Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 27-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

The review of progress toward the Healthy People 2010 smoking objectives showed that many objectives moved toward their targets. Exposure to environmental tobacco smoke (27-10) exceeded its target. Eight objectives and one subobjective moved toward their targets: adult tobacco use (27-1), adolescent tobacco use (27-2), smoking cessation by adults (27-5), smoke-free and tobacco-free schools (27-11), worksite smoking policies (27-12), smoke-free indoor air laws (27-13), enforcement of laws on tobacco sales to minors in the States and the District of Columbia (27-14a), adolescent disapproval of smoking (27-17), and tobacco tax (27-21). Smoking cessation by adolescents (27-7) moved away from its target, and mixed progress was observed for tobacco advertising and promotion targeting adolescents and young adults (27-16). The remaining nine objectives and three subobjectives lacked data necessary to assess progress. However, data are anticipated by the end of the decade.

Objectives that met or exceeded their targets. Between 1988–94 and 1999–2000, the proportion of nontobacco users aged 4 years and older exposed to environmental tobacco smoke (27-10) fell from 88 percent to 54 percent, achieving 136 percent of the targeted change. Exposure was measured by blood levels of cotinine, a marker for cigarette smoke exposure. The primary factors that produced the reduction in secondhand smoke exposure include recent increases in smoke-free policies, both legislated and voluntary, in workplaces and public places¹⁷ ; recent increases in smoke-free home rules¹⁸; and a gradual reduction in adult smoking.¹⁹ The declines in exposure were not as great in select populations, such as children aged 4 through 11 years and the black non-Hispanic population. Levels of secondhand smoke exposure also remained high among certain types of workers, including blue collar and service workers, and especially among restaurant, bar, and gaming workers.¹⁷

In addition, public awareness grew regarding the health risks that secondhand smoke poses to nonsmokers.²⁰ Changes in public and employer policies and home rules both reflected and contributed to changes in social norms regarding the social acceptability of smoking.^{21, 22, 23} Changes in norms then led to further reductions in smoking and secondhand smoke exposure.¹⁹

Objectives that moved toward their targets. Tobacco use, including the use of cigarettes, spit tobacco, and cigars, among persons aged 18 years and older (27-1) made progress from its 1998 baseline. Cigarette smoking rates among persons aged 18 years and older (27-1a) declined from a 1998 baseline of 24 percent to a 2003 level of 21 percent of that population. Rates for spit tobacco use (27-1b) and cigar smoking (27-1c) among persons aged 18 years of age and older progressed toward their targets more slowly than cigarette smoking.

Each day in the United States, approximately 4,000 youth aged 12 to 17 years try their first cigarette.²⁴ Although the percentage of high school students who smoke declined in recent years, rates for all populations remained higher than their targets. In 2003, 22 percent of students in grades 9 through 12 reported using cigarettes within the past month (27-2b); 7 percent reported using spit tobacco (27-2c) during the same timeframe. Fifteen percent of students in grades 9 through 12 reported smoking cigars, cigarillos, or little cigars (27-2d) in the past month. Overall, the proportion of students in grades 9 through 12 who reported using any tobacco product over the past month (27-2a) achieved 68 percent ofthe targeted change.

Prevailing attitudes about smoking play an important role in influencing adolescents and young adults to quit or avoid tobacco products altogether.²⁵ Disapproval of smoking by 8th, 10th, and 12th graders (27-17a, b, and c) all moved toward their respective targets. The disapproval of smoking by adolescents provided an indication of the decreases in youth tobacco use.²⁶

Some progress was made in the enforcement of laws on tobacco sales to minors in the States and the District of Columbia (27-14a). In 2003, one State had reduced the illegal sales rate, compared with no States in 1998. The target for this objective is 50 States and the District of Columbia.

Between 1998 and 2003, students reported a decrease in perceived availability of cigarettes.²⁷ For example, in 1998, 88.1 percent of 10th graders reported that cigarettes were easy to access, compared with 80.7 percent in 2003.

In 2000, 45 percent of schools reported smoke-free and tobacco-free school policies (27-11), up from 37 percent in 1994 but less than the target. In addition, 45.5 percent of school districts and 13 States reported having such policies.²⁸

States are also working toward making workplaces and public places smoke free. The seven measurable subobjectives for smoke-free indoor air laws (27-13) moved toward their targets of 50 States and the District of Columbia. In 2003, the subobjective measuring smoke-free laws in bars (27-13i) was the farthest from the target, with only two States prohibiting smoking in these establishments. Private workplaces (27-13a) and restaurants (27-13c) were smoke free in five States. Policies establishing smoke-free environments are the most effective method in protecting both workers and patrons from secondhand smoke exposure.²⁹ Restrictions on where smoking is allowed are associated with decreased cigarette consumption and possibly with increased cessation rates among workers and the public.^{29, 30}

More than 70 percent of smokers want to quit, though success rates for quitting without treatment are low.^{19, 30} This proportion underscores the importance of increased availability of evidence-based treatments. Between 1998 and 2003, smoking cessation attempts by smokers aged 18 years and older (27-5) increased from 41 percent to 43 percent, representing 6 percent of the targeted change toward the target of 75 percent.

