birth cohorts passed through the ages of tobacco initiation under higher tobacco prices and stronger tobacco controls. Over time, as those birth cohorts are replaced by aging younger cohorts who had lower rates of initiation, the prevalence of tobacco use will continue to decline. Shortly after 2025, however, the decline in prevalence appears likely to plateau at about 15 percent, well above the Healthy People 2010 target of 12 percent.
This steady-state scenario should be compared with a worst-case scenario, based on a weakening of tobacco control policies and programs. If a significant retrenchment occurred, the projected smoking prevalence in 2025 would be about 17 percent, resulting in approximately 4 million more people smoking than would otherwise occur. Although the momentum generated by the last four decades of tobacco control is unlikely to be erased altogether—the model does not take into account new smoking fads, other changes in demand, or industry innovations—these projections do show that a weakened commitment to tobacco control will affect millions of lives.
The committee believes that substantial and enduring reductions in tobacco use cannot be achieved simply by expecting past successes to continue. Continued progress will require the persistence and nimbleness needed to counteract industry innovations in marketing and product design as well as the larger cultural and economic forces that tend to promote and sustain tobacco use. The challenge is heightened by the fact that the customary tools of tobacco control may not be effective in reducing use among some tobacco users. Any slackening of the public health response not only will reduce forward progress but also may lead to backsliding.
Over the past 10 to 15 years, the operating assumptions of tobacco control policies in the United States and elsewhere in the world have fundamentally changed. The old paradigm that shaped public opinion and policymaking on tobacco control efforts tended to emphasize consumer freedom of choice and to decry all government intervention as paternalistic. In retrospect, however, the committee believes that these assumptions were rooted in the tobacco industry’s successful efforts to deny and obscure the addictiveness and health consequences of tobacco use and on an array of resulting market failures, including information asymmetry between producers and users, distorted consumer choice due to information deficits, and product pricing that did not reflect the full social costs of tobacco use (especially the effects on nonsmokers). As the scientific evidence about addiction and initiation has grown and the tobacco industry’s strategies have been exposed in the course of state lawsuits and other tobacco-related litigation, public understanding of tobacco addiction has quickly deepened and, as a result, the ethical and political context of tobacco policymaking has been