[' ', ' ', ' ', ' ', '  ', '-', 'related', 'diseases', 'such', 'as', 'lung', 'cancer,', 'heart', 'disease,', 'and', 'chronic', 'obstructive', 'lung', 'disease.‘', 'Tobacco,', 'the', 'plague', 'of', 'our', 'time,', 'brings', 'forth', 'the', 'need', 'for', 'us', 'to', 'band', 'together—together,', 'we', 'can', 'ultimately', 'save', 'thou-', '.', 'sands', 'of', 'lives', 'now', 'held', 'hostage', 'by', 'smoking.*', 'As', 'a', 'community', 'of', 'health', 'professionals,', 'our', 'mission', 'is', 'to', 'support', 'the', 'year', '2000', 'health', 'objectives®', 'and', 'to', 'acknowledge', 'tobacco', 'as', 'the', 'significant', 'and', 'far-reaching', 'public', 'health', 'problem', 'portrayed', 'in', 'the', 'objectives.', 'If', 'we', 'are', 'to', 'reduce', 'cigarette', 'smoking', 'to', 'a', 'prevalence', 'of', 'no', 'more', 'than', '15%', 'by', 'the', 'year', '2000,°', 'we', 'will', 'need', 'to', 'double', 'the', 'current', 'rate', 'of', 'decline', 'in', 'smoking', 'prev-', 'alence.', 'To', 'meet', 'this', 'objective,', 'environmental,', 'social,', 'and', 'behavioral', 'factors', 'must', 'all', 'be', 'included', 'as', 'part', 'of', 'any', 'national', 'strategies.', 'Any', 'approach', 'to', 'solving', 'this', 'problem', 'must', 'rec-', 'ognize', 'that', 'these', 'factors', 'are', 'intertwined.', '.', 'Even', 'though', '42', 'million', 'Americans', 'have', 'quit', 'smoking,', 'nearly', '50', 'million', 'adults', '(28%', 'of', 'the', 'population)', 'in', 'the', 'United', 'States', 'continue', 'to', 'smoke.’', 'Nicotine', 'addiction', 'is', 'difficult', 'to', 'overcome,®', 'and', 'the', 'decline', 'in', 'smoking', 'has', 'been', 'substantially', 'slower', 'among', 'women', 'than', 'men.', 'Smoking', 'prevalence', 're-', 'mains', 'disproportionately', 'high', 'among', 'minorities,', 'blue-collar', 'workers,', 'and', 'people', 'with', 'less', 'education.’', 'In', 'addition,', 'the', 'rate', 'of', 'smoking', 'during', 'the', '1980s', 'among', 'our', 'nation’s', 'teen-', 'agers', 'has', 'not', 'changed', 'substantially', 'compared', 'with', 'the', 'rate', 'in', 'the', 'late', '1970s', 'and', 'early', '1980s.°', 'The', 'fact', 'that', 'about', '80%', 'of', 'all', 'adult', 'smokers', 'become', 'regular', 'smokers', 'before', 'their', '21st', 'birthday', 'underscores', 'the', 'magnitude', 'and', 'pervasiveness', 'of', 'the', 'problem.', 'The', 'future', 'health', 'and', 'well-being', 'of', 'our', 'children', 'and', 'our', 'nation', 'depend', 'upon', 'our', 'ability', 'to', 'intensify', 'efforts', 'to', 'dis-', 'courage', 'young', 'people', 'from', 'starting', 'to', 'smoke.', 'The', 'coordi-', 'nation', 'of', 'supportive', 'tobacco', 'prevention', 'and', 'cessation', 'pro-', 'grams', 'among', 'health', 'care', 'agencies,', 'businesses,', 'policymak-', 'ers,', 'educational', 'institutions,', 'and', 'other', 'influential', 'groups', 'is', 'also', 'imperative.', 'Once', 'effective', 'school-based', 'prevention', 'pro-', 'grams', 'have', 'been', 'placed', 'in', 'all', 'of', 'our', 'nation’s', 'schools,', 'young', 'people', 'will', 'be', 'better', 'educated', 'about', 'the', 'negative', 'health', 'consequences', 'of', 'tobacco', 'use', 'and', 'about', 'ways', 'they', 'can', 'resist', 'the', 'pressure', 'to', 'experiment', 'with', 'smoking.', 'Tobacco', 'control', 'policies', 'represent', 'important', 'strategies', 'for', 'limiting', 'tobacco', 'use', 'and,', 'therefore,', 'preventing', 'the', 'onset', 'of', 'smoking.', 'One', 'such', 'policy', 