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interventions undertaken by other countries in recent years served as useful models for us.

This is not a report about a research agenda. Many gaps in current knowledge were noted in our deliberations, and the committee is concerned that current National Institutes of Health expenditures on tobacco use (including both initiation and cessation) are not commensurate with the disease burden of smoking and other forms of tobacco use. However, our charge was to propose a blueprint for tobacco control, not for research.


The committee’s report is divided into two parts. Part I, comprising Chapters 1 through 3, provides the context for the committee’s proposed policy blueprint. Chapter 1 discusses the extraordinary growth of tobacco use during the first half of the 20th century and its subsequent reversal in 1965 in the wake of the 1964 Surgeon General’s report on the harmful health effects of smoking. Chapter 1 also examines closely recent trends in tobacco use. Chapter 2 summarizes the ways in which the addictive properties of nicotine make it so difficult for people to quit, thereby sustaining tobacco use at high levels. Chapter 2 also reviews the salient factors associated with smoking initiation, especially the failure of adolescents to appreciate the risk and consequences of addiction when they become smokers. The chapter concludes by discussing several recent trends in smoking epidemiology that may pose problems for tobacco control in the future.

Chapter 3 reviews the history of tobacco control. After the 1964 Surgeon General’s report, the public’s opinion toward smoking changed dramatically. However, until the mid 1980s, antismoking efforts had little success in combating the financial and political power of the tobacco industry. Tobacco control efforts began to make progress when grassroots initiatives galvanized public concern about the health effects of environmental tobacco smoke and began to erode pro-smoking social norms. The tobacco policy debate became transformed in the late 1980s and 1990s, when the public recognized the addictive nature of nicotine, the continued importance of teenage initiation in sustaining the public health burden of tobacco use, and the tobacco industry’s extensive efforts to manipulate and deceive the public. Chapter 3 concludes by projecting the likely prevalence of smoking over the next 20 years if current trends remain unchanged or if tobacco control efforts are weakened.

Part II of the committee’s report presents a blueprint for reducing tobacco use. After reviewing the ethical grounding of tobacco control in Chapter 4, the committee sets forth its blueprint as a two-pronged strategy and offers a vast array of recommendations. The first prong, presented in Chapter 5, envisions strengthening traditional tobacco control measures.

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