“Debate” is a new series offering opposing sides of a continuing, controversial issue in tobacco control. In this and the next article, David Hill, director of the Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria, Australia and Matthew Myers, executive vice president of the National Center for Tobacco Free Kids in Washington, DC, USA, debate whether tobacco control programmes should be targeted principally at adults or the young.—ED

Population-wide tobacco control programmes should aim to reduce teenage and adult smoking. The strategic tobacco control question is about where to put emphasis and how to approach the problem. There are two perspectives from which to argue for an emphasis upon cessation of smoking in adults ahead of prevention of uptake in teenagers: the epidemiology-based and the psychology-based perspectives.

At the tenth world conference on tobacco or health in 1997, Professor Sir Richard Peto used an epidemiological argument that cessation programmes would give the earliest and biggest “dividend” in terms of early reduction of tobacco-related harm.1 Even if the exemplar effect of reduced adult smoking prevalence did not indirectly reduce uptake (and I argue that it does), programmes that increase the proportion of adults giving up smoking will restore to non-smoking status many of those who took up smoking as adolescents, probably with minimal tobacco-related health damage. I concede that this approach is not an adequate response to the evidence that tobacco exposure during youth may be more harmful, dose for dose, than it is in later life.2 On the other hand, the cessation-first approach is a response that gives added protection to the yet-to-be-born and the recently born from teratogenic, intra-uterine and environmental tobacco smoke (ETS) effects of parental smoking.3 4

From a psychological point of view, I argue that by making cessation-focused programmes most salient, …