TOBACCO USE IN AMERICAN SOCIETY

If you were to visit certain businesses, entertainment spots, or sporting events in your community, you might leave convinced that virtually every adult that is a tobacco user.  Certainly, for some segments of society, tobacco use is the rule rather than the exception.  You may be quite surprised to find out that the great majority of adults do not use tobacco products.

Following the Surgeon General’s 1964 report (the first official statement of concern by the federal government regarding the dangers of smoking), the prevalence of smoking began a decline that lasted until 1991, when a leveling off was noted that lasted for the next three years.  Since 1994 the percentage of the population who smoke has declined slowly but progressively.  Current statistics reveal that 22.5% of American adults smoke cigarettes on a daily or near-daily basis.  Men are more likely to smoke (25.2%) than are women (20.0%).  When subsegments of the population, based on race and ethnicity, were studied it was found that whites and blacks were essentially smoking with the same prevalence (24.1% and 22.5%).  At the same time, Hispanics were considerably less likely to smoke, while American Indians and Alaska Natives (40.0%) were more likely to smoke.  Persons of Asian or Pacific Island descent were the Americans least likely to smoke (13.7%).

Cigarette Smoking Among College Students

Until very recently, the rate of cigarette smoking among college graduates was lower than that reported for the population as a whole, and it was significantly lower than the rate for persons with very little formal education.  In fact, the prevalence of smoking among college students decreased progressively from 21% in 1964 to 14% in 1995.  However, an upward trend in cigarette use by college students has been noted, with a recent studying suggesting an incidence approaching 36% smoking within the past month.  In contrast, a downward trending in smoking by twelfth graders was reported in 2002.  Knowing that a segment of those twelfth graders (1998) are now undergraduates on college and university campuses, it is possible that the 35.8% prevalence of cigarette smoking among college students, as reported in 2000, is now experiencing a decline.  This is, in fact, probable since among the 2002 twelfth graders with college aspirations, only 15.1% were cigarette smokers.

When a college community is viewed as a whole regarding which segments of the student body are most likely to smoke, there appears to be a direct relationship between the level of alcohol consumption and cigarette smoking, and between the importance that students assign to “partying” versus other aspects of the college experience.

The historically predictable relationship between higher levels of completed education and the lessened likelihood of smoking remains clearly evident even today.  For example, when comparing the percentage of heavy smokers (a pack or more per day) on the basis of education completed, the influence of education is evident – less than high school (37.5m/31.3f), high school graduate (22.0m/26.2f), some college (25.4m/21.9f), and college graduate (11.0m/10.7f).  unfortunately, the most recently reported incidence of smoking among college students (2002) seems to indicate that the next college graduating classes of 1998 – 2002 were much closer to the high school dropout rate of cigarette smoking.

The most disturbing aspect of the increase in reported smoking among college students, beyond the eventual influence it will have on health and life expectancy, is its negation of the traditional belief that the college and university experience “protected” this segment of the society from making some ill-informed choices.  As recently as the mid-1990s it was still possible to believe that the college population was “too well informed” and “too future oriented” to engage widely in an addictive behavior that fosters dependence, compromises health, and eventually shorten life.  Today that proportion seems to lack some of its former validity, but, hopefully, the corner is being turned.

Other Demographic Factors Influencing Tobacco Use

In addition to gender, race, ethnicity, and education level, other demographic facts appear to influence the extent to which smoking occurs.  Included among these factors are the age groups into which persons fall, the region of the country in which they live, the size of their communities, and their employment status.

If age grouping is begun with 18- to 25- year-olds and progresses to 65 years of age and older, the general trend is for the percentage of persons smoking (during the past month) within each group to go down.  For example, among the younger group (18 – 25), 28.5m/25.1f% report having smoked during the past month, while in the 26- to 34-year-olds, 29.0m/22.5f% smoked during the past month, and in the 65- plus group, only 10.2m/9.3f% did so.  Most likely over the course of time, both quitting and premature death serve to reduce the percentage of smokers.

Comparing smoking during the past month among people in different regions of the country reveals that persons living in the north central portion of the country are the most likely to smoke (26%).  In contrast, persons living in the west are least likely to have smoked during the past month (20.0%).  People in the South (25.4%) and the Northeast (23.9%) fall in between.  In terms of population density, one might be surprises to learn that persons living outside of metropolitan areas are more likely to have smoked during the past month (30.5%), while persons living in small metropolitan areas (27.2%) and large metropolitan areas (26.5%) are less likely to have smoked during the same period.

Employment status too impacts on the likelihood pf regular smoking.  Persons who are employed part-time are more likely to have smoked during the past month (31.2%) than are people who are employed full-time (25.5%) – most likely reflecting the greater opportunity of the former group to smoke, since today’s work place is increasingly a smoke-free environment.  In stark contrast to those who have degree of employment, the unemployed are by far the most likely to have smoked during the past month (50.1%).  This may reflect not only the lower level of education found among this group, but also the immediate gratification that smoking brings to persons who may have little opportunity to seriously pursue long-range goals and the postponed gratification that striving for such goals can often require.

