CDC Grand Rounds: Current Opportunities in Tobacco Control

April 30, 2010 / Vol. 59 / No. 16

There is a strong national and international evidence base that identifies the steps required to end the tobacco use epidemic (e.g., WHO Framework Convention on Tobacco Control, WHO MPOWER policy package, Institute of Medicine tobacco "blueprint for the nation").
Evidence-based interventions that have had the most success include price increases, smoke-free policies, aggressive media campaigns, access to cessation services, comprehensive advertising bans, and graphic warning labels on tobacco products.

Cigarette price increases discourage initiation among youth, prompt quit attempts, and reduce cigarette consumption (e.g., a 10% increase in the price of cigarettes results in a 4% decrease in cigarette consumption among adults).
In 2009, the U.S. government, 14 states, and Washington, DC increased cigarette excise taxes.
As of December 31, 2009 excise tax rates among states ranged from $0.07 cents per pack in South Carolina to $3.46 per pack in Rhode Island. The average excise tax among all states was $1.34 per pack.

Strong smoke-free laws reduce exposure to carcinogens, improve indoor air quality, reduce negative health outcomes, decrease consumption, encourage quit attempts, and change social norms about the acceptability of smoking.
As of December 31, 2009, a total of 21 U.S. states and Washington, DC had comprehensive smoke-free laws in effect that prohibit smoking in indoor areas of workplaces, restaurants, and bars.
About half of U.S. residents are not protected by comprehensive state or local smoke-free laws.
A total of 12 states currently preempt local communities from passing smoke-free policies.

States that invest heavily in comprehensive tobacco control have seen cigarette sales drop more than twice as much as the United States as a whole, and youth and adult smoking prevalence declines faster as spending for tobacco control programs increases.
In 2002, New York City implemented a comprehensive tobacco control effort that reduced youth smoking rates by 50% and reduced adult smoking rates from 21.6% to 15.8% in 2008; the multipronged approach included increasing tobacco taxes, establishing a strong smoke-free policy, implementing aggressive media campaigns, and providing free cessation services.
If all U.S. states funded comprehensive tobacco control programs at state-specific levels recommended by CDC for 5 years, there would be 5 million fewer smokers in the United States.

High-quality surveillance is essential for monitoring progress and identifying needs of tobacco interventions.
The Global Tobacco Surveillance System tracks youth and adult tobacco use worldwide.
The Tobacco Laboratory Network (government, academic, and independent laboratories across the globe) works to strengthen national and regional capacity for testing and research of the contents and emission of tobacco products.

Regulation of tobacco products is a critical component of an overall comprehensive strategy and will further strengthen existing tobacco control efforts.
Until enactment of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) on June 22, 2009, the United States had no product standards for cigarettes or other tobacco products; without standards, the tobacco industry could make unregulated changes to highly engineered products that appeal to youth and help maintain addiction.
The Tobacco Control Act granted the U.S. Food and Drug Administration (FDA) authority to regulate tobacco product content, sales, and marketing.

Worldwide, tobacco use is the leading preventable cause of death.
- It causes more than 5 million deaths per year.
- Left unchecked, it will cause more than 8 million annual deaths by 2020.
In the United States, tobacco use is the leading preventable cause of death and disease.
- Smoking and exposure to secondhand smoke cause an estimated 443,000 deaths each year.
- An estimated 8.6 million U.S. residents have a serious illness caused by smoking.
- Smoking costs $96 billion in medical costs and $97 million in lost productivity each year.
Progress in reducing adult and youth smoking rates in the United States has stalled.
- Adult smoking rates declined from 1965 (42.4%) through the 1990s but remained relatively unchanged from 2004 (20.9%) to 2008 (20.6%).
- Youth smoking rates declined substantially from 1997 (36.4%) to 2003 (21.9%) but remained relatively unchanged from 2003 to 2007 (20%).