Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012 | Lifestyle Behaviors | JAMA | JAMA Network
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1.
Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Surgeon General’s Advisory Committee on Smoking and Health [1964]. http://profiles.nlm.nih.gov/NN/B/B/M/Q/. Accessed December 13, 2013.
2.
Warner  KE, Sexton  D, Gillespie  DB, Levy  DT, Chaloupka  FJ.  The impact of tobacco control on adult per capita cigarette consumption in the United States [published online November 14, 2013].  Am J Public Health. doi:10.2105/AJPH.2013.301591. PubMedGoogle Scholar
3.
Moolgavkar  SH, Holford  TR, Levy  DT,  et al.  Impact of reduced tobacco smoking on lung cancer mortality in the United States during 1975–2000.  J Natl Cancer Inst. 2012;104(7):541-548.PubMedGoogle ScholarCrossref
4.
Holford  TR, Clarke  L.  Chapter 4: Development of the counterfactual smoking histories used to assess the effects of tobacco control.  Risk Anal. 2012;32(suppl 1):S39-S50.PubMedGoogle ScholarCrossref
5.
Jeon  J, Meza  R, Krapcho  M, Clarke  LD, Byrne  J, Levy  DT.  Chapter 5: Actual and counterfactual smoking prevalence rates in the US population via microsimulation.  Risk Anal. 2012;32(S1)(suppl 1):S51-S68.PubMedGoogle ScholarCrossref
6.
Holford  TR, Levy  DT, McKay  LA,  et al.  Patterns of birth cohort–specific smoking histories, 1965–2009 [published online December 17, 2013].  Am J Prev Med. doi:10.1016/j.amepre.2013.10.022.Google Scholar
7.
Anderson  CM, Burns  DM, Dodd  KW, Feuer  EJ.  Chapter 2: Birth-cohort-specific estimates of smoking behaviors for the US population.  Risk Anal. 2012;32(S1)(suppl 1):S14-S24.PubMedGoogle ScholarCrossref
8.
Wynder  EL, Graham  EA.  Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases.  J Am Med Assoc. 1950;143(4):329-336.PubMedGoogle ScholarCrossref
9.
Doll  R, Hill  AB.  The mortality of doctors in relation to their smoking habits; a preliminary report.  Br Med J. 1954;1(4877):1451-1455.PubMedGoogle ScholarCrossref
10.
Reducing the health consequences of smoking: 25 years of progress: a report of the surgeon general [1989]. US Dept of Health and Human Services. http://profiles.nlm.nih.gov/NN/B/B/X/S/. Accessed December 13, 2013.
11.
Rosenberg  MA, Feuer  EJ, Yu  B,  et al.  Chapter 3: Cohort life tables by smoking status, removing lung cancer as a cause of death.  Risk Anal. 2012;32(suppl 1):S25-S38.PubMedGoogle ScholarCrossref
12.
Cancer Prevention Study I. American Cancer Society. http://www.cancer.org/research/researchtopreventcancer/cancer-prevention-studies. Accessed December 13, 2013.
13.
Current Cancer Prevention Studies. American Cancer Society. http://www.cancer.org/research/researchtopreventcancer/currentcancerpreventionstudies/index. Accessed December 13, 2013.
14.
NHANES I Epidemiologic Followup Study (NHEFS). Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhanes/nhefs/nhefs.htm. Accessed August, 2013.
15.
The Human Mortality Database. http://www.mortality.org. Accessed December 13, 2013.
16.
National estimates by age, sex, race: 1900-1979 (PE-11). US Census Bureau. http://www.census.gov/popest/data/national/asrh/pre-1980/PE-11.html. Accessed December 13, 2013.
17.
County-level population files-single year of age groups. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/popdata/download.html#state. December 17, 2013.
18.
Annual estimates of the resident population by single year of age and sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010, to July 1, 2012. US Census Bureau. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2012_PEPALL5N&prodType=table. December 17, 2013.
19.
Warner  KE.  Effects of the antismoking campaign: an update.  Am J Public Health. 1989;79(2):144-151.PubMedGoogle ScholarCrossref
20.
Smoking-attributable mortality, years of potential life lost, and productivity losses: United States, 2000-2004. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm. Accessed December 13, 2013.
21.
Thun  MJ, Carter  BD, Feskanich  D,  et al.  50-year trends in smoking-related mortality in the United States.  N Engl J Med. 2013;368(4):351-364.PubMedGoogle ScholarCrossref
22.
Arias  E.  United States Life Tables, 2006. Hyattsville, MD: National Center for Health Statistics; 2010.
23.
Murphy  SL, Xu  JQ, Kochanek  KD.  Deaths: Final Data for 2010. Hyattsville, MD: National Center for Health Statistics; 2013.
24.
Agaku  IT, Vardavas  CI, Ayo-Yusuf  OA, Alpert  HR, Connolly  GN.  Temporal trends in smokeless tobacco use among US middle and high school students, 2000-2011.  JAMA. 2013;309(19):1992-1994.PubMedGoogle ScholarCrossref
25.
McCarthy  ME.  E-cigarette use doubles among US middle and high school students.  BMJ. 2013;347:f5543.PubMedGoogle ScholarCrossref
26.
Richardson  A, Rath  J, Ganz  O, Xiao  H, Vallone  D.  Primary and dual users of little cigars/cigarillos and large cigars: demographic and tobacco use profiles.  Nicotine Tob Res. 2013;15(10):1729-1736.PubMedGoogle ScholarCrossref
27.
Quinn  VP, Hollis  JF, Smith  KS,  et al.  Effectiveness of the 5-As tobacco cessation treatments in nine HMOs.  J Gen Intern Med. 2009;24(2):149-154.PubMedGoogle ScholarCrossref
28.
Vidrine  JI, Shete  S, Cao  Y,  et al.  Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings.  JAMA Intern Med. 2013;173(6):458-464.PubMedGoogle ScholarCrossref
29.
Levy  DT, Graham  AL, Mabry  PL, Abrams  DB, Orleans  CT.  Modeling the impact of smoking-cessation treatment policies on quit rates.  Am J Prev Med. 2010;38(3)(suppl):S364-S372.PubMedGoogle ScholarCrossref
Original Investigation
January 8, 2014

Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012

Author Affiliations
  • 1Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
  • 2Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
  • 3Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
  • 4Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 5Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
JAMA. 2014;311(2):164-171. doi:10.1001/jama.2013.285112
Abstract

Importance  January 2014 marks the 50th anniversary of the first surgeon general’s report on smoking and health. This seminal document inspired efforts by governments, nongovernmental organizations, and the private sector to reduce the toll of cigarette smoking through reduced initiation and increased cessation.

Objective  To model reductions in smoking-related mortality associated with implementation of tobacco control since 1964.

Design, Setting, and Participants  Smoking histories for individual birth cohorts that actually occurred and under likely scenarios had tobacco control never emerged were estimated. National mortality rates and mortality rate ratio estimates from analytical studies of the effect of smoking on mortality yielded death rates by smoking status. Actual smoking-related mortality from 1964 through 2012 was compared with estimated mortality under no tobacco control that included a likely scenario (primary counterfactual) and upper and lower bounds that would capture plausible alternatives.

Exposures  National Health Interview Surveys yielded cigarette smoking histories for the US adult population in 1964-2012.

Main Outcomes and Measures  Number of premature deaths avoided and years of life saved were primary outcomes. Change in life expectancy at age 40 years associated with change in cigarette smoking exposure constituted another measure of overall health outcomes.

Results  In 1964-2012, an estimated 17.7 million deaths were related to smoking, an estimated 8.0 million (credible range [CR], 7.4-8.3 million, for the lower and upper tobacco control counterfactuals, respectively) fewer premature smoking-related deaths than what would have occurred under the alternatives and thus associated with tobacco control (5.3 million [CR, 4.8-5.5 million] men and 2.7 million [CR, 2.5-2.7 million] women). This resulted in an estimated 157 million years (CR, 139-165 million) of life saved, a mean of 19.6 years for each beneficiary (111 million [CR, 97-117 million] for men, 46 million [CR, 42-48 million] for women). During this time, estimated life expectancy at age 40 years increased 7.8 years for men and 5.4 years for women, of which tobacco control is associated with 2.3 years (CR, 1.8-2.5) (30% [CR, 23%-32%]) of the increase for men and 1.6 years (CR, 1.4-1.7) (29% [CR, 25%-32%]) for women.

Conclusions and Relevance  Tobacco control was estimated to be associated with avoidance of 8 million premature deaths and an estimated extended mean life span of 19 to 20 years. Although tobacco control represents an important public health achievement, efforts must continue to reduce the effect of smoking on the nation’s death toll.

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