Although smoking rates have decreased in the United States, smoking is still a significant contributor to cancer and is responsible for nearly 4 in 10 cancer deaths in some areas.
The finding comes from a study that looked at geographic differences in the United States and found that the highest proportion of smoking-related deaths were in the South and Appalachians.
"This largely mirrors the historically weaker state and local tobacco control policies and programs in these areas, including low cigarette taxes and weak comprehensive smoking-ban laws and tobacco cessation programs," commented study author Farhad Islami, MD, PhD, Scientific Director, Cancer Disparity Research, American Cancer Society, Atlanta, Georgia
The study was published online January 26th in Cancer Causes & Control.
For their study, Islami and colleagues examined the proportion of cancer deaths caused by smoking cigarettes from 2013 to 2017 in 152 statistical metropolitan areas (MMSAs) in the United States.
The percentage of cancer deaths caused by cigarette smoking ranged from 8.8% in Logan, Utah-Idaho, to 35.7% in Lexington-Fayette, Kentucky. But even with this large variation, at least 20% of all cancer deaths were due to smoking cigarettes in 147 of 152 MMSAs.
The smoke-related percentage of smoking-related cancer deaths (or the population-related percentage (PAF)) varied not only across the United States, but across regions and states. In the northeast, for example, the PAF was between 24.2% and 33.7%; and in the same state of Texas, the Wichita Falls PAF was 1.5 times higher than the El Paso PAF.
The data show that the proportion of cancer deaths from cigarette smoking was higher in men than in women in all of the MMSAs assessed. For men, the PAF ranged from 11.7% in Provo-Orem, Utah to 43% in Florence, South Carolina. For women, it ranged from 5.2% in Logan, Utah-Idaho, to 31.7% in Panama City, Florida.
While the article did not address the reasons for the nationwide differences, one factor is unequal implementation of cigarette tax rates and other tobacco control initiatives, the authors say. For example, the high total excise tax in New York City ($ 1.50 per box on top of New York State tax of $ 4.35 per box) may contribute to a lower rate of smoke-related cancer deaths in New York-Jersey City-White in the Plains Metropolitan Division in the Plains Metropolitan Division Compared to other areas of New York State and the Northeast.
"Raising the price of tobacco products through excise taxes is the most effective measure to reduce the prevalence of smoking," said Islami. Although the state cigarette tax rate is $ 4.00 per pack or higher in Washington DC, Rhode Island, New York, and Connecticut, it is still below $ 1.50 per pack in 23 states, 19 of which are in the South and Midwest .
Islami added that the varying proportions of low-income people – who are more likely to smoke – may also contribute in part to higher cancer mortality rates in some areas. "However, previous studies have shown that for the same socio-economic group, state-level smoking prevalence is much lower in the Northeast and West as tobacco control policies are historically stronger."
Other measures such as smoking bans laws, bans on advertising and promoting tobacco products, media campaigns against tobacco use, and counseling and treatment for tobacco addiction have been shown to reduce smoking, he said.
"It should be noted that only a relatively small proportion of current smokers receive tobacco counseling or pharmacotherapy," he said. "Increasing health insurance coverage, including through the expansion of Medicaid, and fully incorporating these preventative measures into health insurance plans could improve successful smoking cessation."
Islami also noted that although this study did not take into account the tobacco industry's influence on smoke-related cancers, previous studies have shown that historically there has been strong political opposition to tobacco control policies in tobacco-growing countries, largely due to the influence of the industry.
The study was supported by the Intramural Research Department of the American Cancer Society. Islami is an employee of the American Cancer Society and has no further information.
Cancer causes & control. Published online 26 January 2021. Executive summary
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