U.S. Department of Health and Human Services

Tobacco Control:

A Winnable Battle

U.S. Department of Health and Human Services Centers for Disease Control and Prevention

The 50th Anniversary Surgeon General’s Report (SGR) has added new health consequences of smoking

Source: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014

The list grows for health consequences of secondhand smoke exposure

Source: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014

Tobacco use is still the leading preventable cause of disease and death in the U.S.

42.1 million U.S. adults smoke Tobacco causes nearly 1 in 5 deaths in U.S.

• >480,000 deaths/year, >1,300/day For each death, it is estimated that 30 more suffer

tobacco-related illnesses Annual costs: $133 billion in medical expenses plus

$156 billion in lost productivity Many Americans left unprotected, especially

service industry workers• 24 states still lack comprehensive smoke-free laws

Tobacco Deaths Compared to other Causes

Source: World Health Organization

Source: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014

Tobacco Use and Chronic Disease

Sources: Adapted from Warner 1985 with permission from Massachusetts Medical Society, ©1985; U.S. Department of Health and Human Services 1989; Creek et al. 1994; U.S. Department of Agriculture 2000; U.S. Census Bureau 2013; U.S. Department of the Treasury 2013. *Adults ≥18 years of age as reported annually by the Census Bureau.

Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events—United States, 1900-2013

Note: Estimates since 1992 include some-day smoking.Sources: 1955 data from Current Population Survey (CPS); 1965-2013 data from National Health Interview Survey (NHIS)

0

10

20

30

40

50

60

Men Women

Year

Pe

rce

nt

(%)

54.2%

2013

24.5%

20.5%

15.3%

Current cigarette smoking among adults aged

≥18 years, by sex—U.S., 1955-2013

Cigarette Smoking Among Adults aged ≥18, by Race/Ethnicity – United States,

2002-2013

Source: National Survey on Drug Use and Health, 2002-2013.

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

28

22.7

28.2

23.025.0

16.8

38.436.5

19.4

8.5

White, Non-Hispanic Black, Non-Hispanic Hispanic

American Indian/Alaska Native, Non-Hispanic Asian, Non-Hispanic

Year

Pe

rce

nt

(%)

Smoking Prevalence(percent)10.0 – 12.9

13.0 – 15.9

16.0 – 18.9

19.0 – 21.9

22.0 – 24.9

WY

OR

ID

MT

WA

ND

IA

SD

MN

OH

MI

IN

PA

ME

NY

IL

WI

VT

D.C.

NJ

MDDE

NH

CTRI

MA

AZ

UTNV

CA

TX

AROK

LA

KS

NE

CO

NM

MO

TN

AL

KY

MS GA

FL

WV VA

NC

SC

AK

HI

* Persons who have smoked at least 100 cigarettes in lifetime and currently report smoking every day or some days. Source: Behavioral Risk Factor Surveillance System (BRFSS)

25.0 – 27.3

Current cigarette smoking* among adults aged

≥ 18 years, by state—U.S., 2013

Heart disease deaths are closely aligned with smoking

Source: Vital Records; National Center for Health Statistics, CDC, 2011- 2013

Impact of a Comprehensive Approach:Adult Cigarette Smoking Rates in NYC

1994—2013

Source: CDC. Decline in Smoking Prevalence -- New York City, 2002—2006. MMWR. 2007. 56(24);604-608; and https://a816-healthpsi.nyc.gov/epiquery/

0

5

10

15

20

25

Perc

en

t of

ad

ult

s w

ho s

moke

cig

are

ttes

3-yr. average

21.6% 21.5% 21.7%

21.6%

19.2%18.3%

18.9%

17.5%16.9%

15.8%

City and State tax increases

Smoke-freeworkplace

TV ad campaign

15.8%

14.0%14.8%

15.5%

16.1%

NYS and Federal tax

increaseNYS tax increase

Free patch

programs start

Long-term impact of a comprehensive approach:Lung and bronchus cancer incidence rates in CA

Rates are per 100,000 and age-adjusted to the 2000 U.S. standard (19 age groups).* The annual percent change is significantly different from zero (p<0.05).Source: Cancer Surveillance Section. Prepared by: California Department of Public Health, California Tobacco Control Program, 1988-2005. 2010.

