Efforts to promote smoking cessation have the potential to prevent substantial mortality and morbidity in this country. Over the past several decades, strong scientific evidence has emerged that smoking is addictive and has serious health consequences.(124)
The Prevalence of Smoking
Recent prevalence estimates indicate that over 46 million (or approximately 23.5 percent) of adults in this country are current smokers - those who smoke every day or almost every day. Smoking rates tend to be somewhat higher among males, individuals between the ages of 18 and 44, and American Indians. Among adolescents, prevalence estimates are generally comparable to those of adults, with approximately 28.5 percent of high school students reporting that they are current smokers.(125) Approximately 80 percent of adult smokers started smoking before the age of 18. According to the 2001 NHSDA, 4,400 young people between the ages of 12-17 years try their first cigarette each day.(126)
Despite these figures, it is encouraging to note that the majority of smokers (approximately 70 percent) have made at least one prior attempt to quit smoking, and between one-third to one-half of all smokers (34 to 46 percent) attempt to quit each year. However, very few of these individuals (approximately 2.5 percent) actually succeed in quitting. The high rate of relapse is largely attributable to the nicotine dependence that most smokers develop.(127) In fact, over 85 percent of current smokers acknowledge that cigarettes are addictive.(128)
The Effects of Smoking
Figure 8. Source of data: Refs. 125.
Tobacco use is the single most preventable risk factor for death and disease, contributing to more than 440,000 premature deaths annually in the United States during 1995 through 1999. This figure represents one out of every five deaths each year being associated with tobacco use, ranking tobacco use as the number one health problem contributing to death and disability in the U.S. Tobacco use is a risk factor for chronic lung disease, heart disease, stroke, and several forms of cancer, specifically cancer of the lungs, larynx, esophagus, mouth and bladder.(129),(130) Additionally, research indicates that smoking contributes to cancer of the cervix, pancreas and kidneys.(131) Shorter-term effects of smoking include increased heart rate and blood pressure, coughing with phlegm or blood, shortness of breath when not exercising, wheezing or gasping, and reported poorer overall health.(132)
The harmful effects of smoking do not appear limited only to those who use tobacco. Pregnant women who smoke are more likely to produce low birth weight babies and infants with a variety of health disorders, including those with an increased risk of death from sudden infant death syndrome and respiratory distress. In addition, an estimated 3,000 nonsmoking Americans die each year from lung cancer, and up to 300,000 children have respiratory tract infections due to increased susceptibility after exposure to secondhand smoke.(133)
An international analysis estimates that roughly half of all adolescents who try smoking will become life-long smokers, and of this group, one in two will die as a result of smoking.(134) Unfortunately, the mortality rates from smoking suggest that given the current prevalence of smoking among adolescents, it can be expected that 6.4 million individuals under the age of 18 will die prematurely as a result of tobacco-related diseases.(135)
The Costs of Smoking
The direct and indirect economic costs associated with tobacco use are significant. According to the National Institute on Drug Abuse (NIDA), the direct and indirect costs of smoking are estimated at $138 billion per year.(136) As with other chronic conditions, employers are significantly affected by the indirect costs of the health problems that result from tobacco use. An extensive review of the literature published in 2001 found solid evidence that 6 to 14 percent of personal health care expenditures could be attributed to smoking, and that smokers had greater medical costs over the course of their lifetimes. The review also found a large number of studies that demonstrated that smokers are more costly to their employers than those employees who do not smoke.(137) The economic costs of smoking are estimated to be about $3,391 per smoker per year. Each pack of cigarettes sold in the United States costs the nation an estimated $7.18 in medical care costs and lost productivity.(138) Roughly 14 percent of all Medicaid expenditures are for smoking related illnesses,(139) and more than $20 billion of Medicare expenditures each year are related to smoking.(140)
Treatment and Prevention
Efforts to promote smoking cessation have the potential to prevent substantial mortality and morbidity in the U.S. One year after quitting, a person's additional risk of heart disease is reduced by half, and after 15 years, this risk equals that of a person who never smoked. Within 10 years of quitting smoking a former smoker's risk of developing lung cancer is 30 to 50 percent below that of a current smoker. The benefits are even greater for individuals who quit smoking before the age of 50. Their risk of dying in the next 15 years is half that of a person who smokes.(141)
Tobacco dependence is a chronic condition that often requires repeated intervention. However, effective treatments do exist that can produce long-term or even permanent abstinence. Three types of counseling and behavioral therapies have been found to be especially effective in treating patients attempting tobacco cessation: practical counseling (problem solving/skills training); social support as part of treatment; and help in securing social support outside of treatment.(142) A number of smoking cessation treatments currently exist including over-the-counter medications (nicotine patches, nicotine gum), behavioral modification techniques, self-help efforts, and prescription medications (tablet, inhalers, nasal sprays).
A number of studies have examined the cost savings from tobacco prevention programs. The State of California estimates that their statewide tobacco prevention program resulted in an overall cost savings of $8.4 billion from the years 1990-1998. This program included a statewide mass media campaign and community programs designed and implemented by local health departments, community coalitions, community-based organizations, and regional and statewide agency networks.(143) Over the course of the statewide program, $3.62 in direct medical costs were avoided for every $1 spent on the program. Reducing smoking prevalence among pregnant women by one percentage point over seven years would prevent 57,200 low birth weight deliveries and save $572 million. Another study estimated that every $1 invested in certain types of school-based tobacco prevention programs saves $19.90 in associated medical costs. The economic benefits of prevention are also apparent for employers: an economic assessment found that a health care plan's annual cost of covering treatment to help people quit smoking ranged from $0.89 to $4.92 per smoker, whereas the annual cost of treating smoking-related illness ranged from $6.00 to $33.00 per smoker.(144)