1. 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

2. 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

3. 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

4. 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

5. Tobacco Deaths Compared to other Causes Source: World Health Organization

6. Source: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 Tobacco Use and Chronic Disease

7. 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

8. Note: Estimates since 1992 include some-day smoking. Current cigarette smoking among adults ages ≥ 18 years by gender – U.S., 1955 - 2012 Sources: 1955 data from Current Population Survey (CPS); 1965-2012 data from National Health Interview Survey (NHIS) Current Adult Cigarette Smoking by Gender Let’s accelerate this decline

9. Cigarette Smoking Among Adults aged ≥18, by Race/Ethnicity – United States, 2002-2012 Source: National Survey on Drug Use and Health, 2002-2012.

10. Current cigarette smoking* among adults aged ≥ 18 years, by state—U.S., 2012 * 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)

11. Heart disease deaths are closely aligned with smoking Source: Vital Records; National Center for Health Statistics, CDC, 2008 - 2010 Division for Heart Disease and Stroke Prevention: Data Trends & Maps Web site. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 2010. Available at http://www.cdc.gov/dhdsp/.

12. Adult Smoking in NYC Down Over 30% Since 2002 Source: New York City Department of Health and Mental Hygiene, Community Health Survey (CHS) 2002-2011. *In 2011, the weighting methodology of the CHS was changed to incorporate Census 2010 data and additional demographic characteristics.

13. 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.

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

15. 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

16. 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.

17. Best Practices 2014 http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

18. National Recommended Funding Levels, by Program Component National Recommended Investment Total State and Community Interventions Mass-Reach Health Communication Interventions Cessation Interventions Surveillance and Evaluation Infrastructure, 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 Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

19. 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.

20. When cigarette prices increase, cigarette sales decrease Source: ImpacTeen Chartbook: Cigarette Smoking Prevalence and Policies in the 50 States.

21. Increased tobacco excise taxes increase 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 the Surgeon 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.

22. 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

23. State Smoke-Free Air Laws – Effective June 30, 2014 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.http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx

24. Source: CDC STATE System Comprehensive Smoke-Free Laws United States 2000-2014 How far we have come

25. Aggressive media campaigns work Media campaigns work to:  Reduce youth initiation  Encourage cessation  Increase negative attitudes toward tobacco use  Increase support for policy change

26. 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

27. 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

28. 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 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-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.