Cigarette smoking used to be cool.
Ads (one even by Ronald Reagan) promoted the health benefits of smoking. "Reach for a treat, instead of a sweet." In 2014, the Nation marked the 50th anniversary of the first Surgeon General’s Report on Smoking and Health. In 1964, more than 40 percent of the adult population smoked. Once the link between smoking and its medical consequences—including cancers and heart and lung diseases—became a part of the public consciousness, education efforts and public policy changes were enacted to reduce the number of people who smoke. These efforts resulted in substantial declines in smoking rates in the United States—to half the 1964 level.
However, rates of cigarette smoking and other tobacco use are still too high, and some populations are disproportionately affected by tobacco’s health consequences. Most notably, people with mental disorders—including substance use disorders—smoke at higher rates than the general population. Additionally, people living below the poverty line and those with low educational attainment are more likely to smoke than those in the general population. As tobacco use is the leading preventable cause of mortality in the United States, differential rates of smoking and use of other tobacco products is a significant contributor to health disparities among some of the most vulnerable people in our society.
What is the scope of tobacco use and its cost to society?
Approximately one fourth of the population uses tobacco products, and 19.4 percent smoke cigarettes. According to the 2016 National Survey on Drug Use and Health (NSDUH), an estimated 63.4 million people aged 12 or older used a tobacco product during the past month, including 51.3 million cigarette smokers. Smoking rates continue to go down year to year; the percentage of people over age 18 who smoke cigarettes declined from 20.9 percent in 2005 to 15.8 percent in 2016, according to the 2017 National Health Interview Survey.
However, smoking rates are substantially higher among some of the most vulnerable people in our society. The 25 percent of Americans with mental disorders, including addiction, account for 40 percent of the cigarettes smoked in the U.S. More than 40 percent of people with a General Education Development certificate (GED) smoke—which is the highest prevalence of any socioeconomic group. Also, people who live in rural areas, particularly in the South Atlantic states, use all forms of tobacco at higher rates than people who live in urban areas. These differences cannot be fully explained by different levels of poverty or affluence.
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Smoking among youth is at historically low levels. According to the NIDA-sponsored Monitoring the Future (MTF) survey, in 2015, an estimated 4.7 million middle and high school students used tobacco products during the past month, according to data from the National Youth Tobacco Survey (NYTS) e-cigarettes) were the most commonly used tobacco products among middle (5.3 percent) and high school (16.0 percent) students in 2015. E-cigarettes deliver synthetic nicotine and do not contain tobacco; however, they are classified as tobacco products for regulatory purposes. These findings are echoed by other studies, including the MTF survey. Scientists have not yet determined the medical consequences of long-term e-cigarette use or the secondhand effects of e-cigarette vapor.
Between 1964 and 2012, an estimated 17.7 million deaths were related to smoking leads to more than 480,000 deaths annually. If current smoking rates continue, 5.6 million Americans who are currently younger than 18 will die prematurely from smoking-related disease.
In addition to the tremendous impact of premature deaths related to tobacco use, the economic costs are high. Experts estimate that between 2009 and 2012, the annual societal costs attributable to smoking in the United States were between $289 and $332.5 billion. This includes $132.5 to $175.9 billion for direct medical care of adults and $151 billion for lost productivity due to premature deaths. In 2006, lost productivity due to exposure to secondhand smoke cost the country $5.6 billion. About 70 percent of current smokers’ excess medical care costs could be prevented by quitting.
