their regulatory efforts related to environmental tobacco smoke by establishing smoke-free indoor workplaces, public buildings, and restaurants.

  • Further restrictions are needed to reduce tobacco promotion and advertising, which compromises youth tobacco prevention efforts. Restrictions now in place include a mix of voluntary agreements, restrictions resulting from settlements of lawsuits, and prohibitions defined by state or local ordinances, but some efforts have been hampered by protection of commercial speech. The Board urges renewed national consideration of how to address the practices of placing advertising at convenience stores and in magazines that are particularly attractive to minors, and tobacco sponsorship of youth-oriented events.

Recommendation 2: A national strategy should be developed and coordinated by the U.S. Department of Health and Human Services to address the epidemic of obesity, unhealthy diet, and physical inactivity in America, which are all significant risk factors for cancer and other diseases. Effective interventions need to be identified and broadly applied to reduce cancer risk among the general population and among populations at higher risk.

Dietary interventions to prevent cancer have, to date, focused primarily on particular components such as the consumption of fruits and vegetables, fiber, and fats. Obesity and physical inactivity have recently joined unhealthy diet as leading risk factors for cancer.

Efforts to maintain a healthy weight that start early in childhood and continue throughout adulthood are likely to be more successful than efforts to achieve and maintain weight loss once obesity is established. Over time, even a small decrease in the numbers of calories consumed and a small increase in physical activity can help prevent weight gain or facilitate weight loss.

Worksite fitness programs have resulted in increased levels of physical activity among employees, and it is recognized that environmental policies related to zoning, land use, safety, and transportation greatly affect opportunities for exercise. Among youth, school policies regarding healthy school lunches, physical education requirements, and the availability of after-school recreational programs improve nutrition and affect rates of participation in exercise.

The National Cancer Policy Board endorses the comprehensive Recommendations for Public Health Action on Weight Control and Physical Activity to Promote Cancer Prevention proposed by the International Agency for Research on Cancer, an agency within the World Health Organization (International Agency for Research on Cancer, 2000) (see Box 11.3 in Chapter 11). These recommendations could serve as a basis for the formulation of a national strategy through the Office of Disease Prevention and Health Promotion.

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