Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Each year, an estimated 480,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million live with a serious illness caused by smoking. Approximately 46.6 million U.S. adults smoke cigarettes still smoke despite these risks. Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers.
The harmful effects of smoking do not end with the smoker. An estimated 88 million nonsmoking Americans, including 54% of children aged 3–11 years, are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same poisons in cigarette smoke as smokers. Tobacco use also presents a significant economic burden—more than $96 billion a year in medical costs and another $97 billion a year from lost productivity.
Secondhand smoke exposure causes serious disease and death, including heart disease and lung cancer in non-smoking adults. Additionally, children in the United States exposed to secondhand smoke are at risk of sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks. Each year, primarily because of exposure to secondhand smoke, an estimated 3,000 nonsmoking Americans die of lung cancer, more than 46,000 die of heart disease, and about 150,000–300,000 children younger than 18 months have lower respiratory tract infections. The more plaguing reality of these devastating numbers is that are larger proportion of these rates represent men, women and children living in the southeastern region of our country.
The Institute of Medicine (IOM) recommendations is that each state should fund a comprehensive tobacco control program at the level recommended by CDC in Best Practices for Comprehensive Tobacco Control Programs–2007, a guide to help states plan and establish effective tobacco control programs to prevent and reduce tobacco use. There is a need for guidance that outlines the specific social conditions and embedded cultures that prohibit and encourage risk behaviors that promote tobacco use and deter individuals from receiving preventive care services, such as timely cancer screenings.
Evidence-based, statewide tobacco control programs that are comprehensive, sustained, address health inequities and are accountable have been shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking. Comprehensive programs must demonstrate a coordinated effort made up of key stakeholders that recognize the root causes of health disparities in order to establish smoke-free policies, reduce the social acceptability of tobacco use, promote cessation, help tobacco users quit, and prevent initiation of tobacco use. This approach combines educational, clinical, regulatory, economic, and social strategies; thereby acknowledging the social determinants of health, a topic area within Healthy People 2020 that is designed to identify ways to create social and physical environments that promote good health for all.