Page 60 - Social Marketing for Public Health Global Trends and Success Stories

57977_CH02_final.qxd:Cheng 11/5/09 4:36 PM Page 33

United States: A Country Overview 33

In terms of demographics, smoking among this nation’s adults is highest
among American Indians/Alaska Natives (32%) followed by African Americans
(23%), whites (22%), Hispanics (15%), and Asians (10%); it is highest among
those with only a general education development (GED) diploma (46%) and
among adults living below the poverty level (31%; CDC, 2007).
Among youth, smoking is highest among whites (23%), followed by
Hispanics (17%). Factors associated with youth tobacco use include low socio-
economic status, approval of tobacco use by peers or siblings, smoking by par-
ents or guardians, accessibility and price of tobacco products, lack of parental
support or involvement, and low levels of academic achievement. Studies also
indicate that youth who smoke are more likely to perceive that tobacco use is the
norm, lack skills to resist influences, have a lower self-image or self-esteem, and
lack self-efficacy to refuse offers of tobacco. In addition, tobacco use in adoles-
cence is associated with many other health risk behaviors, including higher-risk
sexual behavior and use of alcohol and drugs (CDC, 2009).

Reducing Tobacco Use: Major Milestones and Strategies
In 1964, an Advisory Committee to the Surgeon General of the Public Health Service
declared in a seminal report that “Cigarette smoking is a health hazard of sufficient
importance in the United States to warrant appropriate remedial action” (IOM, 2007,
p. ix). As described in Ending the Tobacco Problem: A Blueprint for the Nation (IOM,
2007), noteworthy milestones and strategies eventually contributing to this decline in
the first decades following the 1964 Surgeon General’s report include:

1964–1988: Initial milestones and strategies
• Initial public education publicizing frightening findings about tobacco’s dangers.
• Advocacy by coalitions of voluntary health groups such as the American
Cancer Society, American Lung Association, and American Heart Association.
• Pharmacological approaches to cessation.
• School-based prevention programs, sometimes as a part of alcohol or other
substance abuse programs.
• American Medical Association testimonies before Congress regarding the
dangers of tobacco use.
• Advertising policies including an early Federal Communications Commission
(FCC) requirement that stations run one free counter-advertisement from
health groups for every three cigarette commercials that they aired and a law in
1971 banning all cigarette advertising on television and radio.
• Warning labels progressing from “Warning: Cigarette Smoking May Be
Hazardous To Your Health” to “SURGEON GENERAL’S WARNING:
Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May
Complicate Pregnancy.”