Since 2000, a major advance in providing assistance to smokers who want to quit has been the increased availability of quitline services and the implementation of the National Network of Quitlines in 2004.³¹ Through the network, a national access number for tobacco cessation electronically transfers callers to their State quitline. Forty-nine States, the District of Columbia, and five jurisdictions have been supported by CDC to initiate or expand quitline services. All States are anticipated to have a quitline by the end of the decade.

Other smoking cessation tools are available. A smoking cessation website, www.smokefree.gov, offers tools, information, and support in helping smokers quit. Individuals can use the updated Pathways to Freedom: Winning the Fight Against Tobacco, a comprehensive self-help manual for adult cessation with recommendations by and for the black non-Hispanic population.³² The U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, provides implementation strategies for tobacco-use treatment.⁸ The document contains sections on cessation strategies for clinicians, health care systems, and communities.

Increases in the price of cigarettes through excise taxes (27-21a) had an impact on the smoking population.^{16, 30, 33, 34} These increases influenced all populations, but particularly younger smokers and lower income populations. Price hikes also increased cessation and decreased initiation, aiding in the attainment of the respective targets. ^{30, 34} Between 1998 and 2002, the combined Federal and average State tax on cigarettes (27-21a) increased from 59 cents per pack to $1 per pack, moving toward the target of $2 per pack.³⁵ Three States—Michigan, New Jersey, and Rhode Island—have excise taxes that are at or over $2, thus meeting the target. Three States—Colorado, Montana, and Oklahoma—successfully raised the tobacco tax through ballot measures. Virginia raised its cigarette tax from 2.5 cents to 20 cents per pack—the first increase since 1960. Significant cigarette tax increases motivated smokers to quit and prevented youth from starting.^{9, 34} In addition, 21 States increased their taxes on smokeless tobacco products between 2000 and 2004 (27-21b). The target is increased taxes in all 50 States and the District of Columbia.

Objectives that demonstrated mixed movement toward or away from their targets. Progress was mixed regarding exposure to tobacco advertising for students in grades 9 through 12 (27-16). Advertising in magazines and newspapers (27-16b) targeted primarily to adolescents decreased by 4 percentage points between 2000 and 2002. In 2000, 74 percent of students in grades 9 through 12 reported exposure to tobacco advertising and promotions in magazines and newspapers. In 2002, that number dropped to 70 percent, moving toward the target of 67 percent. However, advertising via the Internet (27-16a) increased. Tobacco advertising exposure rates for high school students increased from 28 percent in 2000 to 38 percent in 2002. Because the Internet has become an integral source of news, information, and communication among younger populations, much work needs to be done to achieve this objective. In 2003, tobacco companies' advertising expenditures represented more than 23 times what States spend on tobacco prevention and control.¹¹ The tobacco industry has increased its expenditures for advertising and promotions.¹¹ In 2003, cigarette companies spent $15.15 billion on advertising and promotions, the most ever reported to the Federal Trade Commission.¹¹

Objectives that moved away from their targets. While progress was made in smoking cessation attempts among adults aged 18 years and older, cessation attempts among students in grades 9 through 12 (27-7) did not improve. From a baseline of 61 percent of smokers in this age group attempting to quit, the most current measurement (2003) was 60 percent.

Objectives that could not be assessed. Trend data were not available for nine objectives: initiation of tobacco use (27-3), age at first tobacco use (27-4), smoking cessation during pregnancy (27-6), insurance coverage of cessation treatment (27-8), exposure to tobacco smoke at home among children (27-9), retail license suspension for sales to minors (27-15), evidence-based tobacco control programs (27-18), preemptive tobacco control laws (27-19), and sales-weighted average levels of toxic chemicals in tobacco products sold in the United States (27-20). Thus, progress for these objectives could not be assessed. However, additional data are expected to be available before the end of the decade.

Data to assess progress toward enforcement of illegal tobacco sales to minors by Territories (27-14b) were not available. In addition, smoke-free indoor air laws for Tribes and Territories (27-13g and h) remained developmental.

No nationally representative data source was available for 27-1d and 27-8c, and these subobjectives were dropped for this reason.

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