Who is smoking now and why is it important

Suppose that you are told that there is something responsible in the death of about one in five Americans and that this is completely preventable. Would you believe – today – that "something" is the cigarette?

If you graduated, you might not believe it. You do not smoke. Your friends and colleagues do not smoke. You never see smoke in your workplace or in the restaurants and bars you frequent. Like many of the country's most educated citizens, you may consider that the problem of smoking is largely solved. Given that the educated population is also the most politically engaged, smoking has virtually disappeared from the country's health policy agenda.

I do not smoke, although, like many of you, I was one (45 years ago, in my case). As a student of tobacco control policy for more than 40 years, I have been instrumental in documenting the remarkable progress we have made in the fight against smoking. But I also understand why smoking remains the most preventable cause of disability and premature death in our country. The lack of attention given by policies to smoking is a public health tragedy.

The good and the bad news

No one can deny the extraordinary victories against smoking. Since the Surgeon General's 1964 report on tobacco and health, the prevalence of adult smoking has declined by two-thirds from 43% to 14%.

The decrease in youth has been even more substantial. For example, since smoking peaked among high school students 20 years ago, the prevalence of smoking over the past 30 days has fallen by almost 80%.

Under the impulse of tobacco control initiatives, Americans decided not to start smoking, but to avoid starting with 8 million premature deaths from 1964 to 2012. The Centers for Control and disease prevention consider tobacco control as one of the top 10 achievements of the 20th century and the first decade of the 21st century.

This is the good news. The bad news is that 1 in 7 adults still smoke. And smoking kills nearly 500,000 Americans each year. This number exceeds – by far – the sum of all deaths caused by opioids and other drugs, alcohol, traffic accidents, homicides, suicides, HIV / AIDS and fires.

Who's smoking now? The role of education

What explains the divergence between common perceptions about smoking and the sad reality? To a large extent, there are remarkable changes in smoking. More and more smokers are those with low levels of education, low income, and most importantly, higher incidence of mental illness.

Consider this: In 1966, the smoking rate of Americans who did not graduate from high school was just 20% higher than that of college graduates. In 2017, by contrast, the prevalence of smoking among the least educated was almost four times higher than that of the most educated.

Smoking has declined dramatically at both ends of the education spectrum, but has a much higher degree among college graduates: half in Americans without a high school diploma, but 85% among college graduates. college graduates.

For college graduates, the smoking rate in 2017 was extremely low. For those who do not have a high school diploma, and in fact for high school graduates, at least one in five remains a smoker. The difference matters. Research badigns a fifth to a third of a large difference in life expectancy related to education to differences in smoking.

Money matters

A trend similar to tobacco consumption concerns income clbades, which are themselves strongly correlated with education. According to the latest data, Americans living below the federal poverty line were three times more likely to smoke than those whose income was at least 400% above the federal poverty line. The gap has widened since the early 1990s.

The life expectancies between the richest and poorest citizens of the country are enormous. Smoking is again an important factor in this disparity.

Mental health too

An extremely important factor in current smoking is that the prevalence of smoking among people with severe mental illness is more than double that of the unaffected population (28% and 13%, respectively, in 2014). People with mental health problems or substance use disorders make up a quarter of the US population but consume 40% of all cigarettes smoked. They have more difficulty quitting.

Fees differ according to mental illness. In 2007, almost 60% of schizophrenics smoked. That was three times the rate of the general population. Smokers in severe psychological distress lose 15 years of life expectancy. Non-smoking victims of the SPD lose five years. Research has thus attributed two-thirds of the reduction in the life expectancy of DPS smokers to cigarette consumption.

Sexual orientation, race and ethnicity

Smoking also disproportionately affects members of the LGBT community. Among racial / ethnic groups, American Indians and Native Americans of Alaska had the highest smoking rates in 2016, while Americans of Asian origin and Pacific Islands were the lowest rates.

In general, women smoke much less than men. The exceptions are Amerindians / Alaska, among whom women have a slightly higher smoking prevalence than men, and non-Hispanic whites, of whom men smoke at slightly higher rates.

Marginalized smokers

As these data indicate, the main victims of smoking are members of marginalized populations. Despite the continuing importance of smoking in the health of the United States, the problem is fundamentally wrong. Smoking no longer affects the country's most economically advantaged population, and those who are the burden of it lack an effective voice in the country's political life.

In addition, smokers tend to blame themselves for their behavior.

In fact, smoking is a stubborn addiction, which the vast majority of smokers have acquired in their youth. They were helped in this task by a stingy tobacco industry that sold aggressively to young people. The children were referred to as "replacement smokers". New smokers had to replenish the industry's customer base while its most loyal customers succumbed to diseases caused by tobacco.

Restoration of tobacco control in the country's public health program

What can be done? The simple – and incomplete – answer is "more of the same". Public education has helped to reduce smoking, as have policy interventions: cigarette taxation, smoke-free workplace laws, ban advertising and promotion of anti-tobacco products and campaigns. the media. Evidence-based anti-tobacco treatments can also help. Interventions must increasingly target specific high-risk groups.

These evidence-based measures are unlikely to be sufficient. A potentially complementary tool may lie in a recent controversial development: the emergence of electronic cigarettes. New, reduced-risk nicotine delivery products, such as e-cigarettes, may be an alternative to smoking, particularly for smokers who are otherwise unable to quit smoking.

Vaping could help a significant number of Americans quit smoking. The risks of vaping are much lower than those of smoking. At the same time, however, there is concern about the attractiveness of e-cigarettes for youth and the uncertainty about the long-term health effects of vaporization.

Although the ultimate effects of e-cigarettes and other new unburned tobacco products remain to be demonstrated, it is generally accepted that it is the burning of tobacco – mainly in the form of cigarettes, with its 7,000 chemicals – which is by far the most lethal method of consuming tobacco.

Despite the tremendous success of tobacco control, smoking remains the No. 1 enemy of public health. Today, the burden of smoking is greatest on marginalized populations – the poor, the low educated, and those with mental health problems. A compbadionate public would resume the fight against smoking with vigor never seen in decades.

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