NEJM Analysis: U.S. Smoking Rate Fell Much Faster Under Obama Administration, Would Reach Zero by 2035 if Recent Progress Continues

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
August 17, 2016

WASHINGTON, D.C. – An analysis published today in The New England Journal of Medicine finds that the adult smoking rate in the United States has fallen much faster under the Obama Administration than under the previous two administrations and would fall to zero by around 2035 if this accelerated rate of decline continues.

These findings are truly remarkable. They show how much can be achieved with strong leadership and a commitment to implementing proven, science-based solutions. They also show that eliminating smoking and all the death and disease it causes is not a faraway dream. It’s a realistic goal that can be achieved relatively quickly with bold action at all levels of government. But continued progress is not inevitable. It will require resisting complacency and rejecting the relentless efforts of the tobacco industry to roll back the gains we’ve made. If anything, our progress should motivate the next Administration – and elected leaders at all levels – to redouble efforts to win the fight against tobacco once and for all.

According to the new analysis, the age-adjusted adult smoking rate in the U.S. has fallen significantly during the Obama Administration – from 20.6 percent in 2009 to 15.3 percent in 2015. This decrease of about 0.78 percentage points per year is more than double the annual rates of decline during the previous two administrations.

This progress is no accident. It comes as the Obama Administration has implemented a series of evidence-based strategies to revitalize the nation’s fight against tobacco. These include:

  • The largest-ever increase in the federal cigarette tax, a 62-cent increase (from $0.39 to $1.01 per pack) implemented in 2009.
  • Enactment of the landmark 2009 law granting the FDA authority over tobacco products.
  • Enhancing coverage for tobacco cessation treatments under the Affordable Care Act.
  • Launch of the first-ever federally-funded mass media campaign to reduce tobacco use, the CDC’s Tips from Former Smokers campaign now in its fifth year. According to the CDC, the Tips campaign has helped at least 400,000 smokers quit for good and saved at least 50,000 lives at a cost of less than $400 per year of life saved, making the campaign a public health best buy. Thanks to the Tips campaign, as well as campaigns by the FDA and Truth Initiative aimed at youth and young adults, the U.S. currently has the strongest and most sustained media campaigns to reduce tobacco use in its history.

According to the new analysis, “The cumulative effects of these legislative, regulatory, and policy actions may have resulted in a snowball effect — a decline in smoking that has accelerated over the Obama years.”

The challenge now is to build on this progress and reject tobacco industry efforts to reverse it. Most immediately, Congress must reject proposals included in House appropriations bills that would cut funding for the CDC’s tobacco control programs by more than half (from $210 million to $100 million) and greatly weaken FDA authority over tobacco products. The CDC funding cut would make it virtually impossible to continue the Tips campaign. The two FDA proposals would dramatically weaken FDA oversight of electronic cigarettes and cigars, products that are popular with kids and threaten to undermine overall progress in reducing tobacco use. Congress should reject these proposals to protect the tobacco industry at the expense of kids and public health.

In addition to strong action at the federal level, states and localities have contributed to smoking declines by increasing tobacco taxes, enacting smoke-free air laws, increasing the tobacco sale age to 21 and, in some cases, funding effective tobacco prevention and cessation programs. However, state progress in enacting tobacco taxes and smoke-free laws has slowed in recent years, and most state tobacco prevention programs are woefully underfunded. States must step up their efforts.

Despite our progress, this battle is far from over. Tobacco use remains the nation’s No. 1 cause of preventable death, killing nearly half a million Americans and costing us about $170 billion in health care bills each year. The CDC has reported large disparities in smoking, with higher rates among people who live below the poverty level, those with less education, American Indians/Alaska Natives, residents of the Midwest and lesbians/gays/bisexuals. Adults who are uninsured or on Medicaid smoke at more than double the rates of those with private health insurance or Medicare. In addition, 10.8 percent of high school students still smoke cigarettes, and over 31 percent still use some form of tobacco, according to the CDC’s 2015 National Youth Risk Behavior Survey. The tobacco industry still spends $9.5 billion a year – more than $1 million every hour – to market its deadly and addictive products.

To keep making progress, elected officials at all levels must fully implement proven strategies so they reach all populations and communities. If they do so, it is within our reach to end the tobacco epidemic and achieve one of the greatest public health victories in our nation’s history.

The New England Journal of Medicine analysis was authored by Dr. Michael Fiore, Director of the University of Wisconsin Center for Tobacco Research and Intervention. Read their press release.