Tobacco use remains a major public health issue in the United States, as cigarette smoking is the leading cause of preventable death. While tobacco use has declined over the past 50 years, almost 20% of Americans still use tobacco. Tobacco use results in approximately 443,000 deaths annually and costs over $193 billion in medical costs each year. The Healthy People 2020 initiative aims to reduce tobacco use through policies restricting advertising, increasing prices, and expanding smoke-free laws and cessation programs to curb both initiation and use. Progress is monitored through ongoing data collection and surveys to evaluate programs and update interventions.

1. TOBACCO USE IN THE UNITED
STATES: A FATAL AND
EXPENSIVE PUBLIC HEALTH
DILEMMA
Jacqueline Brown
Jacksonville University
Nursing 512

2. TOBACCO USE
Cigarette smoking is the leading cause of death in the United States (NIH, 2015)
 Dowst-Mayo (2015) “Tobacco use remains the single largest preventable cause of
death in the United States. Even with the increased cost of
tobacco products, increase in anti-tobacco media campaigns and
smoke-free laws for workplaces and public places, almost 20%
of Americans still continue to use tobacco”(p.58).
 Agaka et al.,(2014) found there is a significant decline in cigarette smoking among adults in the United States over the past
five decades. In recently years progress has slow down and the use of tobacco products such as cigars and smokeless
tobacco remains the same. (p.542).

3. TOBACCO USE
 In 2009, an estimated 20.6% of all American adults age 18 and older—46.6 million people—smoked.
 Every day another 850 young people age 12 to 17 began smoking on a daily basis.
 Result: Widespread tobacco use, results in approximately 443,000 Americans die from tobacco-related illnesses each year.
 Tobacco Related Illnesses: cancer and heart disease.
 An estimated 49,000 of these deaths are the result of secondhand smoke exposure.
 For every person who dies from tobacco use, another 20 suffers from at least one serious tobacco-related illness.

4. TOBACCO USE: FINANCIAL BURDEN ON U.S. ECONOMY
AND MEDICAL CARE SYSTEM
Annually
 Cigarette smoking costs more than $193 billion in medical care cost.
 Second hand smoking cost an additional $10 million

5. TOBACCO USE
 Tobacco use is one of the leading cause of the increase mortality and morbidity in the United States.
 The Tobacco Use Reduction and Initiation is part of the Healthy People 2020 Initiative.
 Goals of the Programs:
 Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth and
adults.
 Health System Changes: Adopting policies and strategies to increase access, affordability, and use of
smoking cessation services and treatments.
 Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke,
increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors.

6. HEALTH CONSEQUENCES OF
TOBACCO USE
Smoking Tobacco:
 The use of tobacco in any form “even intermittent smoking” results in serious disease and health problems including:
 Several forms of cancer, including cancers of the lung, bladder, kidney, pancreas, mouth, and throat
 Heart disease and stroke
 Lung diseases, including emphysema, bronchitis, and chronic obstructive pulmonary disease (COPD)
 Pregnancy complications, including preterm birth, low birth weight, and birth defects
 Gum disease
 Vision problems

7. HEALTH CONSEQUENCES OF
TOBACCO USE
Second Hand Smoking from Cigarette and Cigar:
A. Adults: Heart disease and lung cancer
B. Infant and Children: Asthma, Respiratory infections
C. Ear infections, Sudden infant death syndrome (SIDS)
D. Smokeless Tobacco Causes:
E. Serious oral health problems- mouth cancer, gums, periodontal disease, and tooth loss.

8. MONITORING PROGRAM OUTCOMES
Outcome data is monitored based on specific programs [Cessation and Initiation]
Frequency for data collection:
 Periodic
Methodology for Data Collection:
 The Tobacco Use Supplement to the Current Population Survey (TUS-CPS)
 National Adult Tobacco Survey
 National Sample Size

9. DESIRED CHANGE
 Healthy People 2020 provides a framework for action to reduce tobacco use to the point that it is no
longer a public health problem for the nation.
 Reduce Tobacco Use Strategies:
• Fully funding tobacco control programs.
• Increasing the price of tobacco products.
• Enacting comprehensive smoke-free policies.
• Controlling access to tobacco products.
• Reducing tobacco advertising and promotion.
• Implementing anti-tobacco media campaigns.
• Encouraging and assisting tobacco users to quit.

10. DESIRED CHANGE
 From 2009-2010, major advances were made in the campaign to end the tobacco use epidemic,
including:
 The U.S. Food and Drug Administration (FDA) was granted the authority to regulate the sales,
advertising, and ingredient content of all tobacco products marketed in the United States.15
 The Federal Government increased the Federal tobacco excise tax by $0.61 to $1.01 per pack.
 25 states and the District of Columbia (DC) had comprehensive smoke-free laws eliminating
smoking in workplaces, restaurants, and bars, and 14 States and DC had cigarette excise tax rates
of at least $2 per pack.

11. SUSTAINABILITY
 “Heathy People 2020 is a multi-year cross-disciplinary public health initiative led by the federal
government in close collaboration with a diverse group of individuals and organizations from
partnering public and private entities”.
 “Healthy People initiative began 30 years ago and continues its commitment to improving the
quality of our Nation's health”.
 “The science-based initiative is centered around a framework for public health prevention
priorities and actions. Most recently, Healthy People launched Healthy People 2020, outlining new
10-year goals and objectives for health promotion and disease prevention”.
(U.S. Department of Health & Human Services, 2015)

12. ACCOUNTABILITY AND PROGRAM
EVALUATION
Funding and Accountability:
 Annual audit report
 Make website visit to review financial records and to ensure that everything documented can be verified.
 The use of funds with special permission from the granting agency.
Revising Program Interventions:
 Data is collected and reviewed
 Analysis performed
 The goals, targeted measures, interventions updated (revised or added) applicable to accomplishing the programs
goals
(Milstead, 2016)

13. ACCOUNTABILITY IN PROGRAM EVALUATION
Providing Information:
 Information is updated periodically to reflect the Department’s strategies, actions, and progress toward goals.
(HHS, 2015)
Unintended Effects:
 Evaluations of programs to identify unintended effects.
 No intended effects were identified for this program
Accreditation:
“The goal of the national accreditation program is to improve and protect the health of the public by advancing the quality and performance
of public health departments. State, tribal, local and territorial health departments are eligible to apply” (CDC, 2015)

14. THE END

15. REFERENCE
Agaku, I. T., King, B. A., Husten, C. G., Bunnell, R., Ambrose, B. K., Hu, S. e., & ... Day, H. R. (2014). Tobacco product use among adults -
United States, 2012-2013. MMWR: Morbidity & Mortality Weekly Report, 63(25), 542-547.
Center for Disease Control and Prevention (2015). Program Performance and Accountability. Retrieved on August 2, 2015 from
http://www.cdc.gov/program/performance/index.htm.
Dowst-Mayo, L. (2015). Puff, Not the Magic Dragon... The Cost of America's Tobacco Use. Rdh, 35(1), 57-65.
National Institute of Health(2015). Cancer Trend Progress Report: Adult Tobacco Use. Retrieved on July 31, 2015 from:
http://progressreport.cancer.gov/prevention/adult_smoking
Milstead, J. (2016). Health policy and politics: a nurse's guide (5th ed.). Burlington, MA: Jones & Bartlett Learning.
U.S. Department of Health and Human Services (2015). Healthy People 2020: Tobacco Use. Retrieved on July 30, 2015
from :http://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use