Oregon Death Certificates Underscore Tobacco Risks

The tobacco industry took another hit last month.

Three years ago, Oregon became the first state to require that death certificates state whether tobacco use was a contributing factor. The first results are in: Doctors reported that 6,276 of the deaths in 1989--about one in four--were related to tobacco products.

Michael Skeels, Oregon Health Division administrator, called the total “shocking and startling” and said tobacco use is clearly Oregon’s “biggest public health threat.”

“This report shows that cigarette smoking causes more premature deaths than automobile accidents, suicides, homicides and AIDS combined,” Skeels said.

Walker Merryman, vice president of the Tobacco Institute, an industry group, said he had not seen the report and could not comment on it. He said that information on a death certificate is unreliable unless supported by an autopsy.

“We don’t know if the physician who signs the certificate is the primary care physician or a coroner or had never seen the patient before,” he said.

Skeels said doctors, asked if tobacco use caused death or was a contributing factor, were given the choice of four answers: yes, no, probably or unknown. Probably and yes boxes were counted in the total, which includes estimates--based on computer models--that 43 infant deaths would be attributable to their mothers’ smoking during pregnancy and 688 adult deaths would be linked to secondhand smoke.

The report also estimated that smoking costs Oregonians $72,400 an hour in medical bills and lost productivity, and that, on average, people who use tobacco die nine years younger than those who do not.

Doctors linked tobacco to deaths from breathing disorders, heart disease, cancer, diseases of the circulatory system, diabetes, pneumonia, influenza and strokes.

In a separate move last month, the Oregon Medical Assn. and the American Lung Assn. began an initiative campaign to raise Oregon’s cigarette tax by 25 cents a pack.

Gordon Dickey of the lung association said the 25-cents-a-pack tax increase California passed in 1988 has helped to reduce smoking rates in that state by 17%.

Some of the revenue from a higher cigarette tax in Oregon would be directed toward anti-tobacco advertising.

“We would love to be able to do that,” said Kathy Gaffney, a physician and deputy health administrator who said she believes cigarette companies are addressing children and teen-agers through the use of billboards and cartoon characters in advertising. “We would like to beat (tobacco companies) at their own game with similar resources.”

The report spelled out the hazards of smoking, from premature wrinkling of the skin to disability and death. It also disclosed that:

* More than 5 billion cigarettes were sold in Oregon during 1989, the equivalent of 2,600 cigarettes for each adult in the state.

* Contrary to the images of youth and success in cigarette ads, smoking is most common among people who are middle-aged, divorced and unemployed. It said that smokers tend to be less educated and have lower incomes than nonsmokers.

* Nearly one in four Oregon mothers smoked during pregnancy.