CDC Survey Finds Adult Smoking Declines Have Stalled, Shows Elected Officials Must Step Up Fight Against Tobacco

Washington, D.C. — The government's report today that adult smoking declines have stalled since 2004 is an urgent warning to elected officials that it is premature to declare victory over tobacco and much more must be done to continue reducing tobacco use, which remains the number one preventable cause of death in the United States.

According to the Centers for Disease Control and Prevention, the adult smoking rate in 2008 was 20.6 percent — essentially unchanged since 2004, when 20.9 percent smoked. In fact, the 2008 survey found a small but disturbing uptick in the percentage of smokers, from 19.8 percent in 2007. While the CDC said this increase was not statistically significant, it is the first increase in the adult smoking rate since 1994.

There is no question that we know how to significantly reduce tobacco use, as demonstrated by sharp reductions in adult smoking over the past several decades and a remarkable 45 percent reduction in high school smoking since 1997 (from a peak of 36.4 percent to 20 percent in 2007). But it is also clear from the recent stall in progress that elected officials at all levels must redouble efforts to implement scientifically proven strategies that prevent kids from smoking, help smokers quit and protect everyone from secondhand smoke. The challenge today is to resist complacency and finally fight tobacco use with the political will and the resources that match the scope of the problem.

Congress and President Obama have taken major strides this year by approving a 62-cent increase in the federal cigarette tax and enacting the new law granting the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products and marketing. The 2008 data released today does not reflect the impact of the federal cigarette tax increase, which took effect on April 1 of this year. There is evidence that the cigarette tax increase has already had a significant impact. Cigarette manufacturers reported a 10 percent decline in cigarette sales in the third quarter of this year, and calls by smokers to smoking cessation quitlines increased dramatically following the tax increase.

However, there is much more that must be done at all levels of government:

• The pending health care reform legislation presents Congress with an immediate opportunity for action. It is vital that health care reform include robust funding for community-based prevention initiatives, including tobacco prevention and cessation, that prevent costly diseases. Congress should also require that private and public insurance plans, including Medicaid, cover tobacco cessation services for all beneficiaries. Today's report revealed that almost half of current smokers tried to quit in the past year but were unable to do so successfully. Providing evidence-based interventions will help them succeed. The House-passed health care reform bill achieves these goals, and the Senate bill should as well. With these actions, health care reform can be the first step toward putting in place a national campaign to prevent children from starting to smoke and help smokers quit.
• States must invigorate their efforts to implement three proven strategies to reduce tobacco use: higher tobacco taxes, smoke-free workplace laws and well-funded tobacco prevention and cessation programs. Most states have woefully underfunded their tobacco prevention programs, and in the past year, many have cut them substantially due to fiscal crises. Rather than take these backward steps, states should hike tobacco taxes to help fill budget gaps and use some of the revenue to fund tobacco prevention and cessation programs.

Why have smoking declines stalled in recent years? The CDC and other experts have cited several factors, including deep discounts used by tobacco companies to offset tax increases, significant increases in overall tobacco marketing since the 1998 state tobacco settlement and cuts to state tobacco prevention and cessation programs.

It's really very simple. When we increase tobacco prices and fund tobacco prevention and cessation programs, smoking rates go down. When prices stay flat and programs are cut, rates go up. Between 1997 and 2004, the average real (inflation-adjusted) retail price of a pack of cigarettes increased by 63 percent, while adult smoking declined by 15.3 percent. Between 2004 and 2008, the real price of cigarettes increased by just 2 percent, while adult smoking declined by just 1.4 percent (source of price data: The Tax Burden on Tobacco, 2008). Likewise, studies have shown a dose-response relationship between spending on tobacco prevention and cessation programs and both youth and adult smoking declines.

Tobacco use causes more than 400,000 preventable deaths each year and costs the nation nearly $200 billion in health expenditures and lost productivity. The cost of tobacco use in health, lives and dollars is too steep to allow backsliding. We know what works to reduce tobacco use among both youths and adults. What's needed is the political will to implement these solutions as aggressively as the tobacco industry promotes its deadly products.

The CDC report, published in the November 13, 2009, issue of the CDC Journal Morbidity and Mortality Weekly Report, can be found at www.cdc.gov/mmwr.