Targeting Tobacco Use

The Nation’s Leading Cause

of Preventable Death

2007

AT A GLANCE

“In order to achieve significant decreases in youth and adult smoking rates, we must further enhance our efforts

and fully implement comprehensive tobacco prevention and control programs.”

Julie Louise Gerberding, MD, MPH

Director, Centers for Disease Control and Prevention

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

Coordinating Center for Health Promotion

0

5

10

15

20

25

30

35

40

45

1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2010

Percent (%)

High school students*

Adults†

Year

16% for youth

12% for adults

2007

Healthy

People

2010

goal

Trends in Current Smoking by High School Students and Adults,

United States, 1965–2005

* Percentage of high school students who smoked cigarettes on 1 or more of the 30 days preceding the survey

(Youth Risk Behavior Survey, 1991–2005).

†

 Percentage of adults who are current cigarette smokers (National Health Interview Survey, 1965–2005).

Revised April 2007
Each year, an estimated 438,000 people in the United States 

die prematurely from smoking or exposure to secondhand 

smoke, and another 8.6 million have a serious illness caused 

by smoking. For every person who dies from smoking, 20 

more people suffer from at least one serious tobacco-related 

illness. Despite these risks, approximately 45.1 million U.S. 

adults smoke cigarettes.

Coupled with this enormous health toll is the significant 

economic burden of tobacco use: more than $75 billion per 

year in medical expenditures and another $92 billion per year 

resulting from lost productivity.

Since 1964, 29 Surgeon General’s reports on smoking and 

health have concluded that tobacco use is the single most 

avoidable cause of disease, disability, and death in the United 

States. Over the past 4 decades, cigarette smoking has caused 

an estimated 12 million deaths, including 4.1 million deaths 

from cancer, 5.5 million deaths from cardiovascular diseases, 

2.1 million deaths from respiratory diseases, and 94,000

infant deaths related to mothers smoking during pregnancy.

Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers. 

Low-tar cigarettes and other tobacco products are not safe 

alternatives.

The harmful effects of smoking do not end with the smoker. 

More than 126 million nonsmoking Americans, including 

children and adults, are regularly exposed to secondhand 

smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same carcinogens and toxins

in cigarette smoke as smokers. Secondhand smoke exposure 

causes serious disease and death, including heart disease and 

lung cancer in nonsmoking adults and sudden infant death 

syndrome (SIDS), acute respiratory infections, ear problems, 

and more frequent and severe asthma attacks in children. 

Each year, primarily because of exposure to secondhand 

smoke, an estimated 3,000 nonsmoking Americans die of 

lung cancer, more than 35,000 die of heart disease, and about 

150,000–300,000 children younger than 18 months have 

lower respiratory tract infections.

Although smoking rates among youth fell between 2000 and 

2003, recent surveys indicate that the rate of decline may have 

stalled among both youth and adults. This lack of progress 

suggests the need for greater use of proven antismoking

strategies and for new strategies to promote further declines

in youth smoking.

2

The Burden of Tobacco Use

About 438,000 U.S. Deaths Attributable

Each Year to Cigarette Smoking*

* Average annual number of deaths, 1997–2001.

Source: MMWR 2005;54(25):625–8.

CDC’s Tobacco Control Framework

CDC is committed to ensuring that all people, especially 

those at greater risk for health disparities, will achieve their 

optimal lifespan with the best possible quality of health

in every stage of life. With new health protection goals that 

support healthy people in healthy places across all life stages, 

CDC is setting the agenda to enable people to enjoy a healthy 

life by delaying death and the onset of illness and disability

by accelerating improvements in public health.

With fiscal year (FY) 2007 funding of about $104.3 million, 

CDC’s Office on Smoking and Health provides national leadership for a comprehensive, broad-based approach to reducing 

tobacco use. A variety of government agencies, professional 

and voluntary organizations, and academic institutions have 

joined together to advance this comprehensive approach, 

which involves the following activities:

 • Preventing young people from starting to smoke.

 • Eliminating exposure to secondhand smoke.

