noted above, evidence-based strategies that can rapidly
drop youth initiation and prevalence rates down to single
digits have already been identified and used (USDHHS
2012). Chapter 14 reviews a broad range of well-defined
and effective interventions proven to reduce smoking
rates if implemented and sustained at funding levels consistent
with CDC’s recommended levels (Figure 4).
This and previous reports outline effective programs
and policies: raising the retail price of cigarettes and other
tobacco products, smokefree indoor air policies, highimpact
media campaigns, full access to cessation treatments,
and funding of comprehensive statewide tobacco
control programs at the CDC recommended levels.
However, these five actions are not all that needs to
be done. In considering options for reducing the health
burden caused by smoking, many additional recommended
actions have been defined in evidence reviews and
guidance documents discussed in this report. For example,
selected state experience suggests that all levels of government
can enhance revenue collection and minimize tax
avoidance and evasion through several promising policy
approaches, such as implementing a high-tech cigarette
tax stamp, improving tobacco licensure management,
and making the stamps harder to counterfeit. These state
practices could also be expanded to the national level with
a track and trace system. A track and trace system, in the
tobacco control context, is a system that can track goods
from manufacture to distribution to sale, identifying
points in the supply chain where taxes should be paid and
confirm payment. Implementing such systems would also
simultaneously retain the positive public health effects of
taxation and protect product regulation in the market.
There is no question that these proven interventions
need to be fully implemented and sustained at recommended
levels. In addition to initiatives of the federal government,
other factors in society can significantly affect
social norms. Portrayals of tobacco use in U.S. films appear
to have rebounded upward in the past 2 years (Chapter
14). In 2012, youth were exposed to an estimated 14.9
billion in-theater tobacco-use impressions1 in youthrated
films (Polansky et al. 2013).