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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. This chapter also closely examines 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, and the factors associated with smoking initiation, especially the failure of adolescents to appreciate the risks and consequences of addiction when they become smokers. Chapter 3 reviews the history of tobacco control and 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. The first prong, presented in Chapter 5, envisions strengthening traditional tobacco control measures that are currently known to be effective. Chapter 5 closes with a projection of the likely effects over the next two decades of implementing the policies outlined in this part of the blueprint. The second prong, described in Chapter 6, envisions changing the regulatory landscape to permit new policy innovations that take into account the unique history and characteristics of tobacco use.

Building on the foundation laid in Chapter 6, Chapter 7 briefly explores new frontiers of tobacco control, and urges the federal government to establish the necessary capacity for long-term tobacco policy development. The committee specifically reviews a proposal for gradually reducing the nicotine content of cigarettes. Although the committee acknowledges that this proposal requires further investigation and careful assessment before it is implemented, carrying it out offers a reasonable prospect of substantially curtailing and eliminating the public health burden of tobacco use.

Tobacco Use Since 1965

Wide-angle comparisons of measures of smoking behavior between 1965 and 2005 clearly show that the rates of tobacco consumption and smoking prevalence have declined among adults, the rate of smoking initiation has declined among adolescents, and the rate of smoking cessation has increased. However, a closer look at the trends over the past two decades tells a somewhat more complex story of both modest progress and some backsliding. For instance, although smoking prevalence has continued to

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