Search

Background: Efforts to control tobacco use and tobacco-related morbidity and mortality in the United States continue to be generally successful. In the quarter century since the publication of the first Surgeon General's Report on Tobacco and Health, adult smoking rates in the United States have been reduced by nearly 34%. Controlling tobacco use among our nation's youth, however, has not been as successful. Although there was considerable success in reducing adolescent tobacco use in the late 1970s and early 1980s, tobacco use among youth has remained essentially stable for the past decade., Methods: The health and economic burden of tobacco use, current knowledge about youth tobacco use, and youth-related national tobacco reduction goals for the Year 2000 are reviewed., Results: Analysis of the research of the past two decades clearly indicates that there is no "magic bullet" in existence or in sight for the reduction of tobacco use, either among youth or among adults. This does not mean that opportunities for significant advances through, for example, pharmacological therapies or the broad application of media or policy strategies should not continue to be explored, but that for the moment no single approach appears to work best. Rather, a comprehensive approach that applies multiple prevention and cessation strategies simultaneously appears to be most effective in tobacco use control., Conclusions: Among youth, the combination of tobacco control strategies that may work best includes those that involve the family, primary care physicians, and other health professionals such as nurses and dentists; programs that are carried out in schools and/or through the media; and societal approaches such as access and advertising restrictions and increased taxes.

Despite considerable progress, tobacco use continues to be a major public health problem in the United States, killing more U.S. citizens each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fires, and AIDS combined. There is cause for particular concern about smoking and other tobacco use by children. Although adolescent smoking declined in the late 1970s and early 1980s, the combination of a now-flat daily smoking prevalence rate among high school seniors, high smoking rates among high school dropouts, and increased use of smokeless tobacco argues for renewed efforts in tobacco use prevention. The greater risk associated with tobacco use at early ages suggests the need for comprehensive interventions (i.e., involving policy change, advertising restrictions, health professionals, and comprehensive school health education) before the prime age for tobacco use initiation (i.e., 12 to 14 years old), for repeated reinforcement of these interventions through adolescence, for innovative ways of reaching underserved--particularly high-risk and minority--youth with effective tobacco use prevention efforts, and for research to determine both the short-term and the long-term effectiveness of these approaches.

The National Cancer Institute's efforts to prevent tobacco-related cancers have resulted in numerous activities to reduce smoking prevalence throughout the United States. Two decades of research activity has provided much of the information needed for interventions through channels such as mass media, physician/dentist training, self-help strategies, and school-based prevention programs. However, in the area of adolescent tobacco-use reduction, it has been consistently observed that youth who have the highest tobacco-use rates are among those least likely to be reached through school-based or other programs. Thus, these youth, often labeled "high-risk," are seen as a cornerstone for tobacco use prevention efforts. Although they pose a particularly difficult access problem, many valuable recommendations for strategies to identify and reach this group were made by a recent NCI-convened Expert Advisory Panel on the Prevention and Cessation of Tobacco Use by High-Risk Youth. The Panel considered this issue from three perspectives--methods of identifying these youth, strategies for reaching them with appropriate tobacco-use prevention/cessation programs, and identification of research needs. Their recommendations and conclusions are summarized in this article. Support for research addressing the prevention and cessation of tobacco use among high-risk youth is currently being considered by the NCI.