Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.

Chemotherapy and You: Support for People With Cancer, National Institutes of Health Publication 11-7156, focuses on how patients undergoing chemotherapy can manage their side effects, which symptoms to watch out for, and how to communicate effectively with their health care team.

This monograph is the first major update of adolescent smoking behavior since the groundbreaking reports of the Surgeon General and the Institute of Medicine in 1994. The authors of this National Cancer Institute (NCI) Monograph report some progress toward reducing tobacco use among adolescents but also highlight areas in which more efforts need to be made. Several chapters examine trends in adolescent smoking behavior, among all adolescents nationally, different racial/ethnic groups, and among adolescents residing in specific States. Other chapters examine these trends using different national surveys as data sources and different analytical methods. Finally, the remaining chapters present data on macro-level policies and factors that influence the initiation and maintenance of smoking behavior among adolescents. While this Monograph documents some successes in the reduction of youth smoking initiation in some States and localities, there remains a need for an ongoing and exhaustive search for solutions, followed by committed and successful application to enable the country to reach its goals in the area of adolescent smoking.

The decline in U.S. smoking prevalence since the publication of the first Surgeon General's Report in 1964 has been hailed as one of the greatest public health accomplishments of the past century. Forty four million Americans-almost half of those who ever smoked-have quit, and lung cancer death rates have decreased greatly as a result. As a nation, we've launched wide-reaching tobacco control programs in worksites, schools, communities, and all 50 states, and we've witnessed enormous shifts in social norms, policies, and public attitudes. Growth in clean indoor-air laws and smoking restrictions have made quit-smoking cues "persistent and inescapable," and new data shows that tobacco price increases and mass media cessation campaigns can significantly increase population quit rates. Over the last three decades, we have developed effective clinical treatments-psychosocial and pharmacological-and seen the publication and update of authoritative practice guidelines recommending evidence based treatments that, if universally applied, could double our national annual quit rate in a highly cost-effective way. Prospects for preventing and treating tobacco use and addiction have never been better. Yet the papers in this monograph, Those Who Continue to Smoke: Is Achieving Abstinence Harder and Do We Need to Change Our Interventions?, raise important questions about what it will take to build on the successes of the last century and, in particular, on the last few decades of research and practice. While efforts to promote tobacco cessation need to be part of a much broader national tobacco control strategy that emphasizes prevention, it is clear that the greatest gains in reducing tobacco-caused morbidity, mortality, and health care costs in the next 30 to 40 years will come from helping addicted smokers quit. Further declines in adult smoking are likely to strengthen prevention efforts as well, since adult smoking is a critical determinant of social norms and a vector for youth initiation. In this context, the findings presented in this monograph have important implications for the next generation of research and practice to help addicted smokers quit. Specifically, these papers and the findings they present indicate that helping more smokers quit will require: (1) developing more powerful treatments that can break through the 25% to 30% quit-rate ceiling achieved with our best existing treatments; (2) refining, targeting and tailoring treatments for high-risk populations; (3) greatly improving surveillance of quitting patterns and determinants; (4) developing combined clinical-public health approaches that harness synergies between evidence based clinical treatments, and macro-level policy and environmental cessation strategies; and (5) improving the use of and demand for treatments that work.

In the months immediately after January 1964, when Surgeon General Luther Terry released the first official Government report on smoking and health, cigarette consumption in the United States declined significantly. It was only the second time since the turn of the century that publicity about the hazards of smoking had produced a reduction in cigarette use. At that time, many leaders in the medical and public health arena assumed that, by providing the public with straightforward information about the dangers of smoking, they could discourage large numbers of people from using cigarettes. While the expected change in behavior did occur, it was far more limited than had been hoped-a reflection of the difficulty that individuals often experience when they attempt to alter a complex behavior such as smoking, especially one we now know to be addictive. The recognition that information alone would not eliminate tobacco use shifted the focus to strategies directed to the individual. This focus presumed, erroneously as it turned out, that the major determinants of smoking behavior were centered within the individual rather than sociologic in nature. Subsequent research and natural observation clearly demonstrated that behavior change correlated with changes occurring in the smoker's social and economic environment. This recognition has led to the adoption of public health strategies that now address the smoker's larger social environment while simultaneously offering programs of assistance for the individual. This volume provides a summary of what we have learned over nearly 40 years of the public health effort against smoking-from the early trial-and-error health information campaigns of the 1960'sto the NCI's science-based ASSIST project (the American Stop Smoking Intervention Study for Cancer Prevention), which began in the fall of 1991. Strategies To Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 1990's presents a historical accounting of these efforts as well as the reasons why comprehensive smoking control strategies are now needed to address the smoker's total environment and reduce smoking prevalence significantly over the next decade.

