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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.”
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]
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“25 Though GPs are recommended to ask every patient about smoking, almost all of the reduction in American smoking in the past 25 years has been the result of policy measures, not clinical care, with “large increases in cigarette taxes relative to initial prices”continuing to be the most…”
Vugrin, E., Rostron, B., Verzi, S. J., Brodsky, N., Brown, T., Choinière, C. J., Coleman, B., Paredes, A., & Apelberg, B. (2015) · PLoS ONE · doi:10.1371/journal.pone.0121008 · Cited by 54
Smoking prevalence in Russia. What has changed over 20 years?
Баланова, Ю. А., Shalnova, S. A., Деев, А. Д., Владимировна, К. А., Васильевич, К. В., & Бойцов, С. А. (2015) · Russian Journal of Preventive Medicine · doi:10.17116/profmed201518647-52 · Cited by 57
Akter, S., Islam, M. R., Rahman, M. M., Rouyard, T., Nsashiyi, R. S., Hossain, F., & Nakamura, R. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.22341 · Cited by 57
AACR Cancer Progress Report 2015
Baselga, J. M., Bhardwaj, N., Cantley, L. C., DeMatteo, R. P., DuBois, R. N., Foti, M., Gapstur, S. M., Hahn, W. C., Helman, L. J., Jensen, R. A., et al. (2015) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-15-1846 · Cited by 60
“For example, major public education and policy initiatives to combat cigarette smoking have been credited with preventing eight million premature deaths from 1964 to 2014 (35) (see Figure 9, p.”
BackgroundAn estimation of the harm of menthol cigarettes in the United States from 1980 to 2018
Le, T. T. T., & Méndez, D. (2021) · Tobacco Control · doi:10.1136/tobaccocontrol-2020-056256 · Cited by 49
Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation
Levy, D. T., Mays, D. M., Yuan, Z., Hammond, D. G., & Thrasher, J. F. (2016) · Tobacco Control · doi:10.1136/tobaccocontrol-2016-053087 · Cited by 49
Self-citationAttribution of Cancer Origins to Endogenous, Exogenous, and Preventable Mutational Processes
Cannataro, V. L., Mandell, J. D., & Townsend, J. P. (2022) · Molecular Biology and Evolution · doi:10.1093/molbev/msac084 · Cited by 52
“The importance of understanding the underlying sources of mutations that are selected along the molecular evolutionary trajectory toward cancer in each and every patient is underscored by the remarkable successes of antismoking interventions against carcinogenic exposures, which have saved many lives (Holford et al. 2…”
Pechacek, T. F., Nayak, P., Gregory, K. R., Weaver, S. R., & Eriksen, M. P. (2016) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntw102 · Cited by 51
Ophir, Y., Brennan, E., Maloney, E. K., & Cappella, J. N. (2017) · Communication Research · doi:10.1177/0093650217700226 · Cited by 53
“The use of warning labels is central to educational efforts to increase the public’s knowledge about the risks of smoking (Goodman, 2014), a persistent public health problem that remains a main source of preventable deaths in the United States (Holford et al., 2014).”
BackgroundInfluentialLiber, A. C., & Warner, K. E. (2017) · American Journal of Epidemiology · doi:10.1093/aje/kwx196 · Cited by 47
Self-citationTaylor, K. L., Williams, R. M., Li, T., Luta, G., Smith, L., Davis, K., Stanton, C. A., NIAURA, R. S., Abrams, D. B., Lobo, T., et al. (2022) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djac127 · Cited by 45
Self-citationGauging the Effect of U.S. Tobacco Control Policies From 1965 Through 2014 Using SimSmoke
Levy, D. T., Meza, R., Zhang, Y., & Holford, T. R. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.10.001 · Cited by 47
Self-citationUnderstanding long‐term trends in smoking in England, 1972–2019: an age–period–cohort approach
Breton, M. O., Gillespie, D., Pryce, R., Bogdanovica, I., Angus, C., Alava, M. H., Brennan, A., & Britton, J. R. (2021) · Addiction · doi:10.1111/add.15696 · Cited by 44
Public health implications of vaping in the USA: the smoking and vaping simulation model
Levy, D. T., Tam, J., Sánchez‐Romero, L. M., Li, Y., Yuan, Z., Jeon, J., & Meza, R. (2021) · Population Health Metrics · doi:10.1186/s12963-021-00250-7 · Cited by 47
“These policies have been shown to be effective [54], and can explain much of the reduction in smoking prevalence [44, 50, 92, 101, 102].”
