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...designing effective training strategies. Although the majority of respondents agreed that tobacco use constitutes relevant public health problem, they did not perceive tobacco control to be a public health priority. Academic institutions may not be properly training public health students, and may therefore be missing the opportunity to advance tobacco control at the national and global levels.
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The need for effective tobacco control initiatives has been sufficiently established. Smoking continues to be the single most important cause of preventable death in the US, responsible for 440,000 deaths yearly (CDC, 2002). Globally, tobacco kills almost 5 million people annually, and by the year 2030, smoking will be responsible for 10 million deaths per year. This represents higher mortality than that caused by AIDS, tuberculosis, traffic accidents, killings, and suicides altogether (World Health Organization, 2002).
One of the US public health objectives for the year 2010 is to reduce the prevalence of cigarette smoking among adults to [less than or equal to] 12% (objective 27.1a) (USDHHS, 2000). Despite the consistent decline in smoking prevalence from 25% in 1993 to 22.8% in 2001, a recent study by the CDC estimated that overall prevalence is not decreasing at a rate that will meet the national health objective by 2010. The study recommends an increased emphasis on state-level comprehensive tobacco control programs (CDC, 2003). Such programs consist of a combination of interventions and initiatives with the goal of reducing tobacco-related disease, disability, and death.
PUBLIC HEALTH STUDENTS AND TOBACCO CONTROL
The response of public health to the devastating consequences of tobacco use includes the implementation of "evidence-based" state and community level interventions that involve education, prevention and smoking cessation programs for youth and adults, advocacy and policy development, and counter-marketing campaigns. In this context, "evidence-based" implies strong evaluation and management components (CDC, 1999).
The CDC's recommendations mean that states willing to implement comprehensive programs must rely on highly skilled personnel and support staff. Best Practices for Comprehensive Tobacco Control Programs, the CDC's sponsored guide for planning and implementing state level programs, consists of a multifaceted intervention aimed at: 1) preventing the initiation of tobacco use among young people, 2) promoting quitting among young people and adults, 3) eliminating nonsmokers' exposure to environmental tobacco smoke (ETS), and 4) identifying and eliminating the disparities related to tobacco use and its effects on different population groups. The CDC recommends that programs implement all nine components of comprehensive tobacco control programs identified in the guide (CDC, 1999) (see Figure 1).
Figure 1. Nine components of comprehensive tobacco control programs. 1. Community Programs to Reduce Tobacco Use 2. Chronic Disease Programs to Reduce the Burden of Tobacco-Related Diseases 3. School Programs 4. Enforcement 5. Statewide Programs 6. Counter-Marketing 7. Cessation Programs 8. Surveillance and Evaluation 9. Administration and Management
The complexity of comprehensive, evidence-based, multilevel programs require the active involvement of public health professionals with specific training in tobacco control. How are public health training institutions responding to the challenge? A recent survey conducted by the Association of Schools of Public Health (ASPH) among its 32 member schools found that, although the majority of the institutions that answered the survey (81%) offered "some kind of tobacco-related education and training," only about half of them offered tobacco-related courses in which students could earn academic credit hours. More significantly, during the academic year 2001-2002, less than 5% of all master's and doctoral students were involved in tobacco-related studies. There were no schools offering tracks for academic specialization in tobacco use prevention and control (ASPH, n.d.). Although ASPH members may not constitute a comprehensive representation of...
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