This week, the Institute of Medicine, a branch of the US National Academy of Sciences, released a 400-page comprehensive report (prepublication available here; 8 page summary brief available as pdf file here). It notes that the rates of adult smoking has dropped by more than 50% since 1965 and that the rates of high school students starting smoking are at all-time lows, but also that these trends appear to be flattening and that tobacco still accounts for an estimated >400,000 deaths each year in the US. The report calls for several significant changes, suggesting that state and local governments should ban smoking in malls, restaurants, and essentially nearly all public indoor spaces, and that the US FDA should regulate the marketing, packaging, and sale of tobacco products. This report also recommends an increase in federal taxes on cigarettes and a plan to gradually reduce the concentration of nicotine in cigarettes to a point below which they are no longer predictive. Some other highlights of the report recommendations include:

banning internet- and phone-based sales of tobacco products

requiring licensing of retail outlets that sell tobacco products

adding graphic picture warnings on cigarette packs, as is done in Canada now

restricting advertising to black and while only, text-based displays, and prohibiting tobacco companies from using terms like "light" and "mild" in their marketing

mandating all public and private health insurers to make smoking cessation programs a lifetime benefit

in addition to substantially raising federal taxes on tobacco products, raising taxes in states with lower tobacco tax rates in order to reduce the practice of inter-state smuggling

dedicating increased funds to tobacco control efforts

The goal of these efforts, according to Mr. Richard Bonnie, who is a law professor at the University of Virginia (who'd have suspected a Virginian would lead this campaign?) would be "reducing tobacco use so substantially that it no longer has a significant impact on public heath". A lofty goal, and one we'd all love to see. Let's hope at least some of these ideas get enough traction to move forward.