Tobacco use is the leading cause of preventable death and disease in the United States, responsible for nearly 20% of annual deaths. In response, the Centers for Disease Control and Prevention (CDC) established programs to promote tobacco prevention and control. While smoking rates have declined by around 50% since the 1960s, further reductions are still needed to meet public health targets. Legislative actions, taxation, and prevention programs have improved health outcomes but disparities remain for some groups. Continued evaluation is crucial to refine interventions and sustain progress on this important public health issue.

1. TOBACCO PREVENTION
AND CONTROL
Battling Public Health Enemy #1

2. WHY ADDRESS TOBACCO USE?
• Cigarette smoking is the #1 cause of preventable deaths and illnesses from several types of
cancers, heart and lung disease in the United States
• Accounts for nearly 20% of all deaths annually in the U.S.
• Approximately 480,000 deaths per year (CDC, 2015)
• Over 16 million Americans live with smoking-related diseases (CDC, 2015)
• Over $289 billion total economic costs due to tobacco annually
• Second hand smoke exposure related diseases claims 600,000 lives worldwide (WHO, 2014)
• Parental smoking linked to: Poor pregnancy outcomes, SIDS, increased middle ear &
respiratory infections, decreased lung capacity (Knickman & Kovner, 2015)
• Societal impact: Poor health status impairs worker productivity and national readiness
(Knickman & Kovner, 2015)

3. CENTERS FOR DISEASE CONTROL
AND PREVENTION TAKES ACTION
• In 1965 the CDC established the National Clearinghouse for Smoking and Health
• Now the Office on Smoking and Health (OSH)
• a division of the National Center for Chronic Disease Prevention and Health Promotion,
part of the CDC’s Coordinating Center for Health Promotion
• OSH is the leading federal organization for comprehensive tobacco prevention &
control
• OSH is dedicated to reducing the death and disease caused by tobacco use and
exposure to secondhand smoke.
• OSH Mission is to “develop, conduct and support strategic efforts to protect the
public’s health from the harmful effects of tobacco use” (CDC, 2015)

4. WHY EVALUATE TOBACCO PREVENTION
AND CONTROL PROGRAMS
• Monitor progress toward the program’s goals
• Demonstrate effectiveness of a particular tobacco control program or activity
• Determine if program components are producing the desired effects
• Allows comparisons among groups, especially populations with disproportionately
high tobacco use and related poor health outcomes
• Justifies the need for further funding and support
• Learn ways to improve programs
• Helps ensure effective programs are maintained and resources are not wasted on
ineffective programs (McDonald et al., 2001)

5. CDC’S “INTRODUCTION TO PROGRAM
EVALUATION FOR COMPREHENSIVE
TOBACCO CONTROL PROGRAMS”:
6-STEP FRAMEWORK
• Engage stakeholders
• Describe the program
• Focus the evaluation and design
• Gather credible evidence
• Justify conclusions
• Ensure use of evaluation findings and share lessons learned
• (MacDonald, 2001)

6. OSH PROGRAM GOALS
• Prevent youth and young adults from starting tobacco use
• Reach out to all adults and youth tobacco users to promote its cessation
• Eliminate environmental tobacco smoke (ETS) exposure to nonsmokers
• Smoking bans
• Examine tobacco-related disparities across regions of the country so they can be
eliminated
• race
• ethnicity
• educational level
• socioeconomic status

7. OSH PARTNERS WITH LOCAL AND
GLOBAL AGENCIES
• Broaden the scientific base of effective tobacco control
• Create sustainable, comprehensive tobacco control programs
• Provide timely and pertinent information to stakeholders, the public and policy
makers
• Organize strategic initiatives to support tobacco control priorities that include policy
development and partnerships with agencies
• Collaborate globally to enhance tobacco control through surveillance, capacity
building, and information exchange
• (CDC.gov, 2015)

8. NATIONAL TOBACCO CONTROL
PROGRAM
• Established by the OSH in 1999
• Encourages coordinated efforts to reduce tobacco-related diseases and deaths
• Provides funding and technical support to all 50 state and territorial health
departments to meet the OSH objectives outline in “Best Practices for Tobacco
Control Programs”
• 4 Components
• Population-based community interventions
• Counter-marketing
• Program policy/regulation
• Surveillance and evaluation

9. BEST PRACTICES FOR COMPREHENSIVE
TOBACCO CONTROL PROGRAMS:
EVIDENCE-BASED PROGRAM
INTERVENTIONS
• Price increases and regressive tax on tobacco detract some high-risk populations
from using tobacco
• Smoking bans & restrictions reduce second-hand smoke exposures
• Mass media campaigns that target youth who have started smoking to encourage
cessation
• 1-800-QUIT-NOW – cost free counselling and medications offered by states
• Provides easier access to evidence-based cessation programs for vulnerable and
underserved populations
(Community Preventive Services Task Force, 2016)

10. TOBACCO PREVENTION AND
CONTROL PROGRAM OUTCOMES
• Tobacco prevention and control has been lauded as one of the most successful
public health programs of the last 50 years! (Knickman & Kovner, 2015)
• Program outcomes are monitored and evaluated by multiple agencies and all report
progress continues to be made
• CDC
• Surgeon General
• Cochrane Library
• World Health Organization
• Yet the Healthy People 2020 goals have not yet been achieved

