in 1998,” and that they “have designed their cigarettes to
precisely control nicotine delivery levels and provide doses
of nicotine sufficient to create and sustain addiction while
also concealing much of their nicotine-related research”
(Tobacco Control Act 2009, §2(47) – (49)).
Therefore, this report addresses the question: what
steps are needed to end the tobacco epidemic? There are
different ways to achieve this vision. Should the emphasis
be on ending cigarette use?; ending the use of the
most harmful tobacco products while reducing the harm
of remaining products?; or ending the use of all tobacco
products?
The scientific findings of the 2012 Surgeon General’s
report (USDHHS 2012) show that there are evidence-based
strategies that can rapidly drop initiation and prevalence
rates of smoking among youth to single digits. To reach
this target, these strategies need to be fully implemented
and sustained with sufficient intensity and duration. Without
such increased and sustained action, 5.6 million youth
younger than 18 years of age in this country today are projected
to die prematurely from a smoking-related illness.
But millions of these projected deaths could be averted,
making tobacco control a highest priority in our overall
public health commitment and strategy.
The scientific evidence is incontrovertible: inhaling
the combustion compounds from tobacco smoke,
particularly from cigarettes, is deadly. It has been stated
that “The cigarette is also a defective product, meaning
not just dangerous but unreasonably dangerous, killing
half its long-term users. And addictive by design” (Proctor
2013, p. i27). As the list of diseases caused by smoking has
continued to increase, the updated estimate of the annual
number of deaths attributable to smoking and exposure to
secondhand smoke is now approaching 500,000 (Chapter
12). This increase has occurred despite decreases in per
capita cigarette consumption and prevalence of smoking,
emphasizing our enhanced understanding of the increased
lethality of cigarettes. The high risks of cigarette smoking
and the historic and current patterns of tobacco use in the
United States lead to a primary conclusion of this report:
• The burden of death and disease from tobacco use in
the United States is overwhelmingly caused by cigarettes
and other combusted tobacco products; rapid
elimination of their use will dramatically reduce this
burden.
Could the use of cigarettes and other combusted
tobacco products be rapidly reduced in this country? As