Cigarette smoking can be blamed for at least 167,133 cancer deaths in the U.S. in a single year, according to a new report.
That's more than the total number of people who will attend the first four games of the World Series in Cleveland and Chicago. It's also more than the entire population of Salem, Ore.
These are only the deaths due to the 12 categories of cancer that the U.S. Surgeon General blames on smoking (a list that includes cancers of the lung, trachea and bronchus; the oropharynx; the esophagus; the larynx; the stomach; the bladder; the kidney and ureter; the pancreas; the cervix; the colon and rectum; the liver; and acute myeloid leukemia).
The National Cancer Institute says smoking also causes cancers of the mouth and throat.
And that's just cancer. Smoking is also responsible for nearly one-third of deaths due to coronary heart disease, and it causes chronic obstructive pulmonary disease, diabetes and rheumatoid arthritis, among other ailments, according to the Surgeon General.
The new national estimate on smoking-related cancer deaths in 2014 comes from researchers at the American Cancer Society. They used data from the Centers for Disease Control and Prevention to tally the death toll in each of the 50 states, plus the District of Columbia.
For each state, they combined statistics on the prevalence of current and former smokers — broken down by gender and age group — with statistics on the degree to which cigarettes are to blame for various kinds of cancer deaths.
What they found was wide variation in the proportion of cancer deaths that can be traced to cigarette smoking. It ranged from a low of 16.6% in Utah (where smoking is eschewed by Mormons) to a high of 34% in Kentucky. The average for all states was 29%.
Seven of the states in the top 10 were in the South: Kentucky, Arkansas, Tennessee, West Virginia, Louisiana, Alabama and Oklahoma. (The other three were Alaska, Missouri and Nevada.) Not coincidentally, 95% of tobacco grown in the U.S. is produced in Southern states.
The researchers drew a straight line between the tobacco industry's influence and the "weaker tobacco control policies and programs" in the South, resulting in a higher prevalence of smoking there. For instance:
Among the 21 states with anti-tobacco spending that is less than 10% of the amount recommended by the CDC, eight are in the South (Alabama, Georgia, Kentucky, North Carolina, South Carolina, Tennessee, Texas and Virginia).
Among the 14 states with the fewest restrictions on indoor smoking, nine are in the South (Virginia, West Virginia, Kentucky, South Carolina, Georgia, Alabama, Mississippi, Texas and Oklahoma).
The average cigarette excise tax in “major tobacco states” is 49 cents, compared with an average of $1.80 in other states. Taxes that make cigarettes more expensive are among the most effective anti-smoking policy tools available, the study authors noted.
Demographic factors are also at play. Americans who never attended college are up to four times more likely to smoke than Americans who are college graduates, and residents of the South have less education than people in other parts of the country.
In addition, African Americans — a group for whom 27.2% of cancer-related deaths can be blamed on smoking – are more likely to live in the South, while Latinos – for whom 19.8% of cancer deaths results from smoking — are underrepresented there.
The analysis revealed a significant gender gap in tobacco's contribution to cancer mortality. Nationwide, 34% of cancer deaths in men were due to smoking, compared with 23% of cancer deaths in women.
That gender gap is a reflection of the fact that smoking has historically been more prevalent among men than women, but those figures could converge in the future, the study authors wrote. Indeed, they noted that in South Dakota, Montana and Arkansas, the prevalence of smoking is already higher in women than in men.
After Utah, California had the second-lowest percentage of cancer deaths related to smoking, at 25.5%. However, due to the state's huge size, it was home to the most victims (57,547 in 2014 alone).
The results were published online Monday in JAMA Internal Medicine.
The researchers found plenty of shortcomings in states' efforts to reduce smoking. Only one state — North Dakota — meets the CDC's target for funding anti-tobacco programs.
Instead of lamenting this fact, the researchers focused on the "potential to avert many more premature deaths" by implementing some basic policies. Among them:
States could discourage smoking by raising cigarette taxes. The World Health Organization recommends that taxes account for 75% of the total price of cigarettes, and none of the states (or the District of Columbia) currently meets this goal.
Only one-third of states have laws that prohibit smoking in all public places. The other two-thirds of states could join them.
Connecticut, Indiana, Massachusetts, Minnesota, Nevada, Pennsylvania and Vermont are the only states with Medicaid programs that provide “comprehensive coverage” for smoking cessation services. The rest of the country could follow their lead.
With 40 million Americans still smoking cigarettes, there's still work to do. In a commentary that accompanies the study, a trio of public health experts said the 10 states with the highest proportion of smoking-related cancer deaths should be a priority for stronger anti-tobacco policies and funding.
Government action can make a real difference, they wrote. In New York City, they noted, measures that banned smoking in bars and restaurants, raised the cigarette excise tax from eight cents to $1.50, and made nicotine replacement patches free to those who wanted them reduced the number of smokers there by about 140,000.
But in most parts of the country, anti-smoking efforts have stalled. The federal government could try to jump-start the process by withholding tobacco control funds from states with "weak" policies, the trio suggested. This, they wrote, is how the feds persuaded states to raise the legal drinking age to 21.
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