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of policing Internet tobacco transactions, as well as constitutional barriers to additional, state-imposed delivery requirements, the only practical way to effectively regulate online tobacco retailers is through legislation prohibiting both online tobacco sales and direct shipment of tobacco products to consumers.

Recommendation 12: All states should ban the sale of tobacco products directly to consumers through mail order or the Internet or other electronic systems. Shipments of tobacco products should be permitted only to licensed wholesale or retail outlets.

Intensify Prevention Interventions

The most fully developed programs for preventing tobacco use by youth have been implemented in school settings. School-based programs will and should remain the mainstay of group-oriented or individually-oriented tobacco use prevention activities. However, because teenage smoking initiation rates remain high, the committee also believes that investing in programs for families and health care providers is warranted, even though the evidence base remains thin. Furthermore the committee supports the funding of mass media campaigns, which a recent state-of-the-science panel of the National Institutes of Health identified as one of three effective approaches for reaching the general population and preventing tobacco use among adolescents and young adults.

Recommendation 13: School boards should require all middle schools and high schools to adopt evidence-based smoking prevention programs and implement them with fidelity. They should coordinate these in-school programs with public activities or mass media programming, or both. Such prevention programs should be conducted annually. State funding for these programs should be supplemented with funding from the U.S. Department of Education under the Safe and Drug-Free School Act or by an independent body administering funds collected from the tobacco industry through excise taxes, court orders, or litigation agreements.

Recommendation 15: A national, youth-oriented media campaign should be funded on an ongoing basis as a permanent component of the nation’s strategy to reduce tobacco use. State and community tobacco control programs should supplement the national media campaign with coordinated youth prevention activities. The campaign should be implemented by an established public health organization with funds provided by the federal government, public-private partnerships, or

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