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TOBACCO USE:
Targeting the Nation’s Leading Killer

At A Glance 2009

The Burden of Tobacco Use

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million have a serious illness caused by smoking. For every person who dies from smoking, 20 more people suffer from at least one serious tobacco-related illness. Despite these risks, approximately 43.4 million U.S. adults smoke cigarettes. Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers.

The harmful effects of smoking do not end with the smoker. More than 126 million nonsmoking Americans, including children and adults, are regularly exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same carcinogens and toxins in cigarette smoke as smokers. Secondhand smoke exposure causes serious disease and death, including heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children. Each year, primarily because of exposure to secondhand smoke, an estimated 3,000 nonsmoking Americans die of lung cancer, more than 46,000 (range: 22,700–69,600) die of heart disease, and about 150,000–300,000 children younger than 18 months have lower respiratory tract infections.

Coupled with this enormous health toll is the significant economic burden of tobacco use—more than $96 billion per year in medical expenditures and another $97 billion per year resulting from lost productivity.

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The Tobacco Use Epidemic Can Be Stopped

A 2007 Institute of Medicine (IOM) report presented a blueprint for action to “reduce smoking so substantially that it is no longer a public health problem for our nation.” The two-pronged strategy for achieving this goal includes not only strengthening and fully implementing currently proven tobacco control measures, but also changing the regulatory landscape to permit policy innovations. Foremost among the IOM recommendations is that each state should fund a comprehensive tobacco control program at the level recommended by CDC in Best Practices for Comprehensive Tobacco Control Programs–2007.

Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking. A comprehensive program is a coordinated effort to establish smoke-free policies and social norms, to promote and assist tobacco users to quit, and to prevent initiation of tobacco use. This approach combines educational, clinical, regulatory, economic, and social strategies.

Research has documented the effectiveness of laws and policies to protect the public from secondhand smoke exposure, promote cessation, and prevent initiation when they are applied in a comprehensive way. For example, to prevent initiation, states can increase the unit price of tobacco products; implement smoking bans through policies, regulations, and laws; provide insurance coverage of tobacco use treatment; and limit minors’ access to tobacco products.

If the nation is to achieve the objectives outlined in Healthy People 2010, comprehensive, evidence-based approaches for preventing smoking initiation and increasing cessation need to be fully implemented.

CDC's Response

CDC is the lead federal agency for tobacco control. CDC’s Office on Smoking and Health (OSH) provides national leadership for a comprehensive, broad-based approach to reducing tobacco use. A variety of government agencies, professional and voluntary organizations, and academic institutions have joined together to advance this approach, which involves the following activities:

• Preventing young people from starting to smoke.
   
• Eliminating exposure to secondhand smoke.
   
• Promoting quitting among young people and adults.
   
• Identifying and eliminating tobacco-related health disparities.

Essential elements of this approach include state-based, community-based, and health system-based interventions; cessation services; counter marketing; policy development and implementation; surveillance; and evaluation. These activities target groups who are at highest risk for tobacco-related health problems.

Sustaining State Programs

CDC continues to support comprehensive programs to prevent and control tobacco use in all 50 states, the District of Columbia, 7 U.S. territories, and 7 tribal-serving organizations. In addition, CDC funds national networks to reduce tobacco use among specific populations. CDC also provides funding to 22 state education agencies and 1 tribal government for coordinated school health programs to help prevent tobacco use.

CDC publishes and disseminates accepted best practices to help states plan, implement, evaluate, and sustain their own tobacco control programs and also provides technical assistance and training in these efforts.

Expanding the Science Base

CDC is responsible for conducting and coordinating research, surveillance, laboratory, and evaluation activities related to tobacco and its impact on health. For example,

• CDC provides guidance, funding, and technical assistance to help states evaluate their tobacco prevention and control programs. CDC conducts the National Youth Tobacco Survey and assists with the state-based Youth Tobacco Survey and Adult Tobacco Survey. CDC also develops survey instruments and methods to help assess tobacco use in specific populations.
   
• CDC conducts global tobacco control activities with international, regional, and country-specific partners. CDC, the World Health Organization, and the Canadian Public Health Association have developed the Global Tobacco Surveillance System, which now includes the Global Adult Tobacco Survey, funded through the Bloomberg Global Initiative to Reduce Tobacco Use.
   
