Glynn T J, Greenwald P, Mills S M, Manley M W
Division of Cancer Prevention and Control, National Cancer Institute, Rockville, Maryland 20852.
Prev Med. 1993 Jul;22(4):568-75. doi: 10.1006/pmed.1993.1049.
Efforts to control tobacco use and tobacco-related morbidity and mortality in the United States continue to be generally successful. In the quarter century since the publication of the first Surgeon General's Report on Tobacco and Health, adult smoking rates in the United States have been reduced by nearly 34%. Controlling tobacco use among our nation's youth, however, has not been as successful. Although there was considerable success in reducing adolescent tobacco use in the late 1970s and early 1980s, tobacco use among youth has remained essentially stable for the past decade.
The health and economic burden of tobacco use, current knowledge about youth tobacco use, and youth-related national tobacco reduction goals for the Year 2000 are reviewed.
Analysis of the research of the past two decades clearly indicates that there is no "magic bullet" in existence or in sight for the reduction of tobacco use, either among youth or among adults. This does not mean that opportunities for significant advances through, for example, pharmacological therapies or the broad application of media or policy strategies should not continue to be explored, but that for the moment no single approach appears to work best. Rather, a comprehensive approach that applies multiple prevention and cessation strategies simultaneously appears to be most effective in tobacco use control.
Among youth, the combination of tobacco control strategies that may work best includes those that involve the family, primary care physicians, and other health professionals such as nurses and dentists; programs that are carried out in schools and/or through the media; and societal approaches such as access and advertising restrictions and increased taxes.
美国在控制烟草使用以及与烟草相关的发病率和死亡率方面的努力总体上持续取得成功。自第一份《美国卫生总监关于烟草与健康的报告》发布后的四分之一世纪里，美国成年人的吸烟率已降低了近34%。然而，在我国青少年中控制烟草使用却没有那么成功。尽管在20世纪70年代末和80年代初减少青少年烟草使用方面取得了相当大的成功，但在过去十年中，青少年的烟草使用基本保持稳定。
回顾了烟草使用的健康和经济负担、关于青少年烟草使用的现有知识以及2000年与青少年相关的全国烟草减少目标。
对过去二十年研究的分析清楚地表明，无论是在青少年还是成年人中，都不存在或看不到能减少烟草使用的“神奇方法”。这并不意味着不应继续探索通过例如药物疗法或广泛应用媒体或政策策略取得重大进展的机会，而是目前没有单一方法似乎效果最佳。相反，一种同时应用多种预防和戒烟策略的综合方法在控制烟草使用方面似乎最有效。
在青少年中，可能最有效的烟草控制策略组合包括涉及家庭、初级保健医生以及护士和牙医等其他卫生专业人员的策略；在学校和/或通过媒体开展的项目；以及诸如限制获取和广告以及提高税收等社会方法。
