Despite high taxes, an advertising ban, a tsunami of medical evidence, more than $200 billion in tobacco settlement money for smoking secession programs, and the pariah status of public smokers, one-fifth of U.S. adults still light up, according to new data in the CDC's 2008 National Health Interview Survey.
The survey found that 20.6% of American adults—46 million people—smoke cigarettes, essentially unchanged from the 20.9% of Americans who said they smoked in 2004. The CDC says smoking is the leading preventable cause of death, kills more than 443,000 people every year, and costs the nation $96 billion annually in healthcare costs. The discouraging results of the survey were released as the American Cancer Society prepares to hold its annual Great American Smokeout on Thursday.
"Today tobacco will kill more than 1,000 people, but we can reduce smoking rates," said CDC Director Thomas R. Frieden, MD, in a media release announcing the findings. "We must protect people from second-hand smoke, increase the price of tobacco, and support aggressive anti-tobacco campaigns that will reduce smoking and save lives. If every state had smoking rates similar to places which have implemented effective programs, there would be at least 10 million fewer smokers in the U.S., and millions of heart attacks, cancers, strokes, and deaths would be prevented."
According to the study, the people hardest hit by the tobacco epidemic are those among vulnerable populations, including people with lower levels of education. In 2008, 41.3% of people with a general education development certificate smoked cigarettes, compared to 5.7% of people with a graduate degree.
Another study in last week's CDC Morbidity and Mortality Weekly Report reports that smoking prevalence was highest in West Virginia (26.6%), Indiana (26.1%), and Kentucky (25.3%), and lowest in Utah (9.2%), California (14%), and New Jersey (14.8%).
CDC also reported significant variation among 11 states in the proportion of adults protected by smoke-free workplace policies and the proportion of adults who protect themselves and their families from secondhand smoke in their homes. Smoke-free laws in public places encourage people to adopt smoke-free policies in their homes, according to CDC.
In the 11 states examined, home exposure varied widely from 3% of adults exposed in their homes in Arizona to 10.1% and 10.6%, respectively, in Mississippi and West Virginia. Two-thirds of smokers in Arizona live in households where smoking is not allowed in the home, compared to 41% and 36% in Mississippi and West Virginia.
Nationwide, 21 states and the District of Columbia have implemented smoke-free laws covering workplaces, restaurants, and bars, but more than half of the country still lives in areas without comprehensive smoke-free laws, CDC reported.
"Despite states having received more than $200 billion in tobacco-generated funds over the past 10 years, many Americans—particularly those with low educational attainment levels, and those who work in the hospitality, service, and other industries are exposed to smoke in their workplaces, and they do not have equal access to the support needed to help them quit," Matthew McKenna, MD, director of CDC's Office on Smoking and Health, said in the media release. "We need to make the investments so all people receive the same protections and adequate information to help them quit successfully."
The MMWR report also found that smoking rates among low-income adults enrolled in Medicaid programs are much higher than the general population (33% vs. 19%), and that only six Medicaid programs provided full access to all proven means to help smokers quit.