Community and clinical strategies for tobacco control

Tobacco promoters and advocates of tobacco control have struggled with each other for almost 400 years. While the argument for tobacco control over most of this time period was that the use of tobacco leads to moral decay, research from the last 50 years demonstrates that tobacco represents a significant health risk to the user and that environmental tobacco smoke represents a significant health risk to anyone who is exposed. The dominant finding arising from tobacco control research is that no single intervention is capable of counteracting the aggressive promotion campaigns of the tobacco industry. Instead, a broad-based, comprehensive program needs to be implemented that includes both clinical and community interventions. Clinical efforts need to focus on systematic reinforcement of self-directed quit attempts while community programs need to include at least the following components: smoking cessation messages from health care providers, increased excise tax on tobacco, increased regulation of tobacco advertisements and promotions, coordinated mass media anti-smoking campaigns, elimination of smoking in public places and work sites, tobacco education in school health education programs, and control of youth access to tobacco. It has been suggested that health care community support is necessary if local tobacco control initiatives are to overcome the tobacco industry's superior financial resources. The health care community needs to keep this fact in mind and act accordingly.