Higher cigarette taxes, smoke-free policies, exposure to aggressive media campaigns and access to cessation programs that include counseling are among the biggest factors that help smokers kick the habit, according to recent studies from the Centers for Disease Control and the North American Quitline Consortium, a nonprofit that promotes quit-smoking hotlines.
The states that enacted tobacco taxes, instigated smoke-free policies, and put the most money into smoking-cessation programs generally have shown the biggest success in lowering smoking rates, according to a comprehensive CDC report on all 50 states’ prevention strategies released in April.
On the one hand, smoking reduction is one of the country’s biggest public-health victories. The portion of Americans 18 and older who smoke has dropped substantially from 42.4% in 1965, the first year the CDC tracked that data, to 20.6% in 2008, said Thomas Glynn, director of cancer science and trends for the American Cancer Society.
But declines plateaued with virtually no change from 2004 to 2008, and many public-health advocates worry that state budget cutbacks will make it even harder for the 70% of smokers who say they want to quit.
If all states spent between $9 and $18 per resident on comprehensive tobacco-control programs, which the CDC recommends, 5 million fewer people would smoke five years from now, it says. Just one state, North Dakota, meets that funding level, and 31 states and the District of Columbia allocate less than a quarter of it.
Twenty years of research show that smoking rates decline after policy changes that make it less accessible, less attractive and less affordable to light up, said Terry Pechacek, associate director for science for CDC’s Office on Smoking and Health.
For example, in California, which has the nation’s oldest statewide tobacco-control program, only 14% of adults and 6.9% of youth smoke, and lung-cancer rates have decreased four times as rapidly in the state as in the U.S. overall. The state saved $86 billion in tobacco-related health-care costs between 1989 and 2004, according to the CDC.
New York has some of the highest state cigarette taxes at $2.75 a pack, stringent indoor smoke-free-air laws, and the nation’s second-most intensive tobacco counter-marketing campaign. The Empire State has reduced its percentage of adult smokers to 16.7% in 2008 from 22.3% in 2002, according to the state health department.
Compare that to South Carolina, which spends only 5.4% of the CDC’s recommended investment and has no indoor smoke-free-air laws. About 20% of South Carolina adults and 11.8% of youth smoked in 2008, but the Palmetto state appears to be changing its approach.
On Thursday, South Carolina lawmakers voted to override Gov. Mark Sanford’s veto of a bill that would raise the cigarette tax to 57 cents a pack from 7 cents. The new tax rate hike would take effect July 1.
Overall, state per-pack taxes average $1.36, but 23 states had tobacco taxes of less than $1 as of May 1, according to the American Lung Association. While 24 states and the District of Columbia have comprehensive smoke-free-air state laws for almost all public spaces including work sites, restaurants and bars, 15 have weak or no smoke-free laws.
Insurance coverage matters, too. Only 39% of employers provided smoking-cessation programs as a benefit in their insurance plans, according to a 2009 survey from the Society for Human Resource Management. Seven states have laws or insurance regulations that require cessation coverage in some or all private insurance plans in the state.
Help on the line
Ted Williams of Tucson, Ariz., was a pack-a-day smoker for 45 years. He tried to quit multiple times, unsuccessfully using nicotine patches and other medications. Per-pack prices in his area hit $7 after federal cigarette taxes increased a year ago, and the recession slowed his home-building and design business, but still all he could do was adapt by buying less-expensive loose tobacco and rolling papers and purchasing cheaper packs at a nearby Indian reservation.
“I started at age 15 with peer pressure because everybody that was cool smoked,” said Williams, who is now 60. “I would sit at the computer and smoke nonstop.”
A massive heart attack in January finally convinced Williams his life depended on quitting now. But he still might not have succeeded if hospital staff hadn’t arranged a call with a counselor at his state’s free “quitline,” he said. Williams said he received not only encouragement to quit but also help in developing a plan to combat his urges.
