In the United States, tobacco use is responsible for nearly one in five deaths.  This amounted to 435,000 deaths in 2000.  The number of  people who prematurely die or suffer illness from tobacco use results in substantial  economic costs to society.  For example, smoking causes approximately $158 billion in annual health-related economic costs.  Yet, smoking remains the most preventable cause of death in our society.

This article examines the prevalence of smoking among adults in Southeastern Pennsylvania and the characteristics of smokers.

HOW MANY ADULTS SMOKE?

Results from PHMC's Community Health Data Base 2004 Household Health Survey indicate that in Southeastern Pennsylvania, one in five adults ages 18+ (22.7%) smoke cigarettes, representing 665,000 adult smokers in the region.  This percentage mirrors national patterns (23% of U.S. adults smoke cigarettes) and is nearly double the Healthy People 2010 goal for the nation of 12%.  Additionally, 16.0% of households with children contain at least one adult who smokes inside the home, exposing these children to "environmental tobacco smoke."  This represents nearly 67,000 children in Southeastern Pennsylvania.

·  The percentage of smokers varies across the five counties, from a low of 17.8% in Montgomery County to a high of 26.2% in Philadelphia County;
·  In the suburban counties smoking is less prevalent than in Philadelphia (20.6% versus 26.2%);
·  Only one out of ten children in the suburban counties of SEPA (10.9) live with someone who smokes in the house, while 24.5% of Philadelphia children are exposed to "environmental tobacco smoke."
·  Younger and middle-aged adults ages 18-39 (26.8%) and 40-49 (27.4%) are more likely to smoke than are older adults ages 50-59 (22.8%), 60-74 (16.3%), and 75 and over (6.4%);
·  Males are slightly more likely to smoke than females (24.6% versus 21.2%);
·  Adults with more education are less likely to smoke than non-high school graduates: one-third (33.5%) of non-high school graduates age 25 and over smoke compared to only 9.0% of adults with graduate level education, 28.5% of high school graduates, 25.9% of adults with some college, and 13.9% of college graduates;
·  One in four black (26.9%) and Latino (24.8%) adults smoke compared to one in five (21.9%) white adults.

SMOKING AND HEALTH BEHAVIORS

·  One-quarter of adults with asthma (24.8%), 18.7% of adults who have ever had cancer, and 17.5% of adults with a heart condition smoke.
·  Although cigarette smoking can aggravate diabetes and high blood pressure, 18.7% of diabetics and 20.4% of adults with high blood pressure smoke.
·  One-quarter of adults with asthma (25.5%) are exposed to "environmental tobacco smoke" in their household.
·  Adults who never exercise (28.0%) are most likely to smoke.   However, 24.5% of adults who exercise more than three times per week smoke.
·  Adults with high levels of stress in their lives are more likely to smoke than those with no stress: 15.1% of adults with no stress smoke compared to 43.0% of adults with extreme stress levels.

OTHER COSTS OF SMOKING

In addition to the health risks of smoking, smoking also entails a financial burden for many smokers.  According to the American Cancer Society, smoking causes approximately $157.7 billion in annual health-related costs, including $75.5 billion in medical costs and $81.9 billion annually in mortality-related lost productivity costs.

·  In SEPA,  more uninsured adults (38.1%) smoke cigarettes than insured adults (21.5%).
·  Nearly one in every three poor adults in SEPA smoke cigarettes (31.5%) compared to one in five non-poor adults (20.9%).
·  Of adults who cut meals due to lack of money in the past year, two out of five (42.7%) smoke.  Nearly one-half of adults who did not eat due to lack of money (49.0%) smoke cigarettes. 
·  Adults in SEPA with lower levels of education are more likely to smoke cigarettes.  As shown in the following figure, adults age 25 and over who did not finish high school are the most likely to smoke (33.5%), while those who completed graduate level work are least likely (9.0%).  Twice as many adults with high school diplomas (28.5%) smoke as compared to those with a college degree (13.9%).
·  Unemployed adults (35.3%) and those who are unable to work (40.4%) are most likely to smoke.  Retired adults in SEPA are least likely to smoke (12.3%), followed by homemakers (20.0%), full-time students (23.7%), and those who are employed part-time (21.6%) or full-time (23.3%).

QUITTING SMOKING

Since 1991, the percentage of smokers in SEPA has decreased fifteen percent from 26.8% to 22.8%.  However, the current percentage of smokers in SEPA far exceeds the Healthy People 2010 objective of 12%.  Although more resources than ever are available than ever to smokers who wish to quit, many current smokers who attempt to quit are unsuccessful in their efforts.

·  One-half of SEPA adults who ever smoked (51.7%) have quit smoking.  The overwhelming majority of those who quit (90.1%) quit smoking more than one year ago.
·  In the past year, 56.2% of current adult smokers were advised by their doctors to quit smoking, and one-half of current smokers (54.8%) tried to quit.
·  Two-thirds of adult smokers who tried to quit in the past year (67.8%) tried to quit on their own, but one-quarter (24.5%) used such aids as nicotine patches or gum or Zyban or other medications.

Comprehensive tobacco control programs in some states have effectively reduce smoking rates, saving lives and millions of dollars in tobacco-related health care costs.  The Great American Smokeout aims to reduce these preventable illnesses and deaths by helping current smokers quit and deterring future smokers.  Hopefully, greater information on aids to quitting smoking will help more smokers successfully quit.  For more information on PHMC's Community Health Data Base 2004 Household Health Survey, or to learn more about smoking prevalence in Southeastern Pennsylvania, contact Lisa R. Kleiner at (215) 985-2576 or lisa@phmc.org.