THE TOLL OF TOBACCO IN THE USA

toll of Tobacco in The UNITED sTATES OF AMERICA

Tobacco Use in the USA

· High school students who are current (past month) smokers: 21.9% or 3.5+ million [Boys: 21.8% Girls: 21.9%]

· High school males who currently use smokeless tobacco: 11.0% [Girls: 2.2%]

· Kids (under 18) who try smoking for the first time each day: 4,000+

· Kids (under 18) who become new regular, daily smokers each day: 2,000+

· Kids exposed to secondhand smoke at home: 15.5 million

· Workplaces that have smoke-free policies: 68.6%

· Packs of cigarettes consumed by kids each year: 900 million

(producing tobacco company revenues of roughly $2.0 billion per year)

· Adults in the USA who smoke: 22.5% or about 45 million [Men: 25.2% Women: 20.0%]

Deaths in the USA from Tobacco Use

· People who die each year from their own cigarette smoking: 400,000

· People who die each year from others' smoking (secondhand smoke & pregnancy smoking): 38,000 to 67,500

· Kids under 18 alive today who will ultimately die from smoking (unless smoking rates decline): 6,000,000+

Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined -- and thousands more die from spit tobacco use. Of the roughly 750,000 kids who become new regular, daily smokers each year, almost a third will ultimately die from it. In addition, smokers lose an average of 13 to 14 years of life because they smoked.

Tobacco-Caused Disease in the USA

· Approximately 8.6 million people suffer from smoking-caused conditions.

Tobacco-Related Monetary Costs in the USA

Healthcare Costs. Total annual public and private health care expenditures caused by smoking: $75+ billion

- Annual Federal and state government smoking-caused Medicaid payments: $23.5 billion

[Federal share: $13.4 billion per year. States share: $10.1 billion]

- Federal government smoking-caused Medicare expenditures each year: $20+ billion

- Other federal government tobacco-caused healthcare costs (e.g. through VA health care): $8 billion

Additional smoking-caused health costs caused by tobacco use include annual expenditures for health and developmental problems of infants and children caused by mothers smoking or being exposed to second-hand smoke during pregnancy or by kids being exposed to parents smoking after birth (at least $1.4 to $4.0 billion). Also not included above are costs from

smokeless or spit tobacco use, adult secondhand smoke exposure, or pipe/cigar smoking.

Non-Healthcare Costs: Productivity losses caused by smoking each year: $82+ billion

Annual expenditures through Social Security Survivors Insurance for the more than 300,000 kids who have lost at

least one parent from a smoking-caused death: $2.1 billion

Other non-healthcare costs from tobacco use include residential and commercial property losses from smoking-caused fires

(about $500 million per year) and tobacco-related cleaning & maintenance ($4 billion, commercial only).

· Taxpayers yearly fed/state tax burden from smoking-caused gov't spending: $55+ billion ($528 per household)

· Smoking-caused health costs and productivity losses per pack sold in USA (low estimate): $7.18 per pack

Tobacco Industry Advertising & Political Influence

· Annual tobacco industry spending on marketing its products nationwide: $11.5 billion ($31+ million each day)

Research studies have found that kids are three times as sensitive to tobacco advertising than adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure; and that a third of underage experimentation

with smoking is attributable to tobacco company advertising and promotion.

· Annual tobacco industry contributions to federal candidates and political parties: Over $5 million

· Tobacco Industry expenditures lobbying Congress during 1998 (when McCain bill debated): Over $65 million

[The tobacco companies also spend enormous amounts of money to influence state and local politics.]

· Additional tobacco industry expenditures in 1998 to influence state ballot questions and for a media campaign

