Population-based tobacco control: Progress and prospects

One in four U.S. adults smokes. Downstream cognitive behavioral interventions coupled with effective pharmacotherapy can produce 40% quit rates, particularly for those least addicted, most highly motivated, and without psychiatric comorbidity. Effective midstream school-based prevention activities delay youth use. Worksite programs and physician "quit smoking" advice can be cost-effective, although these are not sufficiently widespread. Community strategies show promise of preventing youth use and helping addicted users quit. Despite failed federal tobacco control legislation, great strides have been made upstream, including proposed regulation of nicotine as a drug, the state master settlement agreement with the tobacco industry, and excise tax increases funding state wide tobacco control programs. Wider dissemination of effective programs and better coordination with upstream policies hold great potential to significantly reduce future use rates and related disease.