11. PROGRESS TOWARD ACHIEVING
PROGRAM GOALS: 3 REPORTS
• The 2014 Surgeon General’s Report marked the 50th Anniversary of their landmark
1964 report that first reported health consequences of smoking.
• Smoking rates cut in half since 1964 in the U.S.
• CDC: Adult smoking has declined from 20.9% in 2005 to 16.8% in 2014 (CDC.gov,
2015)
• Cohrane Systematic Review: Legislative smoking bans worldwide contribute to
improved health outcomes
• Reduced tobacco consumption & second-hand smoke (SHS) exposure
• Reduced admissions for acute coronary syndrome & improved outcomes for
cardiovascular health
• Reduced mortality from smoking-related illnesses
• Improved respiratory symptoms and lung function (Frazer et al., 2016)

12. FUNDING AND RESOURCE
ACCOUNTABILITY
• 2009 Children’s Health Insurance Program Reauthorization Act included an unprecedented
$0.62 tax increase that raised the federal excise tax to $1.01 per pack of cigarettes
• The President’s Fiscal Year 2014 Budget included a $0.94 per pack Federal tobacco tax
increase
• “Increasing the cost of cigarettes is one of the most powerful interventions used to
prevent smoking and reduce prevalence.” (Surgeon General, 2014)
Improved health outcomes and reduction in tobacco use demonstrate accountability

13. 2014 SURGEON GENERAL’S REPORT:
REVISING INTERVENTIONS THROUGH
LEGISLATION
• 2009 Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) aims to
reduce harm caused by tobacco products
• U.S. Food and Drug Administration gained authority to regulate tobacco products.
• Critical for reducing the harm caused by tobacco products
• Tobacco manufacturers will pay “user fees” that provide sustained funding for public
education media campaigns that targets youth prevention and cessation
• The 2010 Affordable Care Act (ACA)
• Expands access to smoking cessation services
• Requires most insurance companies to cover cessation treatments.
• The Affordable Care Act’s Public Health and Prevention Fund
• Supports innovative, effective community-based programs
• Provides for public education campaigns to promote prevention and cessation

14. WORK STILL TO BE DONE: REVISING
PROGRAM INTERVENTIONS
• Adolescent (grades 9-12) smoking is showing reduction:
• 2009 – 19.5% have smoked in the past 30 days
• 2011 – 18.6% have smoked in the past 30 days
• Healthy People 2020 Goal: 16%
• CDC reports 2014 Adolescent smoking rate 9.2% (CDC statistics, 2015)
• Adult smoking is making progress toward Healthy People 2020 goal of 12%
• 2008 – 20.6%
• 2014 – 16.8% (CDC, 2015)
• Ambulatory care settings: Increased tobacco screening and counseling in but still below Healthy
People 2020 goals (Knickman & Kovner, 2015)
• If current trends continue…
• 5.6 million children alive today under age 18 will die prematurely and…
• Nearly 500,000 adults will still die prematurely because of smoking (Surgeon General, 2014)
• Disparities still exist among some high risk populations (Knickman & Kovner, 2015)

15. CONCLUSION
• Rate of smoking continues to fall and progressing toward HP2020 goal
• Health outcomes and incidences from tobacco-related illnesses appears to be
declining worldwide (Frazer et al., 2016)
• Legislation is in place to increase funding to sustain tobacco control and prevention
programs & prevention of environmental smoke exposure to nonsmokers
• Population disparities still exist: Native Americans, Military members and Veterans,
LGBT, Adults living with HIV, Adults with mental health illnesses, Adults with
disabilities, Adults with lower education, Adults living in poverty (CDC, 2015)

16. REFERENCES
• Centers for Disease Control and Prevention. (2016). National Tobacco Control Program. Retrieved
from
http://www.cdc.gov/tobacco/stateandcommunity/tobacco_control_programs/ntcp/index.htm
• Centers for Disease Control and Prevention. (2016). Office on Smoking and Health. Retrieved from
http://www.cdc.gov/tobacco/about/osh/index.htm
• Centers for Disease Control and Prevention. (2016). Retrieved from
http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm
• Community Preventive Services Task Force. (2016). The guide to community preventive services:
What works to promote health. Retrieved fromhttp://www.thecommunityguide.org/index.html
• Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. (2016). Legislative
smoking bans for reducing harms from second hand smoke exposure, smoking prevalence and
tobacco consumption. Cochrane Database of Systematic Reviews . Issue 2. Art. No.: CD005992.
DOI: 10.1002/14651858.CD005992.pub3.
• MacDonald G, Starr G, Schooley M, Yee SL, Klimowski K, Turner K., (2001). Introduction to
program evaluation for comprehensive tobacco control programs. Atlanta (GA): Centers for
Disease Control and Prevention.
• U.S. Department of Health and Human Services. (2014). The health consequences of smoking-50
years of progress: A report from the Surgeon General. Retrieved from
http://www.surgeongeneral.gov/library/reports/50-years-of-progress/front-matter.pdf