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Research & Evidence

Targeted interventions are warranted to reach subpopulations with the highest incidence of use, and can result in substantial reductions in tobacco-related disease and death and billions of dollars in savings from averted medical costs.
Current Cigarette Smoking Among Adults — United States, 2016
Ahmed Jamal, MBBS; Elyse Phillips, MPH; Andrea S. Gentzke, PhD; David M. Homa, PhD; Stephen D. Babb, MPH; Brian A. King, PhD; Linda J. Neff, PhD
CDC Morbidity and Mortality Weekly Report


Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.

Universally, smoking cessation rates among established smokers are poor. Preventing young people from starting use of and becoming addicted to tobacco products remains a key strategy to end the tobacco epidemic. Previous country-specific studies have found that initiation of smoking tobacco use occurs predominantly among young people and have found mixed progress in reducing the prevalence of smoking tobacco use among young people. Current and comparable estimates for all countries are needed to inform targeted interventions and policies.

Sharma KP, DeGroff A, Maxwell AE, Cole AM, Escoffery NC, Hannon PA. "Evidence-Based Interventions and Colorectal Cancer Screening Rates: The Colorectal Cancer Screening Program, 2015-2017." Am J Prev Med ., May 14, 2021.

 The Centers for Disease Control and Prevention administers the Colorectal Cancer Control Program to increase colorectal cancer screening rates among people aged 50-75 years in areas where rates are lower than state or national levels. The aim of this study is to better understand the effectiveness of specific Colorectal Cancer Control Program components.


"The Costs of Cancer." American Cancer Society Cancer Action Network,

This ACS CAN report focuses specifically on the costs of cancer for patients in active cancer treatment as well as survivors. It examines the factors contributing to the cost of cancer care, the types of direct costs patients face, and other costs and hardships associated with cancer. To more fully illustrate what people with cancer actually pay for care, the report presents profiles of several typical cancer patients and shows what they paid when they had different types of insurance coverage. 

The report presents public policy recommendations for making cancer treatments more affordable for patients, survivors and the health care system as a whole. The American Cancer Society Cancer Action Network (ACS CAN) is making cancer – and the affordability of cancer care – a top priority for public officials and candidates at the federal, state and local levels. 

Mariotto, Angela B.; Lindsey Enewold; Jingxuan Zhao; Christopher A. Zeruto; K. Robin Yabroff. "Medical Care Costs Associated with Cancer Survivorship in the United States." Cancer Epidemiology, Biomarkers & Prevention, June 10, 2020.

Background: The prevalence of cancer survivorship is increasing. In this study, we provide contemporary population–based estimates and projections of the overall and site-specific cancer-attributable medical care costs in the United States.

Hu,Tian, Seana L. Gall, Rachel Widome, Lydia A. Bazzano, Trudy L. Burns, Stephen R. Daniels, Terence Dwyer, Johanna Ikonen, Markus Juonala, Mika Kähönen, Ronald J. Prineas, Olli Raitakari, Alan R. Sinaiko, Julia Steinberger, Elaine M. Urbina, Alison Venn,. "Childhood/Adolescent Smoking and Adult Smoking and Cessation: The International Childhood Cardiovascular Cohort (i3C) Consortium." Journal of the American Heart Association, April 8, 2020.

Despite declining US adolescent smoking prevalence from 40% among 12th graders in 1995 to around 10% in 2018, adolescent smoking is still a significant problem. Using the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes 7 international cohorts recruited in childhood and followed into adulthood, the present study was designed to confirm the important relation between adolescent smoking and daily adult smoking and present new data on adult smoking into the forties and comparison of smoking in the United States, Finland, and Australia.

"Annual Report to the Nation: Cancer death rates continue to decline." National Cancer Institute, March 12, 2020.

The Annual Report to the Nation on the Status of Cancer finds that cancer death rates continued to decline from 2001 to 2017 in the United States for all cancer sites combined.

Canfell, DPhil, Karen; Prof. Jane J. Kim PhD; Prof Marc Brisson, PhD; Adam Keane, PhD; Kate T. Simmons, PhD; Michael Caruana, DPhil. "Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries." The Lancet, January 30, 2020.

WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality from non-communicable diseases by 2030.

"Cancer Facts & Figures 2020." American Cancer Society, 2020.

Cancer Facts & Figures 2020 is an educational companion for Cancer Statistics 2020, a scientific paper published in the American Cancer Society journal, CA: A Cancer Journal for Clinicians. The Facts & Figures annual report provides:

  • Estimated numbers of new cancer cases and deaths in 2020 (In 2020, there will be an estimated 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States.)
  • Current cancer incidence, mortality, and survival statistics
  • Information on cancer symptoms, risk factors, early detection, and treatmen


Campbell, Kristin; Kerri M. Winters-Stone; Joachim Wiskemann; Anne M. May; Anna L. Schwartz; Kerry S. Courneya; David S. Zucker; Charles E. Matthews; Jennifer A. Ligibel; Lynn H. Gerber; Stephen G. Morris; Alpa V. Patel; Trisha F. Hue; Frank M. Perna; Kat. "Exercise Guidelines for Cancer Survivors." Medicine & Science in Sports & Exercise, November 2019.