Just as the American Stop Smoking Intervention Study for Cancer Prevention (ASSIST) was a major shift in the National Cancer Institute's (NCI's) tobacco prevention and control research and dissemination efforts, this monograph is a significant departure from NCI's previous tobacco control monographs. For many, the ASSIST project represented a logical progression of NCI's phased-research approach to reducing tobacco use. For others, it represented a controversial and overly ambitious leap in a new direction. Similarly, this monograph departs from the traditional quantitative evidence review format to emphasize instead the practical, hands-on experience of program implementation. Traditional research investigators who defend the sanctity of the randomized clinical trial, many of whom were uncomfortable with ASSIST at its outset, will also be uncomfortable with the personal and anecdotal flavor of this monograph. Public health practitioners, on the other hand, as well as those investigators who have immersed themselves in the untidy world of implementation research, will appreciate the detailed historical accounts of the complexities, politics, and outright opposition encountered by the ASSIST team. The collective experiences described in this monograph provide a rich understanding of the gritty struggle against the powerful forces of the tobacco industry and its allies. For students in public health training programs, this work also provides a unique view of the world outside of academia, where commercial, political, and public health interests collide in a struggle to define the policies, norms, and practices that will affect the health of generations. Monograph 16 begins with the historical context of ASSIST and the scientific base that informed the design of the project. The conceptual framework and the development of organizational infrastructures for implementation and evaluation are then described. The heart of this monograph is the in-depth descriptions of ASSIST's media advocacy and policy development interventions and the challenges posed by the tobacco industry. The monograph concludes by describing ASSIST's contributions to tobacco control and other behavioral health interventions and the significant challenges that remain.

Exposure to environmental tobacco smoke (ETS) has been linked to a variety of adverse health outcomes. Many Californians are exposed at home, at work, and in public places. In the comprehensive reviews published as Reports of the Surgeon General and by the U.S. Environmental Protection Agency (U.S. EPA) and the National Research Council (NRC), ETS exposure has been found to be causally associated with respiratory illnesses-including lung cancer, childhood asthma, and lower respiratory tract infections. Scientific knowledge about ETS-related effects has expanded considerably since the release of the above-mentioned reviews. The state of California has therefore undertaken a broad review of ETS covering the major health endpoints potentially associated with ETS exposure: perinatal and postnatal manifestations of developmental toxicity, adverse impacts on male and female reproduction, respiratory disease, cancer, and cardiovascular disease. A "weight of evidence" approach has been used, in which the body of evidence is examined to determine whether or not it can be concluded that ETS exposure is causally associated with a particular effect. Because the epidemiological data are extensive, they serve as the primary basis for assessment of ETS-related effects in humans. The report also presents an overview on measurements of ETS exposure (particularly as they relate to characterizations of exposure in epidemiological investigations) and on the prevalence of ETS exposure in California and nationally. ETS, or "secondhand smoke," is the complex mixture formed from the escaping smoke of a burning tobacco product and smoke exhaled by the smoker. The characteristics of ETS change as it ages and combines with other constituents in the ambient air. Exposure to ETS is also frequently referred to as "passive smoking," or "involuntary tobacco smoke" exposure. Although all exposures of the fetus are "passive" and "involuntary," for the purposes of this review, in utero exposure resulting from maternal smoking during pregnancy is not considered to be ETS exposure.

