Giovino G A, Henningfield J E, Tomar S L, Escobedo L G, Slade J
Epidemiology Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 30341-3724, USA.
Epidemiol Rev. 1995;17(1):48-65. doi: 10.1093/oxfordjournals.epirev.a036185.
Knowledge of the epidemiology of tobacco use and dependence can be used to guide research initiatives, intervention programs, and policy decisions. Both the reduction in the prevalence of smoking among US adults and black adolescents and the decline in per capita consumption are encouraging. These changes have probably been influenced by factors operating at the individual (e.g., school-based prevention programs and cessation programs) and environmental (e.g., mass media educational strategies, the presence of smoke-free laws and policies, and the price of tobacco products) levels (for a discussion of these factors, see, e.g., refs. 2, 48, 52, 183, and 184). The lack of progress among adolescents, especially whites and males, and the high risk for experimenters of developing tobacco dependence present cause for great concern (48, 183-186). In addition to those discussed above, several areas of research can be recommended. 1. Better understanding of the clustering of tobacco use with the use of other drugs, other risk behaviors, and other psychiatric disorders could better illuminate the causal processes involved, as well as the special features of the interventions needed to prevent and treat tobacco dependence. 2. To better understand population needs, trend analyses of prevalence, initiation, and cessation should, whenever possible, incorporate standardized measures of these other risk factors. Future research should compare the effect of socioeconomic status variables on measures of smoking behavior among racial/ethnic groups in the United States. 3. For reasons that may be genetic, environmental, or both, some persons do not progress beyond initial experimentation with tobacco use (2, 48, 183, 187-192), but about one-third to one-half of those who experiment with cigarettes become regular users (48, 193, 194). Factors, both individual and environmental, that can influence the susceptibility of individuals to tobacco dependence need further attention. 4. To estimate their sensitivity and specificity, comparisons of the National Household Survey on Drug Abuse indicators of dependence with DSM-based criteria are needed. Public health action continues to be warranted to reduce the substantial morbidity and mortality caused by tobacco use (195). A paradigm for such action has been recommended and involves preventing the onset of use, treating tobacco dependence, protecting non-smokers from exposure to secondhand smoke, promoting nonsmoking messages while limiting the effect of tobacco advertising and promotion on young people, increasing the real (inflation-adjusted) price of tobacco products, and regulating tobacco products (186).
了解烟草使用和依赖的流行病学知识可用于指导研究计划、干预项目及政策决策。美国成年人和黑人青少年吸烟率的降低以及人均消费量的下降都令人鼓舞。这些变化可能受到个体层面（如学校预防项目和戒烟项目）和环境层面（如大众媒体教育策略、无烟法律法规和政策的存在以及烟草产品价格）因素的影响（有关这些因素的讨论，见参考文献2、48、52、183和184）。青少年，尤其是白人和男性在这方面缺乏进展，以及尝试吸烟的人有很高的发展为烟草依赖的风险，这令人深感担忧（48、183 - 186）。除上述讨论的内容外，还可推荐几个研究领域。1. 更好地理解烟草使用与其他药物使用、其他风险行为及其他精神疾病的聚集情况，有助于更清楚地阐明其中的因果过程，以及预防和治疗烟草依赖所需干预措施的特点。2. 为了更好地了解人群需求，患病率、开始使用和戒烟的趋势分析应尽可能纳入这些其他风险因素的标准化测量。未来的研究应比较社会经济地位变量对美国不同种族/族裔群体吸烟行为测量指标的影响。3. 由于可能是遗传、环境或两者共同作用的原因，一些人在烟草使用的初始尝试阶段之后就不再进展（2、48、183、187 - 192），但约三分之一到二分之一尝试吸烟的人会成为经常使用者（48、193、194）。个体和环境中能够影响个体对烟草依赖易感性的因素需要进一步关注。4. 为了评估其敏感性和特异性，需要将全国药物滥用家庭调查中的依赖指标与基于《精神疾病诊断与统计手册》的标准进行比较。继续有必要采取公共卫生行动以降低烟草使用导致的大量发病和死亡情况（195）。已推荐了这样一种行动范式，包括预防开始使用、治疗烟草依赖、保护不吸烟者免受二手烟暴露、在限制烟草广告和促销对年轻人影响的同时推广禁烟信息、提高烟草产品的实际（经通胀调整）价格以及对烟草产品进行监管（186）。