BackgroundSelf-citationEllington, T. D., Momin, B., Wilson, R. J., Henley, S. J., Wu, M., & Ryerson, A. B. (2021) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-21-0265 · Cited by 46
“Tobacco-related cancers could be prevented by reducing tobacco use through sustained, comprehensive, evidence-based tobacco prevention and control interventions (32).”
BackgroundTobacco Control 50 Years After the 1964 Surgeon General’s Report
Schroeder, S. A., & Koh, H. K. (2014) · JAMA · doi:10.1001/jama.2013.285243 · Cited by 44
Tam, J., Levy, D. T., Jeon, J., Clarke, J., Gilkeson, S., Hall, T., Feuer, E. J., Holford, T. R., & Meza, R. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019169 · Cited by 42
“Ethics and dissemination A web-based interface is being developed to integrate the results of the simulations into a format that allows the user to explore the projected effects of tobacco control policies in the USA.”
BackgroundMethodInfluentialSelf-citationNon-communicable diseases: Healthy living needs global governance
Gostin, L. O. (2014) · Nature · doi:10.1038/511147a · Cited by 41
Maciosek, M. V., Xu, X., Butani, A., & Pechacek, T. F. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.05.019 · Cited by 41
“While cigarette smoking continues to decline and millions of premature deaths were averted as a result of tobacco control efforts during the last half of the century (Centers for Disease Control and Prevention, 2011; Holford et al., 2014), tobacco use remains the nation's leading preventable cause of death and disease…”
Cigarette Tax Increase and Infant Mortality
Patrick, S. W., Warner, K. E., Pordes, E., & Davis, M. M. (2015) · PEDIATRICS · doi:10.1542/peds.2015-2901 · Cited by 40
Self-citationReward-Based Incentives for Smoking Cessation
Volpp, K. G. M., & Galvin, R. (2014) · JAMA · doi:10.1001/jama.2014.418 · Cited by 39
Prediction of COPD risk accounting for time-varying smoking exposures
Chang, J. T., Meza, R., Levy, D. T., Arenberg, D. A., & Jeon, J. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248535 · Cited by 37
“This model has also the potential to be integrated into micro-simulation models of smoking and health outcomes [26,47,48] to project the incidence and prevalence of COPD for the next decades as smoking patterns continue to evolve in the U.”
BackgroundMethodSelf-citationSmoking is Associated with Increased Risk of Major Bleeding: A Prospective Cohort Study
Langsted, A., & Nordestgaard, B. G. (2018) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1675798 · Cited by 37
AACR Cancer Progress Report 2016
Davidson, N. E., Armstrong, S. A., Coussens, L. M., Cruz-Correa, M. R., DeBerardinis, R. J., Doroshow, J. H., Foti, M., Hwu, P., Kensler, T. W., Morrow, M., et al. (2016) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-16-1993 · Cited by 36
“We have made tremendous progress reducing the public health burden of tobacco use, with researchers estimating that more than 8 million smoking-related deaths were prevented in the United States from 1964 to 2014 as a result of declines in cigarette smoking rates (39).”
Keith, D. R., Stanton, C. A., Gaalema, D. E., Bunn, J. Y., Doogan, N. J., Redner, R., Kurti, A. N., Cepeda-Benito, A., Lopez, A. A., Morehead, A. L., et al. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4062-6 · Cited by 36
“Various tobacco control and prevention policies have contributed to a significant decline in the prevalence of cigarette smoking in the United States over the past decade.(1), 2 This decline is not uniform across the US population, as disparities in tobacco use have been reported by gender, sexual orientation, age, ra…”
BackgroundHolmes, C. B., King, B. A., & Babb, S. D. (2016) · Preventing Chronic Disease · doi:10.5888/pcd13.150409 · Cited by 34
“The most stringent laws were comprehensive smoke-free laws that went into effect in Delaware (2002), the District of Columbia (2007) and Maryland (2008). Less stringent restrictions also went into effect, prohibiting smoking in at least one location (work sites, restaurants, or bars) in 4 southern states (Arkansas, Fl…”
InfluentialLevy, D. T., Sánchez‐Romero, L. M., Travis, N., Yuan, Z., Li, Y., Skolnick, S., Jeon, J., Tam, J., & Meza, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094876 · Cited by 34
Self-citationMcCabe, S. E., Veliz, P. T., McCabe, V. V., & Boyd, C. J. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.02.025 · Cited by 33
Smoking-attributable Mortality by State in 2014, U.S.
Ma, J., Siegel, R. L., Jacobs, E. J., & Jemal, A. (2018) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2018.01.038 · Cited by 34
Trends in Mortality Among Females in the United States, 1900–2010: Progress and Challenges
Hahn, R. A., Chang, M., Parrish, R. G., Teutsch, S. M., & Jones, W. K. (2018) · Preventing Chronic Disease · doi:10.5888/pcd15.170284 · Cited by 31
Vaper, Beware: The Unique Toxicological Profile of Electronic Cigarettes
Schmidt, S. (2020) · Environmental Health Perspectives · doi:10.1289/ehp6628 · Cited by 30
Yamada, H., Suzuki, K. A. O., Fujii, R., Kawado, M., Hashimoto, S., Watanabe, Y., Iso, H., Fujino, Y., Wakai, K., & Tamakoshi, A. (2021) · Scientific Reports · doi:10.1038/s41598-021-84707-7 · Cited by 30
Public Health Effects of Restricting Retail Tobacco Product Displays and Ads
Levy, D. T., Lindblom, E. N., Fleischer, N. L., Thrasher, J. F., Mohlman, M. K., Zhang, Y., Monshouwer, K., & Nagelhout, G. E. (2015) · Tobacco Regulatory Science · doi:10.18001/trs.1.1.7 · Cited by 29
Self-citationHeated tobacco products for smoking cessation and reducing smoking prevalence
Tattan‐Birch, H., Jackson, S. E., Shahab, L., Hartmann‐Boyce, J., Kock, L. S., Simonavičius, E., Brose, L. S., & Brown, J. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013790 · Cited by 29
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Patient-centred care for addiction treatment: a scoping review protocol
Marchand, K., Beaumont, S., Westfall, J., MacDonald, S., Harrison, S., Marsh, D. C., Schechter, M. T., & Oviedo-Joekes, E. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-024588 · Cited by 28
Burcu, M., Steinberger, E. K., & Sorkin, J. D. (2015) · Journal of Cancer Survivorship · doi:10.1007/s11764-015-0446-y · Cited by 27
“themselves as current smokers in the USA has more than halved [3, 7], and yet, smoking still remains an important”
Criss, S. D., Sheehan, D. F., Palazzo, L. L., & Kong, C. Y. (2018) · PLoS Medicine · doi:10.1371/journal.pmed.1002506 · Cited by 27
“%) by 2030 (S2 Appendix).”
InfluentialTrends in cancer incidence and mortality rates in the United States from 1975 to 2016
Yang, R., Zhou, Y., Wang, Y., Du, C., & Wu, Y. (2020) · Annals of Translational Medicine · doi:10.21037/atm-20-7841 · Cited by 31
“Some researchers have attributed the decline in mortality of these cancers to steady reductions in smoking and advances in early detection and treatment (11,13-16).”
Background
Metadata
- 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
- 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 › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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
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