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CDC report: "High-impact strategies" needed to reduce smoking in the U.S. (5/3)

May 3, 2010
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A report by the Centers for Disease Control and Prevention, according to an agency press release, encourages all states to implement coordinated, high-impact strategies to end the stall in the decline of U.S. smoking rates — a move that will prevent millions of smoking-related heart attacks, cancers, strokes, and deaths.

If all states supported and used a combination of proven strategies — hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices — the nation’s adult smoking rate, which has stalled at around 20 percent, would begin to decline and smoking-related diseases, deaths, and health care costs would be substantially reduced. Every year, nearly 1 of 5 American deaths is caused by cigarette smoking.

“Although the nation has not experienced substantial reductions in the national smoking rate over the past five years, this report shows that states know how to end the smoking epidemic,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use. We must redouble efforts to bring down smoking rates, prevent suffering and premature death, and cut health care costs by reducing smoking.”

The report, Tobacco Control State Highlights 2010, provides a state-by-state assessment of tobacco use prevention and control efforts and showcases evidence-based strategies that are successful in reducing smoking rates. The report uses consistent data across all 50 states and the District of Columbia and allows states to compare their efforts with similar programs around the nation. Programs are evaluated on several key measures, including smoking prevalence, public funding for cessation support, enforcement of restrictions on cigarette advertising and promotions, and tobacco pricing. Several states are making great strides in reducing smoking rates using these strategies, while more work needs to be done in other states. National survey data show that a trend of significant reductions in smoking rates among adults and youth has stalled since 2004. According to the report, the smoking rate for American adults varies across states, with Utah (9.3 percent) and California (14 percent) reporting the lowest rates. West Virginia (26.5 percent) and Indiana (26 percent) are among states reporting the highest adult smoking rates in the country in 2008. Utah (6.5 percent) and Hawaii (6.8 percent) have the lowest youth smoking rates, while Kentucky (15.9 percent) and Wyoming (14.9 percent) have the highest.

Studies show that smoke-free laws, which ban smoking in indoor places, public spaces, and work sites, are the only effective way to protect nonsmokers from the dangers of secondhand smoke. The evidence also shows that these laws motivate smokers to quit. According to the new CDC report, 24 states and the District of Columbia have comprehensive smoke-free laws. Recently, Kansas, Wisconsin, and Michigan passed smoke-free laws that will go into effect later this year. Seven states — Indiana, Kentucky, Mississippi, South Carolina, Texas, West Virginia, and Wyoming — do not have statewide smoke-free laws.

The CDC report also examines data from 42 states and the District of Columbia on counter-marketing media campaigns (campaigns that use commercial marketing tactics to reduce tobacco use). Hard-hitting media ads are proven to influence attitudes and behaviors about smoking when they are seen often, by many people, over an extended period.

The report assessed each state anti-smoking campaign's gross rating points (GRPs), which measure the total intensity of the campaigns — the percent of households exposed, multiplied by the frequency of exposure to the ads. Among the states that presented data, counter-marketing campaigns achieved a median of 138 GRPs per quarter—only about a tenth of the CDC-recommended level of 1,200 GRPs. Cigarette manufacturers are spending around $12.5 billion a year to market tobacco products, according to the latest tobacco marketing reports of the Federal Trade Commission. This amounts to $20 for every $1 spent on tobacco control.

The Institute of Medicine reports that increasing cigarette prices through higher excise taxes reduces smoking rates, particularly among youth, who are less likely to start smoking when prices are high. Studies show that a 10-percent increase in cigarette prices results in a 4-percent decline in smoking rates. In 2009, Congress raised the federal cigarette tax by 62 cents, to $1.01 per pack. That same year, 14 states and the District of Columbia also increased cigarette taxes, according to the report. At the end of 2009, cigarette excise tax rates varied widely from state to state, ranging from $3.46 a pack in Rhode Island to 7 cents in South Carolina — a 50-fold difference.

The State Highlights report comes on the heels of a publication by the Campaign for Tobacco-Free Kids, which showed that if all states and the District of Columbia raised their cigarette tax rates by $1 per pack, they would raise $9.1 billion in new annual state revenues, prompt more than 1.2 million adult smokers to quit, and prevent more than 2.3 million young people from starting to smoke.

State revenues from tobacco include excise taxes on tobacco products and payments from the 1998 settlement agreement between the attorneys general of 46 states and the four largest U.S. tobacco companies. According to the report, states are spending less than 3 percent of these revenues on tobacco control programs, and they cut these programs by another $100 million last year. On average, it would take less than 20 percent of their total tobacco revenue for every state to fund a tobacco prevention program at CDC-recommended amounts. The CDC report demonstrates that states that have invested in comprehensive tobacco control programs have significantly reduced smoking rates, which in turn leads to decreased smoking-related diseases, deaths, and health care costs.

California, which has the longest-running tobacco control program in the country, has seen lung cancer rates decline four times faster than those in the nation as a whole. Further, the state saved $86 billion in tobacco-related health care costs between 1989 and 2004. Still, the report points out that no state funds its tobacco control program at levels recommended by CDC.

“Much more work needs to be done to address the smoking epidemic in this country,” said Ursula Bauer, Ph.D., M.P.H., director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “There is excellent research that clearly identifies what needs to be done to eliminate cigarette smoking. The nation must now accelerate its efforts to translate that knowledge to action, or continue to lose hundreds of thousands of its citizens each year to smoking-related diseases.”

CDC funds all 50 states and U.S. territories, tribes, and some national networks to support tobacco control programs.

For an online version of the report visit CDC’s Office on Smoking and Health at www.cdc.gov/tobacco.

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