This monograph is the eleventh volume in the Smoking and Tobacco Control series released by the National Cancer Institute (NCI). The National Association of County and City Health Officials (NACCHO) and the National Association of Local Boards of Health (NALBOH) are working with NCI in disseminating findings from this important publication. NACCHO is a nonprofit membership organization that serves all of the nearly 3,000 local public health agencies (LPHAs) in the nation's cities, counties, townships, and districts. The organization provides local health departments with education, information, research, and technical assistance on a variety of topics. It also facilitates partnerships among local, state, and federal agencies in order to promote and strengthen public health. NALBOH is an organization that represents the interests of local boards of health and assists those boards in assuring the health of the community. NALBOH enhances and supports all 3,200 local health boards across the country by providing linkages, networks, education, and training. It is also committed to promoting health and effective public health policy at all levels of government and also to strengthening the ability of health boards to develop tobacco control policy efforts. NACCHO and NALBOH constituents have unique roles in tobacco prevention and control. They often represent the local government infrastructure, and as such, they can play leadership roles in local policy development, implementation, and enforcement. For years, tobacco control legislation enacted at the city and county levels were much more stringent than those enacted at the federal or state level. However, few local communities were involved in implementing and managing actual public health programs to reduce tobacco use. This was seen primarily as a national or state responsibility. Fortunately, local communities have become more involved in recent years. This trend has been supported mainly by LPHAs, and both NACCHO and NALBOH have helped local communities become more involved in the development of public health policy.

This monograph, the fifth in the NCI Smoking and Tobacco Control series, provides important information for clinicians interested in reducing the tremendous burden of disease caused by cigarettes and other tobacco products. As health professionals we can and must contribute to this effort, both by assisting individual patient cessation and by contributing to broader tobacco control activities in our communities. Cigarette smoking is still this Nation's largest cause of premature death and disability and remains the only product that, when used as intended by the manufacturer, will kill the consumer. Every physician and dentist can and should become a smoking expert to counter the pervasive attempts by the tobacco industry to convince smokers and would-be smokers that smoking is desirable, sexy, or fun. We need to remind ourselves that for decades the cigarette industry blatantly used the medical profession in cigarette advertising and enticed entire generations into believing that smoking was safe. Even today, 30 years after it became known with overwhelming scientific certainty that smoking was a major health threat, cigarette advertisers still portray smoking as free from any significant health risk. Health professionals have been an integral part of the national effort to reduce smoking in the United States, and in fact, the first major smoking information campaign launched by the U.S. Public Health Service was based on changes in physicians' smoking behavior. However, we must do more.

The first great "public health revolution" in developed countries involved measures to control infectious disease, and now we are in the midst of the second revolution: the massive attack on chronic disease. In this revolution, the dramatic decline in cigarette smoking in the United States since 1964 stands out as the most striking success story, which is especially remarkable considering the fact that antismoking advocates play the part of David against the Goliath of the tobacco industry. Anti-tobacco forces, including public advocacy groups, have made steady advances in controlling the smoking epidemic despite the tobacco industry's greater expenditures to expand tobacco use. The industry's counterattacks continue with steadily increasing intensity; this points to a clear need to increase the scope and effectiveness of all existing educational and regulatory anti-tobacco strategies. This monograph on the Community Intervention Trial for Smoking Cessation (COMMIT) field experience meets this need extraordinarily well because organizing, activating, and empowering communities to take action against smoking surely stands as the most important strategy for use in public health campaigns that emphasize control of tobacco use. This monograph, Community-Based Interventions for Smokers: The COMMIT Field Experience, is one of an excellent series on various aspects of tobacco and health published since 1991 by the National Cancer Institute and the first to deal with community-based approaches. It reports exciting victories: (1) a modest decrease in smoking rates in light-to-moderate smokers, especially in the hard-to-reach categories of individuals of low educational attainment and (2) an impressive accomplishment in community empowerment.

