Introduction

Over the last several decades, tobacco control legislation and actions at the federal, state, and local levels have led to dramatic reductions in the number of people in the US who smoke cigarettes (Figure 4.1.5). In the 1960s, more than 40% of adults smoked. In 1964, "Smoking and Health: Report of the Advisory Committee to the Surgeon General" was published. This was followed by the passage of laws, public health campaigns, and other tobacco control policies that led to a large decline in cigarette smoking prevalence among US adults of 11.6% by 2022.¹ Subsequent Surgeon General Reports summarized research on the disease-causing effects of smoking, the dangers of secondhand smoke exposure, prevention of tobacco use, and the health benefits of cessation for the general public and vulnerable populations. These reports led to state and local efforts to restrict smoking in workplaces and public venues.

Despite advances in tobacco control in previous decades, important work remains in further reducing tobacco consumption. Obstacles include tobacco industry challenges to tobacco control policies and scientific evidence, the rapidly evolving tobacco product landscape with slow regulation of newer tobacco products, and social media platforms used by youth that include promotion of tobacco products (e.g., TikTok influencers promoting vaping).

Another important challenge is the funding of tobacco control efforts; these include surveillance of tobacco use, implementation and evaluation of tobacco control policies, and supporting the infrastructure, administration, and management of tobacco control programs. For example, mass media campaigns to prevent smoking initiation or encourage quitting, and which have demonstrated efficacy, require funds to disseminate their messages on paid media platforms in order to reach as wide an audience as possible. Free telephone quitlines and other cessation interventions also require funding for operations, especially if they wish to provide free nicotine replacement therapies or other effective cessation medications to users. The Centers for Disease Control and Prevention (CDC) estimates how much each state should be spending on tobacco control programs based on factors that include the state’s prevalence of tobacco use and the costs of campaigns or interventions that are effective and sustainable.^2,3,4 However, many states do not fund their tobacco control programs at CDC-recommended levels (Map 4.1.6), despite receiving substantial revenues from taxes levied on tobacco products [see Section 4.2.7] and tobacco industry settlement dollars.⁵ The passing and implementation of evidence-based tobacco control policies along with appropriate funding of efforts to prevent tobacco initiation and help people who use tobacco to quit will accrue enormous public health and macroeconomic benefits. These are the inherent goals of tobacco control policies and programs.

"In 1964, the year of the first Surgeon General’s report on smoking and health, nearly one in two US adults smoked cigarettes. We’ve made remarkable progress since then. Today, about one in nine adults smokes cigarettes. Sixty years later, the elimination of all tobacco-related disease and death for our nation is a bold yet attainable goal."

Vivek H. Murthy, M.D., M.B.A.
Vice Admiral, US Public Health Service
19th and 21st Surgeon General of the United States