We’ve made a lot of progress in getting people to stop — or not start — smoking. The deadly habit is much less prevalent today than it was in the past. Right now, slightly less than 20 percent of Americans smoke, down from 40 percent in the early 1960s.
But we have a long, long way to go. This year, 443,000 Americans will die because of their tobacco addiction.
That’s such a huge number that it’s hard for most of us to get our heads around it. Unless, of course, we have a personal experience with it. As I do. My father died of smoking-related lung cancer more than two decades ago.
So I read with great interest a paper that appeared Wednesday in the Journal of the National Cancer Institute (JNCI). Its authors, a group of biostatistians from the Fred Hutchinson Cancer Research Center in Seattle, decided to look at the impact that stop-smoking efforts had on lung cancer deaths in the United States between 1975 and 2000.
They had some very good news: Our public-health efforts saved an estimated 795,851 lives during that 25-year period. The biostatisticians’ mathematical model indicated that if we had done nothing to persuade and help people stop smoking, 3,908,048 individuals would have died of lung cancer. As it was, we lost “only” 3,119,753 people to the disease.
But there was some disheartening news as well: If our tobacco-control efforts had been completely effective, an additional 1,722,213 individuals — my father probably among them — would have gone on to live longer lives.
Still, 795,000 lives saved is certainly something to cheer about.
Here in Minnesota, we can cheer louder than in most other states. “Our lung cancer rates are still lower than they are nationally, at least for most groups,” said Dr. Carin Perkins, an epidemiologist with the Minnesota Department of Health, in a phone interview Wednesday.
Among non-Hispanic whites, for example, both lung cancer incidence and lung cancer deaths are 15 to 20 percent lower than they are nationally, she said.
We used to be 30 percent lower. But that’s not because we’re doing worse at preventing smoking and lung cancer. It’s because the other states are finally doing better.
“Overall, we’re doing well,” said Perkins. “The big exception is American Indians.”
All Northern Plains Indians, including those in Minnesota, she said, have lung cancer rates that are two to three times higher than the rate among American Indians nationwide.
Fighting Big Tobacco
Robert Moffit, communications director for the American Lung Association in Minnesota, agrees that the state’s anti-tobacco efforts have been successful at reducing lung cancer and other tobacco-related illnesses, but he also stresses that there’s still plenty of room for improvement.
“The smoking rate among adults in Minnesota has steadily declined,” he told me on Wednesday. “Right now, it’s 16.1 percent. That’s the lowest it’s ever been. However, the smoking rate among young people is still shockingly high. About 25 percent of Minnesota teenagers say they’ve used some kind of tobacco in the past 30 days.”
Tobacco companies are employing all sorts of new tricks to make their products more alluring, especially to young people, he added. For example, companies are now marketing smokeless products that look — and taste — like candy. And they’re taking what is essentially a cigarette and re-packaging it in a brown wrapper so they can call it a small cigar.
“Cigars aren’t subject to the same taxes and regulations that cigarettes are,” Moffit explained.
Tax hikes effective
Evidence suggests that raising the tax on a pack of cigarettes is the most effective action any state can take to reduce teen smoking. Minnesota’s current tax on cigarette packs is $1.23, placing it 27th among all states.
“There’s really no reason for this,” Moffit said about Minnesota’s reluctance to raise taxes on cigarettes. “But the current legislative leadership is very tax-averse. This is one area where there should be some agreement. Helping young people get off cigarettes should be something that both sides of the aisle could shake hands on.”
The American Lung Association in Minnesota is organizing a “Day at the Capitol: Fight Back Against the Tobacco Industry” event for March 22. They and their volunteers will be urging lawmakers to raise the tax on cigarettes, to tax and regulate “little cigars” like cigarettes, and to make sure the statewide smoke-free workplace law doesn’t get weakened.
Health professionals have to be constantly on their toes, Moffitt said, to counter the relentless pushback against anti-tobacco laws already on the book, including the workplace-smoking ban.
“Still,” he said, “I can’t see Minnesota turning back the clock and going back to the day when we smelled like a smoked turkey whenever we walked out of a restaurant or bar.”
Ending tobacco’s ‘century of death’
Throughout his life my dad downplayed the health risks of smoking. That changed when he was diagnosed with lung cancer. Then he thought he had been a fool to not quit earlier.
Fortunately, we have better anti-smoking public health programs and legislation in place today than we did two decades ago. People who want to quit (and surveys show that almost all smokers today do want to quit) now have a wider range of options and support for overcoming their tobacco addiction.
“We have often lacked the political and financial will to do what is necessary to take full advantage of our knowledge and put an end to the scourge of tobacco in our society … yet we may be entering a new era for tobacco control,” writes Thomas Glynn, director of cancer science and trends and international cancer control at the American Cancer Society, in a heartfelt editorial that accompanies the JNCI paper.
“This era is not without its dangers and potential pitfalls,” he adds. “The tobacco industry remains an aggressive purveyor of cigarettes and other tobacco products within the United States and globally; many state governments have reduced their support for tobacco control; smoking prevalence rates have stalled at around 20 percent for the past several years; and there remain disagreements within the tobacco control community regarding harm reduction issues.”
Glynn also lost a father to lung cancer, so tobacco-related death statistics are very personal to him, too. “Thinking of [his father], and what he missed due to tobacco, brings tears … ,” he writes. “The data that [this new paper provides] should, however, give us greater resolve to wipe our tears away, put science to work, and see to it that the 795 thousand grows to many millions of lives saved in the coming decades. We should use all of the tools at our disposal to rein in the rogue tobacco industry, and assiduously apply all of our political, research, advocacy, public health, and clinical skills to end tobacco’s century of death, disease and disability.”