The single biggest cause of preventable death in America is smoking. “The continuing toll of smoking on people in the United States is staggering. About 34 million U.S. adults still smoke, and half of them will die prematurely if they continue smoking,” according to a Perspective in last week’s New England Journal of Medicine.

 

As much as the world is focused on the current pandemic, long-term the smoking epidemic remains more noxious and is entirely preventable. Although smoking among U.S. adults is the lowest rate ever at 13.7%, adolescents are still hooked by tobacco and other companies who have introduced addictive nicotine via vaping, juuls, and related products.

 

Most adult smokers want to quit. Slightly over half of all smokers try to quit each year and most try multiple times before succeeding. Cigarettes are designed to create and sustain addiction.

 

Nicotine is the primary addictive chemical in tobacco. A major public health victory would be: (1) reducing the addictiveness of cigarettes; and (2) making smoking unattractive to pre-teens and teenagers. Youth are most likely to become habituated because their brains are still in the development stage.

 

Obviously, avoiding smoking in the first place is the most cost-effective strategy. Prevention is always better than treatment. Starting an anti-smoking campaign with youngsters in late elementary school is very effective, costing only $300 per Quality Adjusted Life Year (QALY). QALY is a metric used by epidemiologists to describe one year of healthy living. Adding one QALY to a seventy-year-old woman with tobacco-induced lung cancer costs $700,000. Clearly deterrence through education in early adolescence saves money and, more importantly, misery.

 

For the record, currently a pack of cigarettes costs $6.36. For a one pack/day smoker, the cost per week is $44.52 dollars or $2,315.04 per year. This money, while significant and better spent in a multitude of ways, pales in comparison to personal well-being loss and other costs.

 

From an overall economic point of view, smokers in the workplace cost $6,000/year more than non-smokers due to medical costs and lost productivity during “smoking breaks.” On the macro level, our nation spends $300 billion annually treating tobacco related illnesses.

 

Cessation treatments are available and effective; seven smoking-cessation medications are currently approved by the Food and Drug Administration. These medications in combination with professional counseling and personal encouragement are effective. An innovative national digital portal connects smokers who want to quit with support services including text-messaging. “Tips from Former Smokers” connects motivated smokers with people who are living with serious, long-term health effects from smoking and secondhand smoke exposure. An estimated one million adults have quit smoking due to the Tips campaign.

 

Although many healthy people focus on becoming even healthier by embracing all nine Blue Zones Power 9^® principles, those who smoke have even greater opportunities to change their lives for the better by first addressing their most noxious risk.