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Trends and issues in financing: payment for smoking cessation services
    1. Office of Disease Prevention and Health Promotion, Department of Health and Human Services, Washington, DC, USA

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    Impressive progress has been made in moving the tobacco issue to greater prominence on the health policy agenda. We are seeing renewed emphasis on tobacco education, greater commitment and tougher efforts to reduce access of minors to tobacco, more focus on the possible use of higher tobacco excise taxes, the classification this year by the US Environmental Protection Agency of environmental tobacco smoke as a Group A (known human) carcinogen, and the banning of smoking on the White House premises. These are welcome developments and hopeful harbingers of the prospects for future gains.

    Nonetheless, smoking remains the leading cause of preventable death in the US.1 Despite gains that have been made since the release of the landmark Surgeon General’s Report on Tobacco and Health in 1964, one in every five deaths is still attributable to tobacco, and even today tobacco use is practiced by more than one of every four adults.2 Moreover, trends show that increasing numbers of adolescents are beginning to smoke, with females and minorities disproportionately represented in these increases.3

    Not only is the human cost of smoking high, but the economic costs of tobacco use are staggering. It has been estimated that the health consequences of tobacco use cost our country between $68 and $72 billion each year.4,5 While the national burden of tobacco use is so large as to be difficult to grasp, a more tangible way to look at the economic impact is through the fact that it averages out to a cost per smoker of approximately $3-4 per day. Ironically, the groups for whom title least progress is being made in the campaign against smoking – women and African-Americans – include those who can least afford the economic consequences.

    Related to both individual and national costs of smoking …

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