The recent increase in cigar consumption began in 1993 and was dismissed by many in public health as a passing fad that would quickly dissipate. Recently released data from the U.S. Department of Agriculture (USDA) suggests that the upward trend in cigar use might not be as temporary as some had predicted. The USDA now projects a total of slightly more than 5 billion cigars were consumed last year (1997) in the United States. Sales of large cigars, which comprise about two-thirds of the total U.S. cigar market, increased 18 percent between 1996 and 1997. Consumption of premium cigars (mostly imported and hand-made) increased even more, an astounding 90 percent last year and an estimated 250 percent since 1993. In contrast, during this same time period, cigarette consumption declined 2 percent. This dramatic change in tobacco use raises a number of public health questions: Who is using cigars? What are the health risks? Are premium cigars less hazardous than regular cigars? What are the risks if you don't inhale the smoke? What are the health implications of being around a cigar smoker? In order to address these questions, the National Cancer Institute (NCI) undertook a complete review of what is known about cigar smoking and is making this information available to the American public. This monograph, number 9 in a series initiated by NCI in 1991, is the work of over 50 scientists both within and outside the Federal Government. Thirty experts participated in the multi-stage peer review process. The conclusions presented in the monograph represent the best scientific judgment, not only of the NCI, but also of the larger scientific community.

This, the eighth monograph in the Smoking and Tobacco Control series published by the National Cancer Institute (NCI), is in many respects also the most significant. Contained in this volume are new results from five of the world's largest prospective epidemiological studies defining the magnitude of disease risks caused by cigarette smoking. Thirty years ago, in January 1966, NCI published a similar monograph titled Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. The report of the Surgeon General's Advisory Committee on Smoking and Health had been released in 1964 and had relied extensively on data from prospective mortality studies to delineate the relationship between cigarette smoking and various chronic diseases. The 1966 NCI monograph provided a detailed examination of the outcomes of several of the large prospective mortality studies presented in the 1964 advisory committee report. At that time, the outcomes available from these studies were based on 3 to 6 years of follow up; with the exception of the American Cancer Society's (ACS) Cancer Prevention Study I (CPS-I), studies in the 1966 NCI monograph did not include substantial numbers of females. This monograph includes three new prospective mortality studies (CPS-II, the Nurses' Health Study, and the Kaiser Permanente Prospective Mortality study, provides the outcomes of the CPS-I study after 12 years of follow up, and provides 26 years of follow up of the study of U.S. veterans. Data from these studies provide the most comprehensive description of the disease consequences produced by smoking available to date and are accompanied by a detailed description of the changes in smoking behaviors of the U.S. population over the past century. Prospective mortality studies continue to play a critical role in quantifying the relative mortality risks of smoking for the individual as well as in estimating the overall disease burden caused by cigarette smoking in our society. The goal of this monograph is to facilitate both these tasks by providing, in one volume, comprehensive descriptions of smoking behaviors and the disease risks that result from those behaviors.

The National Institutes of Health Publication 10-6287, Pain Control: Support for People With Cancer, discusses pain control medicines and other methods to help manage pain, and addresses the physical and emotional effects of pain. Having cancer doesn't mean that you will have pain. But if you do, you can manage most of your pain with medicine and other treatments. This book discusses how to work with your health care team and others to find the best way to control your pain.

The National Institutes of Health Publication 12-5726 When Someone You Love is Being Treated for Cancer: Support for Caregivers provides caregivers with coping strategies to help them deal with the stress and anxiety associated with caring for cancer patients. It discusses communication skills, ways to get support, feelings, and the need for self-care. This is for you if you're helping your loved one get through cancer treatment. You are a "caregiver." You may not think of yourself as a caregiver. You may see what you're doing as something natural-taking care of someone you love. There are different types of caregivers. Some are family members, while others are friends. Every situation is different. So there are different ways to give care. There isn't one way that works best. Caregiving can mean helping with day-to-day activities such as doctor visits or preparing food. But it can also be long-distance, coordinating care and services for your loved one by phone or email. Caregiving can also mean giving emotional and spiritual support. You may be helping your loved one cope and work through the many feelings that come up at this time. Talking, listening, and just being there are some of the most important things you can do. Giving care and support during this challenging time isn't always easy. The natural response of most caregivers is to put their own feelings and needs aside. They try to focus on the person with cancer and the many tasks of caregiving. This may be fine for a short time. But it can be hard to keep up for a long time. And it's not good for your health. If you don't take care of yourself, you won't be able to take care of others.

