Although tobacco use remains by far the most important cause of death and disability, it fails to “punch its weight” among the policy, research, and academic communities when compared with other conditions such as breast cancer, obesity, or autism. In part, this may be because smoking has been increasingly concentrated among the have-nots in our society: persons in low socioeconomic classes and those who suffer from mental illnesses and/or substance abuse disorders. And, in part, it reflects a conventional, but false, wisdom that the war against tobacco has been won. Although legacies of the historic relative inattention to smoking are embedded in the Federal agencies charged with promoting health, including the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration, Food and Drug Administration, and Health Resources and Services Administration, some recent progress has occurred. To achieve desired population health outcomes, there needs to be more direct focus on both helping smokers quit and preventing initiation of smoking. In addition, there are many important questions regarding how best to tailor smoking cessation interventions. These questions deserve the attention of those who work in public health agencies at the Federal and state levels.

Dr. Schroeder is Distinguished Professor of Health and Health Care, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, where he also heads the Smoking Cessation Leadership Center. The Center, funded by the Robert Wood Johnson Foundation (RWJF) and the American Legacy Foundation, works with leaders of more than 80 American health professional organizations and healthcare institutions to increase the cessation rate for smokers. It has expanded the types of clinician groups that support cessation, developed an alternative cessation message (Ask, Advise, Refer), created new ways to market toll-free telephone quit lines, and engaged the mental health treatment community for the first time. Between 1990 and 2002, he was President and Chief Executive Officer of RWJF. During that time, the Foundation made grant expenditures of almost $4 billion in pursuit of its mission of improving the health and healthcare of all Americans. It developed new programs in substance abuse prevention and treatment, care at the end of life, and health insurance expansion for children, among others. Dr. Schroeder graduated with honors from Stanford University and Harvard Medical School, and trained in internal medicine at the Harvard Medical Service of Boston City Hospital and in epidemiology as an Epidemic Intelligence Service Officer of the CDC. He held faculty appointments at Harvard, George Washington University, and UCSF. At both George Washington University and UCSF, he was the founding medical director of a university-sponsored HMO and, at UCSF, he founded its Division of General Internal Medicine. He has published extensively in the fields of clinical medicine, healthcare financing and organization, prevention, public health, the work force, and tobacco control. He is a former member of the editorial board of the New England Journal of Medicine, a Director of the James Irvine Foundation and the Robina Foundation, and Chair of the Health Care Services Board of the Institute of Medicine. He formerly chaired the American Legacy Foundation, was a Council member of the Institute of Medicine, an Overseer of Harvard, and President of the Harvard Medical Alumni Association.