Smok­ing is at a record low in the US, ben­e­fits aren’t shared equally

The Sun News (Sunday) - - Coasting - BY KAREN KA­PLAN

Cig­a­rette smok­ing is at an all-time low in the United States, but the ben­e­fits of this pub­lic health achieve­ment are not be­ing shared equally by all Amer­i­cans.

A new anal­y­sis of health data from the na­tion’s 500 largest cities shows that the peo­ple who live in neigh­bor­hoods with the high­est smok­ing rates are more likely to be poor, less likely to be white, and more likely to have chronic heart or lung dis­eases.

“The de­gree of in­equity was sur­pris­ing,” said study leader Eric Leas, who con­ducted the work as a post­doc­toral scholar at the Stan­ford Pre­ven­tion Re­search Cen­ter.

Smok­ing may be a choice, but if you want to live a long and healthy life, it’s a bad one. In the U.S., life ex­pectancy is at least 10 years lower for smok­ers than for non­smok­ers, and smok­ing is re­spon­si­ble for roughly 20 per­cent of deaths each year, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion.

The U.S. sur­geon gen­eral says smok­ing can be blamed for more than 80 per­cent of deaths due to lung can­cer (the dead­li­est type of can­cer in the U.S.) and about 80 per­cent of deaths due to chronic ob­struc­tive pul­monary dis­ease (the coun­try’s thirdlead­ing cause of death). Smok­ers also face in­creased risks of heart dis­ease, stroke, asthma, di­a­betes, and at least 10 other kinds of can­cer.

In 1965, when the Na­tional Cen­ter for Health Sta­tis­tics be­gan track­ing to­bacco use, 42 per­cent of U.S. adults were cig­a­rette smok­ers. By 2017, that fig­ure had de­clined to 14 per­cent.

Leas and his for­mer col­leagues from Stan­ford won­dered how the re­sult­ing health gains were spread across the coun­try. To find out, they ex­am­ined data from the 500 Cities Project, a joint ef­fort of the CDC and the Robert Wood John­son Foun­da­tion that gauges health risk fac­tors in 27,204 cen­sus tracts in Amer­ica’s largest cities.

They found that smok­ing was more pop­u­lar in some cen­sus tracts than oth­ers – and that there were cer­tain things these cen­sus tracts had in com­mon.

For starters, the peo­ple liv­ing in neigh­bor­hoods with higher smok­ing rates tended tomake less money than peo­ple in neigh­bor­hoods with lower smok­ing rates. The re­searchers cal­cu­lated that a $10,000 in­crease in a cen­sus tract’s me­dian house­hold in­come cor­re­sponded with a 0.92 per­cent­age-point de­crease in smok­ing preva­lence.

In ad­di­tion, neigh­bor­hoods with higher smok­ing rates were more likely to be pop­u­lated by African Amer­i­cans and Lati­nos, while the re­verse was true for non-His­panic whites. A 10 per­cent­age-point in­crease in a cen­sus tract’s white pop­u­la­tion corre- sponded with a 0.84 per­cent­age­point de­crease in the preva­lence of smok­ing.

The Stan­ford team also found that the pop­u­lar­ity of smok­ing and the preva­lence of dis­eases rose or fell in tan­dem. For in­stance, if the smok­ing rate in a neigh­bor­hood were to in­crease from 10.7 per­cent (the 10th per­centile of all cen­sus tracts) to 27.6 per­cent (the 90th per­centile), the preva­lence of coro­nary heart dis­ease would rise by 27 per­cent, asthma would jump by 39 per­cent, and chronic ob­struc­tive pul­monary dis­ease would climb by 120 per­cent.

In each of the 500 cities, the re­searchers quan­ti­fied the de­gree of “smok­ing preva­lence in­equity” on a scale from 0 (per­fect eq­uity) to 1 (com­plete in­equity). All cities in the study had a score of at least 0.03, rep­re­sent­ing at least a small de­gree of in­equity, and the bulk of themhad scores be­tween 0.1 and 0.15. The most in­equitable city in Amer­ica wasWash­ing­ton, D.C., with a score of 0.23.

Leas said he was amazed by the dif­fer­ences in the na­tion’s cap­i­tal: The smok­ing preva­lence in some neigh­bor­hoods was 8.8 per­cent, while in oth­ers it reached 49.1 per­cent.

“A rate of 49.1 per­cent is higher even than where the na­tional av­er­age was in the 1960s, high­light­ing how far many neigh­bor­hoods need to come to catch up to the na­tional trends,” said Leas, who is now an as­sis­tant ad­junct pro­fes­sor at the UC San Diego School of Medicine.

Health ex­perts­make a dis­tinc­tion be­tween in­equal­i­ties and in­equities. Some amount of health in­equal­ity may be un­avoid­able, such as when a ge­netic vari­ant makes a per­son­more vul­ner­a­ble to a par­tic­u­lar dis­ease. How­ever, when an un­equal out­come could have been avoided, you have a case of in­equity.

The re­searchers pro­posed sev­eral pol­i­cymea­sures to com­bat the in­equities they doc­u­mented.

For in­stance, peo­ple in neigh­bor­hoods with higher smok­ing rates were more likely to en­counter stores sell­ing cig­a­rettes and other to­bacco prod­ucts – an in­crease of five to­bacco re­tail­ers in a cen­sus tract cor­re­sponded with a 0.11 per­cent­age-point in­crease in smok­ing preva­lence there, the re­searchers found. Reg­u­la­tions aimed at “lim­it­ing the quan­tity, lo­ca­tion, and type of to­bacco re­tail­ers” in an area might lead to re­duc­tions in smok­ing there, they wrote.

Rais­ing taxes on cig­a­rettes to make them more ex­pen­sive would prob­a­bly re­duce de­mand among low-in­come smok­ers, help­ing to erase at least some of the in­equity, they added. The find­ings also sug­gest that smok­ing ces­sa­tion pro­grams would do more good if they were “tar­geted to re­source-poor com­mu­ni­ties,” they wrote.

The study was pub­lishedMon­day by the jour­nal JAMA In­ter­nal Medicine.


ALAN BERNER Seat­tle Times

Smok­ing in the U.S. has fallen to record lows, but the ben­e­fits of that are not equally shared by Amer­i­cans.

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