Preventing Chronic Diseases: 

Investing Wisely in Health 

U.S. DEPARTMENT OF HEALTH Preventing Tobacco Use AND HUMAN SERVICES 

The Reality 

• Tobacco use is the single most preventable cause of death and 

disease, causing approximately 440,000 premature deaths in the 

United States each year. 

• Smoking harms nearly every organ in the body and can cause 

chronic lung disease, coronary heart disease, and stroke, as well 

as cancer of the lungs, larynx, esophagus, mouth, bladder, cervix, 

pancreas, and kidneys. 

• Nearly 70% of the more than 45.4 million American adults


who smoke cigarettes want to quit.


• Approximately 80% of adult smokers started smoking before 

the age of 18. Every day, more than 2,000 young people under 

age 18 become daily smokers. 

• If current smoking patterns in the United States persist, 

approximately 5 million of today’s children will die prematurely 

of tobacco-related diseases. 

The Cost of Tobacco Use 

• Direct medical expenditures attributed to smoking total 

more than $75 billion per year. In addition, smoking costs 

an estimated $92 billion per year in lost productivity. 

• About 14% of all Medicaid expenditures are for smoking-


related illnesses.


• Approximately 20 billion packs of cigarettes were sold in the 

United States in 2002. Each pack cost the nation an estimated 

$8.61 in medical care costs and lost productivity. 

How Tobacco Control Saves Lives 

• A New England Journal of Medicine report noted that the 

California Tobacco Control Program was associated with 33,000 

fewer deaths from heart disease from 1989 through 1997. 

During this time, rates of lung cancer among men declined 

more rapidly in California than in other parts of the country, 

and rates of lung cancer among women in California declined, 

while they continued to increase elsewhere. 

• Following the establishment of the Massachusetts Tobacco 

Control Program, state rates of smoking during pregnancy 

dropped sharply, from 25% in 1990 to 13% in 1996. 

Eliminating smoking during pregnancy may lead to a 

10% reduction in all infant deaths and a 12% reduction 

in deaths from perinatal conditions. 

Average Annual Number of U.S. Deaths 

Attributable to Cigarette Smoking, 

1997–2001 

(Total average number: 437,902) 

Stroke 

17,436 Other cancers 

Other 34,693


diagnoses


84,554


Lung cancer 

123,836 

Chronic lung 

disease 

90,582 

Coronary heart 

disease 

86,801 

Source: CDC. Annual smoking-attributable mortality, years of potential life lost, and productivity 

losses—United States—1997–2001. MMWR 2005;54(25):625–8. 

How Tobacco Control Saves Money 

• Stopping the use of tobacco is the most cost-effective method 

of preventing disease among adults. Each smoker who successfully quits smoking reduces the anticipated medical costs associated with heart attack and stroke by an estimated $47 in the 

first year and $853 during the following 7 years. 

• An economic assessment found that a health care plan’s 

annual cost of covering treatment to help people quit smoking 

ranged from $0.89 to $4.92 per smoker, whereas the annual 

cost of treating smoking-related illness ranged from $6 to $33 

per smoker. 

Revised August 2005 
decision-makers about the health and economic costs of 

vote of the people. 

Secure a Future for 

In 2002, Colorado had a well-established tobacco control 

program that received $15 million in funding from state 

settlement funds as well as federal and nongovernmental 

support. However, in 2003 and again in 2004, the Colorado 

legislature drastically reduced tobacco settlement funds for 

the State Tobacco Education and Prevention Partnership. 

By 2004, Colorado was spending far below the minimum 

funding level recommended by CDC. 

These funding cuts prompted various partners concerned 

about the health of Colorado citizens to come together 

and conduct a campaign to educate the public and 

tobacco use and the need to increase funding for tobacco 

prevention and control. The campaign was a success. In 

2004, voters passed an excise tax increase of 64 cents per 

pack of cigarettes—from 20 cents, one of the lowest tax 

rates in the country, to 84 cents. Voters also approved an 

increase in taxes on other tobacco products—from 20% 

of the manufacturer’s list price to 40%. 

The tax revenues, all earmarked for health initiatives, now 

include 16% of expected revenue to support chronic disease programs that will address cancer, heart disease, and 

lung diseases; 16% for tobacco prevention and treatment; 

46% for the expansion of Medicaid and the Children’s 

Health Insurance Program, 19% for Community Health 

Centers, and 3% to bolster the Old Age Pension Fund. 

This support brings Colorado to the CDC-recommended 

minimum funding level for its comprehensive tobacco 

control program. Also, because the tax increase and use 

of the funds have been incorporated into the Colorado 

Constitution, funds cannot be reallocated without a 

State Program in Action: 

Colorado Voters Step in 

to Strengthen Funding, 

the State Tobacco 

Control Program 

Effective Strategies 

• CDC’s Best Practices for Comprehensive Tobacco Control Programs, 

based on effective strategies from states with comprehensive 

approaches, provides guidelines and funding estimates to help 

states establish highly effective tobacco control programs. 

• These guidelines are further supported by the independent Task 

Force on Community Preventive Services, which strongly recommends increasing the price of tobacco products, conducting 

mass media campaigns, developing multicomponent cessation 

interventions, reducing out-of-pocket costs for treatment, and 

instituting smoking bans and restrictions to reduce exposure to 

environmental tobacco smoke in public places. 

• Funding comprehensive programs—as Arizona, California, Florida, 

Massachusetts, Oregon, and Washington have demonstrated— 

produces measurable progress toward meeting statewide tobacco 

control objectives, including declines in adult and youth smoking 

and per capita cigarette consumption, as well as declines in rates 

of exposure to secondhand smoke. 

• The more states spend on comprehensive tobacco control 

programs, the greater the reductions in smoking. And the longer 

states invest in such programs, the greater and faster the impact. 

Hope for the Future 

A mere 8% of the total available annual income from tobacco 

excise taxes and tobacco settlement payments would allow all state 

programs to be funded at CDC’s minimum recommended level. 

If states spent the minimum amount recommended by CDC on 

tobacco prevention and control, youth smoking rates would be 

reduced by an estimated 3% to 13.5%. 

Percentage of High School Students Who

Currently Smoke Cigarettes,*

United States, 1991–2004

40 

35 

30 

25 

20 

15 

10 

5 

0 1991 1993 1995 1997 1999 2001 2003 

Youth Risk Behavior Survey National Youth Tabacco Survey 

*Smoking one or more cigarettes during the previous 30 days. 

Sources: CDC. Cigarette use among high school students—United States, 1991–2003. MMWR 

2004;53(23):499–502. CDC. Youth tobacco surveillance—United States, 1998–1999. MMWR 

2000;49(SS-10):1–94. CDC. Youth tobacco surveillance—United States, 2000. MMWR 

2001;50(SS-04):1–84. CDC. Tobacco use access and exposure to tobacco in media among 

middle and high school students—United States, 2004. MMWR 2005;54(12):297–301. 

For more information and references supporting these facts, 

visit www.cdc.gov/nccdphp. For additional copies of this 

document, E-mail ccdinfo@cdc.gov.