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 With up to 40 percent of cancer deaths attributable to smoking in
some areas and just 8 percent in others, the disparities may come
down largely to how aggressively states pursue tobacco control,
researchers write in JAMA Internal Medicine, October 24th.
“Declines in smoking prevalence have accelerated over the past seven
to eight years,” lead author Joannie Lortet-Tieulent of Surveillance
and Health Services Research at the American Cancer Society in
Atlanta, told Reuters Health by email.
“However, the decline could have been accelerated much faster with
full implementation of known tobacco interventions throughout the
country such as increased excise tax, banning smoking in all public
places, and reducing nicotine in cigarettes to non-addictive level,”
she said.
The study estimates that at least 28.6 percent of U.S. cancer deaths
in 2014 among people over age 35 were linked to smoking, which
translates to 167,133 lives that might have been saved.
For the new study, the researchers estimated what proportion of
cancer deaths in each state could be attributed to smoking by basing
their calculations on past research showing a smoking-associated
increased risk for 12 cancers: acute myeloid leukemia; cancers of
the oral cavity and pharynx; esophagus; stomach; colorectum; liver;
pancreas; larynx; trachea, lung, and bronchus; cervix uteri; kidney
and renal pelvis; and urinary bladder.
Combining that with state-specific smoking prevalence data, they
found that the portion of smoking-related cancer deaths among men in
2014 ranged from a high of 39.5 percent in Arkansas to a low of 21.8
percent in Utah. With the exception of Utah, the proportion was at
least 30 percent for men in all states.
Among women, 11 percent of cancer deaths in Utah were attributable
to cigarette smoking, compared to 29 percent in Kentucky, and the
proportion was at least 20 percent in every state except Utah,
California and Hawaii.
“We knew that some states have higher tobacco control and higher
funding for anti-smoking programs than others, but we did not
anticipate that would be a doubling between the state with the
lowest fraction and the highest fraction of smoking-attributable
cancer death,” Lortet-Tieulent said.
More than half of the top-10 ranked states for smoking-related
cancer deaths among both men and women were located in the South.
For men, the top five states were Arkansas, Louisiana, Tennessee,
West Virginia and Kentucky. For women, Kentucky, Arkansas and
Tennessee were also in the top five, along with Alaska and Nevada.
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Southern states generally have more current and former smokers and
weaker tobacco control policies, such as lower excise taxes and less
comprehensive smoke-free policies, Lortet-Tieulent said. In
addition, for middle aged people, current and former smoking is more
common for men than women.
“Many of the stalled states are in the southeastern United States,
where tobacco has traditionally been grown and manufactured, and
others are in areas with historically little investment for public
health or tobacco control,” Kurt M. Ribisl of the University of
North Carolina at Chapel Hill and colleagues write in a related
commentary.
After New York City raised the cigarette excise tax from $0.08 to
$1.50, banned smoking in bars and restaurants, and offered free
nicotine replacement patches in 2002 through 2003, smoking decreased
by about 11 percent in the City, equivalent to about 140,000 fewer
smokers, they write.
About three-quarters of smoking-related cancer deaths are due to
lung cancer, Lortet-Tieulent noted.
“The risk of lung cancer death gradually reduces after smoking
cessation but does not reach to the level among never smokers,” she
said. “Nearly all the excess risk of death from lung cancer can be
avoided if a smoker quits smoking before the age of 40 years.”
“Increasing tobacco control funding, implementing innovative new
strategies, and strengthening tobacco control policies and programs
all contribute to increase smoking cessation and avoiding smoking
initiation,” she said. “For example, California, Hawaii and 145
smaller localities have increased the tobacco sales age to 21 years.
Likewise, communities across the U.S. have passed laws that limit or
prohibit smoking in multifamily housing.”
SOURCE: http://bit.ly/2eArcSx and http://bit.ly/2f9Gu4f
JAMA Intern Med 2016.
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