A view to a killer

A half-century ago, smoking was a widespread, widely accepted habit—so much so that tobacco companies put doctors in cigarette ads and no one batted an eye.

We’ve come a long way, baby.

Today, tobacco marketing and packaging receive careful scrutiny. Anti-smoking campaigns are mainstays of mass media. State governments levy taxes to discourage tobacco use and devote the proceeds to health and education efforts.

The turning point traces to a particular date: Jan. 11, 1964. That’s when Dr. Luther Terry, the U.S. surgeon general at the time, publicly tied tobacco to illness. The Surgeon General’s Office refers to his Report on Smoking and Health as “the first federal government report linking smoking and ill health, including lung cancer and heart disease”—adding, “This scientifically rigorous report laid the foundation for tobacco-control efforts in the United States.”

Bruce Baldwin clearly recalls that watershed moment. He was 10, living in Quincy, with a mother and father who smoked. Two years later, he’d pick up and puff his first cigarette, increasing over time to three packs a day before finally quitting more than two decades later. He now teaches smoking-cessation classes locally, including a program through Skyway House and his employer, the Butte County Office of Education.

“I really remember how much controversy [the report] generated,” Baldwin said in a recent phone interview, “and my dad’s response: ‘Oh, that’s BS!’ Basically they both kept smoking and they both ended up dying from it. I ended up smoking for 25 years—you would think that watching my mother have her right lung removed when I was 8 or 9 years old would’ve kept me from wanting to. …

“As big as it was, and the impacts that have come from the report, 50 years later we’re still here fighting tobacco as the No. 1 public-health threat in America. Still one out of five Americans dies from using tobacco. You have lot of people who think we’ve won this war because kids get that smoking’s bad … but one out of three people who try it get addicted, so if the industry can get just one kid in every sixth-grade class in America, they’re set for life.”

Statistics underscore the concern. Though the rate of smoking in America has more than halved since 1964, dropping from 42 percent to 19 percent, the U.S. still has around 44 million smokers. They include more than 3.5 million Californians—200,000 of whom are under age 18. The state’s smoking rate is 13 percent, the second-lowest in the nation, but like many rural areas, Butte County is significantly above the average, at almost 21 percent.

“We’ve got to do better in rural America,” Baldwin said.

The American Cancer Society estimates tobacco use contributes to 443,000 premature deaths a year, plus 3,400 nonsmokers exposed to secondhand smoke, and costs the country $193 billion a year when adding lost productivity to health-care expenditures.

“Tobacco is still the leading preventable cause of death in the United States,” said Jim Knox, vice president of advocacy for the Cancer Action Network, when reached by phone at his office in Sacramento. “I don’t think people realize the continued toll—from a health perspective and a financial perspective—that tobacco takes. Smoking kills more people than AIDS, alcohol, murders, car accidents, suicides and fires combined.

“We still have a lot of work to do.”

Policy pushes from the Cancer Action Network and other anti-smoking advocates include raising tobacco taxes, which would contribute to several other goals: increasing funding levels for cessation and education programs; regulating smoke in multiunit housing complexes; and getting more states to ban smoking in workplaces, as California first did in 1994.

Electronic cigarettes, or e-cigs, represent a fresh wrinkle. The U.S. Food and Drug Administration does not regulate e-cigs—handheld devices that resemble tobacco cigarettes but emit nicotine-laden vapor instead of smoke.

“We don’t have data on the health impacts at this point,” Knox said. “There are definitely carcinogens in a lot of the e-cigarette liquids that are vaporized, but we still don’t know more than we know about electronic cigarettes at this point.”

Particularly worrisome to tobacco-control experts, Knox added, are a rapid rise in the use of e-cigs by teens and “the prospect that electronic cigarettes may help to renormalize smoking.”

As Baldwin knows firsthand, the average smoker tries his/her first cigarette at age 12. Those who successfully shake the habit will have attempted to do so an average of seven times—though Baldwin said he tried hundreds of times over 25 years.

“It is kind of like the perfect storm of addiction with nicotine—the fact that it’s legal, it’s readily available, there are cues and triggers everywhere, and it clearly helps people deal with stress, so the stress of addiction becomes a reason they pick up a cigarette,” he said. “Scientists and researchers say [nicotine] is harder to quit than heroin or cocaine.”

Karen Vollman, a respiratory therapist at Feather River Hospital, also helps North State smokers quit. She says smoking can be “one of the only forms of pleasure for some people” and affirms that many people use nicotine—“a brain stimulant and muscle relaxant”—to “self-medicate to reduce stress.” As a result, “for someone interested in quitting smoking, the hard part is finding the alternatives that work and that satisfy them.”

She continued: “Quitting takes practice. When someone’s smoked hundreds of times—every day, ever since they were 12 years old—it’s hard to learn new behaviors. It can take several methods and techniques.”