V. Key Issues: Population Health >> E. Health Promotion >> Tobacco Use (last update: 11.18.15)
- 1 Key Questions
- 2 Policy Options
- 3 Resources
How Many People Smoke?
- Monitoring the Future (annual survey). Documents trends in teen-age smoking
- Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012
What are the Economic Consequences of Smoking?
- Tobacco use in the U.S. adds $96 billion to health costs and imposes an additional $97 billion in non-health costs related to property losses, lost work productivity etc. (NIDA 2012).
What are the Health Consequences of Smoking?
- From 1964 to 2012, “eight million premature deaths have been prevented because of tobacco control measures,” Theodore R. Holford, a Yale statistician, and his co-authors reported in JAMA. They attributed about one-third of the gains in life expectancy since 1964 to the decline in smoking.
- Office of the Surgeon General. 2014 Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress
- What is third-hand smoke? Is it hazardous? (Scientific American, 1.6.09)
Why Do Smokers Smoke?
- Ert E, Yechiam E, Arshavsky O (2013) Smokers’ Decision Making: More than Mere Risk Taking. PLoS ONE 8(7): e68064. doi:10.1371/journal.pone.0068064. Studies show that smokers are at least as informed as nonsmokers about the risks of smoking — and possibly more informed. Some evidence suggests that smokers do take more risks than nonsmokers: they are more often involved in traffic accidents, less likely to wear seat belts and more likely to engage in risky sexual behavior. Women who smoke even have mammograms less frequently than their nonsmoking counterparts. But the reason is not because smokers have a greater tolerance for risk. An experimental analysis shows that smokers are more easily tempted by immediate high rewards compared to nonsmokers. Thus the salience of risky alternatives that produce large rewards most of the time can direct smokers to make bad choices even in an abstract situation such as the Iowa Gambling Task. These findings suggest that the risk taking behavior associated with smoking is not related to the mere pursuit of rewards but rather reflects a tendency to yield to immediate temptation. Smokers have poor self-control. See New York Times summary of this study.
Public Health Law Research. Americans for Nonsmokers’ Rights Foundation. ANRF has tracked, collected, and analyzed tobacco control laws around the country since the early 1980s, and the lists below represent only a small percentage of the data. Learn more about their comprehensive collection of state and local laws, covering: clean air, restrictions on youth access to tobacco, tobacco advertising and promotion restrictions, tobacco excise taxes, and conditional use permits
- Smoking Cessation: Clinical Practice Guidelines (AHCPR: 1996). Includes summary of impact of smoking and guidelines for health care delivery administrators, insurers and purchasers
- Cost-effectiveness of Smoking Cessation (AHCPR: 12.2.97)
- E-Cigarette Ban. 42 states have banned the sale of electronic cigarettes to minors (listed in Data Appendix).
- Bans Promote Teen Cigarette Use. Using data from the National Survey on Drug Use and Health, a Yale study published 10.19.15 finds that state bans on e-cigarette sales to minors yield a 0.9 percentage point increase in rates of recent conventional cigarette use by 12 to 17 year olds, relative to states without these bans. “Conventional cigarette use has been falling somewhat steadily among this age group since the start of the 21st century. This paper shows that bans on e-cigarette sales to minors appear to have slowed this decline by about 70 percent in the states that implemented them,” said Abigail Friedman, assistant professor of public health and the study’s author. “In other words, as a result of these bans, more teenagers are using conventional cigarettes than otherwise would have done so.”
- Congressional Budget Office. Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget (June 13, 2012). This study uses a policy to discourage smoking as an example for estimating the overall impact on the federal budget of a policy intervention to improve health. Specifically, CBO analyzed the budgetary effects of a hypothetical increase of 50 cents per pack in the federal excise tax on cigarettes and small cigars (from $1.01 to $1.51 in fiscal year 2013, with the increase adjusted each year to keep pace with inflation and, in the long term, with the growth of people’s income).
- Viscusi. Cigarette Taxation and the Social Consequences of Smoking. This paper assesses the appropriate cigarette tax needed to address potential market failures. There is no evidence of inadequate risk decisions by smokers regarding their own welfare. Detailed calculations of the financial externalities of smoking indicate that the financial savings from premature mortality in terms of lower nursing home costs and retirement pensions exceed the higher medical care and life insurance costs generated. The costs of environmental tobacco smoke are highly uncertain, but of potentially substantial magnitude. Even with recognition of these costs, current cigarette taxes exceed the magnitude of the estimated net externalities.
Raising Smoking Age to 21
- Tobacco Settlements: Do Medicaid Recoveries Belong to States? (Center on Budget and Policy Priorities: 12/11/97)
- Centers for Disease Control and Prevention. Smoking and Tobacco Use.
- Tobacco Centers of Regulatory Science. As part of an on-going interagency partnership, FDA and NIH are awarding $53 million in fiscal year 2013 to establish 14 Tobacco Centers of Regulatory Science (TCORS) for tobacco-related research. As a first-of-its-kind regulatory science tobacco program, TCORS is designed to generate research to inform the regulation of tobacco products to protect public health and train the next generation of tobacco regulatory scientists.
- Media Resource Guide on Tobacco (Robert Wood Johnson Foundation)
- Includes information on a) tobacco policy research & evaluation; b) youth and tobacco; and c) smoking cessation.
- Tobacco Web Links (Policy.com)
- The House Commerce Committee (39,000 once-secret tobacco industry documents)