Major Conclusions of the Surgeon General's Report

Measures that have had some success in reducing minors' access include restricting distribution, regulating the mechanisms of sale, enforcing minimum age laws, and providing merchant education and training. Requiring licensure of tobacco retailers provides both a funding source for enforcement and an incentive to obey the law when revocation of the license is a provision of the law.

Litigation approaches
Private law initiative is a diffuse, uncentralized activity, and the sum of such efforts is unlikely to produce optimal results for a larger policy to reduce tobacco use. On the other hand, the actions of individuals are likely to be a valuable component in some larger context of strategies to make tobacco use less prevalent.

Economic Interventions
Research clearly shows that raising tobacco prices is good public health policy. Further, raising tobacco excise taxes is widely regarded as one of the most effective tobacco prevention and control strategies. Increasing the price of tobacco products will decrease
the prevalence of tobacco use, particularly among adolescents and young adults. Nevertheless, the average price and excise tax levels on cigarettes in the United States is well below that of most industrialized nations. Furthermore, the taxes on smokeless tobacco products are well below those on cigarettes in the U.S. Making optimal use of economic strategies in a comprehensive program poses special problems because of the complexity of government and private controls over tobacco economics and the need for a concerted, multilevel, political approach.

HealthyPeople 2010 calls for state and federal taxes to average $2.00 for both cigarettes and smokeless tobacco products by 2010.

Comprehensive Programs
The most important advance in comprehensive programs has been the emergence of statewide tobacco control efforts. Evidence shows that multi-faceted, state-based tobacco control programs are effective in reducing tobacco use. Components of a multifaceted approach include:

     (1)community interventions, which include diverse entities such as schools, health agencies, city and county governments, and civic, social, and recreation organizations
     (2)countermarketing, which includes using media advocacy, paid media, pro health promotions, and other media strategies to change social norms regarding tobacco use
      (3)program policy and regulation, which addresses such issues as minors' access, tobacco pricing, advertising and promotion, clean indoor air, product regulation, and tobacco use cessation and
     (4) surveillance and evaluation, which includes monitoring tobacco industry promotional campaigns, evaluating the economic impact of ETS laws and policies, conducting surveys of public opinion on program interventions, and other activities to make ongoing refinements that lead to more effective prevention strategies. The synergy created by the interaction of various program components in a comprehensive approach is believed to be responsible for increased success in reducing tobacco use.

Elimination of Health Disparities
The elimination of health disparities related to tobacco use poses a great national challenge. Cultural, ethnic, religious, and social differences are clearly important in understanding patterns of tobacco use. Reaching the national goal of eliminating health disparities related to tobacco use will require more research to develop effective interventions for various population groups.

For more information:
Reducing Tobacco Use: A Report of the Surgeon General full report is available on-line at the Office on Smoking and Health Web site at www.cdc.gov/tobacco.