It shouldn't take another 50 years: accelerating momentum to end the tobacco epidemic.

Many thought it could never happen. In an action once considered inconceivable, the major pharmacy chain CVS Caremark recently announced that it will stop selling all tobacco products throughout its 7,600 outlets nationwide (1). Declaring that the sale of tobacco represented an unacceptable paradox for a business trying to promote health, CVS Caremark leaders began phasing out tobacco sales in February 2014 andwill end all such sales byOctober 2014. And thus a new social norm has come to pass. As extraordinary as it was, this private sector action represents only one of three major milestones that have already made 2014 a standout year for tobacco control. A second milestone was the release of The Health Consequences of Smoking—50 Years of Progress (2). On one hand, the 50th Anniversary Report noted striking advances over the past half century. Since 1964, the country has witnessed declining adult per capita cigarette consumption by more than 70%, and the prevalence of adult smoking has decreased by over half [from42.7% (1964) to 18.1% (2012)]. Tobacco control hashelped to avert at least eightmillion earlydeathsover that period. Furthermore, the incidence of lung cancer, an uncommon disease in the early 20th century, which then increased markedly to become the leading cause of cancer death, has begun a decline, first among men and more recently among women. And of note, the report states that quitting smoking improves the prognosis of cancer patients. But the new report also summarizes major challenges for the future. More than 42 million smokers still struggle with tobacco dependence, and 16 million current and former smokers live with smoking-related illnesses (2). New estimates now indicate annual tobacco-related deaths approach half a million in the United States, with more than five million a year worldwide. Fifty years after the first Surgeon General’s Report, evidence now links tobacco as a new causal factor for malignancies, such as colorectal cancer and liver cancer, as well as nonmalignant conditions, such as diabetes mellitus and rheumatoid arthritis. And in a startling conclusion, the report states that 5.6 million youth alive today will die prematurely because of tobacco dependence if we continue at current smoking rates. The 50th Anniversary Report urges enhanced attention to both new and proven strategies for tobacco control tomake the next generation tobacco free. Such strategies are sorely needed as the tobacco industry spends $8 billion a year— nearly a million dollars an hour—to advertise and market cigarettes and smokeless tobacco, thereby outspending current state tobacco control programs by a factor of 18 to 1. Last year, customers consumed over 14 billion packs of cigarettes, and over time these cigarettes have becomemore complex and more addictive, and the risks from smoking have become more deadly. Furthermore, each year the tobacco industry adds to an ever-growing array of novel products, such as flavored small cigars and e-cigarettes, that may have special appeal to young people. In particular, significant questions remain about the net public health benefits of e-cigarettes. In short, the 50th Anniversary Report underscores again that tobacco dependence represents a pediatric disease. Of note, most smokers start before age 18, with themedian age for initiation being only 13 years of age. And for each adult who succumbs to tobacco, two younger replacement smokers stand ready to take their place, thereby perpetuating a cycle of dependence. Too many kids still routinely see tobacco use everywhere and assume it is part of the social norm. Half of the U.S. states still lack comprehensive smoke-free laws for public places. Images glamorizing tobacco use still reach kids through the Internet, at retail stores, and in movies (3). And because tobacco causes damage that may be unseen until many years later, youth can easily dismiss the risks involved. To capture their attention, vulnerable kids need to see, and feel, what the true risks of tobacco actually are. That’s why the third major 2014 tobacco control milestone, the February launch of a $115-million mass media youth prevention campaign by the U.S. Food and Drug Administration (FDA), represents yet anothermajor opportunity to reduce tobacco use. Entitled "The Real Cost," this media campaign has been constructed based on critical scientific and marketing research on how best to reach atrisk youth. The campaign,whichwill extendover a periodof a year, vividly and viscerally conveys graphic messages about tobacco use, building on lessons learned from previous successful national and statewide mass media campaigns. The FDA campaign will have a rigorous evaluation, involving thousands of youth. Other notable related events include the unveiling by the Centers for Disease Control Author's Affiliation: Assistant Secretary for Health, U.S. Department of Health and Human Services