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deaths (DHHS 2006). All told, deaths associated with smoking account for more deaths than AIDS, alcohol use, cocaine use, heroin use, homicides, suicides, motor vehicle crashes, and fires combined.

The economic consequences of tobacco use are in the billions of dollars. Lost work productivity attributable to death from tobacco use amounts to more than $92 billion per year. Private and public health care expenditures for smoking-related health conditions are estimated to be $89 billion per year. In addition, the states and the federal government spend millions of dollars annually on tobacco use prevention and research efforts that could be directed to other needs.

Concerns about the waning momentum in tobacco control efforts and about declining public attention to what remains the nation’s largest public health problem led the American Legacy Foundation to ask the Institute of Medicine (IOM) to conduct a major study of tobacco policy in the United States. The IOM appointed a 14-member committee and charged it to explore the benefits to society of fully implementing effective tobacco control interventions and policies, and to develop a blueprint for the nation in the struggle to reduce tobacco use. To carry out its charge, the committee conducted six meetings in which the committee members heard presentations from individuals representing academia, nonprofit organizations, and various state governments. The committee also reviewed an extensive literature from peer-reviewed journals, published reports, and news articles. The background information and supporting evidence for the committee’s report are contained within 16 signed appendixes written by committee members and three commissioned papers written by outside researchers.

The committee found it useful to set some boundaries on its work concerning the goal (“reducing tobacco use”) and the time frame within which it should be achieved. To make its task manageable and well-focused, the committee decided to focus its literature review and evidence gathering on reducing cigarette smoking, without meaning to overlook or dismiss the health consequences of other forms of tobacco use. However, the committee believes that its recommendations, although derived from the evidence regarding interventions to reduce cigarette smoking, are fully applicable to smoking of other tobacco products and that most of the recommendations are also applicable to smokeless tobacco products. First of all, trends in smokeless use and cigarette use tend to move in tandem, suggesting that the population-level factors at work at any given time are affecting all forms of tobacco use. Although some smokers may switch to smokeless tobacco as a “risk-reducing” tactic, thereby offsetting some of the gains from smoking cessation, successful efforts to curtail smoking initiation do not appear to be compromised by increased initiation of smokeless use. Second, the committee believes that most of the interventions shown to be effective for



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