In this space, we have explored some real conspiracies, using as an example the tobacco companies’ war on truth. Smoking, and smoking-related disease, continues to be a significant burden on the health of Americans. For example, chronic obstructive pulmonary disease (COPD) affects between 10-25 million Americans. This disabling illness, which includes emphysema and chronic bronchitis, is horrifying to watch, and worse to experience. Smoking is also one of the strongest risks for heart disease which kills over half-a-million Americans yearly.
But it seems that smoking is on the decline, at least in my rarefied world of home/office/hospital. Even as I go to the coffee shops, book stores, and restaurants around town, I see very few smokers. So it was a shock when I arrived here in Key West on vacation that I found everyone smoking—not just at the bars and open air restaurants, but a huge number of people just walking down the street. What gives?
Now, I obviously haven’t done any actual counting or data collection—it’s my vacation, after all. But I couldn’t help observing. I started listening for accents, observing manner of dress, looking for any clues to a pattern. The most obvious pattern is that it’s everyone else’s vacation too. I presume (and hope) that they aren’t all drunk every night at home as they are here. But smoking tends not to be just a “vacation thing”. One thing my wife and I both noticed was that there are a lot of young (to us) people around, perhaps having just finished the semester at college. The other thing we both noticed was a high percentage of Southern accents, which shouldn’t perhaps surprise anyone in the Southernmost city in the continental U.S. I pulled up some stats (I love the CDC!). In 2006, smoking rates in Michigan and Florida weren’t that different (21% vs. 22.4%). The highest rates are in Kentucky and Tennessee. Georgia, one of Florida’s immediate neighbors, was only 20%. Another nearby state Mississppi, is way up there at almost 30%. Hmm…no clear pattern here.
OK, let’s check age: 18-24 years (23.9%), 25-44 years (23.5%), 45-64 years (21.8%), and 65 years or older (10.2%). Until you hit the “elderly” category, rates are about equal (which could be partly explained by smokers dying early). Well, looking out on the street, I’m not surrounded by older folks.
OK, let’s check ethnicity. Looking out the window and listening to voices, most folks appear to be Anglo, followed by Latino, witha few African Americans, Haitians, and others. According to the CDC, rates are highest in Native Americans, followed by African Americans. Maybe my observations aren’t worth too much.
But wait, here’s the real news:
Cigarette smoking estimates are highest for adults with a General Education Development (GED) diploma (46.0%) or 9-11 years of education (35.4%), and lowest for adults with an undergraduate college degree (9.6%) or a graduate college degree (6.6%).
Cigarette smoking is more common among adults who live below the poverty level (30.6%) than among those living at or above the poverty level (20.4%).
I have no idea what the education level of the people around me is right now, but I can be pretty sure it isn’t what I’m used to. Almost all of my friends have a college degree, and most have a post-graduate degree of some sort.
So it is, after all, all about me. I do live in a rarefied world of highly educated non-smokers.
But why are those least able to afford it doing the most smoking? I’m a doctor but there’s no way I could budget in a pack-a-day habit.
Yes, yes, it’s terribly addictive, but that’s not the whole story. I’m sure this has been studied, but from my little perch treating the individual distasters wrought by smoking, I see a lot of factors. For one, lot’s of workplaces forbid smoking. If you want to keep your job, you have to severely limit or quit your tobacco use. At my own hospital, there was a long campaign to help people quit before the campus went smoke-free.
In surveys, smokers have reported many factors:
* Smoking may reduce stress, anger and anxiety or “nerves.”
* It can lessen boredom, depression and help one deal with pain.
* It can help someone have more energy and feel more relaxed.
* For some people, smoking helps them control their weight.
* It also can improve learning and memory and help one stay alert.
This certainly helps explain some things. Poor and unemployed people have serious existential worries—getting food, keeping a home, staying safe. Smoking may help allay some of these fears and anxieties. Of course, it’s also horribly expensive and bad for you.
We’re doing a terrible job. We are enabling our most vulnerable to continue smoking. Fighting tobacco and tobacco-related diseases requires fighting poverty and improving education. It’s a societal problem as much as an individual problem.
Let’s get to it.