In the last decade, the United States has seen a 27% decline in cancer deaths due to early detection and improved treatments for cancer. In turn, the number of cancer survivors is growing, with over 15.5 million cancer survivors in the United States—a figure that is expected to double by 2040 (1). Improved prognosis has created a growing need to address the unique health issues facing cancer survivors that result from the disease, its treatment, and related comorbid conditions. For example, the symptom of fatigue can persist in 25% of cancer survivors many years after their treatment has ended and contributes to difficulty returning to work, independent living, and poor quality of life (2). Furthermore, risk of developing heart disease may be elevated by some cancer treatments, and cardiovascular mortality is emerging as a major competing cause of death in cancer survivors along with cancer recurrence (3,4). Cancer is also a disease strongly linked with aging, and almost half of survivors are older than 70 yr (5). The adverse synergistic effects of age, cancer treatment, and related sequelae increase the total burden of cancer. Historically, clinicians advised cancer patients to rest and to avoid physical activity, but early exercise research in the 1990s and 2000s challenged this advice.

Patel, Alpa V.; Christine M. Friedenreich; Steven C. Moore; Sandra C. Hayes; Julie K. Silver; Kristin L. Campbell; Kerri Winters-Stone; Lynn H. Gerber; Stephanie M. George; Janet E. Fulton; Crystal Denlinger; Stephen G. Morris; Trisha Hue. "American College of Sports medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control." Medicine & Science in Sports & Exercise, November 2019.

It was estimated that 18.1 million individuals were diagnosed with cancer in 2018 and 9.6 million individuals died from the disease—making cancer the second leading cause of mortality worldwide (1). In the United States (US) alone, the lifetime risk of developing cancer is 40% in men and 38% in women (2), and 1.74 million individuals were diagnosed with cancer in 2018 (3). There are also high direct and indirect costs related to the cancer burden; for example, in the US alone, the annual cost of cancer care is US $158 billion (4), with billions of additional dollars lost to disability, lost work, and lost household productivity (5). Thus, the burden of cancer remains a significant public health issue worldwide, and there is an increasing need to understand how modifiable health behaviors like physical activity may help prevent and control cancer in the population.

Schmitz PhD, MPH, Kathryn; Anna M. Campbell PhD; Martijn M. Stuiver PT, PhD; Bernardine M. Pinto PhD; Anna L. Schwartz PhD; G. Stephen Morris PT, PhD; Jennifer A. Ligibel MD; Andrea Cheville MD; Daniel A. Galvão PhD; Catherine M. Alfano PhD. "Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer." CA: A Cancer Journal for Clinicians, October 16, 2019.

Multiple US and international organizations have published exercise recommendations for patients living with and beyond cancer, including the American Cancer Society (ACS),1 the American College of Sports Medicine (ACSM),2 Exercise and Sports Science Australia,3 Cancer Care Ontario,4 and the Clinical Oncology Society of Australia.5 In March 2018, the ACSM convened a Second Roundtable on Exercise and Cancer Prevention and Control. This second Roundtable included 17 organizations from multiple disciplines (see Supporting Table 1) and set out to review and update prior recommendations on cancer prevention and control. The products of this Roundtable include 3 articles.

Andy S L Tan; Soneji Samir, Moran, Meghan Bridgid; Choi, Kevin. "JUUL Labs' sponsorship and the scientific integrity of vaping research." The Lancet, August 3, 2019.

As of 2018, 98 countries regulate e-cigarettes, including their sale, marketing, packaging, manufacturing, taxation, reporting, and clean air laws.1 Some countries have banned e-cigarettes completely, such as Argentina, Saudi Arabia, and Singapore,1 whereas other countries, such as the UK, consider e-cigarettes as part of a public health harm reduction strategy.2 The USA has regulated e-cigarettes as a tobacco product since 2016. 

Walton, MS, Kimp; Teresa W. Wang, PhD; Gillian L. Schauer, PhD; Sean Hu, MD; Henraya F. McGruder, PhD; Ahmed Jamal, MBBS; Stephen Babb, MPH. "State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers - United States, 2011-2017." Centers for Disease Control and Prevention - Morbidity and Mortality Weekly Report, July 19, 2019.

From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation (1,2). Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures (3). Increases in cessation are driven in large part by increases in quit attempts (4). Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80% (5). To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011–2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting (2,3).

Blake, Kelly D., Amanda L. Klein, Laura Walpert, Len Casey, Cynthia Hallett, Clifford Douglas, Bidisha Sinha, Howard K. Koh. "Smoke-free and tobacco-free colleges and universities in the United States." BMJ Journals, July 2, 2019.


Objective To describe the number and proportion of accredited, degree-granting institutions with 100% smoke-free and 100% tobacco-free protections across the USA and by state.

Methods Data on postsecondary education institutions from the US Department of Education National Center for Education Statistics Integrated Postsecondary Education Data System 2015, and smoke-free and tobacco-free campus protections from the American Nonsmokers’ Rights Foundation’s Smokefree and Tobacco-Free Colleges and Universities List 2017, were integrated to calculate the number and proportion of: (1) smoke-free and tobacco-free accredited, degree-granting institutions and (2) students and staff protected by campus policies and state laws. Campus protections are given a 100% smoke-free designation if smoking is not allowed on campus anywhere, at any time; 100% tobacco-free designations extend smoke-free protections to include non-combustible products such as smokeless tobacco.

Results 823 accredited, degree-granting institutions (16.7%) representing 1816 individual campuses, sites and schools have either 100% smoke-free or 100% tobacco-free protections. An estimated 14.9 million college students (26.9%) and 8.9 million faculty and staff (25.4%) are protected by campus policies and state laws. Only three states and two territories have 100% smoke-free or 100% tobacco-free protections in over half of their institutions; four states and six territories have no known 100% smoke-free or 100% tobacco-free campus protections.

Conclusions In 2017, just 16.7% of accredited, degree-granting institutions in the USA had 100% smoke-free or 100% tobacco-free protections. Despite progress, more efforts can ensure that students and staff benefit from comprehensive 100% smoke-free and 100% tobacco-free protections at US colleges and universities.