Up in smoke

As a nurse treating stroke patients, Sherry Wirt sees the impacts of smoking on a regular basis. Not everyone who has a stroke happens to smoke, but the unhealthy habit contributes heavily. It’s a leading risk factor for cardiovascular disease and strokes alike.

Interestingly, this bit of information is rarely an epiphany for her patients.

“When I go in and see someone who’s had a stroke or TIA [transient ischemic attack, or ‘mini-stroke’], I normally ask if there’s something in their life that puts them at risk for stroke,” said Wirt, coordinator for the Stroke Program at Enloe Medical Center. “If they smoke, usually that’s the first thing people will say. I think people know it’s bad for them—they just don’t think it’s going to happen to them.”

Jan Wicklas, a respiratory care practitioner for Enloe’s Cardio-Pulmonary Rehabilitation program, agrees: “Smokers know the negative effects.” But knowledge isn’t always power when it comes to smoking. “It’s an addiction,” she said—and a strong one at that. Physical dependency can override reason.

And now, a study released Feb. 12 in the New England Journal of Medicine, which links additional diseases and a higher death toll to tobacco, provides additional reason for pause.

Meanwhile, the health effects of using electronic cigarettes (e-cigs), also known as vaping, are much less certain, but there are local, state and national pushes for tighter regulations. Locally, Paradise just passed an ordinance expanding no-smoking zones along with placing the same restrictions on e-cigs as smoked tobacco. Dr. Ron Chapman, state health officer for California, recently classified e-cigs a public health threat. Meanwhile, U.S. Sen. Barbara Boxer (D-CA) has reintroduced legislation to ban marketing e-cigs to children and teens.

The new study, titled Smoking and Mortality, consolidates research from the American Cancer Society, the National Cancer Institute, Harvard Medical School and three other universities. It unveiled a number of findings, such as:

• Smokers, comprising 21 percent of men and 15 percent of women in America, die a decade earlier than nonsmokers, on average.

• Around 540,000 Americans die each year from smoking-related conditions—60,000 more than ascribed in the Surgeon General’s 2014 report.

• Diseases previously not tied to tobacco use—including kidney failure, a gastrointestinal disorder and certain infections—do have a connection, raising the total to 21 illnesses.

“I’m not surprised that we’re finding tobacco is impacting people’s health even more than we expected,” said Dr. Mark Lundberg, Butte County’s public health officer. “It’s a tragedy, it’s sad, it’s concerning. What a defective product this tobacco is, and how it’s hurting people, hurting children, hurting families….

“This just adds to the huge amount of evidence we already have and continues to build a case that we need to take public health steps to lower the use of tobacco in our country.”

Local numbers are particularly stunning. The most recent statistics show 19 percent of Butte County adults smoke, compared with 12.9 percent of adults in California as a whole. The gap varies based on socioeconomics: Among county subscribers to Medi-Cal (subsidized health insurance), 42 percent smoke, compared to 18.7 percent of statewide Medi-Cal patients.

‘The poor are overburdened with the diseases talked about in the study,” Lundberg said. “They’re going to be overburdened with complications, death and suffering.”

Quitting is important, but isn’t an instant cure. Wicklas stresses that former smokers still need to take care of their lungs, as many have developed COPD (chronic obstructive pulmonary disease) and may have to deal with limitations from restricted breathing.

Indeed, the effects build over time.

“Smoking in itself—or e-cigarettes—you don’t see the damage right away,” Wirt said. “With e-cigarettes, it’s kind of a newer fad; the toll that those will take on people’s bodies we will be seeing in the future, I think. It just doesn’t happen overnight.”

E-cigs and vaping have become controversial because proponents view the product as distinct from tobacco while opponents see a contiguous product line due to nicotine content and other chemicals. Raul Raygoza, a public health educator for Butte County, takes the latter view, which explains his satisfaction when Paradise officials followed Oroville leaders in restricting e-cigs and tobacco alike.

Paradise Ordinance 554—passed Feb. 10 by the Town Council on a 4-to-1 vote—treats “electronic devices providing vapors or smoke from tobacco, nicotine, weeds, marijuana and other substances” the same as “tobacco smoking” under the municipal code. Furthermore, the ordinance extends the previous smoking ban from enclosed public places to include bars and outdoor spaces, namely public parks and anywhere within 20 feet of building doors and windows.

“They’ve taken a bold step to continue to denormalize smoking in their community to protect their citizens,” Raygoza said. “Oroville has taken the initiative to protect their citizens indoors, which is wonderful; Paradise took it just a little bit further.”

Raygoza also noted Oroville’s restrictions on vendors: requiring clerks to check IDs for people who look under 27 and for stores to keep vaping products behind the counter with tobacco products.

Such measures are significant, both he and Lundberg said, because of the spike in vaping among young people. Sen. Boxer’s office, in pushing the Protecting Children from Electronic Cigarette Advertising Act, cites a study released in December showing more teens use e-cigs than cigarettes. The Monitoring the Future report states 9 percent of eighth-graders vape versus 4 percent who smoke—a gap that nearly doubles (16 versus 7) by 10th grade.

Chapman, head of the California Department of Public Health, referred to the same statistics in issuing a state health advisory Jan. 28 along with his own report warning of e-cigs’ toxicity.

“Our cities are on the leading edge of what I think is going to happen across the state,” Lundberg said. “I believe these cities have been proactive, and we’re very excited that they’ve stepped up like this.”