• CDC’s Division of Laboratory Sciences and OSH evaluate additives and chemical constituents of tobacco and tobacco smoke.

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Communicating Information to the Public

CDC translates research into practice by keeping the public, policy makers, health professionals, and partners informed about current developments and initiatives in tobacco control.

• CDC responded to about 42,000 tobacco-related inquiries in Fiscal Year 2008 (FY 2008) and distributed nearly 992,000 publications and video products. About 5.6 million people visited CDC’s new Smoking & Tobacco Use Web site in FY 2008.
   
• CDC works with other federal, state, and local agencies to provide materials and resources to educators, employers, public health workers, the media, and other community leaders who are working to prevent tobacco use.
   
• Through the Media Campaign Resource Center (MCRC) and the Cessation Resource Center (CRC), CDC helps states stretch their media budgets by using and adapting existing ads and other materials rather than creating new ones.

Promoting Action Through Partnerships

CDC works with a variety of national and international partners to ensure that diverse groups are involved in tobacco control efforts. For example,

• CDC is the lead agency for the 21 national objectives on tobacco use in Healthy People 2010.
   
• CDC staffs the U.S. Department of Health and Human Services’ Interagency Committee on Smoking and Health, which coordinates research programs among federal, state, local, and private agencies.
   
• CDC coordinates and promotes tobacco prevention and control activities with partners, including the American Cancer Society, American Heart Association, Americans for Nonsmokers’ Rights, American Legacy Foundation, American Lung Association, Campaign for Tobacco-Free Kids, National Cancer Institute, Robert Wood Johnson Foundation, Substance Abuse and Mental Health Services Administration, Tobacco Technical Assistance Consortium, U.S. Environmental Protection Agency, World Bank, and numerous national networks.
   
• CDC, in partnership with the National Cancer Institute, the North American Quitline Consortium, and state tobacco control programs, has developed the National Network of Tobacco Cessation Quitlines. By calling 1-800-QUIT NOW, callers from across the nation have free and easy access to tobacco cessation services in their state.

Future Directions

CDC will continue to work with policy makers, health officials, partners, and the public to ensure that tobacco control remains a core component of public health domestically and globally. Agency priorities include the following:

• Identify the determinants of the stalling decline in youth smoking rates.
   
• Sustain and expand the capacity and reach of quitlines.
   
• Advance the implementation of smoke-free policies.
   
• Identify and disseminate the evidence base needed to reduce tobacco-related disparities.
   
• Help states increase resources for comprehensive tobacco control programs.
   
• Investigate the public health implications of smokeless tobacco use.

Success Stories

Alaska

Rates of tobacco use, both cigarettes and spit, have historically been higher in Alaska than in the rest of the nation. These rates are especially pronounced in the Alaska Native population, which has significantly higher rates of tobacco use than whites and other racial or ethnic groups in the state. Tobacco use costs the state more than $148 million in lost productivity and more than $132 million in health care costs annually.

To address this health problem, the Alaska Department of Health and Social Services has implemented a comprehensive tobacco control program based upon CDC’s Best Practices for Comprehensive Tobacco Control Programs—2007. Program components include countermarketing, community-based programs, youth and school programs, eliminating exposure to secondhand smoke, eliminating health disparities, cessation, and evaluation. The program includes a free quitline for all Alaskans (1-888-842-QUIT) that includes individualized quit plans, personal quit coaches, and nicotine replacement therapy. Thousands of Alaskans have called the quitline since it was established in 2002, and a 2007 study documented a 40% quit rate.

Program components have been implemented in partnership with the Alaska Tobacco Alliance, local tobacco prevention and control coalitions, nonprofit and Alaska Native organizations and individuals, and schools, with support from legislators and local governments who have supported tobacco-use prevention efforts.

