Tobacco Use Prevention

The medical consequences of tobacco use—including secondhand exposure—make tobacco control and smoking prevention crucial parts of any public health strategy.

History of Smoking Prevention Efforts in the United States

The first Surgeon General’s Report on Smoking and Health was released in 1964, when more than 40% of the adult population smoked. Once the link between smoking and its effects on the body became part of the public consciousness, states and communities began making education efforts and public policy changes to reduce the number of people who smoke, reduce the initiation of smoking, and decrease exposure to smoke.

These efforts resulted in substantial declines in smoking rates—to half the 1964 level. An estimated 8 million premature deaths were averted, and the average life expectancy was extended by 2.3 years for men and by 1.6 years for women.

But there is a long way yet to go: roughly 5.6 million adolescents under age 18 are expected to die prematurely as a result of an illness related to smoking.

Prevention at the Policy Level

Prevention can take the form of policy-level measures, such as:

• Increased taxation of tobacco products
• Stricter laws (and enforcement of laws) regulating:
  • who can purchase tobacco products
  • how and where they can be purchased
  • where and when they can be used (i.e., smoke-free policies in restaurants, bars, and other public places)
• Restrictions on advertising
• Mandatory health warnings on packages

More than 100 studies have shown that higher taxes on cigarettes produce significant reductions in smoking, especially among youth and lower-income individuals. Smoke-free workplace laws and restrictions on advertising have also shown benefits.

Prevention at the School & Community Level

Merely educating potential smokers about the health risks has not proven effective.

Successful evidence-based interventions aim to reduce or delay the initiation of smoking, reduce or mitigate modifiable risk factors (see below), and bolster protective factors.

Risk Factors for Smoking Include:

• Having family members or peers who smoke
• Being in a lower socioeconomic status
• Living in a neighborhood with high density of tobacco outlets
• Not participating in team sports
• Being exposed to smoking in movies
• Being sensation-seeking
• Being male – Males are more likely than females to take up smoking in adolescence
• Age – Older teens are more likely to smoke than younger teens (However, the earlier a person starts smoking or using any addictive substance, the more likely they are to develop an addiction.)

Some evidence-based interventions show lasting effects on reducing smoking initiation. For instance, communities utilizing the intervention-delivery system Communities that Care (CTC) for students aged 10–14 show sustained reduction in male cigarette initiation up to 9 years after the end of the intervention.