1994 EXECUTIVE SUMMARY OF SURGEON GENERAL'S REPORT SGR944 Acknowledgements ACKNOWLEDGMENTS This report was prepared by the Department of Health and Human Services under the general direction of the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. David Satcher, M.D., Ph.D., Director, Centers for Disease Control and Prevention, Atlanta, Georgia. Jeffrey P. Koplan, M.D., M.P.H., Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Richard B. Rothenberg, M.D., M.P.H., Associate Director for Science, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Michael P. Eriksen, Sc.D., Director, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. The editors of the report were =============================== Cheryl L. Perry, Ph.D., Senior Scientific Editor, Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Gayle Lloyd, M.A., Managing Editor, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Frederick L. Hull, Ph.D., Technical Editor, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Contributing authors were ========================== David R. Arday, M.D., M.P.H., Preventive Medicine Specialist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Dennis V. Ary, Ph.D., Research Scientist, Oregon Research Institute, and President, Oregon Center for Applied Science, Eugene, Oregon. Michael Booth, Ph.D., Lecturer, Department of Public Health, University of Sydney, Sydney, Australia. Dee Burton, Ph.D., Associate Director for Media Research, University of Illinois at Chicago Prevention Research Center, School of Public Health, Chicago, Illinois. Frank J. Chaloupka IV, Ph.D., Assistant Professor, Department of Economics, The University of Illinois at Chicago, Chicago, Illinois. K. Michael Cummings, Ph.D., M.P.H., Director, Smoking Control Program, Roswell Park Cancer Institute, New York State Department of Health, Buffalo, New York. Joseph R. DiFranza, M.D., Director of Research, Fitchburg Family Practice Residency Program, Fitchburg, Massachusetts. Roselyn Payne Epps, M.D., M.P.H., Expert, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Jean L. Forster, Ph.D., M.P.H., Associate Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Gary A. Giovino, Ph.D., Chief, Epidemiology Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Elbert D. Glover, Ph.D., Director, Tobacco Research Center, Mary Babb Randolph Cancer Center, West Virginia University School of Medicine/Robert C. Byrd Health Sciences Center, Morgantown, West Virginia. Jack E. Henningfield, Ph.D., Chief, Clinical Pharmacology Branch, Addiction Research Center, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland. Lloyd Johnston, Ph.D., Program Director, Institute of Social Research, University of Michigan, Ann Arbor, Michigan. Laura Kann, Ph.D., Chief, Surveillance Research Section, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. R. Monina Klevens, D.D.S., M.P.H., Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Edward Lichtenstein, Ph.D., Research Scientist, Oregon Research Institute, Eugene, Oregon. Marc Manley, M.D., M.P.H., Chief, Public Health Applications Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Robert K. Merritt, M.A., Behavioral Scientist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. David E. Nelson, M.D., M.P.H., Medical Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Donald Nutbeam, Ph.D., Professor, Department of Public Health, University of Sydney, Sydney, Australia. Mario Orlandi, Ph.D., M.P.H., Chief, Division of Health Promotion Research, American Health Foundation, New York, New York. Cheryl L. Perry, Ph.D., Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Richard W. Pollay, Ph.D., Professor of Marketing and Curator, History of Advertising Archives, Faculty of Commerce, University of British Columbia, Vancouver, British Columbia. Edward T. Popper, D.B.A., Professor of Business Administration and Marketing, Dean, School of Business and Professional Studies, Aurora University, Aurora, Illinois. Jonathan M. Samet, M.D., Professor of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico. Herbert H. Severson, Ph.D., Research Scientist, Oregon Research Institute, Eugene, Oregon. Dana M. Shelton, M.P.H., Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Charles W. Warren, Ph.D., Sociologist, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. John K. Worden, Ph.D., Research Professor, Department of Family Practice and Office of Health Promotion Research, University of Vermont, Burlington, Vermont. Reviewers were ============== David G. Altman, Ph.D., Senior