Tobacco use: still a problem

It’s safe to say that over the past few decades, billions of dollars have been spent in the United States on reducing tobacco use.

It has had an impact. The number of adults who smoke has declined steadily, from about 43 percent in 1965 to the current rate of approximately 20 percent. Among high school students, the age group in which tobacco use most often starts, the smoking rate has fallen as well. Smoke-free workplaces and eating establishments are widespread.

This should be reason to reflect on the progress that has been made. But to those who work in the field of tobacco control, it isn’t enough.

ClearWay Minnesota launched a new campaign this week whose title conveys a blunt message: “Still a Problem.”

Some facts from the website:

- Smoking is linked to health problems that range from coronary artery disease and high blood pressure to lung cancer, oral and neck cancer, chronic bronchitis and increased risk of type 2 diabetes.

- More than a quarter-million children in Minnesota are exposed to secondhand smoke at home.

- Almost half of the adults who responded to the 2010 Minnesota Adult Tobacco Survey said they were exposed to secondhand smoke within the past week.

- Progress in reducing tobacco use among adolescents in Minnesota appears to have stalled. According to the 2011 Minnesota Youth Tobacco and Asthma Survey, 77,000 middle school and high school students are current tobacco users; collectively they will buy or smoke 13.4 million packs of cigarettes this year – enough when stacked sideways to span the entire state from north to south.

- Smoking costs $3 billion in excess health costs annually in Minnesota. This works out to $554 per individual Minnesotan.

None of this information should come as a surprise. The American public has been exposed to public health messages about the physical and economic toll of tobacco use for decades, perhaps to the point of tuning it out.

Tobacco control efforts can be at odds with individual rights and interests, as any smoker forced to huddle outside the company loading dock for a cigarette break might tell you. When a federal appeals court struck down the U.S. Food and Drug Administration’s graphic new warnings for cigarette labels earlier this year, the decision came down to free speech protection.

Yet the other side of this is that for every smoker who doesn’t wish to quit, there’s someone else who does. Last year the U.S. Centers for Disease Control and Prevention analyzed data from the 2010 National Health Interview Survey involving more than 27,000 adults over the age of 18. Among those who smoked, seven out of 10 said they wanted to quit, and half had attempted to quit during the previous year.

Despite long-standing anti-tobacco campaigns, it’s somewhat startling to realize how pervasive tobacco use still is. A new small-scale study, to be published in the upcoming issue of the Pediatrics journal, found that many parents who smoke do so in their car in the presence of their children, and only a minority had a smoke-free policy for the family vehicle.

In another recently published study, researchers observed patients at a large urban hospital and found that among those who smoked, nearly one in five continued to light up during their hospital stay – even though the hospital had a smoke-free policy.

Tobacco smuggling also remains a significant global issue that robs Third-World governments of tax revenue and is thought to contribute to the funding of organized crime. An in-depth report developed by an international team of journalists concluded that the illicit tobacco trade is so widespread and so lucrative that tobacco has become “the world’s most widely smuggled legal substance.”

So is tobacco use “still a problem”? Let the public look at the evidence and judge for themselves.

Fessing up to tobacco use

It’s a question many of us are routinely asked during a visit to the doctor: Do you smoke or use tobacco?

Ideally, nothing less than the truth should suffice – but according to a newly released poll, about one in 10 people opt to conceal their smoking status from their health provider.

The survey, which involved 3,146 American adults who were either current or former smokers and was conducted by Legacy, a national public health organization, offers some interesting insight into the evolving social attitudes surrounding tobacco use – namely, a stigma that seems to be making it harder for some smokers to confess their habit to a doctor. About 13 percent of those who participated in the poll said they didn’t tell their doctor that they smoked.

According to the survey findings, smokers had a variety of reasons for concealing their tobacco use. Some were ashamed; others didn’t want to be nagged or lectured. But what’s especially noteworthy is this: The more stigmatized they felt, the less likely they were to disclose their smoking status.

The poll uncovered another interesting fact: Although the majority of smokers said they were honest with their doctor about whether they smoked, 25 percent did not seek help from a doctor or nurse during their most recent attempt to quit – and hence may have missed out on an important source of support.

Public health policy in the United States is strongly focused on reducing tobacco use. One of the key strategies has been to make it so uncomfortable to smoke – via higher cigarette taxes, smoke-free restaurants, higher health insurance premiums and so on – that people are either motivated to quit or discouraged from taking up the habit in the first place.

There’s evidence that it all contributes to making a difference. According to the most recent figures available from the U.S. Centers for Disease Control and Prevention, the number of American adults who smoke declined from 20.9 percent in 2005 to 19.3 percent in 2010.

It’s worth asking, though, whether efforts to make smoking socially unacceptable might reach a point of diminishing returns. In an accompanying news release, Cheryl Healton, president and CEO of Legacy, notes there’s been “a significant shift in the social climate” surrounding tobacco use in the U.S. in recent years.

“As an unintended result of higher prices of cigarettes, increased measures to ban smoking in public places, and create smoke-free workplaces, many smokers may feel marginalized and less compelled to discuss smoking with their physicians and other providers,” she said.

And when smokers don’t want to disclose their habit for fear of being judged, “it becomes a missed public health opportunity” to connect them with resources that might help them quit, Healton said.

The findings from the survey prompted Legacy to put together a guide that helps clinicians discuss tobacco use with their patients in ways that are sensitive and appropriate rather than stigmatizing. Although it’s ultimately up to smokers to decide to quit, how health providers approach the issue clearly does seem to matter.

Photo: Wikimedia Commons

Tobacco tactics: too graphic?

The images grab your attention, to say the least: A toe tag dangling from a body in the morgue. A man lying in a coffin. A smoker exhaling through a tracheotomy in his neck.

Under a new campaign, announced Wednesday by the U.S. Food and Drug Administration, cigarette packs will carry large, bold warning labels about the health consequences of smoking. The new labels will be accompanied by blunt warnings. “Cigarettes are addictive.” “Smoking can kill you.”

Federal officials hope the warnings will motivate smokers to quit – or to avoid starting the tobacco habit in the first place. Despite more than four decades of anti-smoking efforts, it’s estimated that about 20 percent of American adults and 19 percent of teens are smokers. Tobacco use remains one of the leading preventable causes of death in the United States, taking 440,000 lives annually. What has the health and prevention community especially concerned is how the decline in tobacco use has plateaued in recent years.

Will new, graphic warnings about the health consequences of smoking bring new energy to the national tobacco prevention campaign? Many observers and experts say yes.

The New York Times talked to Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, who called the proposed new warning labels “the most important change in cigarette health warnings in the history of the United States.”

From the Times:

Studies suggest that pictorial warnings are better at getting the attention of adolescents than ones that feature only text; make smokers more likely to skip the cigarette they had planned to smoke and more likely to quit; and make adolescents less likely to start smoking.

It’s also thought that the more brutal and blunt the message is, the better it might be able to motivate people of all ages to avoid tobacco.

Not everyone agrees. Some people are questioning whether the proposed labels will prove to be effective, while others think the FDA has gone too far. More than 600 people have weighed in, pro and con, in the New York Times online discussion. One person declared, “Anything less is a cop-out.” But someone else felt scare tactics don’t work in the long run: “The shock factor wears off quickly and smokers become desensitized to the images.”

The proposed new labels aren’t a done deal yet. The public has until Jan. 11 to submit official comments to the FDA. Final regulations won’t be issued until next June.

In the meantime, what do readers think? Do you think the graphic warnings will be effective? Or do you think they’re going overboard? Post your thoughts in the comment section below.