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Tobacco use is the single most preventable cause of death and disease, causing approximately 440,000 deaths annually in the United States.1 Smoking is a major risk factor for cancer, heart, and lung disease.2 For every one person who dies of a smoking-attributable disease, there are 20 more people who are suffering with at least one serious illness from smoking.3
Cigarette smoking among adults declined by almost 50 percent since 1965; however, 46.2 million adults in this country or more than one in five Americans are current cigarette smokers. Seventy percent of smokers, or 32 million people, want to quit, but fewer than five percent of smokers who try to quit are able to stay tobacco free for 3-12 months.4
Since 1997 there has been a reverse to the rapid rise in smoking among youth that occurred in the early to mid 90's and youth smoking prevalence is at its lowest since monitoring began in 1976. Although about one in four U.S. high school students still smoke cigarettes, there has been a significant downward trend among this group since 1997. If teen smoking continues to decline at the current rate, the U.S. could reach the national health objective for high school students (16 percent) by 2010. However, every day an estimated 4,400 young people try cigarettes for the first time.5
Healthy People 2010 objectives strive to eliminate health disparities and reduce the burden of disease among all population groups. Health disparities exist within specific segments of the population and may be associated with gender, race or ethnicity, education or income, age, geographic location, or sexual orientation. Disparities clearly exist among population groups related to tobacco use; however, approaches to eliminate those disparities are still being developed.6 The first step in eliminating these disparities is to identify which groups are experiencing a higher burden of disease, an increase in tobacco use, or difficulty in accessing tobacco control programs.
Many people experience decreased quality of life due to the adverse health consequences of tobacco use and society will ultimately bear substantial direct and indirect economic costs from these diseases. Direct medical expenditures attributed to smoking have risen since the early 1990s and now total more than $75 billion per year. In addition to direct medical expenditures, smoking results in 5.6 million years of potential life lost and $82 billion in lost productivity.7 As states struggle to curb Medicaid costs, it is important to note that about 14% of all Medicaid expenditures are related to smoking.8 Future changes in the direction of smoking-attributable costs will depend on their investment in tobacco control. Without comprehensive, sustained efforts to reduce rates of tobacco use, health care costs related to tobacco will continue to increase.9
We have the ability to dramatically reduce the health and economic burden of tobacco use by implementing proven strategies. Achieving this goal will require collaboration among state decision makers, public health officials, business leaders and community members. Data from California and Massachusetts have shown that investment in comprehensive tobacco control programs can produce substantial reductions in tobacco use.9 The goal of comprehensive tobacco control programs is to reduce disease, disability, and death related to tobacco use by:10
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