 • Promoting quitting among young people and adults.

 • Identifying and eliminating disparities in tobacco use 

among different population groups.

Other cancers

34,700

Lung cancer

123,800

Coronary heart

disease

Chronic lung 86,800

disease

90,600

Other

diagnoses

84,600

Stroke

17,400
3

Essential elements of this approach include state-based and 

community-based interventions, countermarketing, policy

development, surveillance, and evaluation. These activities 

target groups—such as young people, racial and ethnic

minority groups, and people with low incomes or low levels 

of education—who are at highest risk for tobacco-related 

health problems.

Sustaining State Programs

CDC continues to support basic implementation programs

to prevent and control tobacco use in all 50 states, the District 

of Columbia, 7 U.S. territories, and 7 tribal-serving organizations. In addition, CDC funds national networks to reduce 

tobacco use among priority populations. CDC also provides 

grants to 23 states for coordinated school health programs

to help prevent tobacco use.

CDC provides technical assistance and training to help 

states plan, establish, and evaluate their own tobacco control

programs. A substantial body of research demonstrates that 

comprehensive state tobacco control programs reduce smoking-attributable mortality, smoking prevalence, smoking 

initiation, and cigarette consumption. Recent research shows 

that the more states spend on comprehensive tobacco control 

programs, the greater the reductions in smoking, and that the 

longer states invest in such programs, the greater and faster 

the impact. Unfortunately, recent fiscal crises have dramatically eroded states’ investments in tobacco control. Although 

tobacco prevention funding increased slightly during the past 

2 years, from $538.2 million to $597.5 million, funding

is down 20% since it peaked at $749.7 

million in 2002. States are currently 

spending only 2.8% of the $21.7

billion available through tobacco

excise taxes and settlement funds

on tobacco prevention and control. 

Just 7.3% of these funds would be 

enough to pay for all 50 state tobacco 

control programs at CDC’s minimum 

recommended levels.

As of December 2006, only three states 

(Maine, Delaware, and Colorado) were 

funding tobacco prevention programs 

at CDC minimum levels. The overall 

average funding for tobacco control

in 2005 was $1.22 per person. CDC is 

working with national partners to help 

states regain or maintain their core 

capacity and infrastructure for tobacco 

control so that they can revitalize their 

programs once funding is restored.

Key CDC resources for states include 

the following: Key Outcome Indicators 

for Comprehensive Tobacco Control

Programs, the State Tobacco Activities Tracking and Evaluation

(STATE) System, the Sustaining State Funding for Tobacco 

Control Web site, and the online tool kit, Taking Action 

Against Secondhand Smoke.

Expanding the Science Base

CDC is responsible for conducting and coordinating research, 

surveillance, laboratory, and evaluation activities related

to tobacco and its impact on health. For example,

 • CDC provides technical assistance to help states evaluate 

their tobacco prevention and control programs. CDC also 

conducts the National Youth Tobacco Survey, assists with 

the voluntary state-based Youth Tobacco Survey and Adult 

Tobacco Survey, and develops survey instruments and 

methods to help assess tobacco use in specific populations.

 • CDC, the World Health Organization (WHO), and the 

Canadian Public Health Association developed the Global 

Tobacco Surveillance System to monitor tobacco use and 

to help countries plan, develop, implement, and evaluate 

their comprehensive tobacco control programs. This system 

includes three components—the Global Youth Tobacco 

Survey, the Global School Personnel Survey, and the Global 

Health Professional Survey.

 • CDC’s Division of Laboratory Sciences and Office on 

Smoking and Health are evaluating additives and chemical 

constituents of tobacco and tobacco smoke. This collaboration includes research on tobacco smoke toxicity and 

human smoking behavior.

0

$100

$200

$300

$400

$500

$600

$700

$800

In Millions

2002 2003 2004 2005

$749.7

$674.4

$542.6 $538.2

Fiscal Year

$551.0

2006

$597.5

2007

State Funding for Tobacco Control Programs*

* Reflects allocations from tobacco settlement payments and excise tax revenues.

