Thank you for the opportunity to discuss the public health problem of tobacco use. I will present the scientific evidence regarding the effectiveness of comprehensive state program interventions to reduce and prevent tobacco use and the importance of ensuring that these programs are created and sustained over time.

For the record, I am here to discuss the scientific evidence regarding comprehensive state program interventions to reduce and prevent tobacco use. I am not here to speak for or against any specific legislative proposals.

Since the release of the first United States Surgeon General’s Report in 1964, knowledge about the health consequences of tobacco use has greatly increased. It is now well documented that smoking cigarettes causes heart disease, lung cancer, and chronic lung disease, as well as many other diseases. Cigar smoking and smokeless tobacco use have also been found to have important health risks.

However, the risks of tobacco use extend beyond the actual users. Exposure to secondhand smoke increases nonsmokers’ risk for lung cancer and heart disease. Among children, secondhand smoke is also associated with serious respiratory problems, including asthma, pneumonia, and bronchitis. Additionally, substantial evidence now links secondhand smoke with sudden infant death syndrome and low birth weight.

Because smoking rates in the United States have begun to decline, there may be a tendency to underestimate the magnitude of the health problems tobacco use still causes. For example, in an interview on Entertainment Tonight as he promoted his new book on weight loss, Dr. Phil stated that “obesity is an important epidemic in America.” He went on to assert “that obesity has overtaken smoking as the number one preventable cause of death in America.” And this comment is another indication that many people believe the tobacco problem is nearly solved and it is time to move on to other health issues. While we have made significant progress in many areas of tobacco control, tobacco use remains the leading cause of preventable death and disease in our society, and millions of Americans are still affected by tobacco addiction and tobacco-related diseases.

Each year approximately 440,000 adults die of a smoking-attributable illness in this country. But this is only one part of the story because for every person who dies, there are 20 people suffering with at least one serious illness from smoking.

In (name of state), XXXpeople die from smoking-related diseases every year.

In the United States, cigarette smoking also has important financial costs as it results in $75 billion in direct medical costs and another $82 billion in lost productivity each year, or more than $3300 per person in the United States. About 14% of all Medicaid expenditures are related to smoking. In (name of state), the CDC estimates that $X in Medicaid costs are attributable to smoking. Additionally, male smokers will generate, on average, over $14,000 in additional medical expenditures during their lifetime; for women it is over $16,000. The economic impact of smoking in this state is XXX in direct medical costs and XXX in lost productivity every year.

Cigarette smoking prevalence data from 1965 to 2001 have shown a slow but steady decrease in the percentage of United States residents who smoke– from 42.4 % in 1965 to 22.8% in 2001. This is a decline of nearly 50 % since 1965. However, there are still 46.2 million adults in this country–or more than one in five Americans–who are current cigarette smokers. Seventy percent of these smokers, or 32 million people, want to quit but have yet to be successful. In (name of state), an estimated XXX % of adults, or XXX people, smoke cigarettes.

The good news is that there are also nearly 45 million adults in the United States who are former smokers. These former smokers are literally living proof that smoking cessation treatments are safe and effective.

Perhaps the most impressive recent accomplishment of tobacco control programs has been the decline in smoking among teenagers after nearly a decade of an epidemic of smoking among youth. Although about one in four United States high school students still smoke cigarettes, smoking rates among this group have been declining since 1997. If teen smoking continues to decline at the current rate, the United States may achieve the 2010 national health objective of reducing current smoking rates to 16% among high school students. Yet while smoking among high school students decreased from 2000 to 2002, there was not a decrease among middle school students over this time period. The lack of progress among middle school students suggests that efforts to prevent smoking initiation among adolescents remain critically important. Each day more than 4,000 young people try cigarettes for the first time, and 80 % of adult smokers began smoking by age 18. In this state, XXX% of high school students smoke cigarettes.

Fortunately, we know more than enough to act now and succeed in reducing the tobacco use problem. The 2000 United States Surgeon General’s Report provides an in-depth review of tobacco intervention strategies and offers a science-based blueprint for achieving substantial reductions in adult and teen smoking rates. But these reductions can be achieved only if comprehensive approaches to tobacco control are implemented and sustained.

What are comprehensive approaches? They are approaches that focus on educational, economic, clinical and regulatory strategies to further reduce the prevalence of smoking in the United States And the reason they work is that they bring about a broad shift in the cultural acceptability of tobacco use.

