Progress in Stamping Out Smoking Has Stalled

THURSDAY, Nov. 12 (HealthDay News) -- After decades of progress, the number of Americans who smoke hasn't budged over the last five years and actually rose slightly from 2007 to 2008, according to a new report from the U.S. Centers for Disease Control and Prevention.

Over the longer term, smoking rates have declined. From 1998 to 2008, the percentage of smokers in the United States dropped from 24.1 to 20.6 percent.

However, the report notes that "during the past five years, rates have shown virtually no change," and in fact the percentage of Americans who smoke has begun to creep up again, rising from 19.8 percent in 2007 to 20.6 percent in 2008.

Many experts blame the turnaround on recent cutbacks in funding for state tobacco-control programs, which had proven successful.

"Tobacco is the leading cause of preventable death in the U.S., and we know what to do," said Dr. Thomas Frieden, the CDC director. "We want to provide support to states and localities to implement proven programs, and if we do that, we can save literally millions of lives in the decades to come."

The report is published in the Nov. 13 edition of the CDC's Morbidity and Morality Weekly Report, and arrives just before the American Cancer Society's annual quit-smoking day, the Great American Smokeout, set for Nov. 19.

According to the report, from 2007 to 2008 the number of Americans who smoked remained constant, at about 46 million. Smokers were more likely to be male (23.1 percent) than female (18.3 percent).

The majority of smokers are people who did not graduate from high school, and the lowest rates are among those with a college graduate degree, the report found.

Asian Americans had the lowest smoking rates (9.9 percent), and American Indians and Alaskan Natives had the highest (32.4 percent), the researchers found.

The CDC investigators place much of the blame for the stagnation in smoking rates on states' underfunding of their tobacco-control programs. They point out that from 2000 to 2009, states have received $203.5 billion in tobacco-related revenue. However, less than 3 percent of the funds have been earmarked for tobacco-prevention and smoking-cessation programs in the states, according to the report.

The researchers added that if states were to use just 15 percent of the money they receive from tobacco, they could adequately finance tobacco-control measures at CDC-recommended levels. However, in 2009, no state funds its program to that level, according to the agency.

Frieden noted that in states where tobacco-control programs are supported, "we continue to see a substantial decline" in smoking rates.

"In contrast, too few states are making that kind of progress," he said. "And we are seeing reductions on the spending on tobacco control, despite the fact that we take in, as a country, $25 billion from the Master Settlement Agreement and tobacco taxes. We spend only about 3 percent of that on tobacco control."

Another report in the same issue of the CDC's weekly report examined people's exposure to secondhand smoke, looking at data from 11 states and the U.S. Virgin Islands.

Exposure to secondhand smoke in homes ranged from 3.2 percent in Arizona to 10.6 percent in West Virginia, researchers found. At work, exposure ranged from 6 percent in Tennessee to 17.3 percent in the U.S. Virgin Islands.

In West Virginia, 68.8 percent of the people said they do not allow smoking in their home, as did 85.7 percent of those living in the U.S. Virgin Islands.

"Still, half the people in this country are not protected by comprehensive smoke-free laws," Frieden noted.

The CDC maintains that passing more smoke-free laws and encouraging people not to smoke at home could go a long way toward reducing the danger to nonsmokers from secondhand smoke.

On the plus side, Frieden noted that in 2009, the federal tobacco tax was raised and some states are also raising their tobacco tax. "We know that those increases make a big difference," he said.

In addition, more places are becoming smoke-free, he said. "Going smoke-free not only protects the health of nonsmokers but also encourages smokers to quit," Freiden said.

He added that the U.S. health-care system needs to better encourage people to quit smoking. "If you want to quit, you can double your chances by getting medicine or counseling or both," Frieden said.

Stanton A. Glantz, professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, agreed that underfunded state tobacco-control programs are at the heart of the problem.

"The pro-tobacco forces around the country have used the fiscal mess to justify whacking state tobacco programs," he said. "The tobacco companies are still out there spending around $15 billion a year promoting their products, and the money being spent by public health in de-promoting it has been cut back dramatically."

Glantz's group has also just released a report that takes states to task for allowing film companies to promote smoking in movies -- many of which get state tax breaks and other financial concessions to help with their production.

"Movies are now getting a very large subsidy from state government, adding up to about a quarter of their total production costs, giving the public a really direct interest in those movies," Glantz said. "They are now actually spending more money subsidizing movies that promote smoking than they are spending on their state anti-smoking programs."

As a condition of granting these subsidies, the states should not grant them to films being made for the youth market that promote smoking, Glantz said.

"If these studios are going to be at the trough taking taxpayer's money, they shouldn't be using it to sell cigarettes," he said.

About half the exposure to smoking that children get comes from youth-rated films, he said.

"Smoking in the movies causes kids to smoke," Glantz said. "The more smoking they see in films, the more they smoke."

Many American smokers do want to quit, but a survey of these would-be quitters released Thursday by the American Cancer Society found that many are not well-prepared for the effort it may take.

The survey, involving visitors to the Great American Smokeout Web site, found that 22 percent said they planned to quit over the next 24 hours and 30 percent planned to quit "within a week or two."

The Cancer Society stresses that planning ahead -- getting nicotine replacement aids, for example, and figuring out how to deal with cravings -- is crucial to kicking the habit.

More information

There's more on quitting smoking at the American Cancer Society's Great American Smokeout Web site.

SOURCES: Thomas Frieden, M.D., director, U.S. Centers for Disease Control and Prevention, Atlanta; Stanton A. Glantz, Ph.D., professor, medicine, and director, Center for Tobacco Control Research and Education, University of California, San Francisco; Nov. 13, 2009, CDC, Morbidity and Mortality Weekly Report; Nov. 12, 2009, press release, American Cancer Society