'prohibits', 'the', 'sale', 'and', 'distribution', 'of', 'tobacco', 'products', 'to', 'those', 'younger', 'than', 'age', '19.6', 'Other', 'components', 'for', 'reducing', 'tobacco', 'use—such', 'as', 'banning', 'the', 'use', 'of', 'vending', 'machines,', 'creating', 'a', 'licensing', 'system', 'for', 'vendors,', 'and', 'increasing', 'the', 'frequency', 'of', 'enforcement—should', 'be', 'included', 'in', 'minors’', 'access', 'legislation.', 'The', 'US', 'Department', 'of', 'Health', 'and', 'Human', 'Services', 'has', 'urged', 'the', 'adoption', 'of', 'a', 'model', 'law,', 'the', 'Model', 'Sale', 'of', 'Tobacco', 'Products', 'to', 'Minors’', 'Control', 'Act,”', 'in', 'ali', '50', 'states.®', 'Elimination', 'or', 'restriction', 'of', 'advertisements', 'to', 'which', 'our', 'young', 'people', 'are', 'likely', 'to', 'be', 'exposed', 'is', 'an', 'objective', 'worth', 'considerable', 'effort.', 'According', 'to', 'Louis', 'W.', 'Sullivan,', 'MD,', 'sec-', 'retary', 'of', 'health', 'and', 'human', 'services,', '“access', 'to', 'cigarettes', 'is', 'still', 'too', 'easy', 'for', 'those', 'who', 'are', 'under', 'the', 'legal', 'age,', 'and', 'the', 'tobacco', 'industry', 'continues', 'to', 'advertise', 'in', 'a', 'shameless', 'manner', 'to', 'sus-', 'ceptible', 'young', 'people.”', 'Tobacco', 'advertisements', 'cloaka', 'known', 'deleterious', 'product', 'in', 'images', 'that', 'appeal', 'to', 'youth.', 'JAMA,', 'December', '71,', '1991—Vol', '266,', 'No.', '22', 'Numerous', 'economic', 'studies', 'have', 'demonstrated', 'an', 'inverse', 'relationship', 'between', 'the', 'price', 'of', 'tobacco', 'products', 'and', 'to-', 'bacco', 'consumption.’', 'Increasing', 'the', 'price', 'of', 'cigarettes', 'may', 'reduce', 'the', 'number', 'of', 'adolescent', 'as', 'well', 'as', 'adult', 'smokers', 'in', ';', 'this', 'country;', 'increasing', 'state', 'excise', 'taxes', 'would', 'have', 'the', 'dual', 'advantage', 'of', 'improving', 'the', 'health', 'of', 'citizens', 'and', 'gen-', 'erating', 'state', 'revenues.', 'We', 'cannot', 'reach', 'the', 'year', '2000', 'objectives', 'without', 'accel-', 'erating', 'cessation', 'efforts.', 'Physicians,', 'dentists,', 'and', 'other', 'health', 'care', 'providers', 'play', 'a', 'crucial', 'role', 'in', 'this', 'strategy.', 'All', 'phy-', 'sicians', 'and', 'dentists', 'should', '(1)', 'ask', 'all', 'patients', 'if', 'they', 'smoke,', '(2)', 'advise', 'smoking', 'patients', 'to', 'stop,', '(8)', 'assist', 'smoking', 'pa-', '‘tients', 'with', 'quitting', '(eg,', 'set', 'a', 'target', 'date),', 'and', '(4)', 'provide', 'follow-up', 'support.”', 'One', 'key', 'to', 'prevention', 'is', 'to', 'recommend', 'cessation', 'for', 'all', 'patients', 'who', 'smoke,', 'not', 'just', 'those', 'exhibiting', 'smoking-related', 'symptoms.', 'Making', 'smoking', 'prevention', 'a', 'reality', 'will', 'not', 'be', 'an', 'easy', 'task,', 'as', 'there', 'are', 'many', 'obstacles', 'to', 'overcome.', 'We', 'must', 'intensify', 'our', 'efforts', 'and', 'broaden', 'our', 'partnerships', 'to', 'cre-', 'ate', 'a', 'more', 'efficient', 'networking', 'system.', 'Many', 'diverse', 'organizations', 'in', 'our', 'society', 'have', 'the', 'potential', 'to', 'bring', 'about', 'sweeping', 'changes', 'in', 'public', 'policies', 'with', 'regard', 'to', 'tobacco', 'and', 'health', 'education', 'efforts,', 'minors’', 'access', 'to', 'tobacco', 'products,', 'smoking', 'prevention', 'programs', 'in', 'schools,', 'tobacco', 'advertising,', 