WASHINGTON -- A combination of increased excise taxes, nationwide indoor smoking bans, and other measures would significantly lower the U.S. smoking rate, which now hovers at around 21 percent of the adult population, says a new report from the Institute of Medicine. But to achieve faster, more certain reductions, the U.S. Food and Drug Administration (FDA) should be given broad regulatory authority over tobacco marketing, packaging, and distribution, and other revisions to current tobacco policy should be enacted, said the committee that wrote the report.

Although smoking in the United States has declined by more than 50 percent since 1964, tobacco use still claims about 440,000 lives every year, and secondhand smoke causes another 50,000 deaths annually. Smoking-related health costs are estimated to be $89 billion a year.

The report proposes a two-pronged approach to further reduce tobacco use in the United States. The first element focuses on strengthening existing tobacco control measures to preserve and enhance the gains already made. The committee's recommendations include:

• Increasing the federal excise tax on cigarettes substantially, and boosting taxes in states with lower rates to achieve greater parity in prices nationwide and thwart interstate smuggling.
• Dedicating $15 to $20 per capita annually of the proceeds from higher taxes or other resources to fund tobacco control efforts in each state.
• Imposing smoking bans in all nonresidential indoor settings nationwide, including restaurants, bars, malls, prisons, and health care facilities.
• Requiring all public and private health insurance plans to make coverage of smoking cessation programs a lifetime benefit.
• Licensing retail outlets that sell tobacco products.
• Launching additional efforts aimed at curbing youth interest in smoking and access to tobacco, including bans on online sales of tobacco products and direct-to
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