Tobacco use has been ingrained in American society since this nation was founded, and diseases caused by smoking continue to take their toll on the health and lifespans of millions of people. Despite decades of public education about the dangers of smoking, and increased government regulation of tobacco, smoking rates remain stubbornly high in certain areas of the country, including Kentucky.
However, there are more resources than ever before available to those who want to quit smoking. In addition, efforts by local governments in Kentucky to enact and enforce smoke-free laws are producing tangible reductions in smoking rates.
In this episode of Kentucky Health, host Dr. Wayne Tuckson speaks with one of Kentucky’s leading experts on tobacco control about the effects smoking has on health and about the best ways for persons, and communities, to kick the addiction. This program is part of KET’s 2017 Smoking and Health Initiative, funded in part by the Foundation for a Healthy Kentucky.
Ellen Hahn, PhD., RN, FAAN, is the director of BREATHE at the University of Kentucky College of Nursing and also is the director of the Kentucky Center for Smoke-Free Policy. Hahn says that public knowledge about the dangers of smoking has come a long way over the past 50 years.
“One of the reasons I have very severe asthma, and now I have chronic lung disease, is because while I never smoked a day in my life, my parents smoked in my car in rural Pennsylvania, and many people in my generation probably have the same story to tell,” she says. “But I think that now that we know so much about first-hand, second-hand, and third-hand smoke, there’s really no reason that anybody should be smoking inside a vehicle, or inside their home, for that matter, or inside a public place.
“There’s really no reason to do that, because we know how much harm it causes. Cigarette smoking is the single most preventable cause of death that we know of. It kills 480,000 people in the U.S. every year.”
The Health Risks from Tobacco Addiction
Hahn defines the three levels of smoking exposure:
- First-hand smoke, she says, is the smoke inhaled from orally using a cigarette, cigar, or e-cigarette (also called electronic smoking devices).
- Second-hand smoke affects bystanders when they inhale both the smoke that comes out of a burning cigarette used by someone else, and also the smoke exhaling from the user’s mouth.
- “Third-hand smoke is what happens in a room or building where there’s been smoking going on, and the smoke actually attaches itself to the surfaces – the walls, the carpets, the furniture,” she says. Third-hand smoke can often be seen in buildings where smokers lived for a long time through streaks of nicotine on a bathroom or kitchen wall. The third-hand smoke that lingers on house surfaces is an especially dangerous health risk for infants and pets, Hahn says, since they spend more time close to the floor.
Hahn says that overall, one in five deaths each year in the U.S. is caused by smoking. The association between smoking and lung cancer is high, and receives a lot of attention within the American health care system, but Hahn says that the leading cause of death from cigarette smoking is actually cardiovascular disease.
As for cancer, Hahn says that roughly one-third of all deaths from that disease are caused by smoking. She explains that smoking can cause cancer in many different organs in the body. Although roughly 85 percent of lung cancer deaths are caused by first-hand smoke, the other 15 percent can be caused by either second-hand smoke or exposure to radon gas – or a combination of both, Hahn says. Radon gas has been found at high levels in many counties in Kentucky.
According to Hahn, there are roughly 7,000 chemicals in tobacco smoke, and about 69 are known to cause cancer. In addition, the tiny particles that are released in smoke are also a great danger to lung and cardiovascular health.
Recent research into the effects of e-cigarettes on health indicates that they pose significant health risks as well, Hahn says, despite being marketed as more safe than tobacco products or as “quit aids” for persons seeking to curb nicotine addiction.
“Some of the same chemicals we know are in conventional cigarettes are in electronic cigarettes,” she says. “In addition, there are other chemicals, harmful chemicals. And the research is coming out daily. One of my biggest concerns with e-cigarettes right now is that we know that they pollute the air. And that is generally known. So, if somebody is using an e-cigarette inside your home or your car, restaurants, bars, they’re polluting the air.”
Ways to Quit, for Individuals and Communities
“Smoking is an addiction, don’t forget,” Hahn says. “This is probably the worst addiction – we talk about heroin and opiate addiction, and they’re awful. But cigarette smoking is the drug of choice, really.”
Hahn says that 8,900 persons in Kentucky die each year from smoking-caused illnesses, from a population of roughly 884,000 regular smokers (about one-fourth of the state’s total population). She says that many smokers decide to take up the habit due to family history – growing up with parents and/or siblings who smoke – as well as peer pressure.
Hahn also criticizes the tobacco companies for marketing their products to young people and to certain demographic groups; for example, she says, the advertising of menthol cigarettes is targeted to the African-American community. She says that federal regulation of tobacco products has improved, but argues that there are still too many legally and socially acceptable ways for companies to insidiously market their products.
As for the best ways to reduce smoking rates, Hahn says that “in fact, the most effective, high-impact policy is to increase the real cost of tobacco products.” She says Kentucky’s current state tax of 60 cents per pack (which ranks 43rd in the U.S.) is too low to cause a real reduction in the commonwealth’s 26 percent smoking rate.
“I think what’s important about taxing these products is, you want to increase the price so that it really is a deterrent for people even to buy tobacco, young people, people who are more likely to smoke,” she says. “You know, people who are in poverty, people who are in low education status do smoke at higher rates. But they’re just as likely to want to quit as anyone else.”
In Kentucky, the cities of Louisville and Lexington have passed smoke-free ordinances since the turn of the century. Other towns have done so as well, but Hahn says that there is still much work to be done on the policy front. Smoke-free policies “change the rule so that smoking isn’t as acceptable, and that changes the culture of expectation – and in our bigger cities we’ve done that,” she notes. “But only a third of Kentuckians are covered by smoke-free protections.”
For individuals who want to quit smoking, Hahn says programs such as the 1-800-QUIT NOW counseling line and the resources at www.smokefree.gov are good places to begin a tough but ultimately rewarding journey. She also says that most universities in the state have their own tobacco treatment consultation services, which can offer guidance to persons seeking the right combination of medications and counseling to help them along the way.
“It takes medication – if you’re a heavy smoker, meaning more than 10 to 15 cigarettes a day – and counseling or behavioral support. And you can get that in many ways,” she says. “It’s like anything else: If there was a magic band-aid to stop people from smoking, we would have used it. I’ve never smoked, but everybody I’ve talked to who has smoked says that it’s the hardest thing to do, to put the cigarette down. Because it’s a very severe addiction.”