Tobacco Use & Lung Cancer

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Overview

Tobacco use poses a considerable public health burden in the United States. In fact, it is the leading cause of preventable illness and death in this country.

Smoking tobacco has been causally linked to diseases of nearly all organs of the body, to diminished health status, and to harm to the fetus.

( Surgeon General Report 2014, pg. 7 ).

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Impacts of Tobacco Use

Tobacco smoking increases the risk of many types of cancer, including cancers of the lung, throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, and cervix, and acute myeloid leukemia ( National Cancer Institute ).

About one-third of cancer deaths in this country can be attributed to cigarette smoking and exposure to secondhand smoke. Approximately 7,330 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke. ( Surgeon General's Report , pg 660 table 12.4).

Lung cancer is by far the leading cause of cancer death among both men and women in the United States. And the main risk factor for lung cancer is smoking. In the United States, cigarette smoking is responsible for about 80% to 90% of lung cancers ( Centers for Disease Control ).

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Lung Cancer Incidence

In the United States, the incidence rates of lung cancer (number of new cases per population) vary geographically. States with higher cancer incidence rates are clustered in the South and Northeast regions. A zoom-in to the county level reveals which particular counties (rates) contribute to the overall high state rates.

State Cancer Profiles - Incidence

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Lung Cancer Mortality

A similar geographic pattern is observed in lung cancer mortality (number of new deaths due to cancer per population); states with higher mortality rates are clustered in the South and Northeast Regions of the U.S. As shown in both maps of incidence and mortality, it is not uncommon for counties with high-rates to appear within low-rate states.

From a public health perspective, understanding the geographic patterns of cancer can inform where to target interventions for reducing cancer burden.

Legend Lung Cancer Mortality 2014 to 2018 Age-Adjusted Rate (per 100,000) Blue: 11.80 - 34.50 Light Blue: 34.51 - 41.30 Yellow 41.31 - 47.10 Orange: 47.11 - 54.50 Red: 54.51 - 133.20 Grey: Suppressed — Mortality Map Legend

State Cancer Profiles - Mortality

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Lung Cancer Survival

The relative survival time after diagnosis for cancer of the lung and bronchus is lower than all other cancer sites combined.

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Cigarette Smoking

Smoking rates among adults and teens are less than half what they were in 1964; however, current smoking among adults is about 38 million in 2016 ( Jamal et al 2018 ) and about 3 million high school and middle school students in 2017 DOI: ( Wang et al 2018 ). Although the percentage of adult smokers is higher, the geographic patterns of cigarette use among adults and youth is similar. States with highest percentage of current adult smokers are clustered in the Midwest, South, and Northeast regions.

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Evidence-based Strategies for Reducing Tobacco Consumption

Strategies for reducing tobacco consumption, such as the World Health Organization’s MPOWER Framework, have saved millions of people from early death. The MPOWER framework incorporates six measures: monitoring tobacco use and prevention policies, protecting people from tobacco smoke, providing aid to quit, warning the public about the dangers of tobacco, enforcing bans on tobacco advertising promotion and sponsorship, and raising taxes on tobacco. In the U.S., the Tobacco Control Vaccine framework includes four evidence-based preventive measures to reduce tobacco use: smoke-free policies, tobacco price increase, cessation access, and hard hitting media campaigns.

Implementing Smoke-free Policies

Movement toward comprehensive smoke-free policies—those that, by law, completely prohibit smoking in all indoor areas of private workplaces, restaurants, and bars ( CDC )—has intensified on an international scale in response to growing awareness of the negative economic and health consequences of second hand smoking exposure ( NCI ).

