As many as 15% of all youths (aged 12-17) now smoke. Every day thousands of youths start smoking. The initiation of smoking is primarily an adolescent phenomenon; most young people begin experimenting with cigarettes at about 12 years of age. Hence, prevention efforts which are designed to motivate young people not to start smoking or to stop experimenting should have the highest priority. Such efforts are also the most effective approach for those adolescents who already smoke and for whom the cessation of tobacco use is easier before addictive habits are established.
Those who smoke 2 or more packs of cigarettes a day are 15 to 25 times more likely to die of lung cancer than are nonsmokers. They are also at a substantially greater risk for other smoking-related cancers, including cancers of the oral cavity, larynx, and esophagus. The proportion of heavy smokers has increased in the past 20 years. Almost one third of todays smokers consume at least 1 pack of cigarettes per day. Further, heavy smokers are less likely to give up smoking. They are harder to recruit and retain in a cessation program, and those who are successful in quitting are more likely to relapse. Community interventions can have a substantial impact on smoking prevalence. The Multiple Risk Factor Intervention Trial showed that long-term smoking cessation rates were considerably greater for heavy smokers who received multiple and intensive interventions.
Building on this concept, the STCP has chosen to concentrate on the potential that community interventions will have broad-reaching and long-term effects on the smoking behavior of heavy smokers. Smoking control interventions will be delivered through organizations and social institutions that naturally occur in the community, such as worksites, churches, synagogues, schools, and the media. This trial will be carried out in 22 separate communities in the US (including 2 in Canada), will affect millions of people, and last 9Vfc years. Communities will be the unit of analysis, and while the heavy smoker will be the prime focus, interventions will be aimed at all smokers in the community.