Although cigarette smoking is often referred to as the single leading preventable cause of death in the United States, other forms of tobacco are also dangerous. For example, men who report moderate inhalation and smoke at least five cigars a day experience lung cancer deaths at about two-thirds the rate of men who smoke one pack of cigarettes a day. Cigar smokers experience higher rates of lung cancer, heart disease, and chronic obstructive lung disease than nonsmokers. Cigar smokers who inhale are 6 times more likely to die from oral cancer and 39 times more likely to die from laryngeal cancers than nonsmokers (NCI 1998). Bidis and Kreteks are associated with increased risks of cancers in the gastrointestinal and respiratory systems as well as other respiratory problems. Smokeless tobacco contains 28 carcinogens and is associated with the risk of oral cancer. It is also associated with gum recession and a condition called leukoplakia, a precancerous change in buccal and gingival mucosa (CDC 2004).

The health consequences of tobacco use have substantial economic effects. Because of smoking-related mortality, more than 3.3 million years of potential life among men and 2.2 million years of potential life among women are lost annually (compared with the life expectancies among nonsmokers). The lost productivity attributable to these years of life lost amounts to more than $92 billion annually (CDC 2005).¹ Other economic costs of tobacco use amount to more than $155 billion every year. Private and public health care expenditures for smoking related health conditions are an estimated $89 billion, including $28.4 billion in federal and state payments to Medicaid. Health care expenditures for secondhand smoke alone are approximately $5 billion per year (Lindblom and McMahon 2005).

Other social costs associated with tobacco use include the costs associated with smoking-related fires and casualties and degradation of the environment. Smoking is the fifth most frequent cause of residential fires—the leading cause of fire deaths. In addition, states and the federal government spend millions of dollars annually on prevention and research efforts relating to tobacco use. In FY 2002, for instance, state and federal funding for tobacco control programs totaled $861.9 million, or $3.16 per capita (CDC 2002). In FY 2005, state spending alone totaled $538.4 million, or $2.76 per capita (data for state and national funding combined since FY 2002 are not available).

Tobacco use will not disappear in the United States simply because of the momentum of past achievements. The decline in tobacco use achieved over the last several decades is likely to flatten out in the coming decade, and strong measures are likely to be needed to maintain continued progress