Don't Forget Tobacco

Published at www.nejm.org July 7, 2010 (10.1056/NEJMp1003883) Don't Forget Tobacco

Steven A. Schroeder, M.D., and Kenneth E. Warner, Ph.D.

Smoking Prevalence among U.S. Adults, 1955–2008.

Data are from the Centers for Disease Control and Prevention.

At a time when all eyes are focused on health care reform, escalating medical costs, and childhood obesity, cigarette smoking remains by far the most common cause of preventable death and disability in the United States. Because important strides have been made in tobacco control, in terms of both interventions (tax hikes and laws creating smoke-free workplaces) and outcomes (smoking prevalence that has more than halved since the early 1960s [see graph]), it is tempting to believe that the battle is largelywon and that we should move on to other pressing public health issues. But the prevalence of smoking in the United States hoversat 20%, more than 8 million people are sick or disabled as a result of tobacco use, and smoking kills 450,000 Americans annually. If no additional progress is made in reducing smoking-initiation rates and increasing cessation rates, the prevalence of smoking in the United States will decline only to 16.7% by 2020 and will stabilize at 13.5% shortly after midcentury,¹ and millionsof people will die prematurely. We need to understand the epidemiology of smoking, look at the current state of tobacco control, and determine what more can be done; then we need to do it./.../