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Educational
Strategies
More consistent
implementation of effective educational strategies to
prevent tobacco use will require continuing efforts
to build strong, multi-year prevention units into school
health education curricula and expanded efforts to make
use of the influence of parents, the mass media, and
other community resources.
School-based
programs can have a significant impact on smoking behavior
among young people. Efforts to prevent the onset or
continuance of tobacco use face the pervasive, countervailing
influence of tobacco promotion by the tobacco industry,
a promotion that takes place despite over-whelming evidence
of adverse health effects from tobacco use.
The available
approaches to reducing tobacco use-educational, clinical,
regulatory, economic, and comprehensive-differ substantially
in their techniques and in the metric by which success
can be measured. A hierarchy of effectiveness is difficult
to construct. Approaches with the largest span of impact
(economic, regulatory, and comprehensive) are likely to
have the greatest long-term, population impact. Those
with a smaller span of impact (educational and clinical)
are of greater importance in helping individuals resist
or abandon the use of tobacco. Each of the modalities
reviewed provides evidence of effectiveness.
- Educational
strategies, conducted in conjunction with community-
and media-based activities, can postpone or prevent
smoking onset in 20 to 40 percent of adolescents.
- Pharmacologic
treatment of nicotine addiction, combined with behavioral
support, will enable 20 to 25 percent of users to
remain abstinent at one year post treatment. Even
less intense measures, such as physicians advising
their patients to quit smoking, can produce cessation
proportions of 5 to 10 percent.
- Regulation
of advertising and promotion, particularly that directed
at young people, is very likely to reduce both prevalence
and uptake of tobacco use.
- Clean
air regulations and restriction of minors' access
to tobacco products contribute to a changing social
norm with regard to smoking and may influence prevalence
directly.
- An optimal
level of excise taxation on tobacco products will
reduce the prevalence of smoking, the consumption
of tobacco, and the long-term health consequences
of tobacco use.
The impact
of these various efforts, as measured with a variety
of techniques, is likely to be underestimated because
of the synergistic effect of these modalities. The potential
for combined effects underscores the need for comprehensive
approaches.
State tobacco
control programs, funded by excise taxes on tobacco
products and settlements with the tobacco industry,
have produced early, encouraging evidence of the efficacy
of the comprehensive approach to reducing tobacco use.
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