National smoking rates decline, local challenges remain

Clay Bennett poses for a photo illustration about smoking outside of the Chattanooga Times Free Press on Wednesday, Jan 24, 2018 in Chattanooga, Tenn.
Clay Bennett poses for a photo illustration about smoking outside of the Chattanooga Times Free Press on Wednesday, Jan 24, 2018 in Chattanooga, Tenn.

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Tennessee Quit Week is Feb. 5-9. People who smoke and want to quit can call 1-800-QUIT-NOW (784-8669) to talk with a counselor or visit for information about the state’s free services.

Anti-smoking advocates' hopes are becoming reality as more Americans opt to pass on cigarettes, but large disparities in smoking rates persist among certain populations, meaning their work is far from over.

Nationwide, smoking rates have declined from 20.9 percent of the adult population smoking in 2005 to 15.1 percent in 2015, according to the U.S. Centers for Disease Control and Prevention's latest data. Yet tobacco use remains the nation's leading cause of preventable death and disease, killing more than 480,000 Americans each year, including 11,400 Tennesseans.

Cessation specialist Gerre Schwert, a clinical social worker at CHI Memorial, said people's motivations to kick the habit can vary, "but they really have to want to quit for themselves."

Low-income people, those living in public housing, rural residents, LGBT persons, American Indians, Alaska natives, adults with mental health or substance use disorders - and Tennesseans - have higher rates of tobacco use and smoking-related diseases, such as cancer, heart disease, stroke, lung diseases, diabetes and chronic obstructive pulmonary disease, or COPD.

The current smoking rate in Tennessee - 22.1 percent of adults use cigarettes - gives it the eighth highest rate of smoking prevalence in the nation. In Alabama and Georgia, 21.5 percent and 17.9 percent of adults, respectively, are smokers.

"We lose 30 precious people a day in Tennessee to tobacco use, and beyond these tragic early deaths, it costs our state billions of dollars each year in lost productivity and health care costs," Dr. John Dreyzehner, Tennessee Department of Health commissioner, said in a statement. "The impacts of tobacco and nicotine addiction in Tennessee go beyond the damage done to the health, quality of life and incomes of people using these products, most of whom got addicted as youth."

Despite public health programs targeting youth initiation, pregnancy cessation and secondhand smoke, according to a recent report from the American Lung Association, Tennessee has shown mixed progress enacting tobacco-control policies.

The 16th annual "State of Tobacco Control" report calls on state lawmakers to bolster smoke-free laws, increase funding for anti-tobacco programs and improve access to tobacco cessation treatments.

But Matt Harris, an economist who researches health and labor economics at the University of Tennessee at Knoxville, said changing behavior through policy isn't always easy.

"Policy makers can affect in essence the supply side of things, but they can't really affect people's preferences," Harris said. "You can't necessarily make people want to quit smoking."

Because smokers usually start early - nearly 90 percent begin using cigarettes before age 18, according to the U.S. Department of Health and Human Services Office of Adolescent Health website - the report also pushes for raising the minimum tobacco purchasing age to 21 and increasing cigarette taxes. And while this strategy can deter new users, it may have unintended consequences.

"There is evidence that raising taxes does lead to lower rates of smoking initiation," Harris said, but "since there's a negative correlation between income and smoking, then raising taxes on cigarettes, most of that burden will end up falling on low-income individuals."

Dr. Michelle Fiscus, deputy medical director for disease prevention and health promotion at the Tennessee Department of Health, said there are several other challenges to reducing Tennessee's smoking rates, including its history of tobacco farming and culture that normalizes smoking.

"We know that people are more likely to smoke if they are the children of other smokers, so smoking is often generational," she said. "Youth very often times get their tobacco from their parents or from relatives, so we have to find ways to break that cycle."

The latest report comes at a time when big tobacco company Philip Morris International is pushing its new iQOS, which heats Marlboro-branded tobacco rather than burning it - a method the company touts as a safer than traditional smoking.

But critics claim the modernized, pen-like device is designed to hook youngsters and revive the waning industry.

"They're going to continue to try and innovate and make products that bring in their next generation of tobacco users in whatever form they are able to get them," Fiscus said. "The more we can do to educate children, prevent marketing products toward children and prevent the use of any kind of nicotine product by children, the better off we'll be."

Dr. Asad Javed, a pulmonologist with a focus on lung diseases at CHI Memorial, began practicing medicine in Chattanooga about four months ago. He said he is "surprised" by the number of local patients who began smoking during adolescence.

"A lot of people that I see here, in this region in particular, started very early," he said. "And I'm not talking about in their later teen years - I'm talking about starting at the age 10 or 12."

Social worker Schwert echoed Javed's sentiments.

"For many people who came to my classes, a high percentage started smoking before they were 18 many at 10, 12 and 14, and even younger," she said. "So they've been smoking 30, 40, 50 years."

Although youth smoking rates are down - 24.6 percent of U.S. 12th graders reported smoking cigarettes daily in 1997 compared to 5.5 percent in 2015 - use of e-cigarettes, which contain nicotine but not tobacco, is up. The percent of high school seniors who used an e-cigarette in the past 30 days increased from 1.5 percent in 2010 to 13 percent in 2017.

"I fear that the diseases associated with those [methods] are going to show up later, whether it's the same COPD or something new that we just haven't seen as much," Javed said. "Some of the new technology, we don't know much about, so we need to be cautious. No smoke is good, period."

Contact staff writer Elizabeth Fite at or 423-757-6673.

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