Smoking rates have fallen dramatically in the USA. The average US smoking rate as stated in the CDC Behaviour Risk Factor Surveillance System was 17.9%. However, more recent research they have published (The Morbidity and Mortality Weekly Report, 2015) stated that the present smoking rate is just 15.1% (16.7% of men and 13.6% of women). This has fallen from an alarming 42% in 1965.
This smoking rate is slightly less than that of the UK at 16.9%, and significantly less than France, with the smoking rate standing at 25% and Germany at 24.5%. It has also become widely known that Americans are subsequently smoking fewer cigarettes each day, and fewer smokers are smoking daily.
However, smoking remains the leading preventable cause of death in the US; accounting for 480,000 deaths, and is a major issue for public health in America. Alarmingly, 5 out of the top 10 highest smoking states are also in the top 10 for cancer deaths.
There are substantial regional differences, with numbers varying dramatically across states. Cigarette smoking is highest in the Midwest (18.7%) and lowest in the West (12.4%); demonstrating a 6.3% regional difference.
• The Midwest (18.7%)
• The South (15.3%)
• The Northeast (13.5%)
• The West (12.4%)
One factor for such differences is dependent on how much tax is applied to tobacco products by each state. Those at the top of the statistics for smoking rates have lower tax rates on cigarettes. For example, Kentucky only taxes a mere $0.60 per pack, as opposed to $3.40 in Connecticut. Half of the lowest smoking states unsurprisingly feature in the top 10 for lowest tax per cigarette packet.
Another factor contributing to the states with the highest and lowest smoking rates is how much money each state pumps into tobacco prevention. The Center for Disease Control and Prevention (CDC) laid out a $1.1 billion budget for chronic disease prevention and health promotion. A recommended budget of $210 million was implemented towards tobacco prevention, which was 18% of the total budget. Each state was allocated a set budget to put towards tobacco prevention. Top smoking state Kentucky spend a mere 8% and West Virginia spent just 11% of the recommended budget on tobacco prevention. This is compared to Utah’s spend of 44.9%, and Hawaii’s 45%.
Tobacco 21 is a national campaign that advocates raising the minimum legal age for buying tobacco to 21. The campaign is funded and produced by the Preventing Tobacco Addiction Foundation; a non-profit and public health organisation that has been around since 1996. The bill has been signed in three of the low smoking states. Hawaii was the first state to introduce this new legal age, and since then, many other cities and states have followed suit.
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Additionally, the culture of a particular state in the US can impact on its smoking rate. Utah, a state with a significant Mormon population (62.2%), has a low smoking rate, most probably due to religious beliefs and attitudes towards smoking. Only 5% of the Mormon population smoke. Another factor is level of education, with 4 out of the 10 lowest smoking states possessing among the top 20 for educational attainment levels, as opposed to just 2 out of the 10 highest smoking states.
Other factors for the plummeting smoking rate includes the banning of cigarettes being sold in vending machines, the prohibition of selling packs of fewer than 20 cigarettes and the use of e-cigarettes as a cessation method. Furthermore, some states have cracked down on smoking in public areas. New York for instance has banned smoking in public parks.
Vaping in the USA
E-cigarettes are battery-operated devices which deliver tobacco through vapour, rather than smoke, which is inhaled by the user, in the same was as a regular cigarette. However, research has found the use of e-cigarettes to be 95% less harmful than cigarettes and are consequently being used as an effective cessation method for smokers. E-cigarette usage has increased substantially in the UK (2.2 million use them making up 3.4% of the population) and many have quit or reduced their smoking with the aid of vaping.
In the US, around 9 million citizens vape, with 33% of those successfully quitting or reducing the amount they smoke. Unfortunately, the US has found itself subject to far more restrictions on e-cigarettes than the UK; to the frustration of vaping vendors and those who vape. The FDA (Food and Drug administration) passed some new regulations in 2016, which has made e-cigarettes more difficult to sell and buy.
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Regulations include vapour products now being considered under ‘tobacco products’ under the Tobacco Control Act. Vendors are not allowed to bring in any new products or modify their existing stock unless it is approved by the FDA, which is timely and costly for businesses. Vendors will be required to prove their products have a net benefit to one’s overall public health.
The cracking down on the sales of e-cigarettes to minors is also being implemented. Those appearing to be under the age of 27 will be required to produce photographic ID, and websites making online sales are required to have sufficient age proofing (not just a click box) for those under 18.
From now on, vape shops will be unable to offer free samples without paying for them – something that is an integral part of the process when buying a vape pen. It is important for customers to have the ability to sample and try out flavours before purchasing, but they will now have to pay a fee for the allowance.
Such policies could be disastrous for public health in the US. Electronic cigarettes have already helped 2,970,000 Americans quit smoking. Restricting how they are bought and sold, restricts a potentially crucial cessation method for those addicted to smoking cigarettes and stuck in the cycle of attempting to quit smoking, but relapse too soon.