Message from Howard Koh

Publication Details

Assistant Secretary for Health

Tobacco use imposes enormous public health and financial costs on this nation—costs that are completely avoidable. Until we end tobacco use, more young people will become addicted, more people will become sick, and more families will be devastated by the loss of loved ones.

The simple fact is that we cannot end the tobacco epidemic without focusing our efforts on young people. Nearly 100% of adults who smoke every day started smoking when they were 26 or younger, so prevention is the key. The tobacco industry spends almost $10 billion a year to market its products, half of all movies for children under 13 contain scenes of tobacco use, and images and messages normalize tobacco use in magazines, on the Internet, and at retail stores frequented by youth. With a quarter of all high school seniors and a third of all young adults smoking, and with progress in reducing prevalence slowing dramatically, the time for action is now.

This Surgeon General’s Report is an important addition to our base of knowledge on the prevalence, causes, effects, and implications of tobacco use by young people. It elucidates in powerful detail the factors that lead youth and young adults to initiate tobacco use, and the devastating health and economic impact of that decision on our nation as well as on individuals, their families, and their communities. This report also identifies proven, effective strategies that hold the potential of dramatically reducing tobacco use.

The Department’s overall tobacco control strategy is to strengthen and fully implement these proven, effective strategies as part of a comprehensive approach that combines educational, clinical, regulatory, economic, and social initiatives. In November 2010, the Department released Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan for the U.S. Department of Health and Human Services which provides a framework for coordinating this approach. The plan sets forth specific actions which HHS can implement to build on recent legislative milestones, respond to the changing market for tobacco products, and promote robust tobacco control programs at the federal, state, and community levels.

From 1997 to 2004 youth smoking fell rapidly. Since that time smoking among high school seniors has continued to fall, but slowly from 24.4% in 2003 to 18.7% in 2010 (daily smoking among youth has fallen from 16.8% in 1999 to 7.3% in 2009). Since 2003 prevalence among adults has fallen from 21.6 to 19.3% in 2010 The current problem is not that the evidence-based tools that drove the progress from 1997 to 2004 stopped working; it is that they have not been applied with sufficient effort or nationwide. That these tools still work is reflected in the fact that many states have seen significant reductions since 2005. Between 2005 and 2010 twenty states had declines of 20% or more.

Even with decades of progress and recent tobacco control initiatives, however, we must do more. We have ample evidence that comprehensive, multi-component interventions are effective at reducing tobacco use. But knowledge is not enough. We must also have commitment—the commitment to sustain comprehensive programs, to give our young people another perspective on tobacco, to create an environment that makes it harder for youth to smoke, to make cessation services accessible and affordable. It is within our grasp to make the next generation tobacco-free if we have the will to do so.