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Addition of Prevalence of Cigarette Smoking as a Nationally Notifiable Condition -- June 1996

NOTE: Historical tables may be viewed using the Acrobat version of the issue. On June 6, 1996, by a unanimous vote, the Council of State and Territorial Epidemiologists (CSTE) added prevalence of cigarette smoking to the list of conditions designated as reportable by states to CDC. The addition of prevalence of cigarette smoking marks the first time a behavior, rather than a disease or illness, has been considered nationally reportable.

Goals of smoking prevalence surveillance identified by CSTE include monitoring trends in tobacco use, guiding allocation of tobacco-use prevention resources, and evaluating public health interventions to reduce smoking. Given these goals, CSTE selected population sampling as the appropriate surveillance methodology and designated the Behavioral Risk Factor Surveillance System (BRFSS) as the preferred data source. CSTE and CDC are developing the format to regularly present this information in national disease reporting statistics. The addition of cigarette smoking prevalence brings to 56 the number of diseases and conditions designated by CSTE as reportable by states to CDC.

Reported by: Council of State and Territorial Epidemiologists. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: National notifiable disease surveillance has been critical to the successful campaign against infectious diseases throughout this century. By agreement among states, CSTE, in partnership with CDC, determines the list of conditions reportable to CDC. The addition of prevalence of cigarette smoking to this list is a historic step in the evolution of the public health surveillance in the United States.

Although most conditions reportable by states to CDC have been acute infectious diseases, and surveillance for such diseases remains a public health priority, the addition of prevalence of cigarette smoking reflects shifts in morbidity and mortality patterns in the United States and therefore the need to expand the range of nationally reportable conditions. Traditionally, infectious disease reporting has relied on a single methodology -- mandated reporting of all cases. The decision by CSTE to designate BRFSS as the recommended data source for reporting of this condition marks a transition to a more flexible system in which surveillance methods are determined by surveillance goals. Most importantly, this action underscores the role of tobacco use as the leading preventable cause of death in the United States and the need to conduct national public health surveillance for both conventional disease outcomes and for underlying causes (e.g., smoking and other risky behaviors) amenable to public health intervention (1).


  1. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:2207-12.

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