Currently, there are 40 million adult cigarette smokers in the United States (US).1 A recent analysis depicted the proportion of cancer deaths attributed to cigarette smoking by state.2 Twelve smoking-related cancers were identified as acute myeloid leukemia, cancers of the oral cavity and pharynx, esophagus, stomach, colon and rectum, liver, pancreas, larynx, trachea, lung and bronchus, cervix, kidney and bladder. Findings from this review support ongoing cancer control initiatives through the elimination of tobacco.
Nearly one-third (28.6%) of all cancer deaths were attributed to smoking. In men, statewide differences ranged from a low of 21.8% in Utah, to a high of 39.5% in Arkansas. However, the rate was at least 30% in all states except Utah. The highest death rate for men was identified in the south (i.e., Alabama, Arkansas, Louisiana, Mississippi, and Oklahoma) where 40% of deaths were attributed to tobacco. While the southern region dominated overall prevalence estimates for smoking-related deaths in women as well, female smoking rates recently surpassed male smoking prevalence in South Dakota and Montana.3 Alaska and Nevada also had high female smoking attributable cancer mortality (SACM) rates.
In the US, state-specific initiatives drive tobacco control efforts. The least restrictive public smoking policies and most affordable cigarettes are found in the south where 95% of the US tobacco is grown.4 Spending on tobacco control is inversely related to smoking prevalence. Case in point is that eight of the 21 states that spend less than 10% of what the Centers for Disease Control and Prevention recommends for tobacco control efforts are located in the south (i.e., Alabama, Georgia, Kentucky, North Carolina, South Carolina, Tennessee, Texas, and Virginia).2 Also of note was that the combined tobacco control spending by all states was $500 million dollars in 2016, only a fraction of the annual $10 billion dollar marketing expenditures made by the tobacco industry.5
Tobacco remains the most significant preventable cause of death from cancer and other diseases. Even with modest efforts to date, tobacco control has been credited with preventing nearly eight million premature deaths of Americans over the past five decades.6 Yet, there is much work to be done. As of 2016, two-thirds of states lack 100% smoke-free laws pertaining to public places that protect the public from second-hand smoke.7 No state currently has a cigarette tax that accounts for at least 75% of the retail price which is recommended by the World Health Organization to deter smoking.8
A myriad of possibilities exists for oncology nurses to tackle this major public health problem. When lecturing on a tobacco-related cancer, we can stress the association of smoking to the malignancy’s pathogenesis. We can volunteer at health fairs and high school assemblies to speak about cancer prevention and share the preventable devastation we see daily in our practices as oncology nurses. We can encourage patients already diagnosed with cancer to quit smoking. We can lobby our state representatives to pass legislation that deters smoking and promotes antismoking behaviors. We also need to keep abreast of research that is addressing the best techniques to help people quit smoking.
Just imagine the impact we could have nationally if all 30,000 of us oncology nurses did one thing annually to counter the tobacco epidemic—we could potentially cause the death of tobacco.
- Jamal A, Homa DM, O’Connor E, et al. Current cigarette smoking among adults - United States, 2005-2014. MMWR Morb Mortal Wkly Rep. 2015 Nov 13;64(44):1233-40.
- Lortet-Tieulent J, Sauer A, Siegel R, et al. State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States. JAMA Intern Med. 2016 Dec 1;176(12):1792-1798.
- Centers for Disease Control and Prevention. State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults—United States, 2009. MMWR Morb Mortal Wkly Rep. 2010 Nov 5; 59(43);1400-1406.
- United States Department of Agriculture. 2012 Census of Agriculture. Update 2016 Nov 4.
- United States Federal Trade Commission. Federal Trade Commission Cigarette Report for 2012. 2015.
- Holford TR, Meza R, Warner KE, et al. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964-2012. JAMA. 2014 Jan 8;311(2):164-71.
- American for Nonsmokers’ Rights Foundation. Overview List – How Many Smokefree Laws? 2016 Oct 1.
- World Health Organization. WHO report on the global tobacco epidemic 2015. 2015 Jul.