The National Institutes of Health Publication 11-2059, Taking Time: Support for People with Cancer, addresses the millions of Americans alive today who have a history of cancer. It addresses the feeling and concerns of people with cancer and their families. For them, cancer has become a chronic (on-going) health problem, like high blood pressure or diabetes. Just like everyone, people who have cancer must get regular checkups for the rest of their lives, even after treatment ends. But unlike other chronic health problems, if you have cancer you probably won't need to take medicine or eat special foods once you have finished treatment. If you have cancer, you may notice every ache, pain, or sign of illness. Even little aches may make you worry. You may even think about dying. While it's normal to think these thoughts, it's also important to focus on living. Although some people do die of it, many with the disease are treated successfully. Others will live a long time before dying from it. So, try to make the most of each day while living with cancer and its treatment. This book was written to help you learn from other people with cancer. Many people have helped write this book-patients, their family members, and friends. You will see their comments in all sections of the book. Finding out how others respond to cancer might help you understand your own feelings. And learning how others manage the special problems that cancer brings might help you find ways to cope with the problems that come along for you.

When Your Brother or Sister Has Cancer: A Guide for Teens, National Institutes of Health Publication 06-5733: If your brother or sister has cancer, this book is for you. In this book you will hear from other teens who, like you, have a brother or sister with cancer, find out what has helped them, get ideas about people to talk with when you're upset or fell all alone, and learn a little about cancer and how it's treated. This book can't give you all the answers, but it can help you prepare for some of the things you might face. There is a team of people working hard to help your brother or sister get better. You should know that there are also many people available to help you. No one should go through this alone. This book provides information about cancer treatments, ways teens can talk to family and friends, how to connect with other teens, and where to find other resources for information and support. It includes a glossary of cancer terms and appendices explaining monitoring tests and members of the cancer team.

National Institutes for Health Publication 10-3408 Down Home Healthy Cooking: Recipes and Tips for Healthy Cooking address the concerns that African Americans suffer from higher rates of serious diseases like high blood pressure, Type 2 diabetes, heart disease and some types of cancer. African Americans suffer more serious health problems and die at an earlier age from these diseases. The good news is that eating a healthy diet and leading an active lifestyle promote good health and lowers the chances for getting these illnesses. A healthy diet includes fruits and vegetables, whole grains, fat-free or low-fat milk products, lean meats, fish, beans, eggs, and nuts. A healthy diet is also low in saturated fat, trans fat, cholesterol, salt and added sugars. Everyone has the power to make choices to improve his/her health. And eating right doesn't mean giving up our wonderful soul food. In fact, the basic staples of traditional soul food include lots of healthy vegetables: dark leafy greens, sweet potatoes, and high-fiber black eyed peas just to name a few. But they are often cooked with ingredients that add too much saturated fat, calories and salt to our diet. By making a few simple changes, you and your loved ones can enjoy the flavors of healthy down home cooking. The recipes and hints in this cookbook will help you get started.

The National Institutes of Health Publication 12-0856, Coping With Advanced Cancer: Support for People with Cancer, provides information for patients with end-stage cancer and discusses treatment options such as palliative care, clinical trials, hospice care, and home care, as well as symptom control. It addresses emotional concerns, communicating with friends and family, and living life to its fullest and with meaning. You've struggled with the diagnosis, treatment, and maybe the recurrence of cancer. Now doctors may have told you that you have advanced cancer. They may have said that your cancer is not responding to treatment and that long-term remission is no longer likely. Or they may have said they have run out of standard treatment options. However you learn the news, it can be devastating to you and your loved ones. Often it's hard to believe or accept at first. Having advanced cancer can bring anxiety and uncertainty to your life. But some people with advanced cancer live far longer than expected. And remember, you are still in control of your choices and actions. Having an advanced disease can be a time of personal growth. It can even be a time of second chances. Many people say they started to see life in a new way after learning that their cancer had progressed despite treatment. They realized the importance of making the most of each day. This booklet stresses four main points: Learning more about ways you can help yourself may ease some of your concerns; Your treatment may change, but as always, you deserve to ask for and receive good medical attention from your health care team and support from your caregivers; It's important to talk about your worries, frustrations, and problems, and get support from others. In fact, it may be one of the best things you can do for yourself; As your medical care changes, you still have many choices. You can choose the way you wish to live each day.

