I am pleased to be wearing my public health hat. Sometimes I wear my clinician’s hat, and the two overlap quite a bit. Those of us who see ourselves as public health practitioners believe that we have a responsibility for developing and delivering smoking intervention treatments and policies which decrease risk for as many people as possible. That is the bottom line when we consider public health approaches.

Earlier we heard that a major problem is lack of success in smoking cessation for the poorer, less educated smokers in our country; and that is the issue on which I shall focus most of my comments. Attention to public health requires that we attend to those individuals who are most in need of assistance for making changes and are most able to benefit from our efforts. From a public health perspective, I believe that we do not necessarily lack appropriate and adequate interventions. There are in fact interventions which are effective for all groups of smokers when delivered as intended.

The problems in the public health arena are lack of adequate ways of delivering inter-ventions which are appropriate and acceptable to the providers and consumers who need them, and lack of adequate access to treatment. The latter includes lack of adequate methods of delivery. Improved methods of delivery improve access.

An optimal public health approach could improve delivery of services and access for all consumers. This approach includes five components: the first component, education for the smokers and providers about smoking treatment, is the most important aspect of public health. Education must be delivered in a form or mode which is acceptable to the target population. For example, for a low income adolescent inner city population, it is important for education and other interventions to be delivered in places where inner …