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Targeting Tobacco Use:
The Nation’s Leading Cause of Death

At A Glance

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Percentage of High School Students Who Reported Current Cigarette Smoking*—United States, 1991–2001

Percentage of High School Students Who Reported Current Cigarette Smoking*—United States, 1991–2001

*Smoking one or more cigarettes during the previous 30 days.
Source: CDC, Youth Risk Behavior Surveillance System (MMWR 2002;51(19):409–12).

[A text description of this graph is also available.]

"Our best defense against the dangers of smoking is a comprehensive approach to tobacco use prevention."

Tommy G. Thompson
Department of Health and Human Services

Revised June 2003

The Burden of Tobacco Use

An estimated 46.5 million adults in the United States smoke cigarettes even though this single behavior will result in death or disability for half of all regular users. Cigarette smoking is responsible for more than 440,000 deaths each year, or one in every five deaths. Additionally, if current patterns of smoking persist, 6.4 million people currently younger than 18 will die prematurely from a tobacco-related disease. Paralleling this enormous health toll is the economic burden of tobacco use: more than $75 billion in medical expenditures and another $80 billion in indirect costs resulting from lost productivity.

Smoking-related illnesses cost the nation more than $150 billion each year.

Since the release in 1964 of the first Surgeon General’s report on smoking and health, scientific knowledge about the health consequences of tobacco use has greatly increased. Smoking is known to cause chronic lung disease, heart disease, and stroke, as well as cancer of the lungs, larynx, esophagus, mouth, and bladder. In addition, smoking contributes to cancer of the cervix, pancreas, and kidneys. Researchers have identified more than 250 chemicals in tobacco smoke that are toxic or cause cancer in humans and animals. Smokeless tobacco and cigars also have deadly consequences, including lung, larynx, esophageal, and mouth cancer. Moreover, novel tobacco products such as bidis and clove cigarettes should not be considered safe alternatives to conventional cigarettes or smokeless tobacco.

The harmful effects of smoking do not end with the smoker. Women who smoke during pregnancy are more likely to have babies who have an increased risk of death from sudden infant death syndrome and respiratory distress. These babies are also more likely to have low birth weight and a variety of infant health disorders. In addition, secondhand smoke has harmful effects on nonsmokers. Each year, an estimated 3,000 nonsmoking Americans die of lung cancer, and more than 35,000 die of heart disease. Moreover, up to 300,000 children suffer from respiratory tract infections because of exposure to secondhand smoke.

442,398 U.S. Deaths Attributable Each Year to Cigarette Smoking*

442,398 U.S. Deaths Attributable Each Year to Cigarette Smoking

*Average annual number of deaths, 1995–1999. 
Source: CDC. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States—1995–1999. MMWR 2002;51(14):300–3.

[A text description of this graph is also available.]

Actual Causes of Death, United States, 1990*

Actual Causes of Death, United States, 1990

*The percentages used in this figure are composite approximations derived from published scientific studies that attributed deaths to these causes. Source: McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270:2207–12.

[A text description of this graph is also available.]


CDC's Tobacco Control Framework

With fiscal year 2003 funding of approximately $100 million, the Centers for Disease Control and Prevention (CDC) provides national leadership for a comprehensive, broad-based approach to reducing tobacco use. A variety of federal, state, and local government agencies; professional and voluntary organizations; and academic institutions have joined together to advance this comprehensive approach, which involves

  • Preventing young people from starting to smoke.
  • Eliminating exposure to secondhand smoke.
  • Promoting quitting.
  • Identifying and eliminating disparities in tobacco use among different population groups.

Essential elements of this approach include state- and community-based interventions, countermarketing, policy development, surveillance, and evaluation. These activities target groups—such as young people, racial and ethnic minority groups, people with low incomes or low levels of education, and women—at highest risk for tobacco-related health problems.

Building State Capacity 

Providing Funding 

CDC continues to support programs to prevent and control tobacco use in all 50 states, 7 territories, 7 tribal-serving organizations, and the District of Columbia. Thirteen states and one territory also receive supplemental funding for programs to identify tobacco-related disparities and develop strategic plans for reducing them. In addition, CDC funds nine national networks to promote tobacco use prevention and control efforts among organizations that serve eight priority populations. CDC also provides grants to 21 states for coordinated school health programs that include components for preventing tobacco use.

Providing Guidance


"CDC has provided invaluable help in our efforts to make Oregon a model of cessation services."

Dr. Chuck Bentz, Medical Director, Providence Health System, Oregon

CDC provides technical assistance to help states plan, establish, and evaluate tobacco control programs. In addition to helping states use CDC funds more effectively, CDC also provides assistance to programs funded from increased cigarette taxes and legal settlements with the tobacco industry.

