International control of smoking and the US experience.

International data demonstrate convincingly that lung cancer death rates follow and parallel cigarette smoking prevalence rates in both men and women. Effective control of lung cancer and the many other diseases associated with smoking can be achieved only by continued reductions in smoking prevalence in developed countries and the arrestment of smoking in developing countries. Smoking control strategies can take the form of prevention programs, cessation programs, regulatory and legislative measures, and modifications in tobacco product composition. Because of uncertainties surrounding the efficacies of specific smoking control approaches, the National Cancer Institute recently initiated a major intervention research program to identify and assess the most promising strategies to reduce smoking prevalence in the general public and high-risk populations; heavy smokers, blacks, Hispanics, women, youth, and smokeless tobacco users. By 1990, trial results will be available to allow systematic application of smoking control strategies (demonstrations) using physicians and dentists, mass media, school programs, self-help materials, and the community as a laboratory. For a number of reasons, such approaches are strongly recommended over efforts to reduce cigarette tar and nicotine levels as the primary focus of lung cancer control.