634 



considered at least as favorably by third-party payors as treatment of 

 alcoholism and illicit drug addiction. 



The challenge to health professionals is complicated by the array 

 of new nicotine delivery systems that are being developed and 

 introduced in the marketplace. Some of these products are produced 

 by tobacco manufacturers; others may be marketed as devices to aid 

 in smoking cessation. These new products may be more toxic and 

 more addicting than the products currently on the market. New 

 nicotine delivery systems should be evaluated for their toxic and 

 addictive effects; products intended for use in smoking cessation also 

 should be evaluated for efficacy. 



Public information ampaigns should be developed to increase 

 community awareness of the addictive nature of tobacco use. A 

 health warning on addiction should be rotated with the other 

 warnings now required on cigarette and smokeless tobacco packages 

 and advertisements. Prevention of tobacco use should be included 

 along with prevention of illicit drug use in comprehensive school 

 health education curricula. Many children and adolescents who are 

 experimenting with cigarettes and othci rorms of tobacco state that 

 they do not intend to use tobacco in later years. They are unaware of, 

 or underestimate, the strength of tobacco addiction. Because this 

 addiction almost always begins during childhood or adolescence, 

 children need to be warned as early as possible, and repeatedly 

 warned through their teenage years, about the dangers of exposing 

 themselves to nicotine. 



This Report shows conclusively that cigarettes and other forms of 

 tobacco are addicting in the same sense as are drugs such as heroin 

 and cocaine. Most adults view illegal drugs with scorn and express 

 disapproval (if not outrage) at their sale and use. This Nation has 

 mobilized enormous resources to wage a war on drugs — illicit drugs. 

 We should also give priority to the one addiction that is killing more 

 than 300,000 Americans each year. 



We as citizens, in concert with our elected officials, civic leaders, 

 and public health officers, should establish appropriate public 

 policies for how tobacco products are sold and distributed in our 

 society. With the evidence that tobacco is addicting, is it appropriate 

 for tobacco products to be sold through vending machines, which are 

 easily accessible to children? Is it appropriate for free samples of 

 tobacco products to be sent through the mail or distributed on public 

 property, where verification of age is difficult if not impossible? 

 Should the sale of tobacco be treated less seriously than the sale of 

 alcoholic beverages, for which a specific license is required (and 

 revoked for repeated sales to minors)? 



In the face of overwhelming evidence that tobacco is addicting, 

 policy-makers should address these questions without delay. To 

 achieve our goal of a smoke-. ree society, we must give this problem 

 the serious attention it deserves. 



C. Everett Koop, M.D., Sc.D. 

 Surgeon General 



