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smoking (cessation, health-based interventions, school-based interventions, media efforts, sales restrictions, marketing restrictions) can be implemented in behavior-specific or product-specific manner, and that there is no apparent reason why their effectiveness would be weakened in relation to use of smokeless products if they were sensitively designed. Overall, therefore, the committee believes that it is reasonable to assume that implementation of its blueprint will, in the aggregate, lead to a reduction in all forms of tobacco use. Thus the committee refers throughout the report to the goal of “reducing tobacco use.”

The overarching goal of reducing smoking subsumes three distinct goals: reducing the rate of initiation of smoking among youth (IOM 1994), reducing third-party environmental tobacco smoke exposure (NRC 1986), and helping people quit smoking. For the purposes of this report, the committee sets to one side additional strategies that might reduce the harm of smoking for smokers who cannot quit, a topic dealt with extensively in another recent IOM report (IOM 2001).

Another important question regarding the scope of the committee’s work concerns the time frame. The committee wanted to design a blueprint for achieving substantial reductions in tobacco use, but to have a realistic opportunity for doing so, an ample period of time is needed. Yet, the target should not be so far in the distance as to lose its connection with current conditions or to outstrip the committee’s collective capacity to imagine the future. The committee decided to set a 20-year horizon for its projections and for the policies that it recommends.

The common interest of all nations in reducing tobacco use has been declared and effectuated by the World-Health-Organization–sponsored Framework Convention for Tobacco Control, which went into effect in 2005 and has been ratified by 142 nations (unfortunately not including the United States). The United States has a direct stake in reducing smuggling of tobacco products into this country that could undermine domestic tobacco control efforts, and the committee also recognizes the compelling importance of international tobacco control efforts for world health. However, the committee’s charge was to develop a tobacco control blueprint for the nation, not for the world. We hope, though, that some of the measures recommended in this report will provide useful models for other countries, just as the domestic interventions undertaken by other countries in recent years served as useful models for us.

In sum, the ultimate goal of the committee’s blueprint is to reduce smoking so substantially that it is no longer a significant public health problem for our nation; this is what is meant by the phrase “ending the tobacco problem” used in the title of this report. While that objective is not likely to be achieved in 20 years, the report aims to set the nation irreversibly on a course for doing so.



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