Research Scientist, Stanford Center for Research in Disease Prevention, Stanford University, Palo Alto, California. Karl E. Bauman, Ph.D., Professor, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, North Carolina. Richard F. Beltramini, Ph.D., Associate Professor, Department of Marketing, Arizona State University, Tempe, Arizona. Glen Bennett, M.P.H., Coordinator, Smoking Education Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. Neal Benowitz, M.D., Professor of Medicine, University of California at San Francisco, San Francisco, California. Gilbert J. Botvin, Ph.D., Professor and Director, Institute for Prevention Research, Cornell University Medical College, New York, New York. Robert G. Brubaker, Ph.D., Professor, Department of Psychology, Eastern Kentucky University, Richmond, Kentucky. David M. Burns, M.D., Professor of Medicine, University of California, San Diego School of Medicine, San Diego, California. Laurie Chassin, Ph.D., Professor, Arizona State University, Department of Psychology, Tempe, Arizona. Arden G. Christen, D.D.S., Professor of Oral Biology, Department of Oral Biology, Indiana University School of Dentistry, Indianapolis, Indiana. Robert J. Collins, D.M.D., M.P.H., Chief Dental Officer, Public Health Service, Indian Health Service, Rockville, Maryland. Gregory Connolly, D.M.D., M.P.H., Director, Massachusetts Tobacco Control Program, Massachusetts Department of Public Health, Boston, Massachusetts. K. Michael Cummings, Ph.D., M.P.H., Director, Smoking Control Program, Roswell Park Cancer Institute, New York State Department of Health, Buffalo, New York. Dorynne J. Czechowicz, M.D., Associate Director for Medical and Professional Affairs, Division of Clinical Research, National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland. Michael M. Daube, Public Service Commission, Perth, Australia. Ronald M. Davis, M.D., Chief Medical Officer, Michigan Department of Public Health, Lansing, Michigan. John Elder, Ph.D., M.P.H., Professor of Health Promotion, Graduate School of Public Health, San Diego State University, San Diego, California. Paul Fischer, M.D., Editor, Journal of Family Practice, Augusta, Georgia. Michael C. Fiore, M.D., M.P.H., Director, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison, Wisconsin. Brian R. Flay, D. Phil., Professor and Director, Prevention Research Center, School of Public Health, University of Illinois, Chicago, Illinois. Erica Frank, M.D., M.P.H., Assistant Professor, Department of Community Preventive Medicine/Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Betsy Gelb, Ph.D., Director, Institute for Health Care Marketing, and Professor of Marketing, University of Houston, Houston, Texas. Samuel S. Gidding, M.D., Associate Professor of Pediatrics, Northwestern University Medical School, Division of Cardiology, Children's Memorial Hospital, Chicago, Illinois. Thomas Glynn, Ph.D., Acting Associate Director, Cancer Control Science Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Ellen R. Gritz, Ph.D., Professor and Chair, Department of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. Sandra W. Headen, Ph.D., Assistant Professor of Research, Department of Health Behavior and Health Education, School of Public Health, Chapel Hill, North Carolina. Richard B. Heyman, M.D., Committee on Substance Abuse, American Academy of Pediatrics, and Suburban Pediatric Associates, Inc., Cincinnati, Ohio. David Hill, Ph.D., Director, Anti-Cancer Council of Victoria, Victoria, Australia. Thomas Houston, M.D., Director, Department of Preventive Medicine and Public Health, American Medical Association, Chicago, Illinois. John Hughes, M.D., Professor, Human Behavioral Pharmacology Laboratory, Departments of Psychiatry, Psychology, and Family Practice, University of Vermont, Burlington, Vermont. Saundra MacD. Hunter, Ph.D., Research Professor, Tulane University Medical Center, Department of Applied Health Sciences, School of Public Health and Tropical Medicine, New Orleans, Louisiana. Dushanka V. Kleinman, D.D.S., Deputy Director, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland. Norman A. Krasnegor, Ph.D., Chief, Human Learning and Behavior Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Edward Lichtenstein, Ph.D., Research Scientist, Oregon Research Institute, Eugene, Oregon. Douglas S. Lloyd, M.D., M.P.H., Associate Administrator for Public Health Practice, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland. Russell V. Luepker, M.D., M.S., Professor and