1. Tobacco Progress Review May 14, 2003

2. Public Health Challenges Tobacco Impact and Public Health Challenges Current Smokers Environmental Tobacco Smoke Annual Impact ~440,000 Premature Deaths Lung / Other Cancers Chronic Respiratory Disease Cardiovascular Disease 14% of Medicaid Expenditures Direct and Indirect Costs: $157 Billion 28% of High School Students 11% of Middle School Students 22% of Adults (46 million adults) 54% of Nonsmokers Exposed

3. Public Health Challenges Tobacco Impact and Public Health Challenges Current Smokers Environmental Tobacco Smoke Annual Impact ~440,000 Premature Deaths Lung / Other Cancers Chronic Respiratory Disease Cardiovascular Disease 14% of Medicaid Expenditures Direct and Indirect Costs: $157 Billion Future Smokers

4. Smoking-Attributable Mortality, 1995-1999 Number of average annual deaths Sources: CDC. Annual Smoking –Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States, 1995-1999. MMWR 2002 51;300-3. Burn deaths from: Hall JR. The U.S. smoking-material fire problem. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 2001. Environmental tobacco smoke deaths from: National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Smoking and tobacco control monograph 10. Bethesda, Maryland: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1999. Total does not equal sum due to rounding. Neoplasms Cardiovascular diseases Respiratory disease Total Perinatal conditions Burn deaths Total Lung cancer Ischemic heart disease Environmental Tobacco Smoke All Deaths Smoking-attributable (19%) Other

5. 3-2. Lung Cancer Death Rates Age-adjusted death rate per 100,000 standard population Black male Total population White male White female Black female Notes: Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC. 2010 Target Total male Total female

6. 27-1a. Current Cigarette Smoking: Adults 18 Years and Older Age-adjusted percent 2010 Target Black male 1975 19651975199520011985 White male White female Black female Notes: Data are age adjusted to the 2000 standard population. Survey redesigned in 1997 and data for 1998 and subsequent years may not be directly comparable to earlier years. Source: National Health Interview Survey (NHIS), NCHS, CDC.

7. Age-adjusted death rate per 100,000 standard population Black male Total population White male White female Black female Total male Total female Age-adjusted percent 27-1a. Current Cigarette Smoking: Adults 18 Years and Older 3.2 Lung Cancer Death Rates 19501960 1970198019902000 Black male White male Black female White female 19651985199520011975 60 40 20 0 Sources/Notes: Same as previous slides for objectives 3-2 and 27-1a.

8. Sources: Centers for Disease Control and Prevention and the United States Department of Agriculture. Great Depression End of WW II Nonsmokers’ Rights Movement Begins 1st Surgeon General’s Report Fairness Doctrine Messages on TV and Radio Federal Cigarette Tax Doubles Broadcast Ad Ban Annual Adult Per Capita Cigarette Consumption Master Settlement Agreement Nicotine Medications Available Over the Counter 1st Smoking- Cancer Concern 1st World Conference on Smoking and Health Surgeon General’s Report on Environmental Tobacco Smoke 1st Great American Smokeout

9. 27-1a. Current Cigarette Smoking for Adults American Indian/ Alaska Native only Asian only Hispanic* Black only, not Hispanic* White only, not Hispanic* Total* Males* 9-11 years High school graduate 13-15 years 16 years or more Females* Age-adjusted percent Education level 2010 Target 1998 Baseline Current Level *Preliminary data: January-September 2002, current data year for other groups is 2001. Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes. Data are age adjusted to the 2000 standard population. American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race. Adults: 18 years and older. Source: National Health Interview Survey (NHIS), NCHS, CDC.

10. 27-5. Current Adult Smokers Who Attempted and Failed to Quit in the Past Year, 2001 American Indian/ Alaska Native only Asian only HispanicBlack only, not Hispanic White only, not Hispanic 2010 Target I 95% confidence interval *Current smokers (everyday/some days and have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview. Notes: American Indians/Alaska Natives or Asians may be of Hispanic origin. Hispanics may be of any race. Data are age adjusted to the 2000 standard population. Adults: 18 years and older. Age-adjusted percent Total Source: National Health Interview Survey (NHIS), NCHS, CDC.

