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Two working groups of NCI's Board of Scientific Advisors recently made recommendations to the National Cancer Advisory Board. A report on cancer control observed that:
Although effective interventions have been developed, their efforts tend to diminish over time as a result of competing messages and lack of booster programs. Few effective interventions are available for youth most at risk, such as those from low-income, less-educated families.... Particular attention needs to be given to developing effective interventions for children at early ages, when influence from adults is likely to be most effective. Attention must also be paid to children's social contexts influencing tobacco use, including parents, schools, and communities.40
That working group went on to observe the salutary effect of the ASSIST program. A different working group on prevention previously recommended that NCI "Increase the investment in developing effective interventions for prevention and cessation of tobacco use, particularly in populations where tobacco use has remained high, e.g., adolescents, women, and those with less education and income." The working group on prevention differed from the one on cancer control working group about ASSIST, recommending that NCI "Increase the proportion of the tobacco control investment in basic research and in the development of effective interventions, and decrease the investment in large-scale dissemination efforts, e.g., ASSIST."
The board believes that both reports clearly point to a need for an enhanced research effort, including a grants program for social, behavioral, and biological questions pertinent to tobacco control. They also point to a need for large-scale demonstrations and evaluations that will require significant funding and staff effort.41 The purpose of the ASSIST program was to demonstrate the potential for intervention, and it has done this, becoming the model for nationwide implementation recommended above. Yet a national ASSIST program cannot be an end, but only a beginning. Are workplace and public smoking bans the most effective control measures at the local level? Do youth access restrictions work, and do they reduce youth consumption, or just purchases by minors? Do public education and counteradvertising campaigns have an impact, and is there a "dose" effect? What counteradvertising approaches actually work? Should prevention messages be targeted at youths, or is that counterproductive? These and many other questions needed to help guide future tobacco control efforts cannot be addressed through small research grants alone. They require federal research agencies to commit significant resources to help design and fund high-intensity interventions, to fund rigorous evaluation of federal and state-funded programs, and to disseminate those findings. They will also entail interactions with nongovernmental groups with expertise in social marketing, social science, and community interventions. The resources freed from research budgets by the transfer of ASSIST should be augmented and devoted (a) to fund research grants, (b) to support trials of new preventive and treatment interventions, and (c) to plan and carry out intensive new demonstrations needed to guide national tobacco control efforts.