ChicagoA new Surgeon General's Report argues that smoking rates of United States teens and adults can be cut in half using techniques that are already available.

Surgeon General David Satcher released the report August 9 at a news conference held here at the 11th World Conference on Tobacco or Health. "This is the 28th Surgeon General's Report relating to tobacco, but the first looking at solutions," Satcher said. According to the most recent statistics from the Centers for Disease Control and Prevention (CDC), about 24.7% of US adults smoked in 1997, nearly down to half of the 42% who smoked in 1965. The goal of Healthy People 2010, the US Department of Health and Human Services' health promotion and disease prevention initiative, is to have only 12% of US adults smoking by the end of the decade. Satcher cited six evidence-based actions that could further reduce tobacco use and help meet Healthy People 2010 goals. ACTIONS TO REDUCE TOBACCO USE Using effective school-based programs, combined with community and media-based activities, to prevent or postpone smoking onset in 20% to 40% of US adolescents. Currently, less than 5% of schools are using the major components of guidelines recommended by the CDC. Recent CDC statistics showed that last year, 34.8% of students in grades 9 through 12 reported smoking in the month prior to being surveyed. The goal of Healthy People 2010 is a 16% smoking rate for high school students. Having physicians, even briefly, advise patients to quit smoking, which can double or quadruple normal quit rates. A combination of behavioral counseling and pharmacological treatment can boost success up to 10 times. The report noted that only 15% of smokers seen by a physician in the past year were offered assistance with quitting and only 3% were given a follow-up appointment to address the problem. Meanwhile, about 70% of smokers say they want to quit while only 2.5% per year succeed. Passing and enforcing strong clean indoor air regulations that help change social norms that may decrease tobacco consumption among smokers and increase smoking cessation. Strengthening warning labels in the United States, which are weaker and less prominent than those required in countries such as Canada and Australia. Increasing tobacco prices and excise taxes. Evidence suggests that a 10% increase in price will reduce overall cigarette consumption by 3% to 5%. Even with recent tax increases for cigarettes, the average price and tax is still below those of many other industrialized nations. Changing many facets of the social environment to reduce the cultural acceptability of tobacco use. Implementing these measures would cut in half the rates of tobacco use and meet Healthy People 2010 objectives, Satcher said. NO LACK OF KNOWLEDGE "Our lack of greater progress in tobacco control is more the result of failure to implement proven strategies than it is the lack of knowledge about what to do," he said. "As a result, each year, more than 1 million young people continue to become regular smokers and more than 400,000 adults die from tobacco-related diseases." Satcher noted that such improved efforts will need to overcome the continuing intense marketing efforts by tobacco companies, which spent $6.7 billion in 1998, or more than $18 million a day, promoting their products in the United States. "It is clear that the major barrier to more rapid reductions in tobacco use is the effort of the tobacco industry to promote the use of tobacco products," he said. The report concluded that approaches with the largest span of impacteconomic, regulatory, and comprehensiveshould have the greatest long-term population impact, while those with a smaller span of impacteducational and clinicalare of greater importance in helping individuals quit or resist tobacco use. And while the conclusions of the report are not formal policy recommendations, they do offer a summary of the scientific literature about successful tobacco control efforts that work. This information can then be used by government officials, public health professionals, and others to make informed decisions. "Every death from tobacco use is a preventable death," Satcher said. "It is time to exercise our collective wills to implement this report."

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