11. 27-1a, 27-2b. Current Cigarette Smoking Percent 2010 Target: Students Students (grades 9-12) Adults (18 and older) 2010 Target: Adults 19701975198020001965198519901995 *Preliminary data, January-September 2002. Notes: Adults, age adjusted to the 2000 standard population. Current Smoking: Adults-every/some days (and have smoked at least 100 cigarettes), Students-1+ day/past month. 2002* Sources: Adults, National Health Interview Survey (NHIS), NCHS, CDC. Students, Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

12. Healthy People 2010 Objectives Past Month* Tobacco Users: Students (Grades 9-12), 2001 Tobacco Product Any Tobacco Product CigarettesSpit Tobacco Cigars Current Rate 34% (total) 30% (females) 39% (males) 28% (total) 28% (females) 29% (males) 8% (total) 2% (females) 15% (males) 15% (total) 9% (females) 22% (males) 2010 Target 21%16%1%8% Objective Number 27-2a.27-2b.27-2c.27-2d. *Tobacco use on one or more days in the 30 days preceding the survey. Note: Tobacco users may have used more than one tobacco product. Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

13. 27-2b. Cigarette Use in Past Month*: Students (grades 9-12) Males Hispanic Black, not Hispanic White, not Hispanic Percent TotalFemales Sources: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC and **National Youth Tobacco Survey, OSH, CDC and The American Legacy Foundation. I 95% confidence interval *Smoked cigarette(s) on one or more days of the 30 days preceding the survey. Note: Data for American Indians/ Alaska Natives, and Asians/Pacific Islanders are unreliable. In 2000, 11% of students in grades 6-8 smoked** 2010 Target 1999 Baseline 2001

14. Current Cigarette Smoking, Price and Tax: Students (12 th Grade) Dollars Mean excise tax on a pack of cigarettes Current smoking Real price per pack Current smoking Percent *Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price. Real price and mean excise tax per pack of cigarettes adjusted for inflation. Sources: Original analysis/slide prepared by the ImpacTeen Project. Estimated prices for the period covered by the survey data are based on the 11/01 price for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price. Price data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001. Arlington, Virginia: Orzechowski and Walker, 2002. Smoking prevalence data from: Monitoring the Future Study, NIH, NIDA. Tax data from: The Tax Burden on Tobacco, The Tobacco Institute.

15. Serum Cotinine Levels for Persons Aged 4 Years and Older, 1988-1991 Serum cotinine (ng/mL) Percentage of the population 0 1 2 3 4 5 0.1 1.0 10100 1000 ETS exposure among non-smokers Smokers 0.05* *Lowest level of detection Source: Pirkle et al. Exposure of the US population to Environmental Tobacco Smoke. The Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA, April 24, 1996-Vol 275, No. 16 pp.1233-1240.

16. 27-10. Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**, Ages 4 and Older 2010 Target Age-adjusted percent with detectable serum cotinine Mexican American Total White, not Hispanic Black, not Hispanic Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC. I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: >.05 ng/mL and < 10 ng/mL. Notes: Age adjusted to the 2000 standard population. Data for other Hispanics, American Indians,/Alaska Natives, Asians/Pacific Islanders are unreliable. 1988-94 Baseline 1999-2000

17. 27-13. Smoke-Free Indoor Air Laws* 2010 Target Total number of States with laws (including D.C.) Workplace Transportation Source: State Tobacco Activities Tracking and Evaluation System (STATE System), OSH, NCCDPHP, CDC. *Indoor air laws: smoking bans or limited to separately ventilated areas. 3 5 18 24 6 17 1 13 3 16 22 4 2010 Target 1998 Baseline 2002 25

18. 27-8b. Number of States With Medicaid Coverage for Treatment of Nicotine Dependency Year No Coverage Partial Coverage Full Coverage 199825 1 199916341 200015351 2010 Target: 51 (50 States and D.C.) Source: Health Policy Tracking Service, National Conference of State Legislators.

19. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm