Cigarette smoking causes an increased risk of heart disease and cancer, the two leading causes of death among adults in the United States.  Yet an estimated 47 million U.S. adults smoke cigarettes and according to the American Cancer Society, “when cancer statistics are combined with all smoking-related diseases, cigarette use kills half of all continuing smokers” .  By quitting, however, smokers can drastically reduce the negative health risks associated with smoking, thus making smoking “the most preventable cause of premature death in our society” . 

In a nation-wide effort to increase awareness of the dangerous health effects of smoking, the American Cancer Society will host the 2003 Great American Smokeout.  Held on the third Thursday in November, this annual event not only asks smokers to take the challenge and quit, but it also provides necessary information and support.  In recognition of this event, the following article examines the prevalence of smoking in Southeastern Pennsylvania.

WHO SMOKES IN SOUTHEASTERN PENNSYLVANIA?  Results from PHMC’s Community Health Data Base 2002 Household Health Survey indicate that in Southeastern Pennsylvania, one in five adults ages 18+ (20.7%) smoke cigarettes; this represents approximately 600,000 adult smokers in the region.  Additionally, 28.5% of households contain at least one smoker, and one in every three children (34.4%) in SEPA is exposed to “environmental tobacco smoke”(ETS)  in their home. 

• The percentage of smokers varies across the five counties, with a low of 16.1% in Montgomery County, to a high of 24.9% in Philadelphia County.    
• In the suburban counties, an average of 24.6% of households contain a smoker, while one in every three Philadelphia households contains at least one smoker (34.5%).  (See Figure 1)
• Almost three out of ten children (28.9%) in the suburban counties of SEPA live with a smoker in their household, while 42.7% of children in Philadelphia are exposed to “environmental tobacco smoke” from an adult smoker in their home.  (See Figure 1).
• Younger adults, 18-49 years of age (24.6%), are more likely to smoke than are older adults, ages 50 + (14.8%).  After the age of fifty, the percentage of adult smokers drops steadily from 19.7% of those 50-59 years of age, to 15% of adults 60-74 years of age, and only 6.2% of adults ages 75+.
• One in five white adults (20.2%) and Latino adults (20.3%) smoke cigarettes, while nearly one in four black adults smoke (24%). 
• Males and females in Southeastern Pennsylvania are equally as likely to smoke cigarettes (20.9% and 20.5%, respectively).

SMOKING AND HEALTH BEHAVIORS: 

• Adults in SEPA in fair/poor health (27.4%) are more likely to smoke than those in excellent/good health (19.1%).
• Greater than sixteen percent (16.6%) of adults with a heart condition, 17.0% of adults with cancer, and 24.0% of adults with asthma smoke cigarettes.
• Although diabetes and high blood pressure are also linked with an increased risk of cancer, 14.4% of adults with diabetes and 18.2% of adults with high blood pressure smoke cigarettes. 
• More than one in three SEPA residents with asthma are exposed to “environmental tobacco smoke” in their household (35.2%).
• Adults who never exercise are most likely to smoke (24.5%), followed by those who exercise less than once per week (23.5%).  However, one in five adults (19.8%) who exercise regularly also smoke cigarettes.   
• Adults with greater levels of stress are more likely to smoke than those experiencing less stress in their lives.  Only 15.7% of adults facing minimal levels of stress smoke.  Adults with extreme levels of stress, however, are twice as likely to smoke cigarettes (32.5%). 

OTHER COSTS OF SMOKING:  Smoking not only carries implicit health risks, but with the price of cigarettes on the rise in recent years due to higher taxes on cigarette sales, smoking also entails a costly financial burden for smokers.  This burden extends to the rest of society as well.  According to estimates from the National Institutes of Health, smoking cost the United States $60.9 billion in direct medical costs, $15.5 billion in lost productivity due to illness, and $95.2 billion in cost of productivity due to premature death, bringing the total to $171.6 billion for the year 2002 .

• In SEPA, nearly twice as many uninsured adults (37.9%) smoke cigarettes, as compared to insured adults (19.4%).
• One in every three poor adults in SEPA smoke cigarettes (32.6%) as compared to one in every five non-poor adults (20.6%). 
• Of adults who cut meals due to lack of money in the past year, two out of five (39.8%) smoke.  Nearly half of adults (45.4%) who did not eat due to lack of money smoke cigarettes.
• Adults in SEPA with lower levels of education are more likely to smoke cigarettes.  As illustrated in Figure 2, those who did not finish high school are the most likely to smoke (29.0%) while those who completed graduate level work are the least likely (7.4%).  Twice as many adults with high school degrees (27.5%) smoke as compared to those who finished their education with a college degree (13.2%).  (See Figure 2).  
• Unemployed adults (34.3%) and those who are unable to work (36.9%) are the most likely to smoke.   Retired adults in Southeastern Pennsylvania are least likely to smoke (10.9%) followed by home-makers (16.6%), full-time students ages 18+ (20.9%), and those who are employed full-time or part-time (21.3%).  (See Figure 2).

QUITTING SMOKING:  
Over the past decade, there has been a gradual decrease in the number of smokers nationwide, as well as in the Southeastern Pennsylvania region.  Since 1991, the number of adult smokers in the region has decreased more than twenty percent, from 26.8% in 1991 to 20.7% in 2002.  The current percentage of smokers in SEPA, however, far exceeds the Healthy People 2010 objective of only 12% . 
Research indicates that people are now more aware of the health risks of smoking than ever before and many are choosing to quit.  Unfortunately, many current smokers who want to quit are unsuccessful in their attempts. 

• In the past year, 54.1% of current adult smokers in SEPA were advised by their doctors to quit smoking, and one half of current adults who smoke tried to quit in the past year.
• Nearly seventy percent (69.2%) of adults with asthma, 65.4% of adults with a heart condition, and 49.1% of adults with cancer tried to quit within the past year, but still continue to smoke.

According to the American Cancer Society, “more Americans die each year from smoking than from alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs” .  By helping current smokers quit and deterring future smokers, the Great American Smokeout aims to reduce these premature and unnecessary deaths due to smoking.  With the support and encouragement from such events, hopefully more smokers will be able to successfully quit smoking.  For information regarding PHMC’s Community Health Data Base 2002 Household Health Survey, or to learn more about smoking prevalence in Southeastern Pennsylvania, contact Diana Levengood, at (215) 731-2039 or dianal@phmc.org.