TAKING ACTION TO REDUCE TOBACCO USE

National Cancer Policy Board

Institute of Medicine and Commission on Life Sciences, National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1998



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TAKING ACTION TO REDUCE TOBACCO USE National Cancer Policy Board Institute of Medicine and Commission on Life Sciences, National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1998

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the National Cancer Policy Board, which is responsible for the report, were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors as well as the NRC and IOM in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity and evidence. The content of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: Harvey Fineberg, Coordinator, Harvard University; Virginia Weldon, Monitor, Monsanto Corporation; Neal Benowitz, University of California, San Francisco; Frank Chaloupka, University of Illinois, Chicago; Jack Henningfield, Pinney Associates and Johns Hopkins University; Thomas Houston, American Medical Association; Michael Pertschuk, The Advocacy Institute; and Kenneth Warner, The University of Michigan. While the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the National Cancer Policy Board, the NRC and IOM. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. This study was supported through funding provided by the National Cancer Institute (Contract No. N02-CO-71024), Centers for Disease Control and Prevention, American Cancer Society, Amgen, and Abbott. The views presented in this report are those of the National Cancer Policy Board and are not necessarily those of the funding organizations. International Standard Book No. 0-309-06038-9 Additional copies of this report are available for sale from the National Academy Press, Box 285, 2101 Constitution Avenue, N.W., Washington, D.C. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu. This report is available on-line at http://www.nap.edu/. For more information about the Institute of Medicine or the the National Cancer Policy Board, visit the IOM's home page at http://www2.nas.edu/iom or the NCPB's home page at http://www2.nas.edu/cancerbd. Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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NATIONAL CANCER POLICY BOARD PETER HOWLEY*,† (Chair), George Fabyan Professor and Chair, Department of Pathology, Harvard Medical School JOSEPH SIMONE (Vice-Chair), Medical Director, Huntsman Cancer Foundation and Institute, University of Utah JOHN BAILAR,* Chair, Department of Health Studies, University of Chicago NORMAN DANIELS, Professor of Philosophy, Tufts University JOSEPH DAVIE,* Vice President, Department of Research, Biogen, Inc., Cambridge, Mass. ROBERT DAY, President and Director, Fred Hutchinson Cancer Research Center, Seattle KATHLEEN FOLEY,* Chief of Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York City BERTHA FORD, Coordinator, Cancer Clinical Trials, The Arthur G. James Cancer Hospital and Research Institute, Columbus, Ohio ELLEN GRITZ, Professor and Chair, Department of Behavioral Sciences, University of Texas M.D. Anderson Cancer Center, Houston ELIZABETH HART, President and CEO, Hart International, Dallas JOHN LASZLO, Independent Consultant, Atlanta WILLIAM McGUIRE,* Chief Executive Officer, United Health Care Corporation, Minnetonka, Minn. DANIEL NATHANS,† Senior Investigator, Howard Hughes Medical Institute, Bethesda, Md., and Professor of Molecular Biology and Genetics, Johns Hopkins University School of Medicine SANDRA NICHOLS, Director, Arkansas Department of Health, Little Rock DIANA PETITTI, Director, Research and Evaluation, Kaiser Permanente Medical Care Program, Pasadena, Calif. AMELIE RAMIREZ, Associate Professor, Department of Medicine, Baylor College of Medicine WILLIAM ROPER,* Dean, University of North Carolina School of Public Health, Chapel Hill JOHN SEFFRIN, Chief Executive Officer, The American Cancer Society, Atlanta JANE SISK, Professor, Columbia University School of Public Health ELLEN STOVALL, Executive Director, National Coalition for Cancer Survivorship, Silver Spring, Md. FRANCES VISCO, President, National Breast Cancer Coalition, Philadelphia ROBERT YOUNG, President, Fox Chase Cancer Center, Philadelphia *   Member, Institute of Medicine. †   Member, National Academy of Sciences.

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Special Contributor RICHARD J. BONNIE, John S. Battle Professor of Law, and Director, Institute of Law, Psychiatry, and Public Policy, University of Virginia School of Law Study Staff ROBERT MULLAN COOK-DEEGAN, Director STACEY PATMORE, Senior Project Assistant KATHLEEN McCORMALLY, Research Assistant and Summer Intern CATHARYN LIVERMAN, Program Officer IOM Staff MICHAEL STOTO, Senior Staff Officer, Division of Health Promotion and Disease Prevention JANE DURCH, Program Officer, Division of Health Promotion and Disease Prevention CLAUDIA CARL, Reports and Information Office MICHAEL EDINGTON, Reports and Information Office

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Contents and Recommendations     BACKGROUND   2     RAISE PRICES TO REDUCE USE   4     The price of tobacco products must be increased substantially   4     Failure to achieve targeted reductions in youth consumption should result in further manufacturer-specific penalties   5     STRENGTHEN FEDERAL REGULATION   7     FDA must continue to regulate tobacco products, and the U.S. Congress must strengthen and clarify FDA's role   7     SUPPORT STATE AND LOCAL TOBACCO CONTROL EFFORTS   9     The federal government must support state and local infrastructure for tobacco control   10     Congress must repeal the federal preemption of state and local regulation of advertising and promotion   11     MONITOR PERFORMANCE IN RELATION TO PUBLIC HEALTH GOALS   11     The federal government must establish a system for performance monitoring in collaboration with other levels of government and private organizations   11     HELP CURRENT USERS QUIT   18     Effective smoking cessation interventions, as identified by the AHCPR guidelines, should be widely disseminated and incorporated into the standard of practice   18

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    Government health programs and private insurance and health plans should cover treatment programs for tobacco dependence   18     Treatment programs for tobacco dependence should be incorporated into quality of care measures, "report cards" on health plans, and public health performance monitoring   19     Programs and norms outside the medical care system must also support prevention, cessation, and harm reduction   19     SUPPORT RESEARCH   20     Federal research agencies must increase their commitment to research on tobacco control   20     The U.S. Congress and Public Health Service agencies should intensify research on tobacco-related diseases   22     FDA and NIH should mount research programs to improve future regulation   23     The federal government must support research to clarify the feasibility, risks, and benefits of "harm reduction" strategies   24     FACILITATE INTERNATIONAL TOBACCO CONTROL   25     The United States must promote, participate in, and contribute funds to the building of a capacity for evaluating and monitoring international tobacco control efforts   26     The United States should refrain from implementing trade policies that undermine foreign tobacco control efforts   27     The United States can study and learn from effective foreign tobacco control policies   29     SUMMARY   30     REFERENCES AND NOTES   31

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TAKING ACTION TO REDUCE TOBACCO USE

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