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Smoking Rates Continue to Decline

MMWR – MORBIDITY AND MORTALITY WEEKLY REPORT

The CDC recently updated its statistics about current cigarette smoking among adults. In its MMWR article of November 28, 2014, it tracked changes in smoking between 2005 and 2013. In general, the trends of previous years continued. Here are some of the results:

  • The proportion of U.S. adults who smoke declined from 20.9% to 17.8%, a 15% decline during that period. The 17.8% is a modern low in adult smoking prevalence.
  • The proportion of daily smokers declined from 16.9% to 13.7%, a 19% decline and another all time low.
  • Among daily smokers, the proportion who smoked at least one pack per day decreased from 52.1% to 36.4%, a 30% decline. And daily smokers now average 14.2 cigarettes, down from 16.7, a 15% decline.

Thus, there has been a decline in overall smokers, a slightly greater decline in daily smokers and in number of cigarettes smoked by daily smokers, and a major decline in the number of cigarettes consumed by daily smokers.

The profile of smokers is relatively unchanged:

  • Men (20.5%) are more likely to be smokers than women (15.3%)
  • Smoking prevalence is higher among adults aged 25-44 years (20.1%) and lowest among those over age 65 (8.8%)
  • Among ethnic groups, multiple race groups had the highest rates (26.8%), followed by American Indian/Native Alaskan (26.1%), Whites (19.4%), Blacks (18.3%), Hispanics (12.1%), and Asians (9.6%).
  • Smokers continue to be stratified by education level, often used as a marker for social class. Those without a high school diploma had smoking rates of 24.2%, followed by those with high school diplomas (22%), undergraduate college degrees (9.1%), and graduate degrees (5.6%). Those who obtained General Education Development (GED) certificates in lieu of high school graduation had the highest rates (41.4%). It is likely that many of these persons were incarcerated and thus also had medical conditions associated with high smoking rates, such as mental illness and substance use disorders.
  • Persons living below the federal poverty level had higher rates (29.2%) than those above that level (16.2%).
  • LGB adults were more likely to be smokers (26.6%) than straight adults (17.6%).

Thus, the trend of smoking to be concentrated among the less educated, the poor, and the LGB population continued. Not included in this report, but summarized previously by a special MMWR are recent data documenting the much higher rates among persons with behavioral health issues, the groups with the highest smoking rates in the entire population. Notably, those working in the health professions in the United States have some of the lowest smoking rates in the world, with some surveys showing that only 1% of physicians are smokers.

This new report should encourage us that progress, indeed, is happening. But, the slow rate of decline, in the face of all the evidence about the harms of smoking and the accumulating tobacco control policies such as taxes, clean indoor air laws, counter-marketing, and coverage for smoking cessation therapies, is sobering. As smokers increasingly resemble members of marginalized parts of the American community, the risk is that resources for tobacco control will be diverted to other causes. Yet, over 40 million people still smoke, including many of the most vulnerable of us. And close to 500,000 people die each year from smoking-associated illnesses. We need to capture better the sense of urgency buried in those statistics.

Finally, it is important to recognize two new potential threats to the health of the nation—electronic cigarettes and marijuana. Right now the rhetoric about the benefits and harms of these two commodities outstrips the evidence. We do know that the use of the e-cigarette is climbing, and it is highly likely that marijuana use is also increasing in the wake of state legalization efforts. We also know that because these commodities contain immense potential for profit, marketing efforts to promote usage are certain to increase. As we continue our efforts against the harm from using combustible tobacco, we need to track the use of these new potential threats, as well as to assemble evidence about what happens to those who use them.

E-Cigarettes: Friend or Foe for the LGBT Communities?

