Tobacco use leads to disease and death, costing billions annually. Smoking causes cancer, heart disease, and lung diseases, and smokers die 13-14 years earlier than nonsmokers. Worldwide, tobacco use causes over 5 million deaths per year, with 8 million deaths annually projected by 2030. In the US, tobacco use causes 443,000 deaths per year, with 49,000 from secondhand smoke. Tobacco use costs the US $193 billion annually, with $96 billion for healthcare and $97 billion in lost productivity. States have billions available from tobacco taxes and legal settlements but spend less than 3% on tobacco control programs, below CDC recommendations.