Marketing of Tobacco Products

Shredded plant material, wrapped in paper or leaf, ignited with a flame, and then placed on or near the delicate tissues of mouth … what other human behavior does this resemble? If you answered None! To this question, then you appreciate that smoking is unique, and, therefore, that it must be learned.  How it is learned currently a less than fully understood process that most likely requires a variety of stimuli ranging from modelling to actual experimentation.  The role of advertising as a source of models has long been suspected and intensely debated.  Today, as in the past, controversy surrounds the intent of the tobacco industry’s advertising.  Are the familiar logos seen in a variety of media intended to challenge the brand loyalty of those who have already decided to smoke, as the industry claims? Or are the ads intended to entice new smokers, older children and young adolescents, in sufficient numbers to replace the 3,000 smokers who die each day from the consequences of tobacco use?  This latter objective is now known, by admission of the tobacco industry, to have been pursued for decades.  Its effectiveness has also been documented.  The cartoon character Joe Camel was an especially successful tool for enticing children and teens to begin smoking.

Over the years the tobacco industry has used all aspects of mass media advertising, including radio, television, print, billboards, and sponsorship of televised athletic events and concerts, to sell its products.  In addition, it has often distributed free samples and sold merchandise bearing the company or product logo.

Today the tobacco industry has been denied access to television and radio, and it can no longer distribute free samples to minors, but the industry continues to be active and innovative in other aspects of the media to which it has access.  For example, Phillip Morris has introduced an upscale lifestyle magazine called Unlimited Action, Adventure, Good Times, to be provided free to over 1 million smokers.  Interestingly, the magazine features articles about healthful activities that many longtime smokers would be unable to engage in because of the effects of smoking.

In the 9 months following the 1999 Master Settlement Agreement, the tobacco industry increased their magazine advertising budget by 30% over presettlement levels in magazines with 15% or more youth (under 18 years of age) readership, even they had agreed to discontinue advertising in youth-oriented publications.  Most recently, increased tobacco advertising has been noted in magazines that appeal specifically to younger women, working women, and women of color.

The development of non-market brands of cigarettes for free distribution to patrons of bars and restaurants who are attempting to “bum” cigarettes represents a second form of “advertising.”  This “premarketing” introduction of a prototype brand technically does not violate the law regarding the distribution of samples.  To date, several hundred establishments in several major cities have participated.

A final current example of the tobacco industry’s subtle but effective presence in the mind of the public is that of the tobacco use in motion pictures.  In spite of a 1990 tobacco industry policy and the 1999 Master Settlement Agreement, both of which prohibit “brand placement” of tobacco products in films, cigarette and cigar smoking continue to be disproportionately represented in current films.  Unfortunately, children and adolescents can easily identify with these characters (and their smoking), since they are generally depicted in a positive light.  As an example, in a recent survey, two-thirds of the 43 movie stars most frequently named by 10- to 19-year-old were seen smoking in their most recent films.

Pipe and Cigar Smoking

Many people believe that pipe or cigar smoking is a safe alternative to cigarette smoking.  Unfortunately, this is not the case.  All forms of tobacco presents the users with a series of health threats.

When compared with cigarette smokers, pipe and cigar smokers have cancer of the mouth, throat, larynx (voice box), and esophagus at the same frequency. Cigarette smokers are more likely than pipe and cigar smokers to have lung cancer, cancer of the larynx, chronic obstructive lung disease (COLD), also called chronic obstructive pulmonary disease (COPD), and heart disease.  The cancer risk of death to smokers is four times greater from laryngeal cancer than nonsmokers.

In comparison to cigarette smokers, pipe and cigar smokers are considerably fewer in number.  Interestingly, cigar smoking enjoyed a resurgence through much of the 1990s.  however, during 1998 – 1999 a substantial decline in sales of premium cigars occurred.  Whether this down turn represents an emerging dissatisfaction with cigars as an enjoyable use of tobacco or simply reflects adjustments in the import market remains uncertain.  In 1995 cigars generated sales of $1 billion, mainly to younger adults, including a very small but growing percentage of women.

Perhaps because of the increase in cigar smoking noted above, the National Cancer Institute commissioned the first extensive study of regular cigar smoking.  That report confirmed and expanded upon the Health risks identified in earlier smaller studies.  A subsequent study reported that cigar smokers are nearly twice as likely as nonsmokers to develop oral, throat, and lung cancer, as well as heart disease and chronic obstructive pulmonary disease.  These rates are somewhat lower than those of cigarettes smokers.

In response to the recognition of these risks, the FTC now requires that cigar manufacturers must disclose the tobacco content and additive in their products.  Most recently the FTC announced its intention of requiring five rotating health warnings to appear on cigars, including two that have been currently agreed upon by the FTC and major manufacturers: Cigars Are Not a Safe Alternative to Cigarettes and Cigar Smoking Can Cause Cancer of the Mouth and Throat, Even if You Don’t Inhale.