Tobacco Documents Online

The task is by no means easy. This report underscores the commitment all of us must have to the liealth of young people in the United States. Substantial work will be required to translate the justification, the means, and the will into a world in which young people no longer want to smoke. I, for one, relish the task. M. Joycelyn Elders, M.D. Surgeon General `U TIMN 0138850

Preventing Tobacco Use Among Young People CENTERS FOR DISEASE COHiRCL AND PREVENTK)N A Report of the Surgeon General U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health TIMN 0138843

Preventing acco Tob Use Among Young People A Report of the Surgeon General U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Offlce on Smoking and Health TIMN 0138844,

Suggested Citation U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control'and Prevention,lVational Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C., 20402, S/N 017-001-00491-0. Use of trade names is for identification only and does not constitute endorsement by the Public Health Service or the U.S. Department of Health and Human Services. TIMN 0138845

Chapter 1 Introduction, Summary, and Chapter Conclusions Introduction 5 Development of the Report 5 Major Conclusions 5 Summary 6 Introduction 6 Health Consequences of Tobacco Use Among Young People 6 The Epidemiology of Tobacco Use Among Young People 7 Efforts to Prevent the Onset of Tobacco Use 8 Summary 8 Chapter Conclusions 9 Chapter 2. The Health Consequences of Tobacco Use by Young People 9 Chapter 3. Epidemiology of Tobacco Use Among Young People in the United States 9 Chapter 4. Psychosocial Risk Factors for Initiating Tobacco Use 9 Chapter 5. Tobacco Advertising and Promotional Activities 10 Chapter 6. Efforts to Prevent Tobacco Use Among Young People 10 References 11 TIMN 0138858

?I Health Consequences of Smokeless Tobacco Use Among Young People 39 Introduction 39 Epidemiologic Evidence 39 Health Consequences 39 Nicotine Addiction 40 Smokeless Tobacco Use as a Risk Factor for Cigarette Smoking 40 Smokeless Tobacco Use as a Risk Factor for Other Drug Use 41 Conclusions 41 References 42 TIMN 0138867

THE SECRETARY OF HEALTH AND HUMAN SERVICES WASHINGTON, O.C. 20201 The Honorable,Albert-Gore, Jr. President of the Senate Washington, D.C. 20510 Dear Mr. President: it is my pleasure to transmit to the Congress the Surgeon General's report on the health consequences of smoking entitled Preventing Tobacco Use Amo gYoung People. This report is mandated by section 8(a) of the Public Health Cigarette Smoking Act of 1969 (Public Law 91-222) and includes the health effects of smokeless tobacco products as mandated by section 8(a). of the Comprehensive Smokeless Tobacco Health Education Act of 1986 (Public Law 99-252). The report.was prepared by the Centers for Disease Control and Prevention's Office on'Smoking and Health. This report focuses on the vulnerable adolescent ages of 10 through 18 when most users start smoking, chewing, or dipping and become addicted to tobacco. It examines the health effects of early smoking and smokeless tobacco use, the reasons that young men and women begin using tobacco, the extent to which they use.it, and efforts to prevent'tobacco use by young people. Smoking kills 434,000 Americans each year. Adolescent smoking and smokeless tobacco use are the first steps in this totally preventable public health tragedy. The facts are simple: one out of three adolescents in the United States is using tobacco by age 18, adolescent users become adult users, and few people begin to use tobacco after age 18. Preventing young people from starting to use tobacco is the key to reducing the death and disease caused by tobacco use: This report documents that intervention programs targeting the broad social environment of adolescents are both effective and warranted. A great:'opportunity lies before us to prevent millions of premature deaths and improve the quality of lives. This report points out the overwhelming need in public health for efforts directed toward stopping young people before they start using tobacco. Donna E. Shalala Enclosure TIMN 0138847

Chapter 2 The Health Consequences of Tobacco Use by Young People Introduction 15 Health Consequences of Smoking Among Young People 15 Introduction 15 Overview of the Toxicology of Tobacco Smoke 15 Epidemiologic Evidence of Respiratory Effects 16 Respiratory Symptoms 16 Lung Function 17 Respiratory Morbidity 24 Epidemiologic Evidence of Nonrespiratory Effects 25 Cardiovascular Disease 25 Physical Fitness 28 Health Outcomes in Pregnancy 28 Epidemiologic Evidence of the Health Effects of Passive Smoking 28 Adult Health Implications of Smoking Among Young People 29 Respiratory Diseases 29 Cardiovascular Disease 29 Cancer 29 Nicotine Addiction in Adolescence 30 Introduction 30 Background and Nomenclature 30 Severity of Nicotine Addiction 31 Chemistry and Addiction Potential 1 Pathophysiology of Nicotine Dependence 32 Tolerance 32 Physical Dependence 33 The Clinical Course of Nicotine Dependence 33 Nondrug Factors in Nicotine Dependence 34 Smoking as a Risk Factor for Other Drug Use 34 Introduction 34 Progression of Drug Use 34 Cigarette Smoking and Other Drug Use 35 Smoking as a Facilitator for Other Drug Use 36 TEWIN 0138866

Preventing Tobacco Use Among Young People Chapter 1. Introduction, Summary, and Chapter Conclusions 3 Chapter 2. The Health Consequences of Tobacco Use by Young People 13 Introduction 15 Health Consequences of Smoking Among Young People 15 Adult Health Implications of Smoking Among Young People 29 Nicotine Addiction in Adolescence 30 Smoking as a Risk Factor for Other Drug Use 34 Health Consequences of Smokeless Tobacco Use Among Young People 39 Chapter 3. Epidemiology of Tobacco Use Among Young People in the United States 53 Introduction 55 Cigarette Smoking Among Young People in the United States 58 Smokeless Tobacco Use Among Young People in the United States 95 Chapter 4. Psychosocial Risk Factors for Initiating Tobacco Use 121 Introduction 123 Initiation of Cigarette Smoking 124 Initiation of Smokeless Tobacco Use 140 Implications of Research for Preventing Tobacco Use: Modifying Psychosocial Risk 147 Chapter 5. Tobacco Advertising and Promotional Activities 157 The Role of Advertising and Promotion in the Marketing of Tobacco Products 159 A History of Cigarette Advertising to the Young 164 Historical Content Analyses of Cigarette Advertising 179 Promotional Efforts of the Tobacco Industry 185 Research on the Effects of Cigarette Advertising and Promotional Activities on Young People 188 Chapter 6. Efforts to Prevent Tobacco Use Among Young People 205 Introduction 209 Public Opinion About Preventing Tobacco Use Among Young People 210 Educational Efforts to Prevent Tobacco Use Among Young People 216 Public Policies to Prevent Tobacco Use Among Young People 245 List of Tables and Figures 293 Glossary 297 Index 299 I TIMN 0138857

Preveutiitg Tobacco Use Among Young People References US DEPARTMENT OF HEALTH AND HUMAN SERVICES. The health consequences of using smokeless tobacco. A report of the advisory committee to the Surgeon General. US Department of Health and Human Services, Public Health Services, National Institutes of Health. NIH Publication No. 86-2874,1986. US DEPARTMENT OF HEALTH AND HUMAN SERVICES. The health consequences of smoking: nicotine addiction. A report of the Surgeon General, 1988. US Department of Health and Hu- man Services, Public Health Service, Centers for Disease Con- trol, Center for Health Promotion and Education, Office on Smoking and Health. DHHS Publication No. (CDC) 88-8406, 1988. US DEPARTMENT OF HEALTH AND HUMAN SERVICES. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411,1989. , TIMN 0138865 Introduction 11