Cited by 317Smoking Behavior and CessationGlobal Cancer Incidence and ScreeningGlobal Public Health Policies and Epidemiology

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

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Holford, Theodore R., Meza, Rafael, Warner, Kenneth E., Meernik, Clare, Jeon, Jihyoun, Moolgavkar, Suresh H., Levy, David T.·2014·JAMA

DOI 10.1001/jama.2013.285112PMC PMC4056770

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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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“…U.S. Surgeon Generals report from approximately 42% in 1964 to 15% in 2015, a change estimated to have prevented 8 million premature deaths between 1964 and 2012 (Holford et al., 2014), and also netted tremendous health care cost savings (U.S. Department of Health and Human Services, 2014).”
Background

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)
ORCID: Holford, Theodore R.
Meza, Rafael
Warner, Kenneth E.
Meernik, Clare
Jeon, Jihyoun
Levy, David T.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2014-01-08
Volume: 311
Issue: 2
Pages: 164
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2013.285112
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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Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012

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