Despite great strides in reducing cigarette smoking, tobacco use remains an important public-health challenge according to U.S. Surgeon General Vivek Murthy.

Murthy, who spoke with moderator USA Today medical reporter Liz Szabo on February 25 at the Newseum as part of Truth Initiative’s Warner Series, challenged youth to drive smoking rates down to zero.

In a wide-ranging discussion that touched on the merits of vaccination, ways to reduce the stigma associated with mental illness, and the value of creating walkable communities and play opportunities for children, Murthy said that the reduction in smoking rates in recent decades has been a tremendous public health success.

Still, he added, new challenges in the fight to end tobacco use have emerged in recent years, in particular when it comes to youth smoking.

Teen cigarette smoking rates hit a historic low of seven percent in 2015, but Murthy said that more work is needed. He particularly cited the rise of hookah and e-cigarette use among teens as a public-health problem.

“This is a very interesting time when it comes to tobacco use among youth,” he said, “because unlike 30 or 40 years ago, where the primary tension was on cigarettes and youth, we know now that there are other tobacco products that are being used more and more by high school and middle school students, and these include hookah and e-cigarettes as well.”

He noted the misperception that hookah is less harmful and warned against cultural acceptance of hookah, noting that at one point, cigarette smoking was everywhere.

“Smoking was in bars. It was in restaurants. It was on the cover of magazines. It was in movies. It was everywhere. That didn’t mean that smoking was safe. The same is true with hookah,” he said.

The Surgeon General also stressed the importance of bringing e-cigarettes under the jurisdiction of the Food and Drug Administration.

The agency first published a rule to regulate e-cigarettes in 2014 but has yet to finalize that rule. Truth Initiative has called on newly confirmed the FDA Commissioner Robert Califf to finish that process as his first act in office.

“The truth is, because they are not regulated, we don’t always know what’s in e-cigarettes,” Murthy said.

“That’s why the rule that the FDA is working on is so important,” he added. “It will help us understand the content of e-cigarettes and will help us in particular understand how to keep kids safe.”

During the discussion, Murthy took online and video questions submitted by students from around the country, as well as questions from middle school, high school and college students in the audience. He challenged today’s youth to keep pushing to reduce the rate of smoking.

“One thing I hope that you could help us achieve is getting tobacco use rates down to zero.” 

He estimated that nearly 500,000 lives would be lost in the U.S. this year due to smoking-related diseases.

“If we could eliminate tobacco use in America, we could save many, many lives, and that would be a tremendous crowning accomplishment for your generation,” he said.

The Warner Series is named for Dr. Ken Warner, an economist by training and distinguished professor at the University of Michigan School of Public Health and a former board member at Truth Initiative. Warner is one of the leading voices in tobacco control. The series honors his ongoing contributions by regularly bringing together leaders across the tobacco control, public health, and youth service communities to engage in thought-provoking conversations about ways we can innovate, and inspire action to save lives.