While CDC reports on the health and economic burden of smoking in the United States, state-specific data are not readily available. We estimated the health and economic consequences of cigarette smoking in Alabama to provide the state legislature with the state-specific data that reveal the direct impact of smoking on their constituents. We estimated that in 2009, almost 7,900 adult deaths (18% of all adult deaths) and approximately 121,000 years of potential life lost among Alabama adults aged 35 years and older were attributable to cigarette smoking. Productivity losses due to premature death and smoking-attributable illness were estimated at $2.84 billion and $941 million, respectively. Our findings support a strong need for tobacco control and prevention programs to decrease the health and economic burden of smoking in Alabama. These results are being used by the State Health Officer to illustrate the real costs of smoking in Alabama and to advocate for improved tobacco control policies.

Preparing smoke-free youth requires implementing and evaluating tobacco education in grades K-12 including use of model guidelines from federal agencies and professional organizations. Determining the focus of existing school tobacco policies is an initial step to encourage adoption of comprehensive policies to reduce youth use of tobacco. Youth health advocates may act together with school administrators and legislators to strengthen policies to be consistent with model guidelines for tobacco prevention and control.

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