By Marc Kaufman
Washington Post Staff Writer
Friday, November 9, 2007; A07

The decades-long decline in smoking by Americans has stalled for three years, the first time smoking rates have leveled off for that long since the federal government began collecting statistics more than 40 years ago.

After more than a decade of steep decline, moreover, smoking rates for high school students also have hit a plateau in the past few years and even increased a bit. This comes amid controversy over the targeting of young women by the R.J. Reynolds Tobacco Co. with its Camel No. 9 cigarette -- which is packaged in "hot-pink fuchsia" and is advertised as "light and luscious."

Together, the data released by the Centers for Disease Control and Prevention yesterday present a worrisome picture of smoking patterns, experts said, especially because the trend had been downward for so long.

"Anytime we are not seeing a decline, it's a cause of real concern to us," said Corinne Husten, head of the epidemiology branch of the CDC's Office on Smoking and Health. "Smoking is the biggest cause of preventable disease we have, and we need to bring down the rates as quickly as we possibly can."

According to the CDC report, about 20.8 percent of American adults are smokers -- with 80 percent of them (36.3 million people) smoking every day and the rest smoking on some days. Adult smoking rates declined more than 15 percent from 1997 to 2004 but have been stubbornly unchanged since.

Husten pointed to several probable reasons for the unwelcome news. Cigarette companies have been spending billions of dollars to offset tax increases and to discount their products, and funding has been cut sharply for several very successful state anti-smoking campaigns, she said.

Some anti-tobacco advocates said the Bush administration has not made tobacco control a priority and has not highlighted or promoted the issue. In part, they said, the stalled smoking rates are a result.

William V. Corr, executive director of the Campaign for Tobacco-Free Kids, said the administration has been "AWOL regarding tobacco control -- doing little or nothing." He said it is "inexcusable that elected leaders have not done more, given the overwhelming scientific evidence of what works to reduce tobacco use among both children and adults."

The relatively unchanged price of cigarettes since 2002 is considered important, because more people stop smoking because of cost than for any other single reason. That is especially true of younger smokers. While some states have increased tobacco taxes, the federal government has not raised its rate for more than a decade, and President Bush has strongly opposed a congressional proposal to increase the tax to expand the State Children's Health Insurance Program.

The administration has also been skeptical of a bill that would give the Food and Drug Administration authority to regulate tobacco. FDA Commissioner Andrew von Eschenbach told Congress in October that the agency does not have the budget to take on the regulation of tobacco and has reservations about regulating a product known to be harmful.

Von Eschenbach said in a statement that "the bill could undermine the public health role of FDA." Two major reports this year, one by the Institute of Medicine of the National Academy of Sciences and another by the President's Cancer Panel, called for FDA regulation of tobacco.

The administration has also declined to send the World Health Organization's Framework Convention on Tobacco Control to the Senate for ratification. The treaty, signed by the United States in 2004, would require toughening of U.S. anti-smoking efforts. So far, more than 150 of the 168 nations that signed the treaty have ratified it, but the State Department has consistently said it is still studying the document.

The price of cigarettes increased after tobacco companies agreed in 1997 to pay billions to the states to settle a suit seeking compensation for Medicaid costs of smoking-related diseases. But statistics collected by the Federal Trade Commission show that tobacco companies then dramatically increased their advertising and marketing budgets, from $6.7 billion in 1998 to $15.1 billion in 2003 and $13 billion in 2005. From 2003 through 2005, price discounting accounted for more than 70 percent of the promotion expenditures.

David Sutton, a spokesman for Philip Morris USA, which supplies about half of the U.S. cigarette market, said the company agrees with the public health community that the "best way to reduce the health effects of cigarettes is to quit or not start in the first place." But he said that in the highly competitive domestic market for adult smokers, companies had to offer discounts to retailers to keep old customers and attract new ones.

Since 2000, there also has been a drop of 20 percent in state spending to keep children, in particular, from taking up smoking and to encourage and help smokers to stop, the CDC reported. That decline has been especially stark in several states that had had aggressive and effective programs, including Massachusetts, Florida and Minnesota.

Some of the spending decline has resulted from cuts in state appropriations, and some from a decrease in the amount of money available from the tobacco settlement. Under that landmark agreement, the amount paid by the tobacco companies declines if cigarette consumption falls off, or if more than 1 percent of the cigarette market is captured by small or foreign companies not covered by the settlement -- a threshold that was reached some time ago.

The rate of cigarette smoking began to fall steadily after the 1964 surgeon general's report on tobacco's health risks, although the decline leveled off for two years in the mid-1990s.

The new data, in the CDC's Morbidity and Mortality Weekly Report released yesterday, did not include specific information about youth smoking, but other reports have shown a similar leveling off among young people in the past several years.

The controversy over R.J. Reynolds's Camel No. 9 -- which came on the market in February -- has reached Congress, where Rep. Lois Capps (D-Calif.) has denounced the company's advertising for targeting women, especially young women. She and 40 other members of Congress twice wrote to 11 women's magazines asking them to stop running the ads, which generally feature slinky clothes in black and pink. One ad says the Camel No. 9s are now "available in stiletto" -- longer, thinner cigarettes. Capps has also accused the company of flavoring the cigarettes to taste like a chai latte.

The CDC report showed a small drop-off in adult smoking in the first three months of 2007, but Husten said that it is not considered significant and that rates often come in low at the beginning of a year.

Among the CDC findings was that in 2006, almost 37 percent of people with smoking-related chronic diseases were still smoking, a considerably higher percentage than the general population.