Geographical Disparities Exist With US Smoking Prevention Policies

A new study in JAMA Internal Medicine estimates that US southern states rank at the top when it comes to death from cigarette smoking. Southern states, the analysis found, make up 9 of the top 10 ranked states for men, and 6 of the top 10 ranked states for women, for proportion of smoking-attributable cancer deaths.

According to the American Cancer Society (ACS), smoking was responsible for almost half the deaths from 12 different cancer types, based on the analysis of 2011 research data. About 40 million adults remain documented cigarette smokers in the country, which makes smoking the largest preventable cause of death from cancer and other diseases. Estimates from 2010 attribute 28.7% of all cancer deaths in adults 35 and older in 2010 to cigarette smoking; however, state-wise numbers are lacking.

For their current study, researchers from the ACS estimated the population-attributable fraction of cancer deaths due to cigarette smoking using relative risks for 12 smoking-related cancers and state-specific smoking prevalence data from the Behavioral Risk Factor Surveillance System. The study included 50 US states and the District of Columbia.

The study estimates:

• 167,133 cancer deaths in the United States in 2014 (28.6% of all cancer deaths) were attributable to cigarette smoking.
• In men, the proportion of cancer deaths from smoking ranged from 21.8% in Utah to 39.5% in Arkansas. With the exception of Utah, every state had at least 30% of deaths attributable to smoking-related cancer.
• In women, the proportion ranged from 11.1% in Utah to 29% in Kentucky and was at least 20% in all states except Utah, California, and Hawaii.
• A majority of the above were southern states, including 9 of the top 10 ranked states for men and 6 of the top 10 ranked states for women.

Weak tobacco control policies, the historical prevalence of smoking in the south, and access to cheaper cigarettes could be some of the reasons that have led to the high rate of smoking-related cancer deaths, the authors write. Other factors, such as race and socioeconomic status, are important determinants as well, the authors write. The authors feel, however, that the study may have underestimated the actual number of deaths, since data on only 12 cancers were included in the analysis.

The authors suggest their study likely underestimated death attributable to tobacco use because only 12 cancers were included. Also, self-reported data are known to underestimate smoking prevalence. They propose that tobacco control should spearhead the Cancer Moonshot initiative to accelerate progress against cancer.

“Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of smoking-related cancers,” the study concludes.