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Tobacco use is the single most preventable cause 

of disease, disability, and death in the United States. 

Nearly one-half million Americans still die prematurely 

from tobacco use each year, and more than 16 million 

Americans suffer from a disease caused by smoking. 

Despite these risks, approximately 42.1 million U.S. 

adults currently smoke cigarettes. And the harmful 

effects of smoking do not end with the smoker. 

Secondhand smoke exposure causes serious disease 

and death, and even brief exposure can be harmful 

to health. Each year, primarily because of exposure to 

secondhand smoke, an estimated 7,330 nonsmoking 

Americans die of lung cancer and more than 33,900 die 

of heart disease. Coupled with this enormous health 

toll is the significant economic burden. Economic costs 

attributable to smoking and exposure to secondhand 

smoke now approach $300 billion annually. 

Executive Summary 

F

ifty years have passed since the 1964 Surgeon General’s report on smoking and 

health concluded: “Cigarette smoking is a 

health hazard of sufficient importance in 

the United States to warrant appropriate remedial 

action.” There now is a robust evidence base for 

effective tobacco control interventions. Yet, despite 

this progress, the United States is not currently on 

track to achieve the Healthy People 2020 objective to reduce cigarette smoking among adults to 

12% or less by the year 2020. A 2007 Institute of 

Medicine (IOM) report presented a blueprint for 

action to “reduce smoking so substantially that it is 

no longer a public health problem for our nation.” 

The two-pronged strategy for achieving this goal 

includes: 1) strengthening and fully implementing currently proven tobacco control measures; 

and 2) changing the regulatory landscape to permit policy innovations. Foremost among the IOM 

recommendations is that each state should fund 

a comprehensive tobacco control program at the 

level that the Centers for Disease Control and Prevention (CDC) recommends.

Evidence-based, statewide tobacco control 

programs that are comprehensive, sustained, 

and accountable have been shown to reduce 

smoking rates, as well as tobacco-related diseases 

and deaths. A comprehensive statewide tobacco 

control program is a coordinated effort to establish 

smokefree policies and social norms, to promote 

and assist tobacco users to quit, and to prevent 

initiation of tobacco use. This comprehensive 

approach combines educational, clinical, regulatory, 

economic, and social strategies. Research has 

documented the effectiveness of laws and policies 

in a comprehensive tobacco control effort to 

protect the public from secondhand smoke 

exposure, promote cessation, and prevent initiation, 

including: increasing the unit price of tobacco 

products; implementing comprehensive smokefree 

laws that prohibit smoking in all indoor areas of 

worksites, restaurants, and bars, and encouraging 

smokefree private settings such as multiunit 

housing; providing insurance coverage of evidencebased tobacco cessation treatments; and limiting 

minors’ access to tobacco products. Additionally, 

research has shown greater effectiveness with 

multicomponent interventional efforts that integrate 

the implementation of programmatic and policy 

initiatives to influence social norms, systems, 

and networks.

CDC’s Best Practices for Comprehensive 

Tobacco Control Programs—2014 is an evidencebased guide to help states plan and establish 

comprehensive tobacco control programs. This 

edition updates Best Practices for Comprehensive 

Tobacco Control Programs—2007. The 2014 

edition describes an integrated programmatic 

structure for implementing interventions proven 

to be effective and provides the recommended 

level of state investment to reach these goals 

and to reduce tobacco use in each state. 

These individual components are most 

effective when they work together to produce 

the synergistic effects of a comprehensive 

statewide tobacco control program. On the 

basis of evidence of effectiveness documented 

in the scientific literature and the experiences 

of state and local programs, the most effective 

population-based approaches have been defined 

within the following overarching components. 
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Executive Summary

I. State and Community Interventions 

State and community interventions include supporting 

and implementing programs and policies to influence 

societal organizations, systems, and networks that 

encourage and support individuals to make behavior 

choices consistent with tobacco-free norms. The social 

norm change model presumes that lasting change 

occurs through shifts in the social environment—initially 

or ultimately—at the grassroots level across local 

communities. State and community interventions unite 

a range of integrated activities, including local and 

statewide policies and programs, as well as initiatives to 

eliminate tobacco-related disparities. 

The most effective state and community 

interventions are those in which specific strategies for 

promoting tobacco use cessation, preventing tobacco 

use initiation, and eliminating exposure to secondhand 

smoke are combined with mass-reach health 

communication interventions and other initiatives to 

mobilize communities and to integrate these strategies 

into synergistic and multicomponent efforts. 

