Why it mat­ters who’s smok­ing

The Morning Journal (Lorain, OH) - - OPINION - Ken­neth E. Warner Univer­sity of Michi­gan

Sup­pose you were told that there is some­thing re­spon­si­ble for nearly 1 of ev­ery 5 deaths of Amer­i­cans, and that it is com­pletely avoid­able. Would you be­lieve – to­day – that “some­thing” is cig­a­rette smok­ing? If you’re a col­lege grad­u­ate, you might not be­lieve it. You don’t smoke. Your friends and col­leagues don’t smoke. You never see smoke in your work­place, nor in the restau­rants and bars you fre­quent. Like many of the na­tion’s most ed­u­cated cit­i­zens, you may well re­gard the prob­lem of smok­ing as largely solved. Be­cause the ed­u­cated pop­u­la­tion is also the most po­lit­i­cally en­gaged, cig­a­rette smok­ing has vir­tu­ally dis­ap­peared from the na­tion’s health pol­icy agenda. No one can deny the ex­tra­or­di­nary vic­to­ries against smok­ing. Since the 1964 Sur­geon Gen­eral’s re­port on smok­ing and health, adult smok­ing has dropped by two-thirds, from 43 per­cent to 14 per­cent. The de­crease among young peo­ple has been even more sub­stan­tial. For ex­am­ple, since smok­ing peaked among high school se­niors 20 years ago, smok­ing preva­lence in the past 30 days has plum­meted by nearly 80 per­cent. The bad news is that 1 of ev­ery 7 adults smokes. And smok­ing kills nearly 500,000 Amer­i­cans ev­ery year. That num­ber ex­ceeds the sum to­tal of all deaths caused by the opi­oids and other drugs, al­co­hol, mo­tor ve­hi­cle in­juries, homi­cide, sui­cide, HIV/AIDS and fires. What ac­counts for the di­ver­gence be­tween com­mon per­cep­tions about smok­ing and the dis­mal re­al­ity? In large part it is re­mark­able changes in who is smok­ing. In­creas­ingly, to­day’s smok­ers are those with lower ed­u­ca­tion, lower in­come and - im­por­tantly - a higher in­ci­dence of men­tal ill­ness. Con­sider this: In 1966, the smok­ing rate of Amer­i­cans who hadn’t grad­u­ated high school was just 20 per­cent greater than that of col­lege grads. By 2017, in con­trast, the smok­ing preva­lence of the least ed­u­cated was nearly four times greater than that of the most ed­u­cated. For col­lege grads, the rate of smok­ing in 2017 was van­ish­ingly small. For those with­out a high school de­gree, and in­deed for high school grads too, fully 1 out of 5 re­main smok­ers. The dif­fer­ence mat­ters. Re­search at­tributes a fifth to a third of a large ed­u­ca­tion-re­lated gap in life ex­pectancy to dif­fer­ences in smok­ing. A sim­i­lar pat­tern of smok­ing holds with re­spect to in­come classes, them­selves highly cor­re­lated with ed­u­ca­tional at­tain­ment. Ac­cord­ing to the lat­est data, Amer­i­cans who live be­low the fed­eral poverty level were three times more likely to smoke than Amer­i­cans with in­comes at least 400 per­cent above the fed­eral poverty level. The gap has widened since the early 1990s. There is an enor­mous dif­fer­ence in life ex­pectan­cies be­tween the na­tion’s rich­est and poor­est cit­i­zens. Smok­ing is again a sig­nif­i­cant fac­tor in this dis­par­ity. An enor­mously im­por­tant fac­tor in smok­ing to­day is that the smok­ing preva­lence of peo­ple suf­fer­ing from se­ri­ous men­tal ill­ness is more than dou­ble that of the pop­u­la­tion not so af­flicted. Peo­ple with men­tal health prob­lems or sub­stance use dis­or­ders con­sti­tute a quar­ter of the U.S. pop­u­la­tion but con­sume 40 per­cent of all cig­a­rettes smoked. They have more dif­fi­culty quit­ting smok­ing. Smok­ing also dis­pro­por­tion­ately af­flicts mem­bers of the LGBT community. Among racial/eth­nic groups, Amer­i­can In­di­ans and Alaskan Na­tives had the high­est smok­ing rates in 2016, while Asian Amer­i­cans and Pa­cific Is­lan­ders had the low­est. In gen­eral, women have lower smok­ing rates than men. The ex­cep­tions are Amer­i­can In­di­ans/Alaska Na­tives, among whom women have slightly higher smok­ing preva­lence than men, and non-His­panic whites, among whom men smoke at slightly higher rates. Smok­ing is a tena­cious ad­dic­tion, one that the vast ma­jor­ity of smok­ers ac­quired in their youth. They were as­sisted in so do­ing by an avari­cious tobacco in­dus­try that mar­keted to young peo­ple. Kids have been re­ferred to as “re­place­ment smok­ers,” the new smok­ers needed to re­plen­ish the in­dus­try’s cus­tomer base as its most loyal cus­tomers suc­cumb to smok­ing-pro­duced dis­eases. What can be done? The sim­ple – and in­com­plete – an­swer is “more of the same.” Pub­lic ed­u­ca­tion has con­trib­uted to de­creased smok­ing, as have pol­icy in­ter­ven­tions: cig­a­rette tax­a­tion, smoke-free work­place laws, pro­hi­bi­tions on prod­uct ad­ver­tis­ing and pro­mo­tion, and me­dia anti-smok­ing cam­paigns. Ev­i­dence-based smok­ing ces­sa­tion treat­ments can help as well. In­ter­ven­tions in­creas­ingly need to be tar­geted to spe­cific high-risk groups. Th­ese ev­i­dence-based mea­sures are un­likely to be enough, how­ever. A po­ten­tially com­ple­men­tary tool may lie in a highly con­tro­ver­sial re­cent de­vel­op­ment: the emer­gence of e-cig­a­rettes. Novel re­duced-risk nico­tine de­liv­ery prod­ucts like e-cig­a­rettes may serve as al­ter­na­tives to smok­ing, es­pe­cially for those smok­ers oth­er­wise in­ca­pable of quit­ting cig­a­rettes. Va­p­ing may hold the po­ten­tial to help sig­nif­i­cant num­bers of Amer­i­cans to quit smok­ing. The risks of va­p­ing are clearly sub­stan­tially less than those of smok­ing. At the same time, how­ever, there are con­cerns about the at­trac­tion of e-cig­a­rettes to young peo­ple and un­cer­tainty about the health ef­fects of long-term va­p­ing. While the ul­ti­mate im­pacts of e-cig­a­rettes and other novel non-com­busted tobacco prod­ucts re­main to be seen, there is wide­spread agree­ment that it is the burn­ing of tobacco that is by far the most deadly method of con­sum­ing tobacco. The enor­mous suc­cesses of tobacco con­trol not­with­stand­ing, smok­ing re­mains Pub­lic Health En­emy No. 1. To­day, the bur­den of smok­ing falls pri­mar­ily on marginal­ized pop­u­la­tions – the poor, the poorly ed­u­cated, and those suf­fer­ing from men­tal health prob­lems. A com­pas­sion­ate pub­lic would re­new the bat­tle against smok­ing with a vigor not seen in decades. The Con­ver­sa­tion is an in­de­pen­dent and non­profit source of news, anal­y­sis and com­men­tary from aca­demic ex­perts.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.