MPOWER

Source: WHO Report on the Global Tobacco Epidemic, 2008 - The MPOWER package.

We know what works

Sustained funding of comprehensive programs

Excise tax increases 100% smoke-free policies Aggressive media

campaigns Cessation services access Comprehensive advertising

restrictions

Tobacco Industry is Outspending Prevention Efforts 18:1

Campaign for Tobacco Free Kids, Federal Trade Commission, 2012 Tax Burden on Tobacco Report, CDC's Best Practices for Comprehensive Tobacco Control Programs.

Best Practices 2014

http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

National Recommended Funding Levels, by Program Component

National Recommended

InvestmentTotal

State and Community

Interventions

Mass-Reach Health Communication

InterventionsCessation

InterventionsSurveillance

and EvaluationInfrastructure,

Administration, and Management

Total Level ($ millions) $3,306.3 $1,071.0 $532.0 $1,271.9 $287.7 $143.7

Per Person $10.53 $3.41 $1.69 $4.05 $0.92 $0.46

Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs — 2014. Atlanta: U.S.Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic DiseasePrevention and Health Promotion, Office on Smoking and Health, 2014.

When tobacco control funding increases, high school smoking decreases

Source: Project ImpacTEEN; University of Illinois at Chicago; State University of New York at Buffalo; Youth Risk Behavior Survey, 1993-2009.

* Adjusted to 2009 CPI.† High school students (grades 9-12) who smoked on 1 or more of the 30 days preceding the survey.

When cigarette prices increase, cigarette sales decrease

Source: ImpacTeen Chartbook: Cigarette Smoking Prevalence and Policies in the 50 States.

Increased tobacco excise taxesincrease price

10% increase in cigarette prices 4% drop in adult cigarette consumption*

Youth much less likely to start smoking when prices are high

Adjust taxes to offset inflation and tobacco industry attempts to control retail prices• E.g., promotional discounts for retailers who reduce

cigarette prices Tobacco taxes are the single most effective component of

a comprehensive tobacco control program

*Chaloupka FJ, Straif K, Leon ME. Effectiveness of tax and price policies in tobacco control. Tobacco Control 2011;20(3):235–8. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of theSurgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

Smoke-free policies save lives Prevent heart attacks

• Up to 17% average reduction in heart attack hospitalizations in places that enact comprehensive smoke-free laws

Help motivate smokers to quit Worker safety issue – not “personal nuisance”

• All workers deserve equal protection• Only way to protect non-smokers from secondhand

smoke Smoke-free workplace laws don’t hurt business No trade-off between health and economics

State Smoke-Free Air Laws – Effective March, 2015

Centers for Disease Control and Prevention’s State Tobacco Activities Tracking and Evaluation (STATE) System. Available at: http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx. Washington, DC is included in states. California’s law includes exemptions that preclude it from being considered smoke-free.

Source: CDC STATE System

Comprehensive Smoke-Free Laws

United States2000-2014

How far we have come

Aggressive media campaigns work

Media campaigns work to: Reduce youth initiation Encourage cessation Increase negative attitudes toward

tobacco use Increase support for policy change

The impact of cessation services

Currently: 42.1 million U.S. smokers• 70% of adult cigarette smokers want to quit• More than 50% try to quit each year, 4 – 6% succeed.• Only 2% call state or national quitlines• Medicaid coverage for cessation varies widely among

states

Tobacco cessation can be achieved through:• Significant tax and price increases• Comprehensive smoke-free policies• Aggressive counter-advertising

State and federal policy activities (2009 – 2013)

Excise Tax Increases

• 25 cigarette tax increases Smoke-Free Policies

• 26 states and DC have achieved comprehensive status Federal Legislation

• Federal excise tax increase

• Family Smoking Prevention and Tobacco Control Act

• Prevent All Cigarette Trafficking (PACT) Act

• Affordable Care Act

This is a Winnable Battle

U.S. Department of Health and Human Services Centers for Disease Control and Prevention

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.