The National Institutes of Health Publication 02-5050, Cancer Clinical Trials: The Basic Workbook, features information about and different aspects of clinical trials. The self-modulated workbook, with its accompanying activities, will help readers understand why cancer clinical trials are important, how they work, how participant safety is protected, as well as some of the reasons so few adults participate in these trials. It is designed for individuals who want to develop a basic understanding of clinical trials. Scientific discoveries are providing more and more insights into the causes of cancer. Many of these successes are limited to the laboratory and have yet to be translated into improved care for people with cancer. Clinical trials are a critical part of the research process. Clinical trials help to move basic scientific research from the laboratory into treatments for people. By evaluating the results of these trials, we can find better treatments and ways to prevent, detect, and treat cancer. But very few adults with cancer-only 3 percent-participate in clinical trials. We need to test the best cancer prevention, detection, and treatment ideas in the shortest time possible, and this can only happen if more people participate in clinical trials. We know that most people understand very little about clinical trials. National Cancer Institute (NCI) research has shown that the general public is either unaware of clinical trials as a treatment/ prevention option or misinformed about the clinical trial process. The reasons for this lack of understanding are complex, and there is no simple solution. We do know, however, that there are many barriers that discourage both physicians and potential participants from taking part in clinical trials. By reading this workbook, you are already helping to overcome some of these barriers. Whether you are a cancer survivor, someone who works with people with cancer, or someone who is touched by cancer in another way-this workbook can help answer your questions about clinical trials. It will help you understand why cancer clinical trials are important, how they work, how the participants' safety is protected, and some of the reasons why more adults don't participate in trials. With this information, you can help people in your community make informed decisions about their cancer treatment and prevention options, including the option of participating in a clinical trial.

With this volume, the National Cancer Institute (NCI) presents the 17th monograph of the Tobacco Control Monograph series. This monograph documents the evaluation of a groundbreaking NCI program. The American Stop Smoking Intervention Study for Cancer Prevention, known as ASSIST, put into practice NCI's commitment to prevent and reduce tobacco use across all populations and age groups. ASSIST took evidenced-based interventions from controlled studies and implemented them in the larger community of 17 states. Its underlying rationale-that significant decreases in tobacco use could be realized only with interventions that changed the social environment such that smoking was non-normative-was a significant departure from previous tobacco control programs and in the vanguard of the "new" public health. Prior to ASSIST, few states addressed tobacco use at the population level. The ASSIST legacy remains today in the tobacco control professionals whose work continues to reduce the burden of disability and death caused by tobacco. ASSIST raised significant conceptual and practical challenges for its evaluation team. These challenges included context-dependent implementation and the diffusion of ASSIST and ASSIST-like interventions into non-ASSIST states. In addition, the evaluation did not begin until several years after ASSIST was implemented, and its budget was limited. What had been envisioned as a simple evaluation of a demonstration project became a complex evaluation effort that engaged a diverse group of scientists and practitioners and required numerous sources of data. The resulting evaluation successfully documented the effectiveness of ASSIST. It also validated the causal pathway described in NCI's 1991 Smoking and Tobacco Control Monograph 1: Strategies to Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 1990's-that comprehensive interventions can change the social environment of tobacco use and subsequently result in decreased tobacco use. This monograph stands alone as a documentation of the ASSIST evaluation and describes the challenges met in evaluating a program that was influenced by numerous forces outside the program's control. However, this monograph may also be viewed as a companion to NCI Tobacco Control Monograph 16, which reviews the ASSIST program in detail. Together these two monographs provide a detailed history and evidence base that document the success of an NCI initiative that began with a series of research hypotheses, tested those hypotheses with community-based interventions, and ultimately fielded a demonstration program that fundamentally changed tobacco use prevention and control in the United States. This volume and several future volumes in the Tobacco Control Monograph Series have important implications for research, practice, and policy in tobacco control as well as in other areas of public health. Lessons learned from tobacco prevention and control can be applied to a variety of public health issues, including physical activity, diet and nutrition, overweight and obesity, and substance abuse. NCI is committed to disseminating this cross-cutting knowledge to the widest possible audience so that others can benefit from the experience of the tobacco prevention and control community. By so doing, NCI is increasing the evidence base for effective public health interventions and improving the translation of research to practice and policy.

