Preventing Chronic Disease: Investing Wisely in Health Revised August 2005 Preventing Tobacco Use (PDF–127K) Learn more about PDFs.

Preventing Tobacco Use

The Reality

• Tobacco use is the single most preventable cause of death and disease, causing approximately 440,000 premature deaths in the United States each year.¹
• Smoking harms nearly every organ in the body and can cause chronic lung disease, coronary heart disease, and stroke, as well as cancer of the lungs, larynx, esophagus, mouth, bladder, cervix, pancreas, and kidneys.²
• Nearly 70% of the more than 45.4 million American adults who smoke cigarettes want to quit. ^3,4
• Approximately 80% of adult smokers started smoking before the age of 18. Every day, more than 2,000 young people under age 18 become daily smokers. ^5,6
• If current smoking patterns in the United States persist, approximately 5 million of today’s children will die prematurely of tobacco-related diseases.⁷

The Cost of Tobacco Use

• Direct medical expenditures attributed to smoking total more than $75 billion per year. In addition, smoking costs an estimated $92 billion per year in lost productivity. ^1,8
• About 14% of all Medicaid expenditures are for smoking-related illnesses. ⁸
• Approximately 20 billion packs of cigarettes were sold in the United States in 2002. Each pack cost the nation an estimated $8.61 in medical care costs and lost productivity.⁹

How Tobacco Control Saves Lives

• A New England Journal of Medicine report noted that the California Tobacco Control Program was associated with 33,000 fewer deaths from heart disease from 1989 through 1997. ¹⁰ During this time, rates of lung cancer among men declined more rapidly in California than in other parts of the country, and rates of lung cancer among women in California declined, while they continued to increase elsewhere. ¹¹
• Following the establishment of the Massachusetts Tobacco Control Program, state rates of smoking during pregnancy dropped sharply, from 25% in 1990 to 13% in 1996. ¹² Eliminating smoking during pregnancy may lead to a 10% reduction in all infant deaths and a 12% reduction in deaths from perinatal conditions.¹³

Average Annual Number of U.S. Deaths Attributable to Cigarette Smoking, 1997–2001
(Total average number: 437,902)

Source: CDC. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States—1997–2001. MMWR 2005;54(25):625–8.

(A text version of this graphic is also available.)

How Tobacco Control Saves Money 

• Stopping the use of tobacco is the most cost-effective method of preventing disease among adults.¹⁴ Each smoker who successfully quits smoking reduces the anticipated medical costs associated with heart attack and stroke by an estimated $47 in the first year and $853 during the following 7 years.¹⁵
• An economic assessment found that a health care plan’s annual cost of covering treatment to help people quit smoking ranged from $0.89 to $4.92 per smoker, whereas the annual cost of treating smoking-related illness ranged from $6 to $33 per smoker.¹⁶

Effective Strategies

• CDC’s Best Practices for Comprehensive Tobacco Control Programs, based on effective strategies from states with comprehensive approaches, provides guidelines and funding estimates to help states establish highly effective tobacco control programs. ¹⁷
• These guidelines are further supported by the independent Task Force on Community Preventive Services, which strongly recommends increasing the price of tobacco products, conducting mass media campaigns, developing multi-component cessation interventions, reducing out-of-pocket costs for treatment, and instituting smoking bans and restrictions to reduce exposure to environmental tobacco smoke in public places. ¹⁸
• Funding comprehensive programs—as Arizona, California, Florida, Massachusetts, Oregon, and Washington have demonstrated— produces measurable progress toward meeting statewide tobacco control objectives, including declines in adult and youth smoking and per capita cigarette consumption, as well as declines in rates of exposure to secondhand smoke.
• The more states spend on comprehensive tobacco control programs, the greater the reductions in smoking. And the longer states invest in such programs, the greater and faster the impact.¹⁹

Hope for the Future

A mere 8% of the total available annual income from tobacco excise taxes and tobacco settlement payments would allow all state programs to be funded at CDC’s minimum recommended level. ²⁰ If states spent the minimum amount recommended by CDC on tobacco prevention and control, youth smoking rates would be reduced by an estimated 3% to 13.5%.²¹

Percentage of High School Students Who Currently Smoke Cigarettes,* United States, 1991–2004

*Smoking one or more cigarettes during the previous 30 days.

Sources: CDC. Cigarette use among high school students—United States, 1991–2003. MMWR 2004;53(23):499–502. CDC. Youth tobacco surveillance—United States, 1998–1999. MMWR 2000;49(SS-10):1–94. CDC. Youth tobacco surveillance—United States, 2000. MMWR 2001;50(SS-04):1–84. CDC. Tobacco use access and exposure to tobacco in media among middle and high school students—United States, 2004. MMWR 2005;54(12):297–301.

(A text version of this graphic is also available.)

Supporting References

1. CDC. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001. MMWR 2005; 54(25):625–628.
2. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
3. CDC. Cigarette smoking among adults—United States, 2000. MMWR 2002; 51(29):642–645.
4. CDC. Cigarette smoking among adults—United States, 2003. MMWR 2005; 54(20):509–513.
5. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.
6. SAMHSA. 2003 National Survey on Drug Use and Health. Table 4.18A, Numbers (in thousands) of persons who began daily cigarette use in the United States, their mean age at first use, and rates of first use (per 1,000 person-years of exposure): 1965–2002, based on 2002 and 2003 NSDUHs. Available at http://www.oas.samhsa.gov/nhsda/2k3tabs/Sect4peTabs1to60.htm.
7. CDC. Incidence of initiation of cigarette smoking—United States, 1965-1996. MMWR 1998; 47(39):837–40.
8. CDC. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995–1999. MMWR 2002; 51(14):300–3.
9. CDC. Sustaining State Programs for Tobacco Control: Data Highlights 2004. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
10. Fitchtenburg CM, Glantz SA. Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. New England Journal of Medicine 2000;343(24):1772–1777.
11. CDC. Declines in lung cancer rates—California, 1988–1997. MMWR 2000; 49(47):1066–1069.
12. Mathews TJ. Smoking during pregnancy, 1990–96. National Vital Statistics Reports 1998;47(10).
13. U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001.
14. Eddy DM. David Eddy ranks the tests. Harvard Health Letter 1992;17(9):10–11.
15. Lightwood JM, Glantz SA. Short-term economic and health benefits of smoking cessation. Circulation 1997;96(4):1089–1096.
16. Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. New England Journal of Medicine 1998;339(10):673–679.
17. CDC. Best Practices for Comprehensive Tobacco Control Programs – August 1999. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.
18. Task Force on Community Preventive Services. Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine 2001;20(2S):10–15.
19. Farrelly MC, Pechacek TF, Chaloupka FJ. The impact of tobacco control program expenditures on aggregate cigarette sales: 1981–2000. Journal of Health Economics 2003; 22(5):843–859.
20. Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society, American Lung Association. A broken promise to our children: the 1998 Master Settlement Agreement 6 years later. December 2004.
21. Tauras JA, Chaloupka FJ, Farrelly MC, et al. State tobacco control spending and youth smoking. American Journal of Public Health 2005;95(2):338–44.

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

For more information and references supporting these facts, visit www.cdc.gov/nccdphp. For additional copies of this document, E-mail cdcinfo@cdc.gov.

Department of Health and Human Services Centers for Disease Control and Prevention

Page last reviewed: November 25, 2005
Page last modified: November 25, 2005
Content source: National Center for Chronic Disease Prevention and Health Promotion