Chronic Disease and Cigarette Smoking in Eight Counties

March 24th is Kick Butts Day, http://www.kickbuttsday.org , a day of anti-tobacco activism that focuses on youth and preventing tobacco use.  Most people who smoke cigarettes start as teenagers, and tobacco use is associated with increased risk for chronic disease.  This article provides an overview of tobacco-related chronic disease in Southeastern Pennsylvania and beyond, utilizing data from the Community Health Data Base 2008 Southeastern Pennsylvania Household Health Survey as well as the Community Health Data Base 2008 Berks-Lancaster-Schuylkill Household Health Survey, providing tobacco and chronic disease information for the eight-county area as a whole. 

In the eight-county survey area of Berks, Bucks, Chester, Delaware, Lancaster, Montgomery, Philadelphia and Schuylkill Counties, 20.5% of adults 18+ smoke cigarettes every day or some days, representing 768,500 adults.  Smokers face increased risks for poor health outcomes, including a number of chronic diseases.  A snapshot of a few of those conditions in our region is presented below.  

High Blood Pressure

People with high blood pressure who smoke are at increased risk for heart disease (1). About three in ten adults in the eight-county area (29.6%) or 1,111,400 people have been diagnosed with high blood pressure. This is highest in Philadelphia and Schuylkill Counties, with 35.7% and 34.8% of adults diagnosed, respectively.  Racial and ethnic differences are apparent; throughout the eight-county area, four in ten Black adults (40.0%) have been diagnosed with high blood pressure, compared to 28.1% of White adults and 22.5% of Latino adults.

The risk for high blood pressure increases with age.  One in twelve non-smoking adults 18-39 years of age in the eight-county area (8.3%) has been diagnosed with high blood pressure, compared to nearly one in six smokers in the same age group (15.5%).  A similar effect is seen among adults in their forties.  While about a fifth of the area’s non-smoking adults ages 40-49 (19.3%) have been diagnosed with high blood pressure, more than a quarter of adults in their forties who smoke cigarettes have been diagnosed (27.5%).

About one in five adults with high blood pressure, 20.2%, smoke cigarettes some days or every day. Among adult smokers with high blood pressure who have had a medical visit in the past year, nearly three quarters (73.4%) were advised to quit smoking by their healthcare professional.

Heart Disease

Smokers are at increased risk for heart disease, and are more than twice as likely as non-smokers to die from coronary heart disease. (2) One in ten adults in the eight-county area, 10.7% or about 401,100 people have been diagnosed with heart disease or heart problems. This is highest in Schuylkill County, with 13.8% of adults diagnosed. As with high blood pressure, the risk for heart disease increases with age, and smokers are at greater risk for heart disease at younger ages than are non-smokers.  While 4.5% of non-smoking adults ages 40-49 have been diagnosed with heart problems, 8.1% of smokers in their forties have been diagnosed (Figure1).

Throughout the area, about 75,600 people with heart disease or heart problems currently smoke, and approximately 49,900 tried to quit in the past year.
 
Diabetes

Smokers with diabetes face increased risks for poor health outcomes, including both higher blood sugar and greater risk of other conditions, like heart disease and kidney disease (3). One in ten of adults in the eight-county area (10.3%) have been diagnosed with diabetes, representing 385,700 people.  In Philadelphia this is slightly higher, with 13.0% of adults diagnosed, or 139,800 adults. In the eight-county area, Black adults are at greater risk for diabetes (15.6%), than are Latino adults (10.2%) or White adults (9.0%).

In the survey area, about 70,300 adults with diabetes are also smokers (Figure 2).  Eight in ten smokers with diabetes who have seen a medical professional in the past year (79.3%) have been advised to quit smoking during the past year. About 44,200 smokers with diabetes in the eight-county area (63.0%) have tried to quit smoking in the past year.

Asthma

Tobacco use and exposure to tobacco smoke can trigger or intensify an asthma attack (4).  About one in seven adults in the eight-county area, 14.1% or 529,900 adults have been diagnosed with asthma. This is highest in Philadelphia and Berks Counties, with 17.2% and 15.6% of adults diagnosed (respectively). One in five Latino adults has been diagnosed with asthma (20.3%), which is higher than among Black adults (17.8%) or White adults (12.5%).

Nearly a quarter of adults who have been diagnosed with asthma in the eight-county area are (23.8%) also smokers.  This represents 125,400 smokers with asthma in the survey area. About three quarters, 73.1% of those smokers with asthma who have seen a healthcare professional in the past year have been advised to quit smoking, and throughout the area, 79,800 adults with asthma have tried to quit smoking in the past year.

Smoking Cessation

More than half of smokers in the survey area (54.1%) have tried to quit smoking in the past year, representing 415,000 adults.  Smokers with diabetes, asthma, high blood pressure or heart disease are more likely to have tried to quit than are smokers without these chronic diseases.

Six in ten of the smokers in the eight-county area who have tried to quit in the past year (61.3%) tried without support, or cold turkey.  In Philadelphia, a higher proportion of smokers tried to quit without nicotine replacement therapy, medication, classes or other resources than in other counties, while a lower proportion of Chester County adults tried to quit without support (66.4% and 52.0%, respectively).  Younger smokers are less likely to use support when trying to quit; 72.0% of smokers 18-39 who tried to quit during the past year tried without using medication or support programs, while just over half of adults 60-74 who tried to quit in the past year (49.3%) tried without support. Smokers who are trying to quit and have been diagnosed with heart problems are less likely to forgo assistance; a smaller percentage (51.2%) of smokers with heart problems or heart disease who tried to quit in the past year tried to do it cold turkey, compared to 62.7% of those who have not been diagnosed with heart problems.

Many people in the eight-county area have quit smoking.  While nearly half of adults in the area (46.4%) have ever been cigarette smokers, 20.5% of adults are current smokers. An estimated 91,900 adults in the survey area have quit smoking during the past year, meaning that nearly one in ten adults in the eight-county-area who are former smokers (9.4%) have quit smoking during the past year.

For more information on the Community Health Data Base, or on tobacco use and chronic disease in Southeastern Pennsylvania or Berks, Lancaster, and Schuylkill Counties, please contact Rose Malinowski Weingartner at rosemw@phmc.org.

Resources

For information and resources to help you or a loved one quit smoking in Philadelphia, please visit http://www.smokefreephilly.com/. 

For information and resources in Berks, Bucks, Chester, Delaware, Lancaster, Montgomery and Schuylkill Counties, please visit http://www.sepatobaccofree.org/.

For information and resources on tobacco-related chronic disease, please visit http://beabridge.org/.

(1) American Heart Association. High Blood Pressure: What Can be Done? Retrieved March 5, 2010 from http://www.americanheart.org/presenter.jhtml?identifier=4630.

(2) American Heart Association. Smoking and Cardiovascular Disease. Retrieved March 5, 2010 from http://www.americanheart.org/presenter.jhtml?identifier=3038016.

(3) American Diabetes Association. Smoking. Retrieved March 5, 2010 from http://www.diabetes.org/type-1-diabetes/smoking.jsp.

(4) American Lung Association. Asthma Triggers. Retrieved March 5, 2010 from http://www.lungusa.org/lung-disease/asthma/living-with-asthma/take-control-of-your-asthma/asthma-triggers.html.

To view our archive of past Data Findings articles, please click here http://www.chdbdata.org/datafindings.asp