Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012
Open accessAbstract
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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Effective implementation and enforcement of tobacco control policies and interventions can both increase healthy life expectancy and decrease health-care costs.
“Effective implementation and enforcement of tobacco control policies and interventions can both increase healthy life expectancy and decrease health-care costs.”
From Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019 (2021) · cites this paper as [5]
The Results and Discussion associate tobacco control with fewer premature deaths and increased life expectancy in the United States. They do not measure healthy life expectancy or show a decrease in health-care costs; the cost discussed is productivity lost to illness and death. (LLM, conf=0.86)
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- Authors
- Holford, T. R., Meza, R., Warner, K. E., Meernik, C., Jeon, J., Moolgavkar, S. H., & Levy, D. T.
- Affiliations
- Yale University (US)
- University of Michigan (US)
- Fred Hutch Cancer Center (US)
- Georgetown University (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-01-08
- Volume
- 311
- Issue
- 2
- Pages
- 164
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4056770
- OpenAlex
- W1990025032
- Cited by
- 317
- References
- 23
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 19 · 2023: 24 · 2022: 24 · 2021: 30 · 2020: 22 · 2019: 21 · 2018: 25 · 2017: 33 · 2016: 29 · 2015: 36 · 2014: 23 · 2013: 1
- FWCI
- 26.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01ca152956-05)
- National Cancer Institute (U01-CA-152956, R01-CA-152956)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Keywords
- tobacco control, smoking-related mortality, premature mortality, life-years saved, counterfactual analysis, life expectancy, smoking cessation, smoking initiation, birth cohort, gender differences in smoking, mortality rate ratio, National Health Interview Survey
- MeSH terms
- Smoking Prevention, Adult, Aged, Female, Health Surveys, Humans, Life Expectancy, Male, Medical Records, Middle Aged, Models, Theoretical, Public Health, Smoking, Social Control, Formal, United States, Cohort Studies, Prevalence, Smoking Cessation, Government Regulation, Mortality, Premature
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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