II. Mass-Reach Health Communication Interventions 

An effective state-level, mass-reach health 

communication intervention delivers strategic, culturally 

appropriate, and high-impact messages through 

sustained and adequately funded campaigns that are 

integrated into a comprehensive state tobacco control 

program. Typically, effective health communication 

interventions and countermarketing strategies employ 

a wide range of paid and earned media, including: 

television, radio, out-of-home (e.g., billboards, transit), 

print, and digital advertising at the state and local levels; 

promotion through public relations/earned media 

efforts, including press releases/conferences, social 

media, and local events; health promotion activities, 

such as working with health care professionals and other 

partners, promoting quitlines, and offering free nicotine 

replacement therapy; and efforts to reduce or replace 

tobacco industry sponsorship and promotions.

Innovations in health communication interventions 

include the ability to target and engage specific 

audiences through multiple communication channels, 

such as online video, mobile Web, and smartphone and 

tablet applications (apps). Social media platforms, such as 

Twitter and Facebook, have facilitated improvements in 

how messages are developed, fostered, and disseminated 

in order to better communicate with target audiences 

and allow for relevant, credible messages to be shared 

more broadly within the target audiences’ social circles.

III. Cessation Interventions 

Comprehensive state tobacco control program cessation 

activities can focus on three broad goals: (1) promoting 

health systems change; (2) expanding insurance coverage 

of proven cessation treatments; and (3) supporting state 

quitline capacity.

Health systems change involves institutionalizing 

cessation interventions in health care systems and 

seamlessly integrating these interventions into routine 

clinical care. These actions increase the likelihood that 

health care providers will consistently screen patients 

for tobacco use and intervene with patients who use 

tobacco, thus increasing cessation. Expanding cessation 

insurance coverage removes cost and administrative 

barriers that prevent smokers from accessing cessation 

counseling and medications, and increases the number of 

smokers who use evidence-based cessation treatments 

and who successfully quit. Expanding cessation insurance 

coverage also has the potential to reduce tobacco-related 

population disparities. 

Quitlines potentially have broad reach, are effective 

with and can be tailored to diverse populations, and 

increase quit rates. Because state quitline services are 

free, remove time and transportation barriers, and are 

confidential, they are one of the most accessible cessation 

resources. Optimally, quitline counseling should be made 

available to all tobacco users willing to access the service. 
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Executive Summary

IV. Surveillance and Evaluation 

The primary objectives of the recommended 

statewide comprehensive tobacco control program 

are to reduce tobacco use and the personal and 

societal burdens of tobacco-related disease and 

death. Research shows that the more states spend 

on comprehensive tobacco control programs, the 

greater the reductions in smoking. The longer 

states invest in such programs, the greater and 

quicker the impact. 

Implementing comprehensive tobacco control 

programs at the levels of investment outlined in this 

report would have a substantial impact. As a result, 

millions of fewer people in the United States would 

smoke and hundreds of thousands of premature 

tobacco-related deaths would be prevented. Longterm investments would have even greater effects. 

Surveillance is the process of continuously monitoring 

attitudes, behaviors, and health outcomes over time. 

Statewide surveillance is important for monitoring the 

achievement of overall program goals. Evaluation is 

used to assess the implementation and outcomes of a 

program, increase efficiency and impact over time, and 

demonstrate accountability. 

Publicly financed programs need to have 

accountability and demonstrate effectiveness, as well as 

have access to timely data that can be used for program 

improvement and decision making. 

Therefore, a critical infrastructural component of any 

comprehensive tobacco control program is a surveillance 

and evaluation system that can monitor and document 

key short-term, intermediate, and long-term outcomes 

within populations. Data from surveillance and 

evaluation systems can be used to inform program and 

policy directions, demonstrate program effectiveness, 

monitor progress on reducing health disparities, ensure 

accountability to those with fiscal oversight, and engage 

stakeholders.

V. Infrastructure, Administration, and Management 

A comprehensive tobacco control program requires 

considerable funding to implement. Therefore, a fully 

functioning infrastructure must be in place in order to 

achieve the capacity to implement effective interventions. 

Sufficient capacity is essential for program sustainability, 

efficacy, and efficiency, and it enables programs to plan 

their strategic efforts, provide strong leadership, and foster 

collaboration among the state and local tobacco control 

communities. 

An adequate number of skilled staff is also necessary 

to provide or facilitate program oversight, technical 

assistance, and training. 

We know what works to effectively reduce 

tobacco use, and if we were to fully invest in 

and implement these proven strategies, we could 

significantly reduce the staggering toll that tobacco 

takes on our families and in our communities. We 

could accelerate the declines in cardiovascular 

mortality, reduce chronic obstructive pulmonary 

disease, and make lung cancer a rare disease. With 

sustained implementation of state tobacco control 

programs and policies, the Healthy People 2020

objective of reducing adult smoking prevalence 

to 12% or less by 2020 could be attainable.