This was a key finding of an NIH state-of-the-science panel convened this week to assess the available scientific evidence on tobacco use prevention, cessation, and control. Full text of the panel's draft state-of-the-science statement will be available later today at http://consensus.nih.gov, including the panel's identification of promising directions for future research.

The panel found that smoking cessation interventions/treatments such as nicotine replacement therapy, telephone quitlines, and counseling were individually effective, and even more effective in combination. The panel also concluded that there is strong evidence to support the effectiveness of economic strategies such as increasing the cost of tobacco products through taxes and reducing out-of-pocket costs for effective cessation therapies.

"It's important to recognize tobacco use as a serious, chronic health issue that requires sustained attention," said David F. Ransohoff, M.D., professor of medicine at the University of North Carolina at Chapel Hill and chair of the conference panel. "Quitting is a struggle, but researchers have learned a lot about what works to help people quit smoking. We need to make sure that effective interventions reach the people who need them most."

The panel found that one way to increase the use of effective treatments would be to better target interventions to address health disparities, recognizing that generic treatments are not appropriate for everyone. ?To increase demand for treatments we must motivate smokers to want them, expect them, and use them,? added Ransohoff.

The panel emphasized that preventing initiation to tobacco use is essential to reducing tobacco-related illness and death. Initiation to tobacco use occurs primarily during adolescence, with almost all adult daily smokers trying cigarettes before age 18. In fact, over 20 percent of 12th graders have smoked in the prior 30 days. The panel found that programs aimed at preventing tobacco use in youth are most effective when they utilize multiple approaches such as mass media campaigns and price increases through taxes on tobacco products.

The panel concluded that smokeless tobacco products were of great concern for three reasons: 1) smokeless tobacco use is associated with numerous health risks, 2) there are limited data about the effect of smokeless tobacco on public health, and 3) new products and aggressive marketing may increase use of smokeless tobacco in the United States. The panel stressed that more research is needed to determine the overall effect of marketing and use of these products.

The 14-member panel included experts in the fields of medicine, general and pediatric psychiatry, addiction medicine, nursing, social work, population science, cancer prevention, minority health and health disparities, clinical study methodology, clinical epidemiology, and a public representative. A listing of the panel members and their institutional affiliations is included in the draft conference statement. Interviews with panel members can be arranged by calling Kelli Marciel at 301-496-4819 or via e-mail to marcielk@od.nih.gov.

In addition to the material presented at the conference by speakers and the comments and concerns of conference participants presented during discussion periods, the panel considered pertinent research from the published literature and the results of a systematic review of the literature commissioned by the NIH Office of Medical Applications of Research (OMAR). The systematic review was prepared through the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Centers (EPC) program, by the RTI International-University of North Carolina Evidence-based Practice Center. The EPCs develop evidence reports and technology assessments based on rigorous, comprehensive syntheses and analyses of the scientific literature, emphasizing explicit and detailed documentation of methods, rationale, and assumptions. The evidence report on Tobacco Use: Prevention, Cessation, and Control is available at http://www.ahrq.gov/clinic/tp/tobusetp.htm.

The panel's statement is an independent report and is not a policy statement of the NIH or the federal government. The NIH Consensus Development Program, of which this conference is a part, was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner. NIH has conducted 118 consensus development conferences, and 28 state-of-the-science (formerly "technology assessment") conferences, addressing a wide range of issues. A backgrounder on the NIH Consensus Development Program process is available at http://consensus.nih.gov/forthemedia.htm.