against the McCain tobacco control bill: Over $70 million

Sources of Information for Tobacco’s Toll in the USA

Youth tobacco use. National Youth Risk Behavior Survey (YTS) 2003; U.S. Centers for Disease Control and Prevention (CDC), Youth Risk Behavior Surveillance - United States,2003, Morbidity and Mortality Weekly Report (MMWR) 53 SS-2, May 21, 2004. http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf The 2002 National Youth Tobacco Survey (YTS) found a 22.9% high school smoking rate (21.2% for girls, 24.6% for boys) CDC, "Tobacco Use Among High School Students - United States, 2002,"MMWR 51(19), May 17, 2002, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5119a1.htm .; but the results from the YRBS and YTS cannot be compared because they use different methodologies, Current smoker defined as having smoked in the past month. YRBS is done in odd-numbered years, YTS in even. See, also, Institute for Social Research, University of Michigan, Monitoring the Future Studies, http://monitoringthefuture.org/new.html . Youth initiation. Substance Abuse and Mental Health Services Administration, U.S. Dept of Health and Human Services (HHS), “Summary Findings from the 2001 National Household Survey on Drug Abuse,” 2002, www.samhsa.gov/oas/nhsda.htm. Secondhand smoke exposure. CDC, “State-Specific Prevalence of Cigarette Smoking Among Adults, and Children’s and Adolescents’ Exposure to Environmental Tobacco Smoke – United States 1996,” MMWR 46(44): 1038-1043, November 7, 1997. Good data not currently available re adult exposure to secondhand smoke at home or the numbers of adults or kids exposed to SHS outside the home. Smoke-free workplaces. Shopland, D., et al., "State-Specific Trends in Smoke-Free Workplace Policy Coverage: The Current Population Survey Tobacco Use Supplement, 1993 to 1999," Journal of Occupational and Environmental Medicine 43(8): 680-86, August 2001. Packs consumed by kids. J. DiFranza & J. Librett, “State and Federal Revenues from Tobacco Consumed by Minors,” American Journal of Public Health 89(7): 1106-1108, July 1999; Economic Research Service, U.S. Department of Agriculture, Tobacco Briefing Room, Table 8, http://www.econ.ag.gov/Briefing/tobacco/. See, also, Cummings, et al., "The Illegal Sale of Cigarettes to US Minors: Estimates by State," American Journal of Public Health 84(2): 300-302, February 1994. Adult smoking. National Center for Health Statistics, 2002 National Health Interview Survey, See, also, CDC, Cigarette Smoking Among Adults – United States, 2001,” MMWR 52(40): 953-956, October 10, 2003.

Smoking deaths. CDC, State Highlights 2002: Impact and Opportunity, April 2002, http://www.cdc.gov/tobacco/StateHighlights.htm. Also, CDC, "Annual Smoking-Attributable Mortality, Years of Potential Life Lose, and Economic Costs -- United States 1995-1999," MMWR, April 11, 2002, www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm. National Cancer Institute, Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency, Smoking and Tobacco Control Monograph No. 10, NIH publication no. 99-4645, 1999. CDC, State Highlights 2002: Impact and Opportunity, April 2002, www.cdc.gov/tobacco/StateHighlights.htm [future youth deaths]. See, also, U.S. General Accounting Office (GAO), "CDC's April 2002 Report on Smoking: Estimates of Selected Health Consequences of Cigarette Smoking Were Reasonable," letter to U.S. Rep. Richard Burr, July 16, 2003, http://www.gao.gov/new.items/d03942r.pdf. Smoking-caused disease. “Cigarette Smoking-Attributable Morbidity – United States, 2000” MMWR 52(35): 842-844, September 5, 2003. http://www.cdc.gov/mmwr/PDF/wk/mm5235.pdf

