By Melissa Patrick
Kentucky Health News
About one in four Kentuckians smoke, but the habit affects everyone in the state — if not directly through the many diseases associated with smoking or second-hand smoke, then economically: through increased taxes, higher insurance premiums and decreased worker productivity. The best way to address this is a comprehensive ban on smoking in workplaces.
That was the message of “Clearing the Smoke,” a Kentucky Educational Television “Health Three60” episode that first aired Oct. 19.
Host Renee Shaw opened the program with state Health Commissioner Stephanie Mayfield and Dr. Chizimuzo Okoli, director of the Division of Tobacco Treatment and Prevention at the University of Kentucky.
Smoking in Kentucky
Mayfield told Shaw that while Kentucky’s smoking rate has been trending down, it still has the second highest rate in the country at 26 percent, well above the national rate of 19 percent, prompting her to say, “We have a lot of work to do.”
At least 70 percent of smokers want to quit, Okoli told Shaw, but said, “It is important to remember that smoking is actually an addictive disorder,” and smokers need access to smoking cessation tools to be successful.
Mayfield jumped in and said with enthusiasm, “That is exactly what we have done with enhanced health-insurance access,” noting that the state’s embrace of federal health reform has allowed more Kentuckians to have access to smoking cessation programs. “Health insurance helps tremendously,” she said.
The two also touched on the many diseases linked to smoking: diabetes type 2, rheumatoid arthritis, lung cancer, colon cancer, leukemia, birth defects, respiratory diseases, asthma, breast cancer, oral cancers, other organ cancers, bone loss… with Mayfield noting that these diseases are associated with both smoking and second-hand smoke.
“Second-hand smoke can kill you,” Mayfield said.
Okoli pointed out that smoking has a direct impact on unborn children. He said 70 percent of women quit smoking when they find out they are pregnant, and some studies show that those who continue to smoke sometimes have mental illness or addictive disorders.
Mayfield agreed, saying, “Those with pre-existing behavioral health and mental disorders, we find that their smoking rates can be as high as 50 percent compared to our general population.”
Support for smoke-free legislation
Mayfield and Okoli said they support statewide smoke-free legislation to ban smoking in enclosed public places.
“I think our people deserve this,” Okoli said, noting that a ban would protect against the preventable diseases associated with smoking, decrease cigarette consumption and discourage young people from starting to smoke.
Ashli Watts, director of public affairs for the Kentucky Chamber of Commerce, said 92 percent of the chamber’s members support statewide smoke-free legislation.
“This is not just a health care issue, it is an economic development issue,” Watts told Shaw, noting that businesses look at the health of the workforce, productivity levels and the cost of insurance when they are deciding where to locate.
Watts also pointed out that almost $600 million of Medicaid taxpayer money went directly to pay for smoking related issues and said, “We can simply no longer afford to ignore the issue. Smoking is not only killing us, it is bankrupting us.”
The importance of tobacco cessation programs
Audrey Darville, a certified tobacco treatment specialist with UK HealthCare, told Shaw that it is important to get evidence-based help to stop smoking, with only three to five people out of 100 successful when trying to stop “cold turkey.”
Darville said that people who engage in cessation counseling, tobacco cessation medications and individual counseling have a 40 to 60 percent success rate of “staying quit.”
She explained that nicotine hits the brain within 10 seconds of smoking and causes a release of dopamine, which stimulates pleasure, making it hard to quit.
“We tend to place a lot of the responsibility for quitting or being successful with quitting on the person or some personal characteristics, but we have to have a healthier respect for how addictive this drug (is) and how miserable people feel when they don’t have it when they are trying to quit,” Darville said.
Bobbye Gray, tobacco cessation administrator for the state Department of Public Health, said the Kentucky Quit Line is available to those 15 and older who are ready to quit smoking. Smoking cessation coaching is also available through the Quit Line for those without insurance, who, Gray said, can get nicotine replacement products free of charge. Smoking cessation programs are also available through local health departments.
Smoking and Teens
“Some people are more addicted (than others), especially young people and teenagers,” Gray said,
“They are more sensitive to the nicotine, therefore more susceptible to the addiction.”
About 18 percent of high school students smoke traditional cigarettes, and 24 percent use e-cigarettes, said Elizabeth Hoagland, youth tobacco-policy specialist with the state health department, adding that 30 percent of youth who experiment with smoking will go on to become daily smokers.
Hoagland said that most people aren’t aware that even teenagers have health consequences from smoking, even if they aren’t daily smokers, including insulin resistance and reduced lung growth.
“You have reduced lung growth. The lung is kind of like the brain, the lungs keep maturing and growing until the age of 25. So, if you are a smoker, your lungs don’t grow to their full capacity, and they don’t work as well as they would for a non-smoker,” she said.
Hoagland expressed concern about the growing use of electronic cigarettes, saying that there was “a lot of misinformation” out there. She made it clear that the vapor off of an e-cigarette is not a water vapor, but is an aerosol, “And these are completely unregulated products so we don’t know what is in them,” she said.
She said that we know e-cigarettes contain nicotine and formaldehyde, in addition to ultra-fine particles, which can cause “lung inflammation and lung damage,” and noted that some flavorings like diacetyl, which is used in microwave popcorn, is used in 60 percent of e-cigarettes and has been proven not safe to breathe.
Programs like Teens Against Tobacco Use at Tates Creek High School in Lexington allow high school students to visit elementary and middle schools and talk to the students about the dangerous effects of tobacco use using hands on activities.
At Bourbon County High School, students brought e-cigarettes to the staff and school board’s attention, leading the effort to have them included in their tobacco-free policy at school. Lynlea Kiser, a student in the school who is involved in smoke-fee education, said that many of the staff didn’t know what e-cigarettes were until the students brought them to their attention.
Cyndi Steele of the Bourbon County Health Department said that because the schools already had a tobacco-free policy in place, the culture has shifted. “The students were not willing to tolerate the vapor from the second-hand smoke,” she said.
Hoagland said that schools that are smoke-free have a 30 percent reduction in youth smoking, “So every school district should have one,” she said, also noting the importance of a statewide comprehensive smoke-free law, which would “really have a huge impact on our youth smoking.”