“I don’t think the cravings will ever go away, but what I’ve done is change my habits,” he said. “I used to get up in the morning and have a cup of coffee and four cigarettes, but now I have a glass of tomato juice or brush my teeth — things that make a cigarette taste bad.”
Tobacco use is the No. 1 preventable cause of disease, disability and death worldwide. About 443,000 Americans die from either smoking or secondhand exposure to it annually, according to the CDC.
Another 8.6 million Americans have a serious illness caused by smoking, and smoking costs the nation $96 billion in medical costs and $97 billion in lost productivity annually.
Williams’ case illustrates the importance of state funding for quitline programs in that it is not unusual for smokers to attempt quitting at least three times, and usually many more, before they succeed, Glynn said.
Studies show that quit-success rates rise to 30% when smokers combine one of seven FDA-approved medications to stem cravings, including nicotine patches, gum or lozenges and prescription non-nicotine medications such as bupropion, or Zyban, with some form of counseling, such as a quitline.
Typically the smoker or a health-care provider will make the initial call into a quitline, then the quitline will schedule follow-up calls to walk though the individual’s history of smoking, review habits associated with smoking and develop a customized quit plan, said Linda A. Bailey, president of the North American Quitline Consortium. Smokers can call into the quitline themselves as many times as needed for support or advice.
But because of limited marketing budgets, many smokers don’t know about quitlines, Bailey said. And it may be harder for them to find out and receive help, because state funding for such services nationwide is down 7% this fiscal year compared with last year.
“It really is sad because when you don’t have the budget, you cannot advertise services,” Bailey said. Many states also have had to cut back on other services and now, for example, are making only one to two, rather than five, scheduled follow-up calls to smokers.
Last year, a record 515,000 people, or 1.2% of smokers nationally, used quitlines, which now are available in every state, as well as the District of Columbia, Puerto Rico and Guam. That’s up 129% over the past five years since the program’s nationwide launch, Bailey said.
The cutbacks couldn’t come at a worse time because quitlines reported up to four times their usual caller volume last spring around the time of the federal tax hike, she said.
Raising cigarette prices through higher federal and state excise taxes is another powerful incentive. Studies have shown that a 10% price increase translates into a 4% reduction in adults who smoke and 7% fewer children taking a puff, Glynn said.
Becoming an ex-smoker
If you want to quit and are having trouble, start out by acknowledging that the number of Americans who are ex-smokers, 47 million, now exceeds the number of smokers — 46 million, Glynn said.
“Someone considering quitting knows it’s hard, but also knows that there are 47 million people out there who have successfully done it,” Glynn said.
Also, keep in mind there is no age too old to quit, and you will likely add years to your life. Improved breathing is an immediate benefit, and elevated risks for heart disease, stroke and peripheral vascular disease go away within just a year or two. Lung-cancer risk reduction takes longer, but is down by about one third after a decade of being smoke-free.
Check with your insurer to see what they do and don’t cover. Also, 38 states pay for patches, gum and even drugs if you enroll in a quitline program. However, many states have cut back on such benefits and may restrict that support to certain groups such as Medicaid recipients, pregnant women or the uninsured.
If you do have to pay, keep in mind that although patches, gum and medications may seem to cost a lot up front, they are typically priced not to exceed the amount you would have paid for cigarettes, Glynn said.
Want to compare costs? The American Cancer Society has a tool on Cancer.org where you can calculate how much you’re spending on cigarettes now.
Glynn recommends talking to your doctor, then joining a support group, enrolling in a smoking-cessation program sponsored by your insurer or workplace or calling your state quitline (all are accessible through one national number, 1-800-QUITNOW).
The American Lung Association also has an information and counseling helpline at 1-800-LUNGUSA and information on how to quit on its site, LungUSA.org, including its own web-based cessation program.
The ALA’s web-based program offers a free basic membership where users access information about quitting and use tools and activities on their own. A premium membership costs $15 a month or $40 a year and includes support and tips from others in the program, plus a personal blog and other interactive tools.
By Anya Martin
Marketwatch, May 13, 2010