This monograph, Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine, is the 13th report published in the National Cancer Institute's (NCI) Smoking and Tobacco Control Program Monograph Series. One feature of this monograph is that it blends the old with the new. Monograph 7, The FTC Cigarette Test Method for Determining Tar, Nicotine, and Carbon Monoxide Yields of U.S. Cigarettes, covered the history of that protocol and recommended changes in its procedures. Chapter 2 of this publication cites this earlier monograph, brings us up to date on the FTC method, and provides additional suggestions as to what can be done to help alert the public to the dangers of smoking. The examination of the scientific literature on low-tar and low-nicotine cigarettes is not unique to this monograph. Several of the earlier volumes devoted one or more chapters to discussions of the various health aspects of tar and nicotine levels. However, this monograph includes more than just the study of amounts of tar and nicotine. Chapter 5 includes a discussion on the continued health risks to smokers, even those who smoke a low-tar/low-nicotine cigarette, while Chapter 2 describes how changes in the cigarette design affect an individual's smoking habit. Chapter 7 points out how the tobacco companies' advertisements have changed to match the emerging public preference for low-tar/low-nicotine cigarettes. This monograph is unique in another important aspect. For the first time, the authors who prepared the various chapters have had extensive access to the information gleaned from the internal documents of the tobacco companies. The tobacco industry files now open to the public and available on the Internet constitute some 33 million pages of formal and informal memos, meeting notes, research papers, and similar corporate documents. Included are marketing strategies that express the growing concern among the various tobacco companies of the potential loss of new recruits. This concern over the potential loss of market was due to the evolving public opinion that smoking is harmful to health and that it is related to many of the illnesses that smokers experience over the course of their lives. The singular message that has been delivered to the public-smoking causes cancer-is gradually being accepted by more and more people of all ages.

Smoking cessation is the principal means by which a current cigarette smoker can alter his or her future risk of disease. Prevention of smoking initiation among adolescents can reduce smoking prevalence, but adolescents contribute little to rates of smoking-related illness until they have been smoking for 30 or more years. Cessation is often examined at the individual level in order to deter-mine the effects of cessation interventions or to define individual predictors of who will or will not be successful in their cessation attempts. However, for these individual effects to create a substantive public health benefit, they must sum to create a significant change at the population level. Powerful interventions that affect only a few individuals will have little impact on disease rates, whereas weaker interventions that impact large numbers of smokers will have important and cumulative effects on disease rates. In addition, many interventions (e.g., price increases, changes in social norms, etc.) are delivered to the population as a whole rather than to individual smokers one at a time, and it is these population-based interventions that have formed the core of the tobacco control efforts currently underway in California, Massachusetts, and several other states. This volume examines cessation at the population level. By population level, we mean that all segments of society form the denominator for evaluation of the effectiveness of tobacco control interventions. Therefore, this volume relies heavily on representative surveys of smoking behaviors in state and national populations. By doing so, it defines measures of cessation that can be used to assess the effects of tobacco control programs or public policy changes on smoking behavior. It then uses those measures to identify who is quitting, who is being successful, who is being exposed to various tobacco control interventions, and which tobacco control interventions are proving effective.