When I was researching my 1998 book on the anti-smoking movement, I wondered when the government's estimate for the annual number of smoking-related deaths in the U.S. would start to fall. After all, the prevalence of cigarette smoking had dropped dramatically, from about 43 percent of American adults in 1966 to about 25 percent in the late '90s (it's now about 20 percent). But the official death toll always seemed to go up, not down, partly due to population growth and the long-term effects of cigarette smoking even among people who have given it up. In recent years the number has seemed to stagnate at "more than 400,000," as the CDC puts it. But a new study in the journal Nicotine & Tobacco Research suggests that figure is an overestimate. Instead of adding up deaths due to various smoking-related diseases, University of Louisville tobacco researcher Brad Rodu and University of Alabama at Birmingham epidemiologist Philip Cole used the overall differences in mortality between smokers, former smokers, and never-smokers to estimate that smoking caused 322,000 deaths in 2002, compared to 402,000 in 1987. This 20 percent reduction could be cited as evidence of the anti-tobacco movement's success, but activists and public health officials may worry that a falling death toll would undermine the public's sense of urgency and support for anti-smoking efforts. Bureaucrats in particular want to be seen as effective, but not so effective that their budgets should be cut. Although "the proportion of Americans who smoke cigarettes has declined 50% since 1965," Rodu and Cole note, "the effect on mortality of this considerable reduction has received little attention."
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