Alaska has seen progress as a result of its efforts. Data from the 2008 Alaska Behavioral Risk Factor Surveillance System, showed a significant reduction in tobacco use. The percentage of adult smokers in Alaska has declined by one-fifth since 1996 to 21.5% in 2007. This figure represents more than 27,000 fewer smokers and is expected to result in almost 8,000 fewer tobacco-related deaths and $300 million in averted medical costs. The data indicate that smoking is declining among adults in most age groups and regions of the state. Although smoking rates are still high among Alaska Native adults, they have dropped significantly among Alaska Native youth.

These decreases in smoking rates demonstrate the effectiveness of Alaska’s comprehensive program. Reducing tobacco use in the Alaska Native population has long been a serious public health challenge, and any progress toward reducing prevalence rates in this population is a clear and measurable accomplishment. The recent increase in the Alaska program’s funding demonstrates the support in state government for tobacco control programs that are proven to be effective.

Navajo Nation

Commercial tobacco-use prevalence rates are much higher in American Indian and Alaska Native populations than in the U.S. population as a whole. Some tribes have prevalence rates as high as 40%. However, efforts to reduce commercial tobacco consumption must be implemented in a culturally sensitive way to distinguish traditional or ceremonial use from commercial use.

The Navajo Nation Council proposed the Navajo Nation Commercial Tobacco-Free Act of 2008, which prohibited all commercial tobacco use, including cigarettes, pipes, cigars, and smokeless tobacco. The legislation would have made all “public places, places of employment, and shared public airspace within the Navajo Nation” 100% commercial tobacco-free.

The Tribal Council passed the legislation without proposed amendments that would have weakened it by exempting casinos, resorts, sporting arenas, and golf courses. However, the legislation was vetoed by the Navajo Nation president, and a subsequent attempt to override the veto was unsuccessful.

Although the legislation did not pass, the effort focused attention on commercial tobacco use in the Navajo Nation and possibly throughout other sovereign tribal nations. The partners who came together for this effort plan to try again in the future.

New York

More than 25,000 New Yorkers die from tobacco use each year, and the state annually incurs more than $8 billion in medical costs related to tobacco use. In response, the New York Tobacco Control Program (NYTCP) established several ambitious goals, endorsed by the governor, to achieve by 2010—1 million fewer smokers, an adult prevalence rate of 14%, and a youth prevalence rate of 10%. Reaching these goals will require a comprehensive, evidence-based tobacco-control effort that focuses on sustaining funding and infrastructure.

According to CDC’s Best Practices, the State of New York should be funding its tobacco control program with $254.3 million each year. Although tobacco control funding in the state falls short of this recommendation, New York has seen an impressive increase in recent years—from $32.5 million in 2000 to $85.5 million in 2007. How did New York achieve such an increase—and sustain it—at a time when so many states have seen budgets drastically reduced?

NYTCP began requiring funded community partners to implement sustainability plans and to report on their activities. These sustainability activities include monthly communication with local legislators, including in-person office visits, as well as outreach to the media through letters to the editor and personal stories from those affected by tobacco use. The Center for a Tobacco Free New York and its partners also aggressively advocated for increases in the tax on tobacco products to bring funding for the statewide program closer to CDC-recommended levels. Independent evaluation reports of the statewide program have been published annually for the past 4 years, and the results of the program’s effectiveness are shared widely with legislators and other decision makers.

Through these efforts, NYTCP and its partners—national tobacco control experts, independent evaluators, state-funded community representatives, policy makers, and the public—have been successful in repeating simple and direct key messages:

• Tobacco use is an epidemic that adversely affects every community in the state.
   
• Tobacco control works. New York is effectively implementing evidence-based interventions that get results. Prevalence in New York is lower than the national average—18.2% for adults and 16.2% for high school students.
   
• Evidence demonstrates that the longer states invest in comprehensive tobacco control programs the greater the impact. These programs also become more cost-effective over time.
   
• A huge unmet need exists, which can be better addressed with more financial resources.

In New York, tobacco is an $8 billion problem—with a $250 million solution.

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Related Materials

• Tobacco—At A Glance 2009 (PDF–3.5Mb)
• Tobacco—Success Stories (PDF–766Kb)
• CDC's Smoking & Tobacco Use Web Site
• Preventing Tobacco Use
• State and Program Example (PDF–128Kb)

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Page last reviewed: January 29, 2009
Page last modified: January 29, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion