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Ending the Tobacco Problem: A Blueprint for the Nation (2007)
Board on Population Health and Public Health Practice (BPH)

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. "PART II A BLUEPRINT FOR REDUCING TOBACCO USE, 4 Reducing Tobacco Use: A Policy Framework." Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press, 2007.

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Ending the Tobacco Problem: A Blueprint for the Nation

the statistical evidence. When young people begin to smoke, they typically fail to appreciate the serious possibility that they will continue smoking for many years (see Chapter 2).

Inconsistent Preferences and Regret

Many people neglect long-term risks to their health, simply because they tend to have a short-term perspective when they consider the risks and the benefits of a particular behavior. In the language of economists, they apply a high “discount rate” to future harms. This neglect of the long-term danger is especially serious for young people. Because the most serious health risks of smoking do not come to fruition for many years, young smokers often treat those risks as if they were trivial. Even adult smokers often fail to take adequate account of the associated risks, simply because those risks are not likely to materialize for decades. Smokers themselves will typically change their minds later on, reflecting a difference between their preferences when they start smoking and the preferences that they have later in life, when they want to quit. (Economists call this problem “inter-temporal inconsistency.”) In short, when people begin to smoke, at whatever age, they tend to give more weight to the pleasures of smoking and too little weight to the possible impact of smoking on their long-term well-being. Once people have become addicted, they give more weight to the health concerns and regret having become smokers. Most of them want to stop.

Optimism Bias

In some domains, people are unrealistically optimistic about risks, believing that they are immune from the dangers that others who are similarly situated face. For smokers, the problem of unrealistic optimism takes three distinct forms. First, many smokers, even those who have an adequate sense of the statistical realities, falsely believe that they are unlikely to face the risks that most smokers face. Second, many smokers, both young and old, are unrealistically optimistic about their future health and their longevity if they quit at some later point. Third, many smokers believe, falsely, that they will quit in the near future. Taken together, these forms of unrealistic optimism can be deadly.

More than four decades after the Surgeon General’s initial report (HEW 1964) on the health risks of smoking, policymakers have not addressed these three problems with anything like the seriousness that they deserve. To be sure, the problem of addiction plays a large role in current thinking; and both states and localities, along with the private sector, have adopted commendable steps to protect and to inform young people. However, the whole notion of consumer sovereignty—of unambivalent respect for private

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151
Front Matter (R1-R16)
Summary (1-28)
Introduction (29-38)
PART I BACKGROUND, 1 Epidemiology of Tobacco Use: History and Current Trends (39-76)
2 Factors Perpetuating the Tobacco Problem (77-106)
3 Containing the Tobacco Problem (107-142)
PART II A BLUEPRINT FOR REDUCING TOBACCO USE, 4 Reducing Tobacco Use: A Policy Framework (143-156)
5 Strengthening Traditional Tobacco Control Measures (157-270)
6 Changing the Regulatory Landscape (271-340)
7 New Frontiers of Tobacco Control (341-354)
Index (355-372)
Appendix A Comprehensive Smoking Cessation Policy for All Smokers: Systems Integration to Save Lives and Money (373-422)
Appendix B Clean Air Laws (423-434)
Appendix C Warning Labels and Packaging (435-448)
Appendix D The Long-Term Promise of Effective School-Based Smoking Prevention Programs (449-477)
Appendix E Adolescents' and Young Adults' Perceptions of Tobacco Use: A Review and Critique of the Current Literature (478-494)
Appendix F Interventions for Children and Youth in the Health Care Setting (495-502)
Appendix G Reducing and Preventing Tobacco Use Among Pregnant Women, Parents, and Families (503-515)
Appendix H Smoking in the Movies: Its Impact on Youth and Youth Smoking (516-551)
Appendix I State Statutes Governing Direct Shipment of Alcoholic Beverages to Consumers: Precedents for Regulating Tobacco Retail Shipments (552-577)
Appendix J The Role of Public Policies in Reducing Smoking Prevalence: Results from the SimSmoke Tobacco Policy Simulation Model (578-598)
Appendix K Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures (599-640)
Appendix L Controlling the Retail Sales Environment: Access, Advertising, and Promotional Activities (641-652)
Appendix M Sales and Marketing of Cigarettes on the Internet: Emerging Threats to Tobacco Control and Promising Policy Solutions (653-678)
Appendix N Media Campaigns and Tobacco Control (679-689)
Appendix O Advocacy as a Tobacco Control Strategy (690-703)
Appendix P Special Populations with Higher Rates of Cigarette Smoking: Identification and Implications for Tobacco Control (704-716)