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they are successful. Progress in helping smokers who want to quit achieve successful and permanent cessation requires that a variety of cessation technologies—both clinical and population based—be readily available to the smoking population, and that they be used, and that they be effective.

Second, factors such as distorted risk and harm perceptions, which are associated with the initiation and maintenance of tobacco use among young smokers, pose a continuing obstacle for prevention and control strategies. Unfortunately, many youth view themselves as invulnerable to addiction and its associated harm. They are also sensitive to the social factors and norms that promote smoking, such as the influences exerted by peers, family members, and the exposure to smoking in the media. These influences tend to override the information about the risks of smoking. Therefore, to substantially reduce the rate of smoking initiation, it will be necessary to do a better job of counteracting the perceived benefits of smoking and to develop new tools that make the personal risks of starting to smoke more salient.

All new smokers are not young, however; some initiate smoking during their college years, which helps to explain why some new smokers have characteristics that differ from those of usual smokers. Specifically, they tend to have higher levels of education and income than other smokers. It is also noteworthy that some new smokers smoke at lower levels, and some never reach a level of dependence. It will be important for tobacco control experts to pay close attention to these emerging trends and to design appropriate interventions to respond to them.

On the other side of the ledger are smokers who have a more difficult time quitting, such as “hardcore” smokers with a long career of smoking and individuals with psychiatric comorbidities or special circumstances, including incarceration and homelessness. These groups have not been the primary targets of traditional cessation treatments or research studies. Achieving success in substantially reducing tobacco use will require taking stock of the progress made with current tobacco prevention and control strategies and identifying where they fall short in responding to emerging smoking trends and the characteristics and behaviors of subpopulations of smokers with particular vulnerabilities.

The Consequences of Unchanged or Weakened Tobacco Control

The committee has tried to project the likely public health consequences of intensified or weakened investments in tobacco control compared with those of the status quo. The good news is that even if tobacco control activities remain at present levels, smoking prevalence is likely to decline from about 21 percent in 2005 to a little less than 16 percent in 2025. This continued decline will occur because of the system’s inertia: there are currently more middle-aged and older smokers than there would have been had their



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