Since 1964, when the surgeon general called our attention to the health hazards of cigarettes, the prevalence of smoking has declined substantially. In 1965, 40.4% of the adult population smoked. By 1991, this rate had dropped to 25.7% [1]. The trend actually accelerated between 1987 and 1990. Nevertheless, during this period the rate of smoking dropped by an average of 1.1% per year. This was more than double the rate of decrease in the preceding 20 years [2].

While these are impressive statistics, the national progress toward eliminating tobacco-related disease is again in jeopardy. The estimated prevalence of smoking among adults appears to have leveled off in 1990 at the national mark of 26% [3]. Alarmingly, the Monitoring the Futures project released data recently showing teen smoking skyrocketed over the past five years.

In 1993, 19% of high school seniors considered themselves smokers. By 1998, this rate exploded to nearly 40%. Smoking among high school seniors is at a 19-year high [4]. In 1997, 22.7% of African American high school students were smokers -- up from 12.6% only six years earlier [5]. Smoking among Hispanic high school students increased from 25.3% in 1991 to 34.0% in 1997 [6].

These trends suggest Medicaid costs may accelerate even faster than we anticipate. We estimated future costs based on a 5% annual growth rate in health costs. We believe these projections are conservative. Nevertheless, through 2025, New Mexicans will pay over $4.3 billion in taxes to support Medicaid payments due to tobacco-related illnesses and disease.