'and', 'smoking', 'cessation.', 'Our', 'success', 'in', 'effectively', 'controlling', 'tobacco—a', 'highly', 'lethal', 'consumer', 'product—requires', 'a', 'very', 'real', 'commitment', 'by', 'every', 'one', 'of', 'us.', 'William', 'L.', 'Roper,', 'MD,', 'MPH', '1,', 'Department', 'of', 'Health', 'and', 'Human', 'Services,', 'Reducing', 'the', 'Health', 'Conse-', 'quences', 'of', 'Smoking:', '25', 'Years', 'of', 'Progress:', 'A', 'Report', 'of', 'the', 'Surgeon', 'General.', 'Atlanta,', 'Ga:', 'Centers', 'for', 'Disease', 'Control,', 'National', 'Center', 'for', 'Chronic', 'Disease', 'Prevention', 'and', 'Health', 'Promotion,', 'Office', 'on', 'Smoking', 'and', 'Health;', '1989.', 'US', 'Dept', 'of', 'Health', 'and', 'Human', 'Services', 'publication', 'CDC', '89-8411.', '2.', 'Centers', 'for', 'Disease', 'Control.', 'Smoking-attributable', 'mortality', 'and', 'years', 'of', 'potential', 'life', 'lest—', 'United', 'States,', '1988.', 'MMWR.', '1991;40:62-63,', '69-71.', '8.', 'National', 'Center', 'for', 'Health', 'Statistics,', 'Advance', 'report', 'of', 'final', 'mortality', 'statistics,', '1988.', 'Monthly', 'Vital', 'Stat', 'Rep.', '1990;39(7,', 'supp)):2.', '4.', 'Sullivan', 'LW.', 'Statement', 'on', 'the', 'ASSIST', 'Federal', 'Smoking', 'Control', 'Project.', 'Washington,', 'DC:', 'October', '4,', '1991;', 'press', 'release.', ':', '5.', 'Roper', 'WL.', 'Statement', 'on', 'the', '1990', 'Surgeon', 'General’s', 'Report:', 'The', 'Health', 'Benefits', 'of', 'Smoking', 'Cessation.', 'Washington,', 'DC:', 'September', '25,', '1990;', 'press', 'conference.', '6.', 'Department', 'of', 'Health', 'and', 'Human', 'Services.', 'Healthy', 'People', '2000:', 'National', 'Health', 'Promotion', 'and', 'Disease', 'Prevention', 'Objectives.', 'Washington,', 'DC:', 'US', 'Dept', 'of', 'Health', 'and', 'Human', 'Services;', '1991.', 'US', 'Dept', 'of', 'Health', 'and', 'Human', 'Services', 'publication', 'PHS', '91-50212.', '7.', 'Centers', 'for', 'Disease', 'Control.', 'Cigarette', 'smoking', 'among', 'adults—United', 'States,', '1988.', 'MMWR.', '1991;40:757-759,', '765.', '8.', 'Department', 'of', 'Health', 'and', 'Human', 'Services.', 'The', 'Health', 'Consequences', 'of', 'Smoking:', 'Nicotine', 'Addiction:', 'A', 'Report', 'of', 'the', 'Surgeon', 'General.', 'Atlanta,', 'Ga:', 'Centers', 'for', 'Disease', 'Control,', 'Center', 'for', 'Health', 'Promotion', 'and', 'Education,', 'Office', 'on', 'Smoking', 'and', 'Health;', '1988.', 'US', 'Dept', 'of', 'Health', 'and', 'Human', 'Services', 'publication', 'CDC', '88-8406.', 'ington,', 'DC:', 'US', 'Dept', 'of', 'Health', 'Services;', 'October', '17,', '1991;', 'press', 'release.', '12.', 'Glynn', 'TJ,', 'Manley', 'MW.', 'How', 'to', 'Help', 'Your', 'Patients', 'Stop', 'Smoking:', 'A', 'National', 'Cancer', 'Institute', 'Manual', 'for', 'Physicians.', 'Washington,', 'DC:', 'National', 'Institutes', 'of', 'Health,', 'National', 'Cancer', 'Institute,', 'Smoking,', 'Tobacco,', 'and', 'Can-', 'cer', 'Program;', '1990.', 'US', 'Dept', 'of', 'Health', 'and', 'Human', 'Services', 'publication', 'NIH', 'Editorials', '3189', '  ', ' ', '  ', '    ', '  ', '  ', '  ', ' ', ' ', '  ', '  ', '  ', '  ', '  ', '  ', ' ', '  ', '  ', '  ', '   ', '   ', '   ', '   ', '  ', ' ', '  ', '    ', '   ', '  ', '  ', '   ', '   ', ' ', ' ', ' ', ' ', '   ', '   ', ' ', ' ', ' ', ' ', '   ', '  ', ' ', '  ', '   ', '   ', ' ', '  ', '  ', '  ', ' ', ' ', '  ', '{', 'ETTS', '86L0g', ' ', ' ']