Tobacco use kills more people than any other addiction and we know that addiction starts in childhood and youth.

We all agree that youths should not smoke, but how can this be accomplished? What prevention messages will they find compelling? What effect does tobacco advertising--more than $10 million worth every day--have on youths? Can we responsibly and effectively restrict their access to tobacco products?

These questions and more are addressed in Growing Up Tobacco Free, prepared by the Institute of Medicine to help everyone understand the troubling issues surrounding youths and tobacco use.

Growing Up Tobacco Free provides a readable explanation of nicotine's effects and the process of addiction, and documents the search for an effective approach to preventing the use of cigarettes, chewing and spitting tobacco, and snuff by children and youths. It covers the results of recent initiatives to limit young people's access to tobacco and discusses approaches to controls or bans on tobacco sales, price sensitivity among adolescents, and arguments for and against taxation as a prevention strategy for tobacco use. The controversial area of tobacco advertising is thoroughly examined.

With clear guidelines for public action, everyone can benefit by reading and acting on the messages in this comprehensive and compelling book.

Contents

• COMMITTEE ON PREVENTING NICOTINE ADDICTION IN CHILDREN AND YOUTHS
• PREFACE
• ACKNOWLEDGMENTS
• 1. TOWARD A YOUTH-CENTERED PREVENTION POLICY
  • THE NEED FOR A YOUTH-CENTERED TOBACCO CONTROL POLICY
  • THE ELEMENTS OF A YOUTH-CENTERED TOBACCO CONTROL POLICY
  • REFERENCES
• 2. THE NATURE OF NICOTINE ADDICTION
  • CONTENTS
  • GENERAL ASPECTS OF NICOTINE ADDICTION
  • NICOTINE DEPENDENCY IN YOUTHS
  • NATURE OF TOBACCO PRODUCTS
  • CONCLUSIONS AND RESEARCH RECOMMENDATIONS
  • REFERENCES
• 3. SOCIAL NORMS AND THE ACCEPTABILITY OF TOBACCO USE
  • CONTENTS
  • THE FUNCTION OF SOCIAL NORMS
  • THE EMERGING TOBACCO-FREE NORM
  • TOBACCO USE AS PERCEIVED BY CHILDREN AND YOUTHS
  • OPPORTUNITIES FOR PROMOTING A TOBACCO-FREE NORM
  • ADVOCACY FOR A TOBACCO-FREE NORM
  • REINFORCING THE TOBACCO-FREE NORM: CONCLUSIONS AND RECOMMENDATIONS
  • REFERENCES
• 4. TOBACCO ADVERTISING AND PROMOTION
  • INTRODUCTION: MAINTAINING THE MARKET
  • SHIFTING TRENDS IN TOBACCO MARKETING
  • THE TOBACCO MARKET AND MARKET SEGMENTATION
  • THE APPEAL OF TOBACCO ADS TO CHILDREN AND YOUTHS
  • CRITICAL ASSESSMENT OF STUDIES ON ADVERTISING RECALL, ADVERTISING EXPENDITURES, AND TOBACCO CONSUMPTION
  • RATIONALE FOR RESTRICTIONS
  • RECOMMENDATIONS
  • REFERENCES
• 5. PREVENTION AND CESSATION OF TOBACCO USE RESEARCH-BASED PROGRAMS
  • PREVENTION OF SMOKING
  • PREVENTION OF SMOKELESS TOBACCO USE
  • ADOLESCENT CESSATION OF SMOKING
  • CESSATION OF SMOKELESS TOBACCO USE
  • RECOMMENDATIONS
  • REFERENCES
• 6. TOBACCO TAXATION IN THE UNITED STATES
  • CONTENTS
  • TOBACCO TAXES IN THE UNITED STATES
  • TAX RATES IN OTHER INDUSTRIALIZED COUNTRIES
  • EFFECT OF EXCISE TAXES ON CONSUMPTION
  • ARGUMENTS FOR AND AGAINST HIGHER TOBACCO TAXES
  • CONCLUSIONS AND RECOMMENDATIONS
  • REFERENCES
• 7. YOUTH ACCESS TO TOBACCO PRODUCTS
  • CONTENTS
  • BACKGROUND OF YOUTH ACCESS MEASURES
  • RECENT INITIATIVES
  • THE BENEFITS OF REDUCING ACCESS
  • DESIGNING A YOUTH ACCESS POLICY
  • SUGGESTIONS FOR ADDITIONAL POLICY INITIATIVES AND RESEARCH
  • REFERENCES
• 8. REGULATION OF THE LABELING, PACKAGING, AND CONTENTS OF TOBACCO PRODUCTS
  • TOBACCO: AN UNREGULATED HAZARD
  • WARNINGS AND PACKAGING
  • REGULATION OF CONSTITUENTS OF TOBACCO PRODUCTS
  • REFERENCES
• 9. COORDINATION OF POLICIES AND RESEARCH
  • CONTENTS
  • THE ROLE OF THE FEDERAL GOVERNMENT
  • THE ROLE OF STATE AND LOCAL GOVERNMENTS
  • THE ROLE OF PRIVATE SECTOR ORGANIZATIONS
  • LINKAGE BETWEEN EXCISE TAX REVENUES AND TOBACCO CONTROL PROGRAM FUNDING
  • OPTIONS AND RECOMMENDATIONS FOR COORDINATION
  • EPILOGUE
  • REFERENCES
• APPENDIXES
  • A SPECIFIC RECOMMENDATIONS, BY CHAPTER
  • B COMMITTEE BIOGRAPHIES

This project was funded by the Robert Wood Johnson Foundation (Grant No. 20520-R); Metropolitan Life; the American Heart Association; by funds provided by the Cigarette and Tobacco Surtax Fund of the State of California through the Tobacco-Related Disease Research Program (Grant No. 3SP-0416); the Centers for Disease Control and Prevention and the National Institute on Drug Abuse (Grant No. M93-OSH-DASH); the Indian Health Service; the Center for Substance Abuse Prevention; and the National Cancer Institute, the Maternal and Child Health Bureau of the Health Resources and Services Administration, and the Agency for Health Care Policy and Research (Grant No. I-R13-CA62355-01).

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 committee responsible for this report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

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.