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Tobacco Use

Extinguishing the Epidemic
At A Glance 2017

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Every day, about 3,200 young people aged 18 or younger try their first cigarette. Each year, nearly half a million American adults die prematurely of smoking or exposure to secondhand smoke. Another 16 million live with a serious illness caused by smoking.

The Centers for Disease Control and Prevention (CDC) is at the forefront of the nation’s efforts to reduce deaths and prevent chronic diseases that result from tobacco use. CDC and its partners promote tobacco control interventions, including smoke-free environments, programs to help tobacco users quit, actions to prevent young people from starting to use tobacco, and steps to eliminate tobacco-related health disparities in different population groups.

Public Health Problem

Cigarette smoking rates for both adults and young people are less than half what they were in 1965. Nearly 60% of the US population is covered by state or local laws that protect nonsmokers from exposure to tobacco smoke in public places, such as worksites, restaurants, and bars. Yet even with this progress, more than 1 in 7 US adults still smoke cigarettes, and one-quarter of the US population is exposed to secondhand smoke.

Nearly 9 in 10 US adult cigarette smokers first tried a cigarette before age 18. Today, about 3.9 million middle and high school students use at least one tobacco product, such as e-cigarettes, hookah, and conventional cigarettes. Cigarette smoking damages nearly every organ of the body. Cigarette smokers miss more work, visit a doctor more often, are hospitalized more often, and die 10 to 12 years earlier than nonsmokers. Each year, the United States spends nearly $170 billion on medical care to treat diseases related to cigarette smoking in adults.

Secondhand smoke exposure also causes many serious illnesses—such as heart disease, stroke, and lung cancer—in nonsmoking adults. In children, secondhand smoke can cause sudden infant death syndrome, acute respiratory infections, ear infections, and more frequent and severe asthma attacks. About 58 million nonsmoking Americans are exposed to secondhand smoke, including 15 million children aged 3 to 11 years.

Annual Deaths from Smoking, United States

More than 480,000 US Deaths Every Year Are From Cigarette Smoking: Lung Cancer 137,989 (29%); Heart Disease 158,750 (33%); Stroke 15,300 (3%); Other Cancers 36,000 (7%); Other Diagnoses 31,681 (7%); Chronic Obstructive Pulmonary Disease 100,600 (21%)

Note: Average annual number of deaths for adults aged 35 or older, 2005–2009.
Source: 2014 Surgeon General’s Report, Table 12.4, page 660 [PDF – 2.7 MB].

CDC’s Response

The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) works in four key areas or domains: epidemiology and surveillance, environmental approaches, health care system interventions, and community programs linked to clinical services. This comprehensive approach supports healthy choices and behaviors, makes healthier options more available, and helps Americans better manage their health.

CDC works with partners—such as public health agencies, other federal agencies, academia, community organizations, businesses, and faith-based groups—to improve the nation’s health by reducing the use of tobacco products. With $205 million in FY 2017 funding, CDC’s Office on Smoking and Health supports these efforts by working in all of NCCDPHP’s four domains. More than 80% of its budget supports state, local, and tribal tobacco control efforts.

Epidemiology and Surveillance

CDC conducts and coordinates surveillance, laboratory, and evaluation activities related to tobacco use and its effect on health. For example, CDC:

  • Monitors changes and trends in the use of tobacco products.
  • Assesses tobacco knowledge, attitudes, and behaviors using surveys of adults and young people.
  • Evaluates the effectiveness of comprehensive tobacco control and prevention programs and policies.
  • Publishes studies to answer important questions about tobacco use and tobacco control.
  • Evaluates additives and chemical constituents of tobacco products and secondhand smoke.

Environmental Approaches

Supporting Comprehensive Tobacco Control Programs

In 2014, the US Department of Health and Human Services (HHS) published a 50th anniversary Surgeon General’s Report on the health consequences of smoking. This report outlines strategies to end the smoking epidemic and recommends the use of comprehensive tobacco control programs, which reduce smoking rates, as well as deaths and diseases caused by smoking. The goal of these programs is to use coordinated activities to:

  • Prevent adolescents and young adults from starting to use tobacco.
  • Promote quitting.
  • Eliminate exposure to secondhand smoke.
  • Identify and eliminate tobacco-related health disparities.

CDC supports comprehensive tobacco control programs in all 50 states, the District of Columbia, 8 US territories or jurisdictions, and 12 tribal organizations. This support includes the evidence-based guide, Best Practices for Comprehensive Tobacco Control Programs. These programs are a good investment for states. For example, California’s program saved the state $55 for every $1 invested in tobacco control over 20 years, mostly in health care costs to treat smoking-related illness.

Comprehensive tobacco control programs include hard-hitting media campaigns that give tobacco users information about the negative effects of smoking and encouragement for quitting. These campaigns can also help prevent people from starting to use tobacco.

