Jan 25 2013
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Danny McGoldrick Q&A: Some Good — and Some Bad — News for Smokers This Week

Two new studies published this week in the New England Journal of Medicine found that smoking remains a very serious public health problem in the United States, but smokers who quit between the ages of 25 and 34 regained nearly the same life expectancy as people who had never smoked.

The study on life expectancy (21st-Century Hazards of Smoking and Benefits of Cessation in the United States) found that, on average, smoking reduces a person's life expectancy by at least 10 years. But smokers can significantly extend their life expectancy by quitting. Those who quit between the ages of 25 and 34 lived about ten years longer than people who didn’t quit. Those who quit between 35 to 44, 45 to 54, and 55 to 64 gained 9, 6 and 4 years of life, respectively.

A second study, on smoking and mortality rates in the United States (50-Year Trends in Smoking-Related Mortality in the United States), found that death rates among female smokers — previously shown to be lower than those of male smokers — have increased and are looking similar to those of men for lung cancer, chronic obstructive pulmonary disease (COPD) and other tobacco-related diseases. The study authors say research has shown a rise in similar smoking patterns among men and women since the 1960s. The second study also found that the death rate from COPD continues to rise among both male and female smokers, while there has been a significant decrease in COPD risk among men who never smoked.

"A plausible explanation for the continuing increase in deaths from COPD among male smokers is that cigarettes marketed since the late 1950s have undergone design changes that promote deeper inhalation of smoke,” according to the researchers, who also note that cigarette design changes may have contributed to an increase in one form of lung cancer (called peripheral adenocarcinomas).

According to the Campaign for Tobacco-Free Kids, tobacco use kills more than 400,000 Americans and results in health care costs for the United States of $96 billion in health each year.

NewPublicHealth spoke with Danny McGoldrick, Vice President for Research at the Campaign for Tobacco-Free Kids, about the new studies.

NewPublicHealth: What’s most important about these two new studies?

Danny McGoldrick: I think they really point out, once again, just how devastating smoking is to smokers. The average smoker loses more than ten years from their lifetime and we know that it causes all of these horrible diseases, so the studies quantify, yet again, just how devastating smoking is to health.

But it clears up some other things and one is that women who smoke like men also die like men. There were some suggestions in earlier data that maybe women’s risks from smoking were slightly lower than men’s, but these studies make clear that women’s health is just as devastated by smoking. So that is something that we all need to be concerned about. The study also shows that the risk of different types of diseases from smoking has changed. That is probably because of actions taken by tobacco companies. We know tobacco companies manipulate the products in ways that can cause new harms or more harm.

But the good news from the research published this week is that quitting smoking, and particularly quitting smoking early, has tremendous benefits. The risks of smoking are greatly reduced if one can successfully quit. Obviously the only way to avoid all the risk is to never start smoking — but if you can quit early and stay quit for the rest of your life, then many of the excess risks of smoking are reduced.

NPH: What are the implications of these studies for policy makers and public health officials?

Danny McGoldrick: Obviously we need to continue doing all the things to prevent people from starting to smoke, because we know how addictive tobacco is and how hard it is to quit. But the enormous benefits of quitting that are documented by these studies show the need for encouragement and help for smokers to quit smoking. We know that 70 percent of smokers want to quit, we know that almost half of all smokers try to quit every year, but a relatively small percentage are able to succeed because of the addictive power of nicotine. So we have to make sure that all smokers have access to the evidence-based interventions that help them quit smoking — primarily counseling and then medications such as nicotine replacement therapy and prescription drugs. They have to have access to these interventions without co-pays. We know that makes a difference.

NPH: What provisions in the Affordable Care Act are aimed at helping smokers quit?

Danny McGoldrick: The Affordable Care Act will require private healthcare plans to include coverage for smoking cessation services. Insurance companies should know that these are not only life-saving measures, but they are cost-saving measures as well. And in addition to access, smokers need to be encouraged to use those services and to try to quit smoking and we know what to do to encourage smokers to quit. And that includes raising prices by increasing tobacco taxes. We know that is one of the best ways to both prevent kids from starting and to encourage smokers to quit. Another way is to pass smoke-free laws which create an environment that not only protects everyone from second-hand smoke, but encourages smokers to try to quit, because they can’t smoke at work or in public places. And it also helps them succeed because there are fewer chances for relapse.

And finally we need to invest in the kind of comprehensive prevention and cessation programs that also encourage people to quit by running media campaigns that educate people about the harms of smoking, motivate them to try to quit, and steer them to quit lines and other resources that can help them succeed in doing so. We need that at the federal level. Last year’s highly successful media campaign from the CDC, Tips from Former Smokers, came from The Prevention Fund of the Affordable Care Act, so we have to protect that fund so that CDC can continue these campaigns. We know the "Tips" campaign doubled calls to quit lines, quadrupled visits to smoking cessation websites and encouraged many other smokers to quit. And states also need to step up their investment in their tobacco prevention programs that encourage and help smokers to quit. Most are not funding anywhere near the level that the CDC recommends, even though they take in all this money from their tobacco settlement dollars and their tobacco taxes.

Tobacco continues to take a devastating toll on our health, but we know what to do about it and if we just put the interventions in place that we know work to help people quit then we will see tremendous benefits in health.

Bonus Link: The U.S. Centers for Disease Control and Prevention today released the Tobacco Control State Highlights 2012, report which looks at strategies implemented in all fifty states and the District of Columbia to reduce tobacco use. According to CDC, while states have made progress, the reduction of tobacco use nationwide has slowed.

Tags: Public and Community Health, Q&A, Tobacco