A time for conceptual stocktaking

The Surgeon-General's report, by redefining the nature of the tobacco problem, invites a re-examination both of our goals and of our concepts and categories of tobacco use. A crucial pre-requisite to the acceptability of the development of refined nicotine-containing products, and of long-term nicotine maintenance therapy, will be progress in understanding the health risks of nicotine use per se. A broader conceptualization of prevalence and cessation is urged, one which takes account of cigar and pipe smoking as well as cigarettes. In addition to increasing overall prevalence somewhat, this approach drastically alters estimates of cessation rates, and indicates that the often-claimed gender difference in cessation is myth rather than reality. An analysis which combines social class and housing tenure as conjoint indicators of socio-economic position sharpens class gradients of smoking prevalence and shows that smokers are still comfortably in the majority among substantial groups of the population in the UK. Future progress in lowering prevalence, and hence smoking-related disease, is increasingly going to depend on reaching the most disadvantaged members of society.