1. Tobacco Control: A Winnable Battle
U.S. Department of Health and Human Services
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
This image shows each part of the body that can be affected by cancer or chronic disease due to smoking. New findings from the 50th Anniversary Surgeon General’s Report are in red.
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
This image illustrates the adverse health effects across the body due to secondhand smoke exposure for both children and adults with new findings from the 50th Anniversary Surgeon General’s Report in red.
Source: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014

4. 42.1 million U.S. adults smoke
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. Tobacco Use and Chronic Disease
Why focus on tobacco?
Tobacco is the single most preventable cause of death and disease in the United States, every year over 480,000 people die due to diseases caused by smoking and secondhand smoke
This graphic breaks down the percentages of tobacco-related deaths in the U.S.
Source: The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014

7. Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events—United States, 1900-2013
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 *Adults ≥18 years of age as reported annually by the Census Bureau.

8. Current cigarette smoking among adults aged ≥18 years, by sex—U. S
20.5%
24.5%
15.3%
Note: Estimates since 1992 include some-day smoking.
Sources: 1955 data from Current Population Survey (CPS); data from National Health Interview Survey (NHIS)

9. Cigarette Smoking Among Adults aged ≥18, by Race/Ethnicity – United States, 2002-2013
Source: National Survey on Drug Use and Health,

10. Smoking Prevalence (percent)
Current cigarette smoking* among adults aged ≥ 18 years, by state—U.S., 2013 WA VT MT ME ND OR MN NH ID WI MA SD NY WY MI RI CT IA PA NJ NV NE IL IN OH UT DE CA CO WV MD KS MO VA KY
D.C.
Smoking Prevalence (percent) NC TN AZ OK AR SC
10.0 – 12.9 NM MS AL GA
13.0 – 15.9 LA
Adult smoking rates vary widely -- Nearly 3x higher in some states than others TX
16.0 – 18.9 FL
19.0 – 21.9 AK HI
22.0 – 24.9
25.0 – 27.3
* 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
U.S. Map is color-coded to illustrate heart disease death rates by county.
Source: Vital Records; National Center for Health Statistics, CDC,

12. Impact of a Comprehensive Approach:
Adult Cigarette Smoking Rates in NYC
1994—2013
3-yr. average
21.6%
21.5%
21.7%
19.2%
18.3%
18.9%
17.5%
16.9%
15.8%
City and State tax increases
Smoke-free
workplace
TV ad
campaign
Free patch programs start
NYS and Federal tax increase
NYS tax increase
15.8%
15.5%
16.1%
Percent of adults who smoke cigarettes
14.8%
14.0%
So what happens when we combine these interventions?
In 2002, New York City implemented a comprehensive tobacco control initiative that included a tax increase, a comprehensive smoke-free law, a media campaign, and a cessation initiative, including free nicotine replacement therapy.
As a result, from 2001 to 2007, youth smoking rates, shown on the gold line, were cut by more than 50%.
Meanwhile, adult smoking rates, which had not declined for almost a decade, fell by more than a quarter from 2002 to This decrease translates into 350,000 fewer adult smokers in New York City. 
This example illustrates the power of a comprehensive, policy-focused approach.
Source: CDC. Decline in Smoking Prevalence -- New York City, 2002—2006. MMWR (24); ; and

13. Long-term impact of a comprehensive approach: Lung and bronchus cancer incidence rates in CA
The California Tobacco Control Program invested in a comprehensive approach designed to change social norms with some striking results.
The social norm change approach seeks to indirectly influence current and potential future tobacco users by creating a social milieu in which tobacco becomes less desirable, acceptable and accessible.
The Program combined an aggressive media campaign with public policy change, particularly in the area of promoting smokefree environments at the local level.
The Program has been premised on the fact that youth smoking will decline when more adults stop smoking.
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,

14. MPOWER
M represents monitoring policies, programs, and tobacco use. This is the area where CDC has focused much of its global contributions - through management of the Global Tobacco Surveillance System.
To help countries improve their results, WHO developed a technical package called MPOWER. The components are: 
P represents protecting people from 2nd hand smoke through smoke-free regulation
O is offering help to quit through treatment programs for nicotine addiction
W deals with warning about the dangers of tobacco use through counter-marketing such as warning labels on tobacco packaging
E relates to enforcing regulations on tobacco marketing and
R is raising taxes on tobacco, the intervention most certain to reduce consumption.
Next, we’ll review the effective policies and regulations in more depth and look at the global status in relation to those policies.
Source: WHO Report on the Global Tobacco Epidemic, The MPOWER package. 14 14 14

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
Today’s cigarettes contain over 7,000 chemicals and chemical compounds- over 70 cause cancer.
Designed to addict their users quickly and heavily (deliver a jolt of nicotine to the brain in 10 seconds)
Young brains are sensitive and teens become addicted more quickly than adults (3 out of 4 teens become adult smokers)
In addition to making powerfully addictive, industry spends $8 billion annually (a million dollars an hour)to advertise and market cigarettes and smokeless tobacco.
Outspend current state tobacco control programs by a factor of 18 to 1.
Marketing and glamorization of tobacco products remains rampant
Despite causal evidence that depictions of smoking in the movies lead to smoking initiation among young people, movies remain one of the largest unrestricted traditional media channels promoting smoking and tobacco use to youth. In fact, smoking incidents in movies surged from 2010 to 2012.
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
Our document “Best Practices” is the road map for comprehensive tobacco control. A new edition was just released. BP recommends funding levels and strategies that support the work in states and local communities to achieve success in policy, systems and environmental changes.
This edition reflects the changing environment of tobacco control and suggests minimum and maximum funding levels.

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
This edition suggests:
A recommended total of $3,306.3 million with a minimum of $2,325.3 million
And Per Person (based on total state population) Recommended: $10.53 and Minimum: $7.41
The report also suggests funding levels for each of the individual components of a comprehensive tobacco control strategy.
Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs — 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
Graph shows correlation between tobacco prevention spending levels and high school smoking rates.
Source: Project ImpacTEEN; University of Illinois at Chicago; State University of New York at Buffalo; Youth Risk Behavior Survey,
* 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
Graph shows inverse correlation between cigarette prices and cigarette sales.
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. (BULLET 1)
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.
(BULLETS 2, 3 4)
*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 March, 2015
The 2006 SGR concluded there is no risk-free level of SHS exposure.
The 2014 SGR: “wide geographic, occupational, and demographic disparities remain and only about one in three residents of the United States lives under state or local laws that make worksites, restaurants, and bars completely smokefree.”
However, there is significant progress being made at the local level with smokefree ordinances that offer protection from the harms of SHS exposure.
Centers for Disease Control and Prevention’s State Tobacco Activities Tracking and Evaluation (STATE) System. Available at: Washington, DC is included in states. California’s law includes exemptions that preclude it from being considered smoke-free. 23 23

24. Comprehensive Smoke-Free Laws United States 2000-2014
This slide is a good example of changes over the last decade.
As of 2013 most indoor workplaces are smoke-free and over half of states prohibit smoking in other indoor areas of public places (restaurants, bars and airports)
Many colleges and universities have adopted smoke-free/ tobacco free campuses. Inclusion of e-cigs in these laws is becoming an issue.
How far we have come
Source: CDC STATE System

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
For more information please contact Centers for Disease Control and Prevention
We have come a long way with reducing smoking prevalence, but we still have a way to go to win the battle. Implementing comprehensive tobacco policies and programs to the full extent will help us achieve our vision of a world free of tobacco-related death and disease.
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, CDC-INFO ( )/TTY:
Web:
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.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention