Tobacco Use

The Problem

Tobacco use is the leading cause of preventable death in the United States. Smoking harms nearly every organ in the body and causes cancer, heart disease, stroke, respiratory illness, and many other health problems.7

More about the problem

The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of select policies and practices that can help states prevent or reduce smoking or exposure to secondhand smoke.

These policies and practices include

These policies and practices have been recommended by the Institute of Medicine, World Health Organization, Community Preventive Services Task Force, US Surgeon General, and CDC on the basis of scientific studies supporting the policies’ effectiveness in preventing or reducing tobacco use.1-6

Policies & Practices

State cigarette excise tax

State cigarette excise tax refers to the amount of state excise tax, in dollars, on a pack of 20 cigarettes. Healthy People 2020, the nation’s 10-year health objectives, sets a target of increasing cigarette excise taxes in all states and the District of Columbia by $1.50 per pack by the year 2020.8 This increase would generate millions in revenue annually, prevent more children from starting to smoke, help smokers quit, save lives, and save millions in long-term healthcare costs.9,10

Status of state cigarette excise tax, United States (as of June 30, 2013)

Bar chart showing Status of state cigarette excise tax, United States (as of June 30, 2013). Green: In 15 states, the cigarette excise tax was ≥$2.00 per pack . Yellow: In 16 states, the cigarette excise tax was $1.00–$1.99 per pack. Red: In 20 states, the excise tax was <$1.00 per pack. (State count includes the District of Columbia.)

(State count includes the District of Columbia.)

States were rated green, yellow, or red according to the following criteria:

Green

As of June 30, 2013, the state had cigarette excise taxes of $2.00 or more per pack, significantly exceeding the average state cigarette excise tax of $1.48.

Yellow

As of June 30, 2013, the state had cigarette excise taxes of $1.00–$1.99 per pack. These states are making progress, but higher excise taxes would accelerate tobacco cessation and reduce initiation.

Red

As of June 30, 2013, the state had comparatively low excise taxes of $0.99 or less per pack. These tax rates have the lowest impact on reducing initiation or increasing cessation.

Comprehensive state smoke-free policy

State smoke-free policies prohibit smoking in public places and workplaces. CDC defines comprehensive smoke-free laws as laws that prohibit smoking in all indoor areas of private workplaces, restaurants, and bars, with no exceptions.11 Healthy People 2020 sets a target of a statewide ban on smoking in public places and worksites in all states and the District of Columbia by the year 2020.8 Studies have shown that smoke-free laws reduce secondhand smoke exposure, help smokers quit, and reduce heart attack and asthma hospitalizations.3,4,10,13–16

Status of comprehensive state smoke-free policies, United States (as of June 30, 2013)

Bar chart showing Status of state comprehensive state smoke-free policy, United States (as of June 30, 2013). Green: 27 states had a statewide smoke-free policy covering workplaces, restaurants, and bars. Yellow: 5 states had a statewide smoke-free policy covering two of the three locations. Red: 19 states had no smoke-free policy covering workplaces, restaurants, or bars, or had a policy covering only one of the locations. (State count includes the District of Columbia.)

(State count includes the District of Columbia.)

States were rated green, yellow, or red according to the following criteria:

Green

As of June 30, 2013, the state had a statewide smoke-free policy banning smoking 100% of the time in three locations: workplaces, restaurants, and bars, without exceptions.

Yellow

As of June 30, 2013, the state had a statewide smoke-free policy banning smoking 100% of the time in two of the three locations.

Red

As of June 30, 2013, the state had a statewide smoke-free policy banning smoking in one or none of the locations.

Funding for tobacco control

State tobacco control program funding refers to the amount of funding allocated for statewide tobacco control activities, including state and federal dollars. In Best Practices for Comprehensive Tobacco Control Programs, CDC identified recommended levels of annual investment in tobacco control programs for all states and the District of Columbia.6

States that have made larger investments in comprehensive tobacco control programs have seen cigarette sales drop more than twice as much as sales in the United States as a whole, and smoking prevalence among adults and youth has declined faster as spending for tobacco control programs has increased.6,17,18

Status of state funding for tobacco control, United States (as of FY2010)

Bar chart showing Status of state funding for tobacco control, United States (as of FY2010). Green: 1 state had funding for tobacco control that was at ≥100% of the CDC recommendation. Yellow: 9 states had funding for tobacco control that was at 50.0%–99.9% of the CDC recommendation. Red: 41 states had funding for tobacco control that was at <50% of the CDC recommendation. (State count includes the District of Columbia.)

(State count includes the District of Columbia.)

States were rated green, yellow, or red according to the following criteria:

Green

As of FY 2010, the state had dedicated tobacco control funding at 100% or more of the CDC-recommended annual investment for that state.

Yellow

As of FY 2010, the state had dedicated tobacco control funding at 50%–99.9% of the CDC-recommended annual investment for that state.

Red

As of FY 2010, the state had dedicated tobacco control funding at less than 50% of the CDC-recommended annual investment for that state.

Prevention Status Reports: Tobacco Use, 2013

The files below are PDFs ranging in size from 100K to 500K. Adobe PDF document

References

  1. Institute of Medicine. Ending the Tobacco Problem: A Blueprint for the Nationexternal icon. Washington, DC: National Academies Press; 2007.
  2. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008—the MPOWER Packageexternal icon. Geneva, Switzerland: World Health Organization; 2008.
  3. The Task Force on Community Preventive Services. The Guide to Community Preventive Services: What Works to Promote Health? pdf icon[PDF 363K]external icon New York, NY: Oxford University Press; 2005.
  4. CDC. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon Generalexternal icon. Atlanta, GA: US Department of Health and Human Services; 2006.
  5. CDC. Reducing Tobacco Use: A Report of the Surgeon General.pdf icon[PDF – 2.61MB] Atlanta, GA: US Department of Health and Human Services; 2000.
  6. CDC. Best Practices for Comprehensive Tobacco Control Programs—2007. Atlanta, GA: US Department of Health and Human Services; 2007.
  7. US Surgeon General. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon Generalexternal icon. Rockville, MD: US Department of Health and Human Services; 2010.
  8. US Department of Health and Human Services. Tobacco use across the life stagesexternal icon. In: Healthy People 2020. Rockville, MD: US Department of Health and Human Services; Updated Nov 20, 2012.
  9. Congressional Budget Office. Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget.pdf icon[PDF – 922KB]external icon Washington, DC: Congressional Budget Office; 2012.
  10. Hopkins DP, Razi S, Leeks KD, et al. Smoke-free policies to reduce tobacco use: a systematic review.pdf icon[PDF – 267KB]external icon American Journal of Preventive Medicine 2010;38(2S):275–89.
  11. CDC. State smoke-free laws for worksites, restaurants, and bars—United States, 2000–2010. MMWR 2011;60:472–5.
  12. International Agency for Research on Cancer. Evaluating the Effectiveness of Smoke-free Policies.pdf icon[PDF – 2.67MB]external icon Lyon, France: International Agency for Research on Cancer; 2009.
  13. Millett C, Lee JT, Laverty AA, et al. Hospital admissions for childhood asthma after smoke-free legislation in Englandexternal icon. Pediatrics 2013:131(2):e495–e501.
  14. Hahn EJ. Smokefree legislation: a review of health and economic outcomes researchexternal icon. American Journal of Preventive Medicine 2010;39(6 Suppl 1):S66–S76.
  15. Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidenceexternal icon. Washington, DC: National Academies Press; 2010.
  16. Herman PM, Walsh ME. Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after implementation of Arizona’s comprehensive statewide smoking banexternal icon. American Journal of Public Health 2011;101:491–6.
  17. Farrelly MC, Pechacek TP, Chaloupka FJ. The impact of tobacco control program expenditures on aggregate cigarette sales: 1981−2000external icon. Journal of Health Economics 2003;22(5):843–59.
  18. Tauras JA, Chaloupka FJ, Farrelly MC, et al. State tobacco control spending and youth smokingexternal icon. American Journal of Public Health 2005;954:338–44.

Page last reviewed: January 21, 2014