
leading
cause
of
preventable
illness
and
death
in
the
United
States.
Each
year,
more
than
400,000
Americans
die
too
young
because
of
smoking-related
diseases.
Today,
nearly
one
in
four
U.S.
adults
and
one
in
three
teenagers
smoke.
Tragically,
if
current
trends
continue,
an
estimated
25
million
people
(including
5
million
of
today’s
children)
will
die
prematurely
of
a
smoking-related
disease.
A
major
challenge
to
our
nation’s
public
health
leaders
and
policy
makers
in
the
new
millennium
is
to
provide
the
support
and
resources
necessary
to
carry
out
tobacco
control
programs
that
work.
The
Surgeon
General’s
report
on
Reducing
Tobacco
Use
will
give
the
nation
a
blueprint
for
preventing
tobacco
use
and
improving
our
citizens’
quality
of
life.
Each
type
of
activity
described
in
this
report–educational,
clinical,
regulatory,
economic,
and
comprehensive–has
proven
to
be
effective.
Although
our
knowledge
about
tobacco
control
remains
imperfect,
we
already
know
more
than
enough
to
take
action
now.
If
we
start
today,
we
can
greatly
ease
the
future
burden
of
tobacco-related
disease
and
death
in
our
country.
EDUCATIONAL
INTERVENTION
- Increase
the
number
of
schools
that
fully
implement
the
CDC’s
Guidelines
for
School
Health
Programs
to
Prevent
Tobacco
Use
and
Addiction.
Less
than
5%
of
schools
nationwide
currently
use
these
guidelines,
even
though
full
implementation
could
help
20%
to
40%
of
U.S.
adolescents
postpone
or
never
start
smoking.
- Establish a smoke-free and tobacco-free environment in schools,
including all school facilities, property, vehicles, and school events, as
called for in Healthy People 2010. In 1994 only 37% of middle, junior
high, and senior high schools were free of smoke and tobacco. Fully
implementing the Pro-Children’s Act of 1994, which prohibits smoking in
facilities that receive any federal funding for children’s services, will
bring us closer to the Healthy People 2010 target of 100% smoke-free
schools.
CLINICAL
INTERVENTIONS
- Begin
providing
universal
insurance
coverage
of
evidence-based
treatment
for
nicotine
dependency
as
called
for
in
Healthy
People
2010.
It
is
estimated
that
smoking
cessation
programs
are
more
cost-effective
than
other
commonly
provided
clinical
preventive
services,
including
screening
for
cervical,
breast,
and
colon
cancer;
treatment
of
mild
to
moderate
high
blood
pressure;
and
treatment
of
high
cholesterol.
- Encourage
more
physicians
to
advise
their
patients
to
quit
smoking.
This
simple
intervention
could
produce
quit
rates
of
5%
to
10%
per
year.
- Combine
behavioral
counseling
with
pharmacologic
treatments
such
as
nicotine
gum
or
nicotine
patches.
A
combination
of
counseling
and
treatment
can
produce
20%
to
25%
quit
rates
after
one
year.
REGULATORY
INTERVENTIONS
- Increase
smoking
bans
to
reduce
people’s
exposure
to
environmental
tobacco
smoke
(ETS).
ETS
contains
more
than
4,000
chemicals;
of
these,
at
least
43
are
known
carcinogens.
ETS
is
still
a
common
public
health
hazard
that
can
be
easily
eliminated,
and
smoking
bans
are
the
most
effective
method
for
reducing
ETS
exposure.
Healthy
People
2010
calls
for
an
increase
in
laws
that
prohibit
smoking
or
limit
it
to
separately
ventilated
areas
in
public
places
and
worksites.
- Strengthen
warning
labels
on
tobacco
products
sold
in
the
United
States.
Current
U.S.
labels
are
weaker
and
less
conspicuous
than
those
in
other
countries.
- Better
regulate
the
advertising,
promotion,
and
sale
of
tobacco
products
in
the
United
States.
Tobacco
marketing
here
is
considerably
less
restricted
than
in
several
other
countries,
notably
Canada
and
New
Zealand.
U.S.
youth
have
easy
access
to
tobacco–a
high
proportion
of
underage
smokers
across
the
country
continue
to
be
able
to
purchase
their
own
tobacco.
Healthy
People
2010
calls
for
more
states
to
suspend
or
revoke
retail
licenses
for
violating
laws
that
prohibit
the
sale
of
tobacco
to
minors.
Stricter
regulation
of
selling
and
promoting
tobacco
products
is
needed
to
keep
young
people
from
starting
to
smoke.
- To
protect
young
people
around
the
world,
make
exported
tobacco
products
subject
to
the
same
laws
as
domestic
tobacco
products.
Federal
laws
and
regulations
concerning
the
packaging
and
advertising
of
domestic
cigarettes
do
not
apply
to
tobacco
products
exported
from
the
United
States.
ECONOMIC
INTERVENTIONS
Raise
tobacco
prices
to
Healthy
People
2010
target
levels
by
increasing
the
average
federal
and
state
tax
on
tobacco
products
to
$2.00
for
both
cigarettes
and
spit
tobacco
products.
Research
shows
that
increasing
the
price
of
tobacco
products
would
decrease
the
prevalence
of
tobacco
use,
particularly
among
minors
and
young
adults.
However,
both
the
average
price
of
cigarettes
and
the
average
cigarette
excise
tax
in
this
country
are
well
below
those
in
most
other
industrialized
countries,
and
the
taxes
on
smokeless
tobacco
products
are
well
below
those
on
cigarettes.
COMPREHENSIVE
INTERVENTIONS
- Allocate
more
Master
Settlement
Agreement
funds
to
tobacco
control.
The
National
Conference
of
State
Legislatures
reported
that
less
than
10%
of
tobacco
settlement
funds
appropriated
by
state
legislatures
in
fiscal
year
2000
were
allocated
for
tobacco
prevention
and
control
programs.
- Reduce
the
cultural
acceptability
of
tobacco
use.
By
carrying
out
a
comprehensive
program
that
includes
educational,
clinical,
regulatory,
and
economic
interventions,
we
can
change
the
social
environment
that
makes
tobacco
use
acceptable.
- Finally,
while
putting
all
these
activities
into
motion,
we
must
focus
on
making
the
elimination
of
tobacco-related
health
disparities
a
priority.
Cultural,
ethnic,
religious,
and
socioeconomic
differences
clearly
are
important
in
understanding
patterns
of
tobacco
use.
For
example,
the
average
smoking
rate
among
American
adults
is
24%,
but
among
Native
American
adults
is
34%.
People
with
16
or
more
years
of
education
smoke
much
less
than
people
with
9
to
11
years
of
education–11%
and
36%,
respectively.
Achieving
the
goal
of
eliminating
tobacco-related
health
disparities
will
require
stronger
research
efforts
to
find
new
and
more
effective
interventions
for
our
nation’s
diverse
population
groups.
|
|