Source: A Broken Promise to Our Children: The 1998 State Tobacco Settlement

Eight Years Later. Available at http://www.tobaccofreekids.org/reports/settlements.
4

Communicating Information to the Public

CDC responded to about 23,000 tobacco-related inquiries 

in FY 2006 and distributed about 320,000 publications and 

video products. Also in FY 2006, more than 3.1 million

people visited CDC’s tobacco control Web site. CDC

provides materials and resources to educators, employers, 

public health workers, and other community leaders who

are working to 1) prevent people from starting to use tobacco, 

2) help people who use tobacco to quit, and 3) support

community interventions.

Through its Media Campaign Resource Center (MCRC), 

CDC continues to provide counteradvertising materials and 

technical assistance to help state and local programs conduct 

effective media campaigns. Through the Cessation Resource 

Center (CRC), CDC provides user-tested materials on topics 

such as reimbursement, quitlines, and evaluation. The MCRC 

and CRC help states stretch their media budgets by using and 

adapting existing ads and other materials rather than creating 

new ones.

In addition, CDC developed training modules for chapters

in the 2003 Designing and Implementing an Effective Tobacco 

Countermarketing Campaign to help state and local health 

departments conduct local training workshops. In partnership 

with other federal, state, and local agencies, CDC communicates key tobacco messages through the media, schools, and 

communities. CDC also works with the sports and entertainment industries to communicate its tobacco-free message.

Promoting Action Through Partnerships

CDC works with a variety of national and international 

partners to ensure that diverse groups are involved in tobacco 

control efforts. For example,

 • CDC is the lead agency for the 21 national objectives

on tobacco use in Healthy People 2010 and works with 

other agencies and organizations to monitor progress

toward meeting these objectives.

 • CDC staffs the U.S. Department of Health and Human 

Services’ Interagency Committee on Smoking and Health, 

which coordinates research programs and other efforts 

among federal, state, local, and private agencies.

 • CDC coordinates and promotes tobacco prevention and 

control activities in collaboration with partners, including 

the American Cancer Society, American Heart Association, 

American Legacy Foundation, American Lung Association,

Association of State and Territorial Health Officials, 

Campaign for Tobacco-Free Kids, Council of State Governments, National Association of County and City Health 

Officials, National Association of Local Boards of Health, 

National Cancer Institute, Pan-American Health Organization, Robert Wood Johnson Foundation, Substance Abuse 

and Mental Health Services Administration, Tobacco

Technical Assistance Consortium, U.S. Environmental 

Protection Agency, and World Bank.

 • CDC conducts global tobacco control activities with

a range of international, regional, and country-specific

partners. CDC, WHO, and the Canadian Public Health

Association have developed the Global Tobacco Surveillance

System.

 • CDC, in partnership with the National Cancer Institute, the

North American Quitline Consortium, and state tobacco 

control programs, has developed the National Network 

of Tobacco Cessation Quitlines. By calling 1-800-QUIT 

NOW, callers from across the nation have free and easy

access to tobacco cessation services in their state.

Future Directions

To accelerate progress toward a tobacco-free future, CDC

is focusing on four strategic priorities:

 • Sustaining science-based, comprehensive state tobacco 

control programs.

 • Conducting tobacco product research and disseminating 

information.

 • Engaging the business sector in supporting comprehensive 

tobacco prevention and control.

 • Strengthening global tobacco control surveillance and 

translating the data into action.

CDC will work to help policy makers, health officials, and the 

public understand that tobacco control is a core component

of public health that needs to be sustained if the nation is to 

reduce the terrible toll of death and disease from tobacco use.

For more information or copies of publications referenced in this document, please contact

Centers for Disease Control and Prevention

 National Center for Chronic Disease Prevention and Health Promotion

4770 Buford Highway NE, Mail Stop K–50, Atlanta, GA 30341-3717

Telephone: 800-CDC-INFO (232-4636) • TTY: 888-232-6348

E-mail: cdcinfo@cdc.gov • Web: http://www.cdc.gov/tobacco

Capitalizing on Unique Opportunities for Research and Collaboration

CS110431