Advancing Tobacco Control Through Evidence-Based Programs

Burden

Tobacco use is the single most preventable cause of death and disease in the United States. Each year, it causes more than 440,000 deaths and costs the nation approximately $75 billion in medical expenses and $81.9 million in productivity losses.⁷ Tobacco use is associated with cancer, heart disease, chronic obstructive pulmonary disease, and stroke—4 of the 5 leading causes of death in the United States. In 2000, an estimated 46.5 million U.S. adults (23.3%) were current smokers. The prevalence of smoking was higher among men (25.7%) than among women (21.0%). Among racial/ethnic groups, Asians (14.4%) and Hispanics (18.6%) had the lowest prevalence of adult cigarette use, and American Indians/Alaska Natives had the highest rates (36%) (Table 1).⁸ Although nearly 70% of adult smokers want to quit smoking completely, only a small fraction are successful in any given year because of the highly addictive nature of tobacco use.⁹

Smoking rates among children and youth are perhaps even more disturbing than rates among adults. For example, rates among U.S. high school students increased significantly from approximately 28% in 1991 to 35% in 1999,¹⁰ while 15% of middle school students currently use some form of tobacco (cigarettes, smokeless tobacco, cigars, pipes, bidis, or kreteks).¹¹ Overall, white teens are taking up smoking at higher rates than are black and Hispanic teens.¹¹ Although recent studies indicate that U.S. teen smoking rates may have leveled or begun to decline,¹² they are still substantially above the goals articulated in Healthy People 2010.¹³

Tobacco products other than conventional cigarettes have also had catastrophic effects on users' health. The use of smokeless tobacco has been associated with leukoplakia and oral cancer, as well as with the early indicators of these conditions, peridontal degeneration and soft tissue lesions; regular cigar use has been associated with cancers of the lungs, larynx, oral cavity, and esophagus; and the use of bidis (small, brown, often flavored tobacco cigarettes from India that are hand-rolled in tendu or tenburni leaf and secured with a string at one end) has been associated with heart disease and cancers of the mouth, pharynx and larynx, lung, esophagus, stomach, and liver. Although bidis were virtually unheard of in this country until quite recently, their popularity among young people has grown alarmingly: as of 2000, 2.4% of middle school students and 4.1% of high school students reported smoking bidis.

Table 1. Percentages of persons aged 18 years and older who were current smokers,* by selected characteristics—National Health Interview Survey, United States, 2000

* Smoked >100 cigarettes during their lifetime and reported at the time of interview smoking every day or some days. Excludes 301 respondents for whom smoking status was unknown.
† Confidence interval.
§ Excludes 287 respondents of unknown, multiple, and other racial/ethnic categories.
¶ Wide variances among estimates reflect limited sample sizes.
** Does not include Native Hawaiians and Other Pacific Islanders.
†† Persons aged >25 years. Excludes 305 persons with unknown years of education.
§§ General Educational Development.
¶¶ The 1999 poverty thresholds from the Bureau of the Census were used in these calculations.

Smoking also poses health risks for nonsmokers as well as for those who smoke. Nearly 9 of 10 nonsmoking Americans are exposed to environmental tobacco smoke (ETS), which has been associated with lung cancer and heart disease among nonsmoking adults and with serious respiratory problems among children. In addition, substantial evidence now indicates that ETS exposure is also associated with low birthweight and sudden infant death syndrome.

The consequences of tobacco use have become a global concern. The World Health Organization (WHO) estimates that about 4 million people die every year of tobacco-related diseases and that without effective international tobacco control programs, the annual death toll will increase to as many as 10 million by 2030, including 7 million among people in developing countries.

Healthy People 2010 Objectives

Tobacco use is one of the 28 focus areas of Healthy People 2010 . For more information on the tobacco-related objectives in Healthy People 2010, visit www.healthypeople.gov.

Back to Top