Healthy Choices

Smokers hold out for habit despite public pressure, taxes

Although it’s a brisk 14 degrees Monday in Walla Walla, Wash., Macy’s employee Terri Lei Cosgrove, 55, enjoys a work break in the sunshine to reflect and enjoy a hot cup of coffee and a quick smoke..
Although it’s a brisk 14 degrees Monday in Walla Walla, Wash., Macy’s employee Terri Lei Cosgrove, 55, enjoys a work break in the sunshine to reflect and enjoy a hot cup of coffee and a quick smoke.. Walla Walla Union-Bulletin

Perhaps the reason Mark Twain is so often quoted on quitting smoking is that his wry words ring all too true for so many smokers, former and current.

“Giving up smoking is the easiest thing in the world,” Twain said. “I know, because I’ve done it thousands of times.”

Dana Applegate has been there. Standing outside the Senator Hotel office building across from the Capitol on Tuesday, Applegate, 51, said she would not be joining Thursday’s Great American Smokeout, a national event in which smokers are urged to refrain for a day each November.

“The Great American Smokeout?” Applegate said. “Not for me. Not this year.”

Not even a case of pneumonia some years ago – so severe that Applegate felt like an elephant had settled on her chest – prevented her from resuming her cigarette habit.

“It’s a disgusting habit and I don’t like smelling like cigarettes,” Applegate said, between frequent puffs while on break from her job as a political pollster. “But it’s the only vice I have. I’m so stressed I can’t even think about the hazards to my health, the way life is right now.”

All in all, a combination of sin taxes, public education and shifting societal norms has driven down smoking rates nationwide in the past few decades. Today, in California, about 12percent of adults smoke, lower than the national rate of 18.1percent. But the state rate hasn’t budged much in the last three years. Many hardcore smokers, it seems, are having a hard time kicking the habit. And some young people are still picking it up.

A coalition of health advocacy groups says increasing taxes on cigarettes will shock more people into quitting, thereby lowering health care costs and saving taxpayer dollars. Dubbed Save Lives California, the coalition comprises the American Lung Association, the American Cancer Society, the California Hospital Association, Health Access California and other organizations.

“Prevention is the best medicine when it comes to tobacco-related diseases,” said Dr. Richard Thorp, past president of the California Medical Association. “As California has shown before, prevention is possible.”

On Thursday, coalition leaders unveiled a proposal to impose a $2 tax on a pack of cigarettes through legislation or a ballot initiative. Sticker shock, they said, may save approximately 100,000 lives per year and persuade young people not to become longtime smokers.

Opponents argue that the tax will disproportionately target the poor. Smoking cessation researchers say low-income Americans are the ones having the hardest time quitting.

Applegate, for one, is coping with the loss of economic stability. During the recession, she lost the job she loved, helping people negotiate health insurance coverage. Just like that, there went her house, her savings and her peace of mind. Her current salary is just two-thirds of what she made before. Home is now somebody else’s spare bedroom.

Cigarettes help calm her, she said. When that nicotine hits the receptors in her brain, she relaxes a little.

Kenneth Warner, a professor of public health at the University of Michigan, penned an article in The Atlantic called “The Nicotine Fix.” In it, he and a colleague argued that while the nation’s cigarette addiction may be waning, low-income Americans continue to smoke, and die, at alarming rates.

“The tobacco industry has been so effective at saying, ‘Oh, sure, smoking is bad for you but so is everything else,’” Warner said. “So if you are part of a largely blue-collar group that accepts smoking as a social norm and doesn’t understand the nature of health hazards beyond lung cancer, you may continue to smoke because everyone around you does,” he said.

California, which launched the Great American Smokeout in 1976, was an early adopter of smoking cessation campaigns. Now, however, the state’s tobacco tax rate ranks 33rd in the country.

A pack of cigarettes now sells for about $6 in California, according to The Awl, a current events website in New York that tracks cigarette prices in all 50 states. That compares to a low of $5.25 in Missouri and a high of nearly $13 in New York.

Tobacco tax supporters say state budget figures show that California’s taxpayers spend an estimated $13.29billion annually through Medi-Cal to treat tobacco-related diseases ranging from heart disease to lung cancer.

Today, the question of who becomes a lifelong smoker correlates tightly with a person’s level of education.

In 2011, only 7.5percent of college graduates smoked, Warner said. That’s a decrease of 78percent since 1966, shortly after the U.S. surgeon general warned Americans that cigarettes can kill.

Over the years, California has pressed its population to quit smoking mainly through taxes that make cigarettes more expensive and by spending part of the tax revenue on public interest campaigns. Bit by bit, lawmakers also have reduced the footprint where smokers can light up by banning cigarettes from workplaces, bars, restaurants, playgrounds, schools and health facilities.

But critics, including the American Lung Association, note that California lawmakers have declined to raise taxes on cigarettes since 1999, when a 37-cent-a-pack tax was increased to 87cents. And not all of that cigarette tax revenue directly funds no-smoking programs. Ten percent is diverted to the state’s general fund, the lung association said.

Smoking cessation advocates say more needs to be done to battle the health hazards of cigarettes. Lately, advocates have broken up into two camps: those who want out-and-out radical abolition of cigarettes through prohibition, and those who seek a middle ground through what’s now called tobacco harm reduction.

The latter group includes Warner, who concedes it took him four tries before he was able to shake off the nicotine fix. These advocates acknowledge that nicotine is highly addictive and that some users may not be able, or may not want, to stop using tobacco products. They tend to promote alternative tobacco products such as e-cigarettes, smokeless tobacco and other forms of noncombustible tobacco.

According to Warner, lighting up a cigarette and inhaling its estimated 7,000 chemicals, including arsenic, hydrogen cyanide and polonium-210 (used in the widely publicized poisoning of an ex-Russian spy in recent years) accounts for the vast health damage done by tobacco use.

“If you light up anything, any plant leaf, and inhale, you are letting substances reach your lungs that have no business being there,” he said.

In his article, Warner calls attention to Sweden’s dramatic success in reducing lung cancer death rates. Currently, the U.S. Food and Drug Administration is reviewing for approval a Swedish tobacco product called snus (pronounced snooze).

Decades ago, Swedish Match, a cigarette manufacturer in Sweden, stopped producing cigarettes and developed the smokeless tobacco product that users tuck inside their cheek. Snus is a tiny tea-bag-like product filled with moist, refrigerated, unadulterated tobacco.

Refrigeration prevents the tobacco from fermenting, a process American tobacco growers use to dry the leaves that produces a flavorful cigarette but one laced with a natural carcinogen that is not present in the moist, refrigerated tobacco.

When the Swedish government heaped higher taxes on cigarettes but kept the price of snus low, men switched to the smokeless tobacco product. Today an estimated 30percent use snus, and, as a result, Sweden now boasts Europe’s lowest male lung cancer death rate.

Swedish women, who consider smokeless tobacco a man’s product, still have cigarette smoking rates – and tobacco-related death rates – similar to those of females in the rest of the European Union.

Whether such a variation on a tobacco product receives FDA approval and is embraced by the American market remains an open question.

As the debate over how to drive down smoking rates continues, some longtime smokers voice little optimism that they’ll quit soon, even as nonsmoking regulations continue to limit where and when they are permitted to light up.

Doris Burke, 56, or Sacramento, said she believes she needs to quit because she is growing older and fears developing health problems.

“Actually I want to quit,” Burke said. “No, actually I need to quit because of my age. But I still enjoy it.”

Call The Bee’s Cynthia H. Craft, (916)321-1270.