Other CDC efforts include funding eight national networks to reduce tobacco use among specific populations and managing HHS’s Interagency Committee on Smoking and Health, which coordinates research programs between federal, state, local, and private agencies. In addition, CDC is helping to support the US Department of Housing and Urban Development’s smoke-free policy for the nation’s 1.2 million public housing units, which house more than 2 million people.

Health Care System Interventions

CDC supports efforts to help tobacco users quit through innovations within the health care system. The agency works with partners, including payers, purchasers, and providers in both private and public health systems, to:

  • Expand access to and use of proven tobacco cessation treatments that follow the US Public Health Services’ Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update.
  • Remove barriers to accessing proven cessation treatments, such as cost-sharing and prior authorization.
  • Promote use of proven cessation treatments by tobacco users.

Community Programs Linked to Clinical Services

Promoting Quitline Services

Quitlines are telephone-based services that help tobacco users who want to quit by giving callers counseling, practical information on how to quit, referral to other cessation resources, and, in some states and for certain populations, cessation medication approved by the US Food and Drug Administration. CDC supports state quitline services in all 50 states, the District of Columbia, and 2 US territories. The agency works to expand the reach of these services, especially in populations with high rates of tobacco use. CDC promotes 1-800-QUIT-NOW, which connects callers nationwide to free services from their state quitlines.

CDC also promotes the national Asian Language Quitline, which provides services in Chinese, Korean, and Vietnamese, and the national Spanish Quitline (1-855-DEJELO-YA), which connects callers to Spanish-language services available from state quitlines.

Communicating Information to the Public

CDC translates research into practice by educating the public, policy makers, health professionals, and partners about the dangers of tobacco use. For example, the agency developed the Tips® campaign to highlight stories of people living with disease caused by tobacco use and exposure to secondhand smoke.

CDC also uses social media to reach specific audiences, including adolescents and young adults, with information and links to resources to help them quit. The agency creates digital content and traditional media products that can be used by the public, partners, and policy makers.

Promoting Action Through Partnerships

To advance tobacco prevention and control, CDC works with partners such as the American Cancer Society, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Truth Initiative, Campaign for Tobacco-Free Kids, Robert Wood Johnson Foundation, and North American Quitline Consortium.

Fast Facts

  • Tobacco use kills nearly 500,000 Americans each year.
  • About 1 in 7 US adults still smoke cigarettes, and about 3.9 million middle and high school students use at least one tobacco product, including e-cigarettes.
  • Nicotine is highly addictive and can harm teens’ developing brains. No tobacco product is safe for young people to use.
  • About 25% of US nonsmokers are exposed to secondhand smoke where they live, work, or play.
  • CDC supports comprehensive tobacco control programs in all 50 states, the District of Columbia, 8 US territories or jurisdictions and 12 tribal organizations.
A group of young teens sitting together on a set of stairs

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E-Cigarette Use Among
Young People

Electronic nicotine delivery systems—including e-cigarettes, vape pens, e-hookah, and similar devices—have been the tobacco product most commonly used by young people since 2014.

The good news is that, in 2016, e-cigarette use among US youth dropped for the first time—from 16.0% in 2015 to 11.3% in 2016 among high school students and from 5.3% to 4.3% among middle school students.

These declines are likely the result of tobacco prevention and control strategies at national, state, and local levels.

Use of any tobacco product, including e-cigarettes, poses dangers to young people. Most e-cigarettes contain nicotine, which is a highly addictive drug that can harm brain development.


Tobacco Use in the Past 30 Days
Among High School Students

Hookah 4.8%. Smokeless 5.8%. Cigars 7.7%. Cigarettes 8%. E-Cigarettes 11.3%.

Source: National Youth Tobacco Survey, 2016.

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Tips® Campaign Motivates
Millions to Try Quitting

In 2012, CDC launched the first-ever federally funded, national tobacco education campaign, called Tips From Former Smokers. The campaign features real people who tell their stories of living with serious health problems from smoking or secondhand smoke exposure.

The Tips campaign connects smokers who want to quit with resources to help them quit, including a free national quitline (1-800-QUIT-NOW). It also encourages doctors, nurses, dentists, pharmacists, and other health care providers to help their patients quit for good.

This groundbreaking campaign has motivated millions of Americans to try to quit smoking, and at least 500,000 smokers quit for good during 2012–2016.

If you smoke with diabetes, plan for amputation, kidney failure, heart surgery... or all three.


Future Directions

CDC will continue to work with decision makers, partners, health officials, and the public to end the tobacco epidemic by:

  • Supporting comprehensive state tobacco prevention and control programs.
  • Educating the public about the harms of tobacco use, including through paid media campaigns like Tips.
  • Supporting health systems to improve cessation insurance coverage, remove barriers to evidence-based cessation treatments, and promote use of covered treatments.
  • Reducing tobacco-related health disparities through national networks working to reduce tobacco use among specific populations.
  • Supporting state quitlines and maintaining and promoting 1-800-QUIT-NOW,
    1- 855-DEJELO-YA, and the Asian Language Quitline.

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