Power of Prevention

Cost-Effectiveness of Tobacco Use Interventions

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Cigarette smoking harms nearly every organ of the body and causes cancer, heart disease, stroke, lung diseases, and type 2 diabetes.

Secondhand smoke also causes stroke, lung cancer, and heart disease in adults. Children who are exposed to secondhand smoke are at increased risk of sudden infant death syndrome, impaired lung function, acute respiratory infections, middle ear disease, and more frequent and severe asthma attacks.

Tobacco Use in the United States

  • About 34 million US adults smoke cigarettes,1 and 58 million nonsmoking Americans are exposed to secondhand smoke.2
  • Every day, about 2,000 young people under 18 smoke their first cigarette, and more than 300 become daily cigarette smokers.3,4
  • Cigarette smoking causes more than 480,000 deaths every year, including 41,000 deaths from secondhand smoke.5
  • Differences in tobacco use exist across population groups. For example, American Indians and Alaska Natives have the highest prevalence of cigarette smoking compared to all other racial or ethnic groups in the United States.
  • In 2018, 23.9% of adult Medicaid enrollees were current cigarette smokers, compared with 10.5% of adults with private health insurance, placing them at greater risk for smoking-related disease and death.1

Strategies That Work

The Benefits of Using Proven Strategies

The Community Preventive Services Task Force (CPSTF) reviews health interventions to determine which ones work and offer good value.* Its review of tobacco interventions found that:

  • Comprehensive tobacco control programs can save money because the amount saved from reductions in smoking-related health care costs can be higher than the costs of adopting these programs.6
  • A nationwide smokefree policy could save $700 to $1,297‡(a) for each person not currently covered by a smokefree policy by preventing illness and reducing deaths from secondhand smoke.7
  • Interventions that increase the price of tobacco products by 20% can save an average of $72.52‡(a) per person per year in health care costs.8
  • Communication interventions that reach large numbers of people save lives.9

CDC is at the forefront of the nation’s efforts to reduce diseases and deaths that result from tobacco use, which can help reduce smoking-attributable costs.

The agency and its partners promote efforts to prevent young people from starting to smoke, create smokefree worksites and public spaces, help smokers quit, and reduce health disparities for groups with higher rates of chronic diseases caused by smoking.

For example, CDC’s National Tobacco Control Program is the only nationwide initiative that supports all 50 states, the District of Columbia, 8 US territories, and 26 tribes and tribal organizations for tobacco control efforts.

These efforts have resulted in strategies to protect Americans from the risks of tobacco use and secondhand smoke exposure. For example:

  • CDC’s Tips From Former Smokers® (Tips®) campaign is the first federally funded tobacco education campaign focused on motivating US adults who smoke to try to quit. Tips features real people—not actors—who are living with serious health conditions caused by smoking and secondhand smoke exposure. During 2012–2018, CDC estimates that more than 16.4 million people who smoke have attempted to quit and about 1 million have quit because of the Tips campaign.10
  • CDC also helps people stop using tobacco through 1-800-QUIT-NOW, a toll-free telephone line that routes callers to their state quitlines. Callers have access to free counseling and, in many states, free smoking cessation medications when eligible.
  • 61% of the US population is now protected by a comprehensive state or local smokefree law pdf icon[PDF – 119 KB]external icon.11

CDC, states, and other partners have helped reduce cigarette smoking among US adults from 20.9% (about 1 in every 5 adults) in 2005 to 13.7% (nearly 1 in every 7 adults) in 2018.1



annual cost of smoking-related disease and death

The High Cost of Tobacco Use

  • For every American who dies because of smoking, at least 30 are living with a serious smoking-related illness. That’s over 16 million Americans.5,12
  • Smoking-related economic costs in the United States are more than $300 billion‡(b) each year. This includes $170 billion in direct medical costs.12
  • Smoking-attributable costs associated with premature death are more than $156 billion‡(c) each year and include $5.6 billion in lost productivity due to secondhand smoke exposure.5
  • Indoor smoking is associated with $117‡(d) in additional health care expenditures for respiratory conditions for each exposed child from birth to 4 years.13
  • Globally, the economic burden of tobacco use is more than $1 trillion a year in health care costs and lost productivity.14
The CPSTF considers interventions cost-effective if they cost less than $50,000 per quality-adjusted life year gained.
Costs were measured in a2011 US dollars, b2010 US dollars, c2007 US dollars, and d2004 US dollars. Older cost estimates are likely to be underestimates.
  1. Creamer MR, Wang TW, Babb S, et al. Tobacco product use and cessation indicators among adults — United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(45):1013–1019.
  2. Centers for Disease Control and Prevention. Vital signs: disparities in nonsmokers’ exposure to secondhand smoke—United States, 1999–2012. MMWR Morb Mortal Wkly Rep. 2015;64(4):103–108.
  3. Substance Abuse and Mental Health Services Administration. 2017 National Survey on Drug Use and Health: Detailed Tables. https://www.samhsa.gov/data/report/2017-nsduh-detailed-tablesexternal icon. Accessed December 18, 2019.
  4. Campaign for Tobacco-Free Kids. Fact Sheets website. Smoking and Kids. https://www.tobaccofreekids.org/assets/factsheets/0001.pdf pdf icon[PDF – 53 KB]external icon. Accessed December 18, 2019.
  5. US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2014.
  6. Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-comprehensive-tobacco-control-programsexternal icon. Accessed December 18, 2019.
  7. Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Smoke-Free Policies website. https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-smoke-free-policiesexternal icon. Accessed December 18, 2019.
  8. Contreary KA, Chattopadhyay SK, Hopkins DP. Economic impact of tobacco price increases through taxation: a Community Guide systematic Review. Am J Prev Med. 2015;49(5):800–808.
  9. Community Preventive Services Task Force: Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions website. https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-mass-reach-health-communication-interventionsexternal icon. Accessed December 18, 2019.
  10. Centers for Disease Control and Prevention. Tips Impact and Results website. https://www.cdc.gov/tobacco/campaign/tips/about/impact/campaign-impact-results.html. Accessed December 18, 2019.
  11. American Nonsmokers’ Rights Foundation. Percent of US State Populations Covered by 100% Smokefree Air Laws. https://no-smoke.org/wp-content/uploads/pdf/percentstatepops.pdf pdf icon[PDF – 281 KB]external icon. Accessed January 31, 2020.
  12. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual healthcare spending attributable to cigarette smoking: an update. Am J Prev Med. 2014;48(3):326–333.
  13. Hill SC, Liang L. Smoking in the home and children’s health. Tob Control. 2008;17:32–37.
  14. National Cancer Institute and World Health Organization. The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control Monograph 21. Bethesda, MD: National Cancer Institute, National Institutes of Health, US Dept of Health and Human Services and Geneva, Switzerland: World Health Organization; 2016. NIH publication 16-CA-8029A.
Page last reviewed: September 29, 2020