Mar. 24 2014
WASHINGTON, DC – While the United States as a whole has made significant progress in reducing smoking, smoking rates vary dramatically by county even within the same state, according to a study published today by the Institute for Health Metrics and Evaluation at the University of Washington. The study provides new evidence for the effectiveness of tobacco control measures, but also reveals pockets of high-risk populations that have higher smoking rates associated with income, education, geography and race/ethnicity. Overall, counties in the South and parts of the Midwest, as well as those with large Native American and Alaska Native populations, have lagged behind and have the highest smoking rates.
It is troubling and unacceptable that the United States is becoming a nation of haves and have-nots when it comes to fighting tobacco use, the nation’s number one cause of preventable death. This study underscores the need for every state and county to fully implement proven strategies that reduce tobacco use, including higher tobacco taxes, comprehensive smoke-free air laws and well-funded programs to prevent kids from smoking and help smokers quit. The study also points out the need for additional focus on particular high-risk populations. As the recent Surgeon General’s report found, there is conclusive evidence that these measures work, but they have not been implemented nearly enough.
The disparity in smoking rates among low-income populations and Native Americans and Alaska Natives is an urgent public health issue for our country because it is a driving force behind overall disparities in health, including rates of major killers such as cancer and heart disease and life expectancy. To improve overall health, all residents of the United States must be protected by life-saving tobacco control measures, regardless of how much they make, where they live or their ethnicity.
Not surprisingly, there are strong correlations between smoking rates and whether states have implemented effective tobacco control measures. Many states identified in the study as having counties with the highest smoking rates, such as Kentucky, Tennessee, West Virginia and Missouri, have very low cigarette tax rates and have failed to enact strong laws requiring smoke-free workplaces and public places.
A Campaign for Tobacco-Free Kids analysis of statewide adult smoking rates in 2012 (the most recent year for which data are available) found a similar pattern. The 12 states with the highest smoking rates (three are tied for 10th) have an average cigarette tax of just 82 cents per pack, and only two of the 12 are smoke-free. In contrast, among the 10 states with the lowest adult smoking rates, the average cigarette tax is $2.42 per pack and nine of the 10 have smoke-free laws that include restaurants and bars.
In addition to raising tobacco taxes and enacting strong smoke-free laws, the states must also increase funding for tobacco prevention and cessation programs, which are critical to reaching high-risk populations. Unfortunately, most states are falling woefully short. This year, the states are collecting $25 billion in revenue from the 1998 state tobacco settlement and tobacco taxes, but are spending only 1.9 percent of it – $481.2 million – on tobacco prevention and cessation programs. They are providing less than 15 percent of the CDC’s recommended funding for such programs.
We know that states can succeed when they do more to reduce smoking among high-risk populations. Massachusetts, for example, reduced smoking among Medicaid beneficiaries by 26 percent in the first two and half years after it began providing Medicaid coverage for smoking cessation treatments in 2006.
While the states have not done enough, tobacco companies have been very aggressive in targeting vulnerable populations. They have a long history of specifically targeting low-income communities with advertising campaigns that include price discounts, promotional giveaways, and heavy product placement at retail locations. Studies have found that there is more tobacco advertising in retail outlets in predominantly minority, low-income communities compared to non-minority, higher income communities.
Despite our remarkable progress in reducing smoking, tobacco use continues to have a uniquely devastating impact on the nation’s health, as the new Surgeon General’s report reminded us. Smoking annually kills 480,000 Americans – causing about one out of every five deaths in the U.S. – and costs us at least $289 billion in health care bills and other economic losses. There is simply no excuse for failing to do more to reduce smoking and other tobacco use among all Americans, especially among the high-risk populations identified in this study.