Tobacco use is the leading preventable cause of death in the U.S., killing an estimated 443,000 Americans each year and is responsible for approximately one in every five deaths (Ezzati and Lopez 2003; U.S. Department of Health and Human Services 2010; Oza et al. 2011). In many low- and middle-income countries, use of tobacco products is increasing, while it is steadily and slowly decreasing in many high-income countries (World Health Organization, 2008). In 2007, the prevalence of smokers in U.S. adults (except California) was established at 17.9%, with 5.3% of low-intensity (0–9 cigarettes smoked per day (CPD)), 5.4% of moderate-intensity (10–19 CPD), and 7.2% of high-intensity smokers (≥20 CPD) (Pierce et al. 2011).
