摘要：In August 2002, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH) was charged with developing recommendations to substantially increase rates of tobacco cessation in the United States. The subcommittee’s report, A National Action Plan for Tobacco Cessation , outlines 10 recommendations for reducing premature morbidity and mortality by helping millions of Americans stop using tobacco. The plan includes both evidence-based, population-wide strategies designed to promote cessation (e.g., a national quitline network) and a Smokers’ Health Fund to finance the programs (through a $2 per pack excise tax increase). The subcommittee report was presented to the ICSH (February 11, 2003), which unanimously endorsed sending it to Secretary Thompson for his consideration. In this article, we summarize the national action plan. WE FACE A NATIONAL imperative to reduce tobacco use in America. A confluence of circumstances and events make this an ideal time to take bold, effective steps to achieve this goal. At a time when health care dollars are scarce, tobacco-related diseases cost $150 billion each year. 1, 2 At a time when numerous effective tobacco dependence treatments exist, millions of tobacco users are unable to obtain or afford such treatments, nor do clinicians systematically address tobacco use with every patient. 3– 6 At a time when sound scientific research reveals strategies certain to reduce tobacco use, 7– 9 funding sources such as the Master Settlement Agreement are being used to address budget shortfalls rather than to implement effective tobacco control programs. 10, 11 At a time when the devastating health impact of tobacco has been exhaustively documented, the tobacco industry continues to entice adolescents and adults into tobacco dependence through an $11.2 billion advertising and promotion effort. 12, 13 Unless the prevalence of tobacco use is reduced dramatically, about 25 million Americans, 1 of 2 current smokers in the United States, will die prematurely of a disease caused by their dependence on tobacco, 14 shortening lives by an average of 13 to 14 years. 1 Furthermore, it is estimated that approximately 5 million American children living today will die prematurely as a result of tobacco-related diseases. 15 Moreover, the adverse health effects of tobacco use are inflicted disproportionately on individuals of lower socioeconomic status and on members of certain racial and ethnic minority groups. 16– 18 Finally, recent research has led to a greater understanding of the health effects of environmental tobacco smoke, 19, 20 making tobacco cessation of vital importance to family members, coworkers, and others who come into contact with environmental tobacco smoke. In recognition of the profound costs of tobacco use, in 2002 Tommy G. Thompson, secretary of the US Department of Health and Human Services, requested that the US Interagency Committee on Smoking and Health (ICSH) establish a subcommittee on cessation to craft a set of bold, evidence-based recommendations for promoting cessation in the United States. The subcommittee met on 5 occasions between October 2002 and January 2003, including 3 regional meetings at which public input was solicited. A comprehensive review of available evidence-based strategies supplemented by public input guided the development of the subcommittee’s 10 recommendations. On February 11, 2003, the report produced by the subcommittee was unanimously endorsed by its parent committee, the ICSH, chaired by Surgeon General Richard Carmona, and sent to Secretary Thompson for his consideration. This essay summarizes the subcommittee’s report. The subcommittee developed a national tobacco cessation action plan that (1) targets meaningful reductions in both tobacco use and its human and economic costs; (2) relies on the strongest scientific evidence; (3) addresses disparities in tobacco use; (4) is national in scope and regional in application; (5) includes public–private partnerships; (6) targets both immediate and sustained effects of tobacco use; (7) is comprehensive and integrated, with each component having an independent impact; (8) is regularly evaluated; and (9) is securely funded. The plan was designed to reduce tobacco use by a minimum of 10% in its first year; that is, 5 million smokers will quit in the first year. This target was chosen because of its significant public health benefit and its feasibility. As a consequence of this reduction in tobacco use, the plan will prevent approximately 3 million premature deaths through the avenues of smoking cessation and prevention of smoking initiation (F. J. Chaloupka, oral and written testimony to Subcommittee on Cessation, December 3, 2002, and December 20, 2002). The National Action Plan for Tobacco Cessation comprises 10 recommendations and includes both federal initiatives and public–private partnership opportunities. In this article, we describe the 6 federal recommendations in detail (Figure 1 ▶ ) and summarize the 4 public–private partnership recommendations. Open in a separate window FIGURE 1— Federal initiatives in the National Action Plan for Tobacco Cessation.