CDC offers an evidence-based guide to help states plan and establish such comprehensive approaches to effective tobacco control programs. The guide, Best Practices for Comprehensive Tobacco Control Programs, describes the key elements of effective state tobacco control programs designed for communities, schools, and the entire state. In this guidance document, CDC recommends that states establish tobacco control programs that are comprehensive, sustainable, and accountable. Effective state-based programs include the following components: community and school programs and policies, counter-marketing campaigns (such as anti-smoking tobacco ads), and cessation programs.

How did CDC prepare these “best practices” to help States assess options for comprehensive tobacco control programs and evaluate their funding priorities? The Best Practices document draws on evidence-based analyses over many years in California and Massachusetts and by CDC’s involvement in helping other states plan comprehensive tobacco control programs, including excise tax-funded programs in Oregon and Maine and programs funded by money from individually settled lawsuits with the tobacco companies in Florida, Minnesota, Mississippi, and Texas.

Approximate annual costs to implement all of the recommended program components have been estimated to range from $7 to $20 per person in small states (population under 3 million) and from $5 to $16 per person in large states (population over 7 million). Total recommended program costs for the average state range from $31 million to $83 million each year. In 2003, (name of state) spent XXX on tobacco prevention and control which is only XXX% of the minimum amount CDC recommends. This amounts to only XXX cents per person each year in (name of state). By comparison, the tobacco industry spends more than $11 billion per year–or $30 million per day, which amounts to about $39 per person each year.

Comprehensive state tobacco control programs have helped to reduce rates of tobacco use. We have seen that such state tobacco control efforts have been highly successful, as demonstrated by declines in youth and adult smoking rates and cigarette sales. Thus, a comprehensive approach to tobacco control sustained over time has emerged as the guiding principle for future efforts to reduce tobacco use.

Two recent scientific studies across multiple states provide the strongest evidence to date that state tobacco control programs are an excellent investment. A Journal of Health Economics study found that between 1990 and 2000, cigarette sales dropped more than twice as much in states with comprehensive tobacco control programs than in the United States overall. The more states spend on comprehensive programs, the more efficient they become and the longer states invest in tobacco control–the larger the impact. Investments in states tobacco control programs have a strong effect that grows as programs continue to dedicate resources to curbing tobacco use over many years.

Another recently published study, this one in the Journal of the National Cancer Institute, provides even more evidence that investing in state tobacco control programs can reduce smoking rates. In an evaluation of the National Cancer Institute’s American Stop Smoking Intervention Study (ASSIST), the 17 states that were part of the ASSIST intervention program showed a greater reduction in smoking rates than the other states.

By virtue of its duration and intensity, the California tobacco control program has the distinction of being the first program to demonstrate a reduction in tobacco-related deaths. From 1988 to 1997, the number of lung cancer cases in California declined at a faster rate than the rest of the United States Even more striking is that while lung cancer rates among women were increasing elsewhere during this time, they decreased in California. And the California Tobacco Control Program resulted in an estimated 33,000 fewer deaths from heart disease between 1989 and 1997 and saved an estimated $8 billion in smoking-attributable direct and indirect costs between 1990 and 1998. California estimates that for every dollar they spent on tobacco control between 1990 and 1998, they avoided over $3.00 in direct medical cost.

Another example is Oregon. An evaluation showed that the Oregon program reduced cigarette consumption by 11% between 1996 and 1998, reversing a 4-year period of increasing consumption.

Currently, CDC spends $58 million per year on state tobacco control programs. In contrast, the tobacco industry spends $11 billion annually marketing and promoting its products to the public. In fact, spending on tobacco industry marketing doubled from 1997 to 2001. Thus CDC’s funding alone is not enough to fully address this problem. State comprehensive tobacco control programs are a necessary component.

The public health community and the public at large would not tolerate an immunization coverage rate of 20% or 30% for our children. But this is exactly what is happening to the tobacco control programs in some states that are being drastically cut—even though for every dollar invested in tobacco prevention, between $2.00 and $3.60 is saved in smoking-related health care costs. We do not want to make a mistake that will lead to higher tobacco use rates and higher tobacco-related disease and death.

As long as tobacco use continues to be a major preventable cause of death, we need the resources necessary to support sustainable comprehensive tobacco control programs. Because without adequate and sustained funding, the most well-designed state tobacco control program cannot be effective.

Thank you. I would be happy to answer any questions that you may have.

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Page last updated 02/28/2007

Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion

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