issue by Prokhorov in this volume). The tobacco industry recognized the importance of physicians in the 1930s when it advertised that more doctors smoked Camels, and later advertised that dentists advised the public to smoke Viceroys.

In every country that has seen a decline in smoking prevalence, the first group that has reduced its prevalence is the medical profession. It would appear that physicians are very important role models for health behavior in society. If physicians smoke, the population is less likely to be concerned about the health hazards of smoking. In the United States, some 60 percent of physicians smoked in 1949. By 1964, some 30 percent of doctors smoked. Today, it is estimated that less than 6 percent of physicians in the United States smoke. Physicians' rate of quitting appears similar to that of other highly educated groups in society. This rapid decline in smoking prevalence among the medical profession has been brought about by the virtual elimination of smoking among medical students (U.S. Department of Health and Human Services, 1994b). Indeed, the trends in smoking among physicians, and particularly among medical students, can be used as a barometer for the level of tobacco control activity in a country.

In addition to being role models, health professionals can play an important part in convincing smokers to quit and nonsmokers not to start smoking, as shown in Table 11-2. Over two-thirds of smokers visit a physician each year in the United States. While they may seek care for a specific problem not be related to smoking, the physician has an opportunity, and many would say a duty, to counsel them about preventing future disease.6 The physician's role is to help reinforce the smoker's motivation to quit and to provide support on each subsequent visit. Unfortunately, physicians are much more likely to counsel a patient on smoking if the patient presents them with a problem that could be smoking related. Efforts to increase this kind of activity have not yet been able to generate widespread physician involvement in assisting patients to quit.

School-Based Smoking Prevention Programs

Since the 1964 Surgeon General's report started the official public health campaign against smoking, prevention of the uptake of smoking has been recognized as crucial to major long-term reductions in prevalence among the population (U.S. Department of Health and Human Services, 1964). To this end, the 1964 Surgeon General's report advocated the conduct of programs directed at educating high school and college students about the health hazards of smoking. Early programs assumed that young people who started to smoke had somehow either not been exposed to or not paid attention to information on the health effects of smoking. Efforts were concentrated on presenting the information as vividly as possible; educational aids included films, posters, and pamphlets, which focused on arousing fear of the long-term effects of smoking. However, by the late 1970s there was general agreement that these smoking prevention programs had little impact on the probability that an adolescent would become a smoker



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