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Tobacco Use

Tobacco Use

Goal

Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure.

Overview

Scientific knowledge about the health effects of tobacco use has increased greatly since the first Surgeon General’s report on tobacco was released in 1964.1,2,3,4 Since the publication of that report, more than 20 million Americans have died because of smoking.4

Tobacco use causes:4

  • Cancer (oropharynx, larynx, esophagus, trachea, bronchus, lung, acute myeloid leukemia, stomach, liver, pancreas, kidney and ureter, cervix, bladder, and colorectal)
  • Heart disease and stroke
  • Lung diseases (emphysema, bronchitis, chronic airway obstruction, chronic obstructive pulmonary disease, and pneumonia)
  • Reproductive effects (ectopic pregnancy, premature birth, low birth weight, stillbirth, reduced fertility in women, and erectile dysfunction; and birth defects, including clept-lip and/or cleft palate)
  • Other effects (Type 2 diabetes, age-related macular degeneration, rheumatoid arthritis, blindness, cataracts, hip fractures, impaired immune function, periodontitis, and overall diminished health)

The harmful effects of tobacco do not end with the user. There is no risk-free level of exposure to secondhand smoke. Since 1964, 2.5 million deaths have occurred among nonsmokers who died from diseases caused by secondhand smoke exposure.4 Secondhand smoke causes heart disease, lung cancer, and stroke in adults,4 and can cause a number of health problems in infants and children, including:5

  • More severe asthma attacks
  • Respiratory infections
  • Ear infections
  • Sudden infant death syndrome (SIDS)

In addition, smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth and gums, periodontitis, and tooth loss.1,3

Why Is Preventing Tobacco Use Important?

Tobacco use is the largest preventable cause of death and disease in the United States.4 Each year, approximately 480,000 Americans die from tobacco-related illnesses. Further, more than 16 million Americans suffer from at least one disease caused by smoking.4

Smoking-related illness in the United States costs more than $300 billion each year, including nearly $170 billion for direct medical care for adults and more than $156 billion in lost productivity.4

Healthy People 2020: A Framework for Ending the Tobacco Use Epidemic

Healthy People 2020 provides a framework for action to reduce tobacco use to the point that it is no longer a public health problem for the Nation. Research has identified effective strategies that will contribute to ending the tobacco use epidemic, including:7,8,9,10,11,12

  • Increasing the price of tobacco products
  • Enacting comprehensive smoke-free policies
  • Expanding cessation treatment in clinical care settings and providing access to proven cessation treatment to all smokers
  • Implementing hard-hitting anti-tobacco media campaigns
  • Fully funding tobacco control programs at CDC-recommended levels
  • Controlling access to tobacco products, including e-cigarettes and combustible and non-compustible products
  • Reducing tobacco advertising and promotion directed at children

The Healthy People 2020 Tobacco Use objectives are organized into 3 key areas:

  1. Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth and adults.
  2. Health System Changes: Adopting policies and strategies to increase access, affordability, and use of smoking cessation services and treatments.
  3. Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors.

Preventing tobacco use and helping tobacco users quit can improve the health and quality of life for Americans of all ages. People who stop smoking greatly reduce their risk of disease and premature death.13,14,15 Benefits are greater for people who stop at earlier ages, but quitting tobacco use is beneficial at any age.14

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Understanding Tobacco Use

Many factors influence tobacco use. Risk factors include race/ethnicity, age, education, and socioeconomic status. Significant disparities in tobacco use exist geographically; such disparities typically result from differences among states in smoke-free protections, tobacco prices, and program funding for tobacco control.

Emerging Issues in Tobacco Use

Major advances have been made in recent years to address the tobacco epidemic:

  1. In 2009, the U.S. Food and Drug Administration (FDA) was granted the authority to regulate the sales, marketing, and manufacture of all tobacco products marketed in the United States.16
  2. In 2009, the Federal tobacco excise tax was increased by $0.61 to $1.01 per pack.
  3. As of 2015, 26 states and the District of Columbia (DC) had comprehensive smoke-free laws prohibiting smoking in workplaces, restaurants, and bars. Moreover, 15 states and DC had cigarette excise tax rates of at least $2 per pack.17
  4. In 2010, the Affordable Care Act was passed, which provided the opportunity for access to barrier-free proven tobacco use cessation treatment including counseling and medication to all smokers.18
  5. In 2012, CDC launched the first-ever paid national tobacco education campaignTips From Former Smokers (Tips). The initial campaign resulted in 1.6 million additional smokers making a quit attempt and over 100,000 sustained quitters. Similarly, in 2015, Tips ads had an immediate and strong impact, showing that the campaign's success has continued since its launch in 2012.

However, there are several emerging issues in tobacco use: 

  1. The tobacco product landscape is rapidly changing, and use of emerging tobacco products is increasing, particularly among youth. In 2014, e-cigarettes became the most commonly used tobacco product among U.S. middle and high school students, surpassing cigarettes. 
  2. The Family Smoking Prevention and Tobacco Control Act prohibits characterizing flavors other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products, including for instance, cigars, cigarillos, e-cigarettes, and hookahs. In 2014, an estimated 70% (3.26 million) of all current youth tobacco users had used at least one flavored tobacco product in the past 30 days. 
  3. During 2002-2012, the number of youth and young adults who tried cigarette smoking during the past year increased from 1.9 to 2.3 million. Raising the minimum age of sale for tobacco products to 21 years has emerged as a potential strategy for addressing use among this population.
  4. An estimated 58 million Americans remain exposed to secondhand smoke each year. The home is the primary source of secondhand smoke exposure for children, and multiunit housing residents are particularly vulnerable to involuntary exposure in their homes. 

References

1U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989. DHHS Publication No. (CDC) 89-8411.

2U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. DHHS Publication No. (CDC) 90-8416.

3U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. 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, 2004.

4U.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. Printed with corrections, January 2014.

5U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

6Centers for Disease Control and Prevention. Cigarette smoking among adults and trends in smoking cessation—United States, 2008. MMWR. 2009;58(44):1227-32 [cited 2009 Nov 16].

7Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995–1999. MMWR. 2002;51(14):300-3 [cited 2009 Aug 18].

8Institute of Medicine. Ending the tobacco problem: A blueprint for the nation. Washington: National Academies Press; 2007.

9World Health Organization (WHO). WHO report on the global tobacco epidemic, 2008: The MPOWER package. Geneva, Switzerland: WHO; 2008. available from: http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf [PDF - 7.62MB]  

10Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. Best practices for comprehensive tobacco control programs—2007. Atlanta: CDC; 2007. Available from: http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

11U.S. Department of Health and Human Services. Reducing Tobacco Use. A Report of the Surgeon General. 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, 2000.

12National Institutes of Health, National Cancer Institute (NCI). The role of the media in promoting and reducing tobacco use. Tobacco Control Monograph No. 19. Bethesda, MD: NCI; 2008 Jun.

13Fiore MC, Jaen CR, Baker TB, et al. Clinical practice guideline: Treating tobacco use and dependence—2008 update. Rockville, MD: US Department of Health and Human Services. Public Health Service; 2008 May.

14U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. DHHS Publication No. (CDC) 90-8416.

15U.S. Department of Health and Human Services. Women and Smoking. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001.

16Family Smoking Prevention and Tobacco Control Act. Public Law No. 111-31 (June 22, 2009).Available from: http://www.gpo.gov/fdsys/pkg/PLAW-111publ31/content-detail.html

17State Tobacco Activities Tracking and Evaluation System. http://www.cdc.gov/statesystem

18Patient Protection and Affordable Care Act. Public Law No. 111-148 (March 23, 2010). Available from: http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html

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