CDC has recently released several publications to provide further guidance to states as they manage their tobacco control programs. These documents include Best Practices for Comprehensive Tobacco Control Programs, Reducing Tobacco Use: A Report of the Surgeon General, and Investment in Tobacco Control: State Highlights 2002. Guidance is also offered through CDC’s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction and the Guide to Community Preventive Services: Tobacco Use Prevention and Control.

Expanding the Science Base 

To strengthen the scientific foundation for preventing and controlling tobacco use, CDC examines trends, health effects, and economic costs. For example,

  • Since 1964, the Surgeon General’s reports on the health consequences of tobacco use, published by CDC, have presented comprehensive, scientific findings on such topics as tobacco use among populations at high risk and effective interventions for reducing tobacco use.
  • WHO and CDC developed the school-based Global Youth Tobacco Survey (GYTS) to track tobacco use among young people in over 140 countries using a common methodology and a core questionnaire. The GYTS enhances the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. In addition, CDC’s National Tobacco Information Online System (NATIONS) provides countrylevel data on tobacco use and its health effects, laws and regulations, economics, and more. CDC’s State Tobacco Activities Tracking and Evaluation (STATE) System provides similar state-level data.
  • CDC’s air toxicants laboratory is developing and applying laboratory technology to prevent death and disease from tobacco use and exposure to secondhand smoke. The laboratory examines tobacco additives and toxic chemicals in cigarette smoke and assesses exposure to harmful substances in tobacco products.

Communicating Information to the Public


"CDC’s Investment in Tobacco Control: State Highlights 2001 helped us to shape specific and credible recommendations for how Nebraskans can tackle the tobacco problem."

Cindy Wostrel, Executive Director, Health Education, Inc.

CDC researches, develops, and distributes tobacco and health information nationwide. For example, CDC responds to over 100,000 tobacco-related requests annually, 60,000 of which come through the Internet. In the past year, CDC distributed more than 800,000 publications and video products. In addition, CDC provides access to tobacco use prevention information and databases through its Web site. Visits to this site increased from 2 million in 2001 to over 3.5 million in 2002.

Through its Media Campaign Resource Center and its interactive database, CDC continues to provide high-quality counteradvertising materials and technical assistance to help state and local programs conduct media campaigns to prevent tobacco use.

CDC’s health communication messages continue to focus on reducing smoking among young people while increasing the emphasis on helping people to quit, reducing exposure to secondhand smoke, and reducing disparities. In partnership with other federal, state, and local agencies, CDC communicates key tobacco messages through the media, schools, and communities. Some recent products include the following:

Cover of Scene Smoking publicationScene Smoking—A 60-minute documentary and teacher’s guide. In the video, professionals from the entertainment and health fields discuss real-life choices they have made and their thoughts about the use of tobacco on screen.

Pathways to Freedom—A self-help guide to quitting smoking for African Americans. The guide includes up-to-date information on nicotine replacement therapy.

I Can’t Breathe—A powerful, compelling video story of a woman who started smoking as a young girl and died of a smoking-related disease at age 31. A teacher’s guide accompanies the video.

Facilitating Action Through Partners 

CDC works with a variety of national and international partners to ensure that diverse groups are involved in tobacco control efforts.

  • CDC is the lead agency for the 21 national objectives on tobacco use in Healthy People 2010. Along with other agencies and organizations, CDC helps to monitor progress toward these objectives.
  • CDC coordinates and promotes tobacco prevention and control activities in collaboration with the American Cancer Society, the American Heart Association, the American Legacy Foundation, the American Lung Association, the Association of State and Territorial Health Officials, the Environmental Protection Agency, the National Association of County and City Health Officials, the National Association of Local Boards of Health, the National Cancer Institute, the National Center for Tobacco-Free Kids, the National Conference of State Legislatures, the Pan-American Health Organization, the Robert Wood Johnson Foundation, the Substance Abuse and Mental Health Services Administration, and the World Bank.
  • As the only World Health Organization Collaborating Center on Global Tobacco Prevention and Control in North America, CDC implements international studies, conducts epidemiologic research, and provides international assistance on reducing tobacco use.

Future Directions 

CDC will continue to broaden support for comprehensive tobacco control programs by expanding the science base and by increasing technical assistance, training, and funding to states. As part of this effort, CDC will help state and local programs develop media campaigns to reach high-risk populations.

For more information or additional copies of this document, please contact the

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention
and Health Promotion
Mail Stop K–50
4770 Buford Highway, NE
Atlanta, GA 30341-3717



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This page last reviewed July 08, 2003

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion