Winnable Battle: Tobacco Use

Tobacco use is the leading preventable cause of disease, disability, and the death in the United States (CDC, 2012). Smoking harms nearly every organ of the body, causing many diseases and negatively impacting the health of both smokers and nonsmokers who are exposed to secondhand smoke. According to the National Institute on Drug Abuse (NIDH), cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. In addition to cancer, smoking causes lung disease such as chronic bronchitis and emphysema and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysms. Smoking also harms and endangers the people who are exposed to smoke without smoking themselves. Nonsmokers who are exposed to secondhand smoke at home or work increase their lung cancer risk by 20–30%. Since 1964, 2.5 million nonsmokers have died from exposure to secondhand smoke.

According to the Center for Disease Control and Prevention (CDC) website (2014) 42.1 million people– 18.1% of all adults ages 18 and older– smoke cigarettes despite the detrimental impact to overall health and appearance. When one in five deaths each year in the U.S. is smoking related, why is it that so many Americans choose to keep inhaling the tar, carbon monoxide and nicotine filled time bomb otherwise known as cigarette smoke (Adult Cigarette Smoking, para. 1)? We can get a better understanding of why some people smoke by looking at contributing social determinants as well as observing the demographics of smokers.

Smoking habits generally develop in the adolescent years or early to mid-twenties, as reported by the CDC (2014) that nine out of ten smokers began smoking by the age of 18, with 99 percent of smokers having their first cigarette by age 26. There are a few factors that may contribute to the high percentage of high school students and middle school students (23% and 7% respectively) who use tobacco. The first is television and media in general: according to the CDC seeing smoking and tobacco use in movies and television can influence youth to use tobacco themselves. Another factor the CDC lists is social proximity to smokers; both as peer pressure and having parents that smoke. This leads adolescents to believe that smoking is an acceptable, possibly even desirable, behavior. One other factor the CDC lists as contributing to adolescent smoking is socioeconomic status. Just as adolescents who come from less well-off families are more likely to be involved in with the criminal justice system, they are also more likely to smoke cigarettes (Youth and Tobacco use, para. 1-5).

This trend continues through to adulthood, with the CDC (2014) stating that 27.9% of adults living under poverty level are smokers (compared to nearly 11% for adults living above poverty level). Tied into socioeconomic status is formal education, and the CDC statistics show that adults with degrees are less likely to smoke than others. Specifically, the CDC reports that 41.9% of adults who obtain only a GED diploma smoke cigarettes, dropping to 9.1% of adults with an undergraduate degree and 5.9% of adults with a postgraduate smoke as well (Adult Cigarette Smoking, para. 4-5).

The scope of this problem has produced many evidence-based program interventions that seek to address the issue of tobacco use. The CDC, through the Office on Smoking and Health (OSH), is the lead federal agency for comprehensive tobacco prevention and control (Smoking &Tobacco Use, 2014). OSH is controlling tobacco use by helping states and communities implement tobacco control programs featuring national and local campaigns and events (National Tobacco Control Program, 2014). One of their most successful campaigns is called “Tips from Former Smokers,” the first-ever paid national tobacco education campaign launched by the CDC in 2012. It features real people and their stories of how their lives have been affected by serious long-term illness as a consequence of smoking and secondhand smoke exposure. The primary audience of this campaign is smokers from age 18 to 54 (Tips from Former Smokers, 2014). It also alerts non-smokers such as parents, family members, adolescents, health care providers, and faith communities that aim to help people quit smoking.

As discussed above, one of the many social determinants of smoking is media. Most populations in the United States watch television every day. The large number of television scenes where tobacco use is associated with desirable traits (bravery, honesty, independence, etc.) make an impact on not only adolescents, but also adults. This campaign is taking advantage of the power of media to raise awareness by launching hard-hitting ads on television, radio, newspapers, outdoor billboard advertisements and many other media sources nationwide. The key messages of this campaign are: 1, smoking causes immediate damage to your body, which can lead to long-term health problems; 2, for every smoking-related death at least 30 Americans live with a smoking-related illness; and 3, now is the time to quit smoking, and if you want help, free assistance is available (Campaign Overview, 2014).

These messages were sent out with graphic scenes of the devastating effects of smoking, as well as heart-touching stories of these former smokers. One particularly memorable ad featured a woman whose name was Terrie. She had cancer as a result of smoking. In the ad, she was describing her life with a raspy voice. She was a former cheerleader. Her father smoked all his life and most of her friends smoked. Under the influence of peer pressure, she started smoking as well. At the age of 40, she was diagnosed with oral cancer and soon after with throat cancer. The doctors had to removed her larynx in order to save her life. Ever since then, she had to speak with the aid of an artificial voice box inserted in her throat. By the end of the ad, the subtitle appeared; reading “Cancer from smoking killed Terrie. She was 53.” The shocking ending was a wakeup call for thousands of smokers. The goals of this campaign are building public awareness of the immediate health damage caused by smoking and exposure to secondhand smoke; encourage smokers to quit and make free help available; and encourage smokers not to smoke around others and nonsmokers to protect themselves and their families from exposure to secondhand smoke. (Tips Campaign Goals, 2014)

This intervention was shown to be effective in September 2013, when The Lancet (a medical journal) published an article about the effects of the 2012 Tips campaign. It reported that the campaign motivated 1.6 million smokers to make an attempt to quit with the result of more than 200,000 Americans quitting immediately after the three-month campaign, an estimate of 100,000 Americans who have quit permanently. This exceeded their initial goal of 500,000 quit attempts and 50,000 successful quits. Also, an estimated 6 million nonsmokers talked with friends and family about the dangers of smoking and referring smokers to quit services (Campaign Overview, 2014) By quitting, former smokers added more than a third of a million years of life to the U.S population (Tips from Former Smokers, 2014). Plans are under way for a new set of “Tips from Former Smokers” to come out within the next year (Campaign Overview, 2014).

The CDC declares an issue a “Winnable Battle” if it meets a few criteria: first, that it be a large-scale health issue; second, that there be interventions capable of addressing the issue already discovered; third, that measurable and rapid positive change can occur on this issue (CDC 2014). We have demonstrated that tobacco use is a large-scale health problem by showing its scope and associated harms. The “Tips from Former Smokers” intervention is an effective intervention which we also discussed. The third facet, of measurable change was presented as a combination of the intervention and the medical journal publication discussing outcomes – all of which occurred over less than 2 years’ time. For all of these reasons, tobacco use is a CDC Winnable Battle.

References

Centers for Disease Control and Prevention. About This Office. (2013, September 20). Retrieved November 29, 2014, from http://www.cdc.gov/tobacco/osh/index.htm

Centers for Disease Control and Prevention. Adult Cigarette Smoking in the United States: Current Estimates. (2014, February 14). Retrieved November 19, 2014, from   http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm

Centers for Disease Control and Prevention. Campaign Overview. (2014, June 19). Retrieved November 29, 2014, from http://www.cdc.gov/tobacco/campaign/tips/about/campaign-overview.html

Centers for Disease Control and Prevention. Campaign Resources. (2014, July 2). Retrieved November 29, 2014, from http://www.cdc.gov/tobacco/campaign/tips/resources/

Centers for Disease Control and Prevention. How can smoking affect your health?. (2014, February 7). Retrieved November 19, 2014 from http://www.cancer.org/cancer/cancercauses/tobaccocancer/womenandsmoking/women-and-smoking-health-effects

Centers for Disease Control and Prevention. National Tobacco Control Program. (2012, November 15). Retrieved November 29, 2014, from http://www.cdc.gov/tobacco/tobacco_control_programs/ntcp/index.htm

Centers for Disease Control and Prevention. Press Release. (2013, September 13). Retrieved November 29, 2014, from http://www.cdc.gov/media/releases/2013/p0909-tips-campaign-results.html

Centers for Disease Control and Prevention. Tips From Former Smokers campaign results. (2014, February 28). Retrieved November 29, 2014, from http://www.cdc.gov/media/dpk/2013/dpk-TIPS-campaign-results.html

Centers for Disease Control and Prevention. Tobacco Use. (2012, November 16). Retrieved November 19, 2014, from http://www.cdc.gov/chronicdisease/resources/publications/aag/osh.htm

Centers for Disease Control and Prevention. Youth and Tobacco Use. (2014, February 14). Retrieved November 19, 2014, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

Drug Facts: Cigarettes and Other Tobacco Products. (n.d.). Retrieved November 30, 2014, from http://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products

Tobacco Control Programs. (2014, February 10). Retrieved November 30, 2014, from http://www.cdc.gov/tobacco/tobacco_control_programs/index.htm