With the 38th annual Great American Smokeout set for Thursday and the 50th anniversary of the Surgeon General’s first report warning of the dangers of smoking tobacco coming in January, the issue seems to be at another crossroads.

Smoking & lung cancer

Lung cancer is the leading cause of cancer death among both men and women in the United States.

More than 228,000 people are expected to be diagnosed with lung cancer in 2013 (4,390 in South Carolina), and nearly 160,000 will die from the disease (2,990 in South Carolina).

Lung cancer is lethal: the five-year survival rate for all stages combined is only 16 percent, a statistic that has not improved in many decades.

Despite these sobering statistics, progress has been made against the disease. Lung cancer death rates in men have dropped by more than 30 percent in the past two decades, and death rates in women are starting to decline after increasing for many decades.

Smoking is a major risk factor for lung cancer, accounting for about 80 percent of lung cancer deaths. However, many people who have never smoked or are former smokers also get lung cancer. Lung cancer among never-smokers would still rank in the Top 10 causes of cancer deaths in the U.S.

American Cancer Society, Centers for Disease Control and Prevention

Today’s snapshot of smoking in America includes public smoking bans and declining smoking rates, a re-focus to obesity prevention, and the rise of e-cigarettes and tobacco on the global market.

Since 1964, the smoking rate in the United States has dropped from 42 percent to 19 percent in 2012. But more promising is the fact that youth smoking rates continues to drop. Since 2000, the rate has plummeted from 28 percent to 14 percent.

But on a sobering note, the follow-up Surgeon General’s report will note that in the past 50 years, an estimated 20 million Americans died from smoking-related diseases, according to Michael Cummings, co-lead of tobacco research at Medical University of South Carolina and a nationally recognized tobacco expert who contributed to the report.

Cummings admits he is worried about that complacency about smoking could set in as much of the nation’s health attention has shifted to preventing obesity and as the health risks of smoking shift to a global one.

“Worldwide, the number of tobacco-related deaths in the 20th century was 100 million. That number is expected to increase 10 times, to 1 billion, in the 21st century,” says Cummings.

He points to places such as China, Indonesia and Africa where smoking is on the rise, partly as tobacco companies seek new markets to replace a declining American market, and that “global health is a fiscal issue for everyone.”

Disruptive technology

Besides smoking bans, one of the biggest affects on cigarette smoking in the U.S. and abroad comes from electronic cigarettes, or e-cigarettes.

E-cigarettes are growing in popularity, particularly among young people. According to the Centers for Disease Control and Prevention, a 2012 survey found a 1.5 percent increase in usage from 4.1 percent in 2011.

Cummings, who used to be on the fence about e-cigarettes, sees the switch by adult and teen smokers to e-cigarettes mostly as a positive step. He notes that e-cigarettes have five chemicals, including nicotine, propylene glycol, vegetable glycerin, water and flavors, compared to 7,000 chemicals in most tobacco cigarettes, “more than 60 of which are known or suspected carcinogens.”

E-cigarettes are a disruptive technology for cigarettes, much like the cell phone for land lines,” says Cummings.

For smokers, particularly the “hopelessly addicted,” Cummings says e-cigarettes are more effective than nicotine gums and patches and a safer alternative to tobacco cigarettes, not only to the smoker but the people around him or her.

“Most of the vapor that comes from an e-cigarette is no different from what you would get from theatrical fog,” says Cummings.

His main concerns about e-cigarettes, however, remain the lack of regulatory oversight of manufacturing and youth using e-cigarettes as gateway to tobacco smoking or “re-normalizing” smoking.

Rise of COPD

Among the latest smoking studies of note, Cummings says, is “50-year Trends in Smoking-Related Mortality in the United States,” published in the Jan. 24, 2013, edition of the New England Journal of Medicine.

Cummings says the paper demonstrates that the evolution of cigarettes, basically from unfiltered to filtered, blended, low-tar cigarettes, has made cigarettes more dangerous by making inhalation easier. In turn, the rates of COPD (chronic obstructive pulmonary disease) deaths have increased.

The study’s conclusion states, “A plausible explanation for the continuing increase in deaths from COPD among male smokers is that cigarettes marketed since the late 1950s have undergone design changes that promote deeper inhalation of smoke.

“For example, the introduction of blended tobacco and genetic selection of tobacco plants lowered the pH of smoke; as a result, inhalation was easier and deeper inhalation was needed for the absorption of nicotine. Other design changes, such as the use of more porous wrapping paper and perforated filters, also diluted the smoke.

“Deeper inhalation of more dilute smoke increases exposure of the lung parenchyma ... the likely net effect of deeper inhalation on COPD could be wholly detrimental, since COPD results from injury to the lung parenchyma.”


Meanwhile, bans on smoking in the workplace and public places continue to be part of the smoking story, especially in South Carolina.

In June 2012, Gov. Nikki Haley signed a bill that gives public and private colleges and institutions the right to establish tobacco-free campuses.

The Medical University of South Carolina was the first to do so and now the University of South Carolina, Clemson and College of Charleston are among the universities in the state in the process of creating 100 percent tobacco-free campuses, according to Susan Johnson, director of health promotion at MUSC.

She added that since MUSC implemented the policy, 180 people signed up for a smoking cessation program and that 200 people at the institution committed to quitting smoking.

“While not all can be attributed to these policies, the majority indicated that if they could go all day without smoking while at work, then they were more motivated to quit altogether,” says Johnson.

She adds, “The majority of people understand that side-stream smoke is hazardous and not only can cause health issues for nonsmokers, but also detracts from quality of life and contributes to litter.”

The Smokeout

Since its inception in 1976, the American Cancer Society’s Great American Smokeout has been a critical effort in educating people about the dangers of smoking and encouraging them to quit, according to Kari Dahlstrom, a spokeswoman for the American Cancer Society in the Carolinas.

While the Carolinas have a long history with tobacco, she says progress has been made. Adult smoking rates are in 22 percent in North Carolina and 23 percent in South Carolina.

“Smoking-related diseases remain the world’s most preventable cause of death and smoking is the cause of nearly one in three cancer deaths. So, while we have made significant progress, we still have a long way to go,” says Dahlstrom.

Reach David Quick at 937-5516.