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The Paradox of Tobacco Control

David Satcher, MD, PhD; Michael Eriksen, ScD
JAMA. 1994;271(8):627-628. doi:10.1001/jama.1994.03510320067033.
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Under the best of circumstances, knowledge brings about changes in behavior and public policy. When thinking about what we know and what we have accomplished in the realm of smoking and health, we perceive a paradox. Decades of careful medical research have documented the hazards of smoking. Social scientists continue to investigate and define the factors that impede efforts to prevent the use of tobacco. We know that nicotine is an addictive substance and that our children are very vulnerable to this addiction. We know that smoking is the single greatest cause of death in the United States.1 Yet, we are still plagued by an entirely preventable problem, and this is the paradox of tobacco control.

To better understand this paradox and perhaps be better able to reconcile what we know and what we do, we have developed a framework that provides an organized approach to categorizing tobacco control


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