After declining for seven years, national smoking rates have remained steady at nearly 21% from 2004 to 2006, prompting concern among federal health officials that progress in curtailing smoking has stalled.
The national Centers for Disease Control and Prevention said that reduced spending on anti-tobacco campaigns and bigger marketing budgets from cigarette companies appeared to be the reasons for the leveling off.
According to a CDC report released Thursday, funding for state tobacco control and prevention programs decreased about 20% from 2002 to 2006. Between 1998 and 2005, tobacco- industry marketing spending nearly doubled from about $7 billion to $13 billion, according to the report.
"What is happening doesn't have to happen," said Dr. Matt McKenna, director of the CDC's Office on Smoking and Health. "With appropriate support and efforts and counter-marketing, tens of thousands of people don't have to die."
About 438,000 Americans die each year because of tobacco use, the CDC said. The agency estimated that for every death, there are 20 people living with a tobacco-related illness.
"Smoking is still the No. 1 preventable cause of death," McKenna said. "No other behavior kills so many people as tobacco, even with these low levels."
U.S. smoking rates have been on a downward trend since a 1964 surgeon general report linked lung cancer and cigarette smoking. At the time, about 42% of American adults were smokers, according to a study conducted the following year.
Between 1997 to 2004 -- the most recent period of consistent decline -- the proportion of U.S. adult smokers dropped from 24.7% to 20.9%.
Over the decades, there have been occasional periods when the declines have appeared to stall, such as between 1995 and 1997, which also appeared to be tied to changes in tobacco marketing, McKenna said.
The most recent period of leveling began in 2004, according to the report. The smoking rate was the same in 2005 and dropped 0.1% in 2006, which McKenna said was an insignificant decline.
Smoking rates in California, which have tended to be lower than the national average, have continued their downward trend, according to the state Department of Public Health.
From 2004 to 2006, the proportion of California's adults who smoked decreased from 14.6% to 13.3%.
California was one of the earliest states to move against smoking and has had more consistent funding for its educational programs, mostly because of the passage in 1988 of Proposition 99, which increased the taxes on cigarettes, said Colleen Stevens of the state Tobacco Control Program.
The tax provided $77 million for tobacco education this year, according to state figures.