Tobacco use causes more than 440,000 deaths each year in the United States.¹ Of these, approximately 38,000 deaths result from secondhand smoke exposure. For every person who dies from a smoking-related disease, 20 more people suffer with at least one serious illness from smoking.² Since the release of the 1964 Surgeon General's report on smoking and health, more than 12 million Americans have died prematurely due to smoking. Currently, estimates of annual smoking-associated economic costs in the United States are more than $167 billion.¹

Progress toward reaching objectives—especially for secondhand smoke, youth smoking rates, and youth exposure to tobacco advertising—is ongoing. The objective to reduce the proportion of nonsmokers exposed to environmental tobacco smoke was achieved, exceeding its targeted change at midcourse by 36 percent. If the current rate of decline since 1997 were maintained, the Nation could achieve its target for reducing high school smoking rates. However, recent findings suggest a slowing of this downward trend; less progress is being made in reducing overall adult tobacco use and tobacco-related disparities.

While positive trends are noted in eliminating tobacco-related disparities, continued and enhanced efforts across a broad spectrum of players, including the Federal Government, States, and the private sector, need to address tobacco use in racial and ethnic populations disproportionately affected by the health burdens of tobacco.^{3, 4}

Progress to date is due, in part, to comprehensive tobacco control programs.^{5, 6} Many effective evidence-based interventions exist and are detailed in the Centers for Disease Control and Prevention's (CDC's) Best Practices for Comprehensive Tobacco Control Programs; the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence; and the Guide to Community Preventive Services: Tobacco Use Prevention and Control.^{7, 8, 9} These publications present evidence for the effectiveness of comprehensive tobacco control programs that include the following:^{7, 8, 9}

• Increasing tobacco prices.
• Sustained media campaigns.
• Smoke-free policies in workplaces and public places.
• Reduced out-of-pocket costs for cessation services.
• Telephone quitlines.
• Prompts to clinicians to provide evidence-based intervention counseling.
• Community mobilization combined with additional interventions.

Many of these components are reflected in Healthy People 2010 objectives.

Public health efforts continue to be partially offset by several factors that encourage smoking, such as lack of indoor air regulations, discounted tobacco prices, and smoking scenes in movies.¹⁰ Significant countervailing forces include increased advertising and promotions by the tobacco industry.¹¹ In the time between the Master Settlement Agreement in 1998 and the year 2003, cigarette company marketing expenditures increased by more than 125 percent.¹¹ More than three-fourths of the total is for discount pricing or promotional allowances to retailers, which undercut the effect of tax increases.¹¹ In addition, the tobacco industry and smoker rights groups continue to oppose smoke-free indoor air policies and price increases through excise taxes and to promote preemptive State laws that block local nonsmoking ordinances.^{12, 13}

Another factor, which may slow or even reverse these positive trends, is the loss of funding for State tobacco prevention programs and national countermarketing campaigns.¹⁴ The amount that States are investing in tobacco control decreased 28 percent from 2002 to 2004.¹⁴ In 2004, spending was less than 3 percent of the $20 billion that the States received from tobacco excise taxes and tobacco settlement money in 2004.¹⁴ One recent finding shows an association between a large decline in State funding for an antitobacco media campaign in Minnesota and a subsequent 10 percentage point increase in the likelihood youth will engage in cigarette smoking.¹⁵ Another example is the substantial decrease in funding in Massachusetts, which was followed by a 74 percent increase in retail outlet sales of cigarettes to minors.^{5, 16}