By: Scout, PhD, Director of CenterLink’s Network for LGBT Health Equity – HuffingtonPost Blog
Working in tobacco control sometimes elicits interesting reactions from people. Some try to hide their smoking. While I certainly appreciate not being near the smoke itself, I’ve got great empathy for smokers. In fact, since most smokers have already tried to quit, they’re much more likely to be fellow fighters against tobacco than non-smokers. Sometimes they ask me how to best quit and I’m happy to tell them (hint, call 1-800-QUITNOW). These days everyone’s asking me something new: What about e-cigarettes? The shortest answer is “they could be helpful for a few, but we all worry about our youth.”
First, if you’re not familiar with e-cigs, they are battery-powered imitators of old-school cigarettes, designed to deliver nicotine, flavor and other chemicals through vapor inhaled by the user. Most of them have a swag little electronic light at the tip to make it seem more like an old-school cig. Some now have other names like e-hookah to avoid any cigarette associations. The claim is here’s a no-combustion device to get your nicotine fix, great for cessation and great to smoke in places where cigarettes are banned.
There is one study supporting the effects of e-cigs in helping people quit smoking but now another study is out contravening it. Considering how toxic cigarette smoke is, we all applaud anything that helps reduce the amount of cigarette smoke in the air. But if you’re trying to use e-cigs as a cessation device it’s a bit dicey right now because they’re unregulated, so the amount of nicotine you get in each dose varies, and sometimes does not match the advertising. It’s commonly known that it only takes about two weeks to kick the nicotine addiction of smoking, but anyone who’s quit will tell you, it’s the social habit of smoking that draws you back again and again. I’m not sure how putting a cigarette replacement in your mouth helps you kick that social habit — sounds to me like it’s just perpetuating it. Plus there is a new study showing other toxic chemicals in the vapor. To top it off, there’s no real science on the long-term effects of inhaling nicotine vapor. So while I’m willing to bet it’s better than inhaling tobacco smoke, that’s like saying I bet it’s better than inhaling truck exhaust. Nicotine is so toxic, poison control centers just issued an alert about high numbers of calls on accidental exposure. Just touching the liquid is enough to cause vomiting andingesting as little as a teaspoon of some of the liquid nicotine concentrations can be fatal. I hope people set a higher bar for their own cessation journey.
The real problem is, as anyone who’s visited a vaporium can see, it’s not a cessation game. Vaporiums and e-cigs are all about enticing, and particularly enticing young people. Wander into your local vaporium belly up to the “bar” and you’ll be shocked to see how many vaporiums look like the lovechild of a hip coffee shop and a candy store. I’m not sure exactly which adult Marlboro user would switch to cotton candy flavored nicotine cartridges, or banana nut bread, or cherry limeade. Sounds to me more like flavors I’d find at a little league game. To make it worse, these products are easily available online and many states aren’t yet doing anything to restrict access to minors. Data show LGBT youth continue to smoke at rates much higher than their non-LGBT counterparts and the number of youth experimenting with e-cigs is rising rapidly… the very last thing we need is to have some fancy new gadgetry on the market enticing LGBT youth to start using a highly addictive drug to deal with the stress of stigma against us all.
We pass on smoking down through the LGBT generations socially. I’ve always called it an STD for us, a socially transmitted disease. So I also worry about adult e-cig use. Every time you “light up” you’re perpetuating the huge LGBT cigarette culture, all of us laughing and having fun and hanging out, with cigarettes in our mouths.
We already have cessation aids that deliver you nicotine in controlled regulated doses, you can find those on every drugstore shelf. Nicely, there’s not one gummy bear or watermelon flavored nicotine patch, spray or gum. So while e-cigs might help a few in quitting, I say the big picture on e-cigs for the LGBT communities is we need to think of our youth and “beware of the wolf in sheep’s clothing.”
http://www.huffingtonpost.com/scout-phd/e-cigarettes-friend-or-foe_b_5024583.html
 

Letter: NDQuits wins a commendation

By: Jessie Azure, West Fargo, INFORUM
I would like to commend those with NDQuits on finding a creative way to reach a “tobacco at risk community!”
Clearly, representatives from the North Dakota Policy Council need to sit down and read the 2007 Best Practices manual issued by the CDC on Tobacco Prevention and Control Policy before commenting. Maybe then they’d understand the importance of reaching target populations with education and support.
Their comments make me ask a far more important question: What if the parade had been for an organization raising awareness for mental health (as this is another community with a high rate of tobacco use)? Would Zach Tiggelaar still be compelled to question such actions? I bet he’d agree that we shouldn’t dismiss one community over another; rather, look to find ways to reach all of our citizens, just as the folks at NDQuits did. After all, as Rep. Josh Boschee, D-Fargo, reminds us, the cost of tobacco is far more staggering to treat than prevent.
http://www.inforum.com/event/article/id/406374/

Forum editorial: Take deep breath and relax

Some folks in North Dakota are in a snit because anti-smoking funds are being used to promote the cause at specific events, such as the Fargo-Moorhead gay pride festival. They should take a deep breath, preferably at a nearby smoke-free bar, and calm down.
ND Quits and the state health department are doing what they’re supposed to be doing. They are using funds, some state and federal, some from the multi-year settlement with tobacco companies, to get smokers to quit or others to never start. They are developing and implementing strategies to educate about the known dangers of smoking and secondhand smoke. The efforts can include targeting groups with high rates of tobacco use, such as the gay, lesbian, bisexual and transgender population, which is 70 percent more likely to smoke than the general population, according to the Centers for Disease Control and Prevention.
Since the federal dollars for state smoking-cessation programs come from the CDC, it logically follows that the state effort should include the at-risk LGBT community. It’s no different than spending a portion of the budget for information and education programs aimed at youth, women or oil workers – groups, by the way, that are in the anti-smoking agencies’ sights. ND Quits operates under a clear mandate from the people of North Dakota, who overwhelmingly approved a ballot measure that set up an agency to manage and spend tobacco settlement dollars. That came a few years ago after an intransigent Legislature refused to act responsibly, even as anti-smoking sentiment took hold in the state.
More silliness about the application of anti-smoking money came from the North Dakota Policy Council’s Zack Tiggelaar. He said that while he supports efforts to encourage smokers to quit, “… is it something the public and taxpayers should be funding?” The answer, as made crystal clear by North Dakota voters, is “yes.”
He added: “The government shouldn’t be using taxpayer dollars to support specific causes.”
Where has he been? North Dakota has special state tax that goes to research sponsored by the Lignite Energy Council. That’s pretty specific. The state funds loans and grants for beginning farmers. That’s specific. The Renaissance Zone program for cities uses tax incentives (public money) to stimulate private development. Yet another specific cause.
Purists of the council’s ilk might wag a finger, but such programs evolved from long-standing public policy, and ND Quits is operating within the same ethic.
Oh, and by the way, those partnerships – whether associated with lignite research, farm and city investment or smoking cessation – work. The money is well spent.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.