Head, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. William R. Lynn, Public Health Advisor, Cancer Control Science Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Willard Manning, Ph.D., Professor, Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Stephen E. Marcus, Ph.D., Senior Epidemiologist, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland. J. Michael McGinnis, M.D., Deputy Assistant Secretary for Health, Office of Disease Prevention and Health Promotion, Department of Health and Human Services, Washington, D.C. Ann D. McNeil, Ph.D., Manager, Smoking Program, Health Education Authority, London, England. David Murray, Ph.D., Professor, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Thomas Novotny, M.D., M.P.H., Centers for Disease Control and Prevention Liaison Officer and Assistant Dean for Public Health Practice, School of Public Health, University of California, Berkeley South, Berkeley, California. Patrick O'Malley, Ph.D., Research Scientist, Institute for Social Research, Survey Research Center, University of Michigan, Ann Arbor, Michigan. Guy S. Parcel, Ph.D., Professor and Director, Center for Health Promotion and Research Development, University of Texas Health Science Center, Houston, Texas. Joseph Patterson, Director of Government Relations and Special Projects, American Cancer Society, Atlanta, Georgia. Terry F. Pechacek, Ph.D., Associate Professor, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York. Michael Pertschuk, J.D., Co-Director, The Advocacy Institute, Washington, D.C. John P. Pierce, Ph.D., Associate Professor and Head, Cancer Prevention and Control, University of California, San Diego, California. John M. Pinney, Chief Executive Officer, Corporate Health Policies Group, Bethesda, Maryland. Patrick Remington, M.D., State Medical Officer and Epidemiologist, Chronic Disease and Health Promotion Section, Wisconsin Department of Health and Social Services, Madison, Wisconsin. John W. Richards, Jr., M.D., Associate Editor, Journal of Family Practice, Augusta, Georgia. Julius Richmond, M.D., John D. McArthur Professor of Health Policy Emeritus, Harvard Medical School, Boston, Massachusetts. Nancy A. Rigotti, M.D., Assistant Professor of Medicine and Preventive Medicine, Harvard Medical School and Associate Director, Quit Smoking Service, Massachusetts General Hospital, Boston, Massachusetts. Jonathan M. Samet, M.D., Professor of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico. Thomas C. Schelling, Ph.D., Distinguished Professor of Economics and Public Affairs, Department of Economics/School of Public Affairs, University of Maryland, College Park, Maryland. Russell Sciandra, M.A., Project Manager, American Stop Smoking Intervention Study for Cancer Prevention, New York State Department of Health, Albany, New York. Donald R. Shopland, Coordinator, Smoking and Tobacco Control Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Vivian L. Smith, M.S.W., Acting Director, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Jesse Steinfeld, M.D., Surgeon General, U.S. Public Health Service, 1969, 1973, San Diego, California. Steve Sussman, Ph.D., Associate Professor, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Alhambra, California. Ira B. Tager, M.D., Professor of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California. Larry Wallack, Dr. P.H., Professor, School of Public Health, University of California at Berkeley, Berkeley, California. Kenneth E. Warner, Ph.D., Professor and Chair, Department of Public Health Policy and Administration, School of Public Health, University of Michigan, Ann Arbor, Michigan. Jeffrey Wasserman, Ph.D., Associate Director, Health Policy Research, SysteMetrics, Santa Barbara, California. Scott T. Weiss, M.D., Associate Professor of Medicine, Harvard School of Public Health, and Channing Laboratory, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts. Judith Wilkenfeld, J.D., Assistant Director, Division of Advertising Practices, Federal Trade Commission, Washington, D.C. Deborah M. Winn, Ph.D., Chief, Analytical Studies and Decision Systems Branch, Epidemiology and Oral Disease Prevention Program, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland. Ernst L. Wynder, M.D., President, American Health Foundation, New York, New York. Other contributors were ======================= Deborah Anker, M.A., Graphic Artist, Circle Solutions, Inc., McLean, Virginia. Victoria Agee, M.L.S., Agee Indexing Services, Albuquerque, New Mexico. Kelly L. Byrne, Word Processing