By Chris Adams

Smoking in the United States has been in a long and steady decline for five decades, and if it continues its current trajectory it could be eliminated in two more.

But that progress is threatened by proposed federal budget cuts and regulatory rollbacks at the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration, the two agencies mainly responsible for U.S. tobacco control efforts.

Matthew Myers, president of Campaign for Tobacco-Free Kids, talked with National Press Foundation fellows about the progress that’s been made in reducing smoking, as well as the challenges that remain.

“We’re at a crossroads,” Myers said. “We have demonstrated an ability to make a fundamental change in reducing tobacco use, which would probably be one of our nation’s most significant public health efforts ever. But it’s threatened.”

Twenty years ago, the smoking rate among high-school students was 36 percent; now, it’s under 10 percent, and in four states it’s lower than 5 percent. That shows the impact of government, media and social efforts to clamp down on a habit that carries with it significant public health problems.

Tobacco use adds $170 billion to the health care costs in the U.S. Those who smoke tend to be poor, undereducated, uninsured and unemployed or underemployed.

“The impact on their families is enormous,” Myers said. Money goes to buy tobacco products rather than food; second-hand smoke affects other family members; smokers are more likely to become disabled and unable to work. “Half of people who die of smoking die in middle age,” he said.

Under the fiscal 2018 budget advanced by the Trump administration, the CDC’s Office on Smoking and Health would be eliminated. In addition, the FDA said in May 2017 that it would delay enforcement of a rule finalized in 2016 to more tightly regulate e-cigarettes.

Myers talked about those efforts, as well as state-level regulation of tobacco and how federal cuts trickle down to statehouses. At that level, he said, “a number of states have been unwilling to increase the price of tobacco products or protect people from second-hand smoke. And those are the states that have higher rates of tobacco use, lung cancer and pregnant women who smoke.”