19 September 2018

Why more Americans are kicking the smoking habit

The decline in smoking rates in the USA didn't happen overnight – it took time for anti-smoking campaigns and policies to unfold.

More and more Americans are putting out their cigarettes – for good.

The overall cigarette smoking rate among US adults has hit an all-time low, according to the US Centers for Disease Control and Prevention. Preliminary data from the National Health Interview Survey showed that smoking rates declined from 15.5% in 2016 to 13.9% in 2017.

In South Africa the number of smokers has also been declining for a while; this country was in fact one of the first developing countries to impose a 50% excise tax on the price of cigarettes in 1994 and banned tobacco advertising in 2001.

In a recent Health24 survey on tobacco use and related issues, many participants reveal that they quit because they wanted a healthier lifestyle – even those with a high level of dependence on nicotine products.

Glamorous portrayal

"Cigarette smoking among adults has been on a downward trajectory for decades," said Brian King, deputy director for research translation in the CDC's Office on Smoking and Health. "It's the lowest percentage we've seen since we started monitoring smoking rates in 1965." Still, the preliminary 2017 data indicates 34 million Americans still smoke, according to King. And an estimated 480 000 Americans die each year due to cigarette smoking and secondhand smoke exposure, according to the latest CDC data.

Anti-smoking laws in South Africa have become stricter, and in the new proposed Control of Tobacco Products and Electronic Delivery Systems Bill people will not be allowed to smoke in cars transporting children and restaurants will no longer be able to reserve space for smokers, to name just a few examples.

Fifty years ago, it seemed impossible to imagine a world where less than 15% of adults smoked. At the time, roughly 42% of American adults lit up, and smoking was a normal part of everyday life. You could smoke at work, in restaurants and bars, and on planes. You could buy cigarettes from vending machines. Tobacco was glamorously portrayed in the movies and on TV and advertised on billboards lining the highways.

That started to change in 1964 when the surgeon general released the first report on smoking and health. The landmark report concluded that smoking causes lung and laryngeal cancer and is a major cause of health conditions such as cardiovascular disease, ushering in policies that would change the tobacco landscape.

But the decline in smoking rates didn't happen overnight. It took time for anti-smoking campaigns and policies to unfold, said Dr Charlie Shaeffer, a California-based cardiologist who has been active in tobacco control efforts. And quitting the highly addictive products required tools and resources that didn't yet exist.

Lower influx of new smokers

Both King and Shaeffer credit the combination of cigarette price increases, anti-smoking campaigns, smoke-free laws, and access to cessation programs as powerful levers aided by health advocacy groups. "These interventions really de-normalise tobacco use," said King.

Higher-priced cigarettes made it more expensive to smoke, especially for teenagers – an age when most smokers first tried smoking. Money raised from taxes funded ads that showed the adverse health impacts of tobacco, sometimes in gruesome detail. And not being able to smoke at work, bars or public places created smoke-free environments, making it easier for people to not smoke. Plus, in 2010, most commercial health insurance plans and Medicaid were required to cover smoking cessation programmes, giving smokers access to the resources and tools they needed to quit.

But real strides in decreasing smoking have come from prevention efforts. Greater education, particularly aimed at children, spread the word about tobacco's effects, and health warnings on products, beginning in 1965, reiterated that message. "We're not getting an influx of new smokers on the front end. We're starting to see the impact of reducing [smoking] initiation among youth and young people in overall smoking rates," said King.

While lower smoking rates are a major public health success, experts say there's still work to do.