Specialist, Circle Solutions, Inc., McLean, Virginia. Michele Chang, Special Assistant to the Director, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Jeffrey H. Chrismon, Computer Programmer, The Orkand Corporation, Atlanta, Georgia. Anita Cowan, M.L.S., Director, Information Systems and Services Group, Circle Solutions, Inc., McLean, Virginia. Karen M. Deasy, Assistant Director (Liaison), Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Washington, D.C. Susan R. Derrick, Editorial Assistant, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Alice A. DeVierno, M.L.S., Manager, Technical Information Center, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Elizabeth D. Eckl, M.S.L.S., Information Specialist, Circle Solutions, Inc., McLean Virginia. Joseph Gfroerer, Statistician, Division of Epidemiology and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland. Donna Gloria, Secretary, HCR Consulting Group, Atlanta, Georgia. Lakshmi M. Grama, M.L.S., Database Advisor, Circle Solutions, Inc., McLean, Virginia. Janet C. Greenblatt, Statistician, Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Washington, D.C. William A. Harris, Computer Specialist, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Lillian Hatch, M.S.L.S., Information Specialist, Circle Solutions, Inc., McLean, Virginia. Corinne G. Husten, M.D., M.P.H., Medical Officer, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Gwendolyn A. Ingraham, Writer-Editor, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. Jeffrey C. Johnson, Computer Specialist, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Doreen Johnson-Kloehn, M.A., Scientist, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Steven C. Joseph, M.D., Dean, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Sarah Knowlton, J.D., Attorney-Advisor, Office of the General Counsel, Centers for Disease Control and Prevention, Atlanta, Georgia. Kelli Komro, M.S.W., M.P.H., Doctoral Student, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Sushil Kriplani, M.A., Consultant, Minneapolis, Minnesota. Mark J. Leech, M.A., Information Specialist, Circle Solutions, Inc., McLean, Virginia. Peggy Lytton, Editor, Circle Solutions, Inc., McLean, Virginia. Karen McCloud, Editorial Assistant, HCR Consulting Group, Atlanta, Georgia. Bonnie L. Manning, Executive Secretary, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. William L. Marx, Technical Information Specialist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Daniel F. McLaughlin, Editor, Circle Solutions, Inc., McLean, Virginia. Jennifer A. Michaels, M.L.S., Technical Information Specialist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Nancy A. Miltenberger, M.A., Editor, Circle Solutions, Inc., McLean, Virginia. Kimberly J. Miner, Ph.D., Postdoctoral Fellow, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Paul D. Mowrey, M.S., Research Scientist, Battelle Memorial Institute, Atlanta, Georgia. Suong Nguyen, Student, School of Public Health, San Diego University, San Diego, California. Gwen J. Nunnally, Secretary, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Cathie M. O'Donnell, Project Director, Circle Solutions, Inc., McLean, Virginia. J.P. Peddicord, M.S., Computer Scientist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Richard Ray, Director of Computer Services, Circle Solutions, Inc., McLean, Virginia. John Robey, Word Processing Specialist, Circle Solutions, Inc., McLean, Virginia. Kathleen L. Schroeder, D.D.S., Associate Professor of Oral Pathology, West Virginia University School of Medicine, Morgantown, West Virginia. Maggie Shelby, Secretary, HCR Consulting Group, Atlanta, Georgia. Michael B. Siegel, M.D., M.P.H., Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Renee E. Sieving, M.S.N., Doctoral Student, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Michael J. Staufacker, M.P.H., Doctoral Student, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Scott L. Tomar, D.M.D., Dr.P.H., Epidemiologist, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Traci L. Toomey, M.P.H., Doctoral Student, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Laura Williams, Student, Northeast Ohio University College of Medicine, Rootstown, Ohio. Rebecca B. Wolf, M.A., Program Analyst, Office of Program Planning and Evaluation, Centers for Disease Control and Prevention, Atlanta, Georgia. Bao-Ping Zhu, Ph.D., Research Scientist, Battelle Memorial Institute, Atlanta, Georgia. ===========================================================