Smoking In America

Smoking In America

Although smoking prevalence is slowly declining in the United States, it continues to impose a huge burden on the nation’s health system—a burden that has health officials wondering whether anything can be done to further reduce America’s tobacco epidemic.

Last year the Institute of Medicine (IOM) asked Associate Professor David Mendez and SPH Dean Ken Warner, who also directs the University of Michigan Tobacco Research Network, to evaluate several scenarios that depict potential patterns of smoking prevalence in the U.S. for the next 20 years.

Mendez and Warner began by looking at the state with the highest rate of tobacco consumption, Kentucky, and a state with one of the lowest rates, California, and asking what would happen if the entire country began to emulate one of those two states.

Kentucky implements few policies known to reduce smoking. Until last spring, Kentucky had the lowest cigarette excise tax in the country—three cents per pack. Although the state raised the tax to 30 cents per pack in April 2005, the number is still low; the average state tax in the U.S. is 91 cents.

California, by contrast, is widely regarded as a model state for its implementation of highly successful tobacco-control efforts. It has launched aggressive media and educational campaigns aimed at reducing tobacco consumption, particularly among young people, and the state’s smoke-free indoor air policies are considered to be the best in the nation. “They try to hit smoking from all possible policy angles,” Mendez says.

But even though California—which Mendez and Warner term the “best-case scenario”— has drastically diminished tobacco consumption in comparison to the country as a whole, over 15 percent of the state’s adult population continues to smoke, says Mendez. “We still have a lot of work to do,” he adds. “Continued efforts are necessary to reduce this burden.”

In their study, which was based on a computer simulation, Mendez and Warner concluded that “smoking prevalence carries with it tremendous inertia, and its trajectory cannot be altered substantially without near-heroic efforts.” If current conditions persist, even with today’s best-practice tobacco control efforts, it will take more than two decades to halve the smoking prevalence in the U.S. As Mendez notes, every year 25 percent of the nation’s population takes up smoking permanently.

Their study will be incorporated into an IOM report, which is due for release later this year.

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Even with best-practice tobacco control efforts, it may take more than two decades to halve the smoking prevalence in the United States.