Smoking-caused costs: CDC, State Highlights 2002: Impact and Opportunity, April 2002, http://www.cdc.gov/tobacco/StateHighlights.htm. CDC, "Annual Smoking-Attributable Mortality, Years of Potential Life Lose, and Economic Costs -- United States 1995-1999," MMWR, April 11, 2002, www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm. See, also, Zhang, X., et al., “Cost of Smoking to the Medicare Program, 1993,” Health Care Financing Review 20(4): 1-19, Summer 1999 [nationwide smoking-caused health costs = $89 billion]. Health Care Financing Administration [federal gov't reimburses the states, on average, for 57% of their Medicaid expenditures]. Office of Management and Budget, The Budget for the United States Government - Fiscal Year 2000, Table S-8 at page 378, January 1999. Pregnancy-related costs. Adams, E.K. & C.L. Melvin, “Costs of Maternal Conditions Attributable to Smoking During Pregnancy,” American Journal of Preventive Medicine 15(3): 212-19, October 1998; CDC, “Medical Care Expenditures Attributable to Cigarette Smoking During Pregnancy,” MMWR 46(44), November 7, 1997; Aligne, C.A. & J.J. Stoddard, “Tobacco and Children: An Economic Evaluation of the Medical Effects of Parental Smoking,” Archives of Pediatric and Adolescent Medicine, 151: 648-653, July 1997. Stoddard, JJ & B. Gray, “Maternal Smoking and Medical Expenditures for Childhood Respiratory Illness,” American Journal of Public Health 87(2): 205-209, February 1997. Smoking & SSSI costs: Leistikow, B., et al., "Estimates of Smoking-Attributable Deaths at Ages 15-54, Motherless or Fatherless Youths, and Resulting Social Security Costs in the United States in 1994," Preventive Medicine 30(5): 353-360, May 2000. Fire costs. J. R. Hall, Jr., National Fire Protection Association, The U.S. Smoking-Material Fire Problem, April 2001. Cleaning and maintenance costs. D. Mudarri, The Costs and Benefits of Smoking Restrictions: An Assessment of the Smoke-Free Environment Act of 1993 (H.R. 3434), U.S. Environmental Protection Agency report submitted to the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House of Representatives, April 1994. CDC, Making Your Workplace Smokefree: A Decision Maker’s Guide, 1996. Additional sources for non-health costs. U.S. Department of the Treasury, The Economic Costs of Smoking in the U.S. and the Benefits of Comprehensive Tobacco Legislation, 1998; Chaloupka, F.J. & K.E. Warner, “The Economics of Smoking,” in Culyer, A. & J. Newhouse (eds), The Handbook of Health Economics, 2000; CDC, MMWR 46(44), November 7, 1997. Tobacco tax burden. Smoking-caused federal/state tax burden taken to equal listed government expenditures plus 3% of total tobacco-caused health costs to account for unlisted federal/state smoking-caused health and other costs. CDC, "Medical Care Expenditures Attributable to Smoking -- United States, 1993," MMWR 43(26): 1-4, July 8, 1994.

Tobacco marketing. U.S. Federal Trade Commission (FTC), Cigarette Report for 2001, June 12, 2003 [data for top six manufacturers only], http://www.ftc.gov/os/2003/06/2001cigreport.pdf, FTC, Federal Trade Commission Smokeless Tobacco Report for the Years 2000 and 2001, August 2003 [top five companies], http://www.ftc.gov/os/2003/08/2k2k1smokeless.pdf . See, also Campaign fact sheet, Increased Cigarette Company Marketing Since the Multistate Settlement Agreement Went into Effect. Tobacco marketing studies. R. Pollay, et al., “The Last Straw? Cigarette Advertising and Realized Market Shares Among Youths and Adults,” Journal of Marketing 60(2):1-16, April 1996. N. Evans, et al., “Influence of Tobacco Marketing and Exposure to Smokers on Adolescent Susceptibility to Smoking,” Journal of the National Cancer Institute 87(20): 1538-45, October 1995. J.P. Pierce et al., “Tobacco Industry Promotion of Cigarettes and Adolescent Smoking,” Journal of the American Medical Association 279(7): 511-505, February 1998 [with erratum in JAMA 280(5): 422, August 1998]. Tobacco industry political contributions, lobbying, political advertising. Federal Election Commission. Common Cause, http://www.commoncause.org. Public Citizen, http://www.citizen.org/tobacco. Center for Responsive Politics, http://www.opensecrets.org. Torry, S. & N. Abse, "Big Tobacco Spends Top Dollar to Lobby," Washington Post, April 9, 1999. Jamieson, K., "Tax and Spend" vs. "Little Kids": Advocacy and Accuracy in the Tobacco Settlement Ads of 1997-8, Annenberg Public Policy Center, Univ. of Penn., August 6, 1998. Media reports. TFK website, http://tobaccofreekids.org/reports/contributions.

Other major source of State tobacco-related data: CDC, state-specific tobacco information, http://www.cdc.gov/tobacco/statehi/statehi.htm.

All CDC MMWR's at http://www.cdc.gov/mmwr. Abstracts of many of the cited articles at PubMed, http://www.ncbi.nlm.nih.gov/entrez.

Related Campaign Fact Sheets, available at http://www.tobaccofreekids.org or http://tobaccofreekids.org/research/factsheets:

National Center for Tobacco-Free Kids, May 25, 2004, www.tobaccofreekids.org/ Eric Lindblom