The year 2014 marks the 50th anniversary of the release of the first US surgeon general’s report¹ on the health effects of smoking. The report’s conclusions led to further research on both the consequences of tobacco use and potential interventions to reduce tobacco prevalence and cigarette consumption. A wide range of effective interventions are available including increasing prices and bans on advertising, promotion, sales to minors, and smoking in public places.^2-5 The adoption of the Framework Convention on Tobacco Control (FCTC) in 2003 and its subsequent ratification by 177 countries reflects growing global efforts to control tobacco.^6,7 Despite such efforts, tobacco continues to adversely influence global health patterns, leading to 5.7 million deaths, 6.9% of years of life lost, and 5.5% of disability-adjusted life-years (DALYs) in 2010.^8,9 Given the importance of tobacco as a risk to health, monitoring the distribution and intensity of tobacco use is critical for identifying priority areas for action and evaluating progress.

Studies have routinely shown that life expectancy in the United States varies geographically, in some cases dramatically.^1-3 Counties are the smallest administrative unit routinely available in death registration data and represent an opportunity to explore the extent of geographic inequalities in the United States. In particular, tracking inequality at the county level over time is an important means of assessing progress toward the goal of more equitable health outcomes, as enshrined in the Healthy People 2020 objective: “Achieve health equity, eliminate disparities, and improve the health of all groups.”⁴ Moreover, county-level information on basic health outcomes is essential for appropriately targeting resources and designing and implementing health and social welfare policy at both the federal and state level.

Cancer is the second leading cause of death in the United States and globally.¹ Moreover, cancer is a major cause of morbidity in the United States¹ and is associated with a high economic burden.² Overall cancer mortality rates have declined in the United States in recent decades; however, major differences in cancer mortality still exist.³