This image shows Smokefree Indoor Air - Private Worksites, Restaurants, and Bars in the United States and territories as of Dec 31, 2021. States and territories are colored to denote how state-wide legislation covers smoking indoors for the three area types: Worksites, Restaurants, and Bars. No Law: WY, AK, TX, OK, MO, KY, WV, VA, MS, AL, GA, SC 100% Smokefree in one location: ID, AR, TN, PA, NH 100% Smokefree in two locations: NV, IN, LA, NC, FL 100% Smokefree in three locations: HI, WA, OR, CA, MT, UT, AZ, CO, NM, ND, SD, NE, KS, MN, IA, WI, IL, MI, OH, ME, VT, MA, RI,CT, NY, NJ, DE, MD — Smokefree Laws by State

Raising Tobacco Taxes

A substantial body of research, which has accumulated over many decades and from many countries, shows that significantly increasing the excise tax and price of tobacco products is the single most consistently effective tool for reducing tobacco use. Significant increases in tobacco taxes and prices reduce tobacco use by leading some current users to quit, preventing potential users from initiating use, and reducing consumption among current users.

Tobacco use by young people is generally more responsive to changes in taxes and prices of tobacco products than tobacco use by older people ( NCI )

This map shows the dollar amount of excise tax levied on cigarettes as of Dec 31, 2021. Alabama $0.68 Alaska $2 American Samoa $6 Arizona $2 Arkansas $1.15 California $2.87 Colorado $1.94 Connecticut $4.35 Delaware $2.10 District of Columbia $4.94 Florida $1.34 Georgia $0.37 Guam $4 Hawaii $3.20 Idaho $0.57 Illinois $2.98 Indiana $1.00 Iowa $1.36 Kansas $1.29 Kentucky $1.10 Louisiana $1.08 Maine $2 Marshall Islands $1 Maryland $3.75 Massachusetts $3.51 Michigan $2 Minnesota $3.04 Mississippi $0.68 Missouri $0.17 Montana $1.70 Nebraska $0.64 Nevada $1.80 New Hampshire $1.78 New Jersey $2.70 New Mexico $2 New York $4.35 North Carolina $0.45 North Dakota $0.44 Northern Marianas $3.75 Ohio $1.60 Oklahoma $2.03 Oregon $3.33 Palau $5 Pennsylvania $2.60 Puerto Rico $5.10 Rhode Island $4.25 South Carolina $0.57 South Dakota $1.53 Tennessee $0.62 Texas $1.41 Utah $1.70 Vermont $3.08 Virgin Islands $1.10 Virginia $0.60 Washington $3.03 West Virginia $1.20 Wisconsin $2.52 Wyoming $0.60 — Cigarette Excise Tax by State

There is a wide geographic variation in cigarette tax by State.

Aid to Quit: Quitline Services

Encouraging and helping tobacco users quit is critical to reducing tobacco-related disease, death and healthcare costs. Quitlines are telephone-based tobacco cessation services that help tobacco users quit. The North American Quitline Consortium promotes evidence based quitline services across diverse communities in North America. Today, residents in all 10 provinces and two territories in Canada, Mexico, and all 50 U.S. states, Puerto Rico, Guam, and the District of Columbia have access to quitline services (NAQC). The quitline profile for each state can be accessed through the interactive map found at: naquitline.org

Youth Access Restrictions: Tobacco21

Raising the minimum age of sale for tobacco products to 21 years has recently emerged as a promising strategy to reduce youth tobacco use ( IOM 2015 Report ). As of September 19, 2018, six states – California, New Jersey, Massachusetts, Oregon, Hawaii and Maine –have raised the tobacco age to 21, along with at least 350 localities, including New York City, Chicago, San Antonio, Boston, Cleveland, Minneapolis, and both Kansas Cities. Some of the localities are in the states that subsequently enacted statewide laws ( www.tobaccofreekids.org ).

A map of States which limit tobacco for those under 21: VT, PA, DE, MD, WV, VA, NC, SC, AL, TN, KY, IN, WI, IA, LA, NM, WY, MT, ID, NV, WA, PR.

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Conclusion

As shown in these maps, there are geographic patterns in the implementation of preventive measures such as higher cigarette taxes and comprehensive smoke-free policies across the United States. These patterns contribute to differences in both smoking rates and lung cancer incidence and mortality at the state and local level.

Improving federal, state, and local infrastructure and resources for designing, delivering, and evaluating programs and policies aimed at reducing tobacco use and secondhand smoke exposure is critical to advancing our understanding of tobacco -related health patterns and to reducing the disproportionate burden of tobacco-related cancer.

( National Cancer Institute )