摘要：Objectives. We sought to outline an optimistic yet achievable goal for future US smoking prevalence rates based on empirical evidence reflecting the success of smoking control efforts in California. Methods. Using a dynamic model and the smoking initiation and cessation rates achieved in California as a guide, we projected US adult smoking prevalence rates through the year 2020. Results. If smoking initiation and cessation rates for the nation do not change, population dynamics will result in smoking prevalence rates falling to 19.1% in 2010 and 16.8% in 2020. If the country attains California’s initiation and cessation rates by 2010, adult smoking prevalence rates will be 18.5% in 2010 and 14.7% as of 2020. Conclusions. If California’s smoking initiation and cessation rates are attained nationwide, the US smoking prevalence rate could be 5.9 percentage points lower than the 2005 rate by the year 2020, and there would be 10.2 million fewer smokers than in 2005. A target of 14% smoking prevalence by 2020 is aggressive yet feasible, given that it takes into account the constraints imposed by population demographics. Adult smoking prevalence rates in the United States continue to decline, although painfully slowly. Despite enormous progress in smoking control during the past 40 years (the adult prevalence rate dropped from 42.4% in 1965 to 20.9% in 2005 1 ), cigarette smoking remains the leading cause of premature death among Americans, killing approximately 440 000 citizens annually. 2 Currently, more than 44 million Americans smoke, and half of these individuals will die prematurely unless they abandon their addiction in time. 3 The overall US smoking prevalence rate of 20.9% in 2005 (the most recent year for which data were available at the time this article was written) reflects a diverse combination of rates stemming from the differences between states in terms of demographic characteristics and implementation of tobacco control efforts. Rates vary from a low of 11.5% in Utah, commonly attributed to the state’s large Mormon population, to a high of 28.7% in Kentucky, where population demographics, the prominence of tobacco in the history and economy of the state, and limited tobacco control efforts contribute to the persistently high prevalence of smoking. 4 We addressed the question of how much lower, and how much faster, overall US smoking prevalence rates would fall by the year 2020 if the initiation and cessation rates achieved as of 2005 in California, the state with the second lowest adult smoking prevalence in the country (15.2% in 2005), could be reproduced across the entire country. Assessing the degree to which there is a causal link between antismoking policies and declining smoking prevalence rates in California or any other state is challenging because it is plausible that regions with strong antitobacco attitudes are more likely to implement stringent smoking control measures. 5 However, proof of causality is not necessary to make our intended point. If we assume, correctly or otherwise, that smoking control policies are solely responsible for California’s smoking initiation and cessation rates—and therefore its low smoking prevalence—replicating those rates across the country would allow us to derive an optimistic scenario for smoking trends in the United States in the immediate future given the effectiveness of currently available tobacco control programs. Given that the government is currently initiating the process of setting objectives for its Healthy People 2020 program, an analysis of these trends could assist the nation in selecting a challenging yet potentially reachable smoking prevalence target for the year 2020 based on best-case effects of tobacco control programming.
