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comprehensive state programs, as well as their individual components, have been shown to be effective. Failure to sustain these efforts will cost lives. This chapter of the committee’s report outlines the core components of tobacco control as they have been implemented within the existing legal structure. It should be emphasized, however, that one of the constraints on the current legal structure is that no federal agency has regulatory jurisdiction over tobacco products. Another constraint is that the federal statute regulating the labeling and advertising of cigarettes forecloses state regulation of advertising and marketing of cigarettes “based on smoking and health.” This unfortunate circumstance, addressed in Chapter 6, preempts most state efforts to regulate the appearance, display, promotion, and placement of cigarettes in retail outlets.

Chapter 5 begins with a discussion of the effectiveness of comprehensive state programs, as well as the states’ current approaches toward funding these programs. The states’ expenditures for tobacco control are placed in the context of the revenue streams generated by tobacco excise taxes and payments received under the MSA.

The remainder of the chapter focuses on seven key substantive elements of comprehensive state programs:

  • Tobacco excise taxes

  • Smoking restrictions with broad coverage

  • Youth-access restrictions with adequate enforcement

  • Prevention programs based in schools, families, and health care systems

  • Media campaigns

  • Cessation programs

  • Grassroots community advocacy

The recommendations made throughout the chapter are meant to set forth a blueprint for strengthening and intensifying current tobacco control policies and programs, assuming that the current legal structure of tobacco control remains unchanged. The chapter closes with a projection of the likely impact of following (or not following) this blueprint on the national prevalence of tobacco use over the next 20 years.

COMPREHENSIVE STATE PROGRAMS

During the early days of tobacco use prevention, after the publication of the 1964 Surgeon General’s report (HEW 1964), many state health departments relied on the funds in their state budgets for tobacco control and treatment. Interventions tended to be targeted toward smoking cessation for individuals. By the late 1980s, however, funding for comprehensive state



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