Gregory A. Hand, Clay B. Marsh: Tobacco is WV’s opportunity for change

By Gregory A. Hand and Clay B. Marsh

The World Health Organization says that cigarette sales is the only business where the product, used as directed, will kill about half of its customers. West Virginia has the highest rate of smoking among children, adults, seniors and among pregnant women of all states. Not surprisingly, we have an average life expectancy that is over three years less than the national average.

Our state spends over $1.3 billion a year on health care costs directly related to cigarette smoking and loses another $1 billion in workplace productivity.

The state government’s financial crisis is directly tied to the $277 million we must spend each year on Medicaid charges associated with cigarette smoking. That’s about $150 per citizen, smoker or not.

Last year, about 3.5 billion cigarettes were sold in West Virginia. Children and teens bought or smoked about 70 million of those.

A quick back-of-the-envelope calculation shows each pack of cigarettes costs West Virginia over $7 in health care spending: more than the price of the pack! And, that $7 is about equal to the on-average consumer spending in one visit to a convenience store.

On average, it costs us all more in health costs for that pack than the store is making in sales for that smoker.

The good news is that there are evidence-based strategies that reduce smoking and its associated disease risk, for both smokers and non-smokers. From a broad, public health perspective, these strategies should be based on collaboration among state government, the business community and healthcare providers. And the strategies should focus on three areas of impact: reducing sales, enforcing smoke-free environments and helping smokers quit.


Reduce sales

Quite simply, increasing the tax on cigarettes is the most cost-effective way to reduce smoking and smoking-related disease in West Virginia.

An increase of 45 cents proposed — a little less than a 10 percent increase in the cost of a pack of cigarettes — would result in a significant improvement in the heath of West Virginians and generate new revenues that could be used to further improve the health of the state’s citizens.

West Virginia University’s Bureau for Business and Economic Research reports that a 45-cent increase in the cost of cigarettes would result in a 6- to 12-percent decrease in cigarette purchases. Data from previous studies show that the tax-related reduction in cigarette purchases among more vulnerable people will be almost twice that of adult smokers.

Thus, not only will an increase of 45 cents generate $60 million to $69 million dollars in new revenue for the state, but it will also selectively reduce smoking in vulnerable citizens, like teens and pregnant women. Of course, a $1 increase in the cigarette tax would have an even greater impact on smoking — particularly among children — and would likely generate over $130 million in new revenue.

As our leaders take up the challenge of balancing the state budget for next year, it is important to remember that an increase in the cigarette tax is not just about dollars, but — more importantly — it is about reducing death and disease resulting from cigarette smoking.

Models