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NAQC Newsroom: Tobacco Control

Does data matter? What CDC’s new report on smoking in the U.S. means for our road ahead as tobacco c

Thursday, January 18, 2018  
Posted by: Natalia Gromov

Dear Colleagues,
Today (January 18), the CDC published new data on the prevalence of smoking in U.S. adults, noting that although we are making progress towards the national goal of 12% adult smoking prevalence, the prevalence varies greatly by region of the country and economic status, taking the greatest toll among those of us who are the poorest, the least educated, the most vulnerable, with little access to preventive services and health care. Cigarettes continue to result in about 480,000 premature deaths in our country every year. We can expect nearly half a million of our fellow residents to die as a result not only of their smoking behavior but also of a very deadly product that has scant government restrictions and regulations. Does this data matter?
During a long-ago course on business law, a guest lecturer touted cigarettes as a great investment – you can make them for a penny, sell them for a dollar, and they are addictive! The early 90’s were a different time, but still, I don’t think a law school guest lecturer would have spoken such words about heroin, opioids or other addictive substances (which, for comparison purposes, resulted in a total of about 64,000 overdose deaths in 2016). Why the difference? Does the legal status of the product drive our perception of the product and our decisions about whether to use the product or how much time and effort to spend trying to convince a friend or sibling not to use the product? Does the profit of the tobacco industry diminish government interest, especially legislators’ interest, in restricting sale of a product that is the leading cause of premature deaths in the country? What more can we do to give voice to our data and make the case for action?
Consider the findings revealed in the CDC’s report. The differences in smoking rates among important segments of the U.S. population demands that we consider ways to improve equity in the cessation activities we offer as well as more generally in education, health care, and community resources:

  • By age group, current cigarette smoking was 13.1% among those 18-24 years old, 17.6% among those 25-44 years old, 18.0% among those 45-64 years old, and 8.8% among those 65 years old and older.
  • By race/ethnicity, current cigarette smoking was 31.8% among American Indian/Alaska Natives, 25.2% among multi-racial adults, 16.6% among whites, 16.5% among blacks, 10.7% among Hispanics, and 9.0% among Asians.
  • By education level, current cigarette smoking was lowest among those with an undergraduate (7.7%) or graduate degree (4.5%), and highest among those without an undergraduate/graduate degree (24.1% among those with 0-12 years of education and no diploma, 40.6% among those with a GED, 19.7% among those with a high school diploma, 18.9% among those with some college education but no degree, 16.8 % among those with an Associate degree).
  • By poverty status, current cigarette smoking was 14.3% among those living at or above the poverty level, 25.3% among those living below the poverty level, and 12.0% among those whose poverty status was unspecified.
  • By U.S. region, current cigarette smoking was 13.3% among those in the Northeast, 18.5% among those in the Midwest, 16.9% among those in the South, and 12.3% among those in the West.
  • By health insurance coverage, current cigarette smoking was 11.8% among those with private insurance, 25.3% among those with Medicaid, 10.2% among those with Medicare only, 19.8% among those with other public insurance, and 28.4% among those uninsured. [Question from Linda: Why is it that the largest health insurer in the country, Medicaid, has nearly as high a prevalence of smoking among its members as among the uninsured?]
  • By disability/limitation, current cigarette smoking was 21.2% among those with a disability/limitation and 14.4% among those with no disability/limitation.
  • By sexual orientation, current cigarette smoking was 15.3% among those who are straight and 20.5% among those who are gay, lesbian, or bisexual.
  • By serious psychological distress, current cigarette smoking was 35.8% among those with serious psychological distress and 14.7% among those with no serious psychological distress.

The CDC report highlights that proven public health interventions, including tobacco price increases (through state and federal excise tax), comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest prevalence rates.
As a final thought, I would like to circle back to the idea of legislation and regulation, two important tools for public health, and ask whether we have fully explored the use of these tools with regard to cessation.  Here are a few ideas for reflection:

  • Are we supporting FDA as much as we should with regard to its activities to regulate tobacco and its consideration of a continuum of harm reduction for smokers?Are we sharing data and ideas with FDA staff? Are we submitting public comments?
  • Medicaid presents the biggest opportunity and challenge we have in tobacco cessation. We have been trying to improve the program one state at a time. Is there a way to use federal and state legislation to improve the system as a whole (ie, CMS administration as well as state programs)?
  • It is unfortunate indeed that the federal funding source for many cessation interventions – the Prevention and Public Health Fund – is slated to be reduced by $750 million dollars over the next few years.Such a reduction to this important funding source is likely to result is fewer state and local interventions being implemented rather than more. Can we present a better case for the importance of tobacco cessation activities to national legislators?
I ask that you consider the data and analyses in CDC’s new report and their implications for our path ahead as tobacco cessation professionals. The data doesn’t speak for itself but we can use it to make a case for adequately funded and effective services for those we serve.
To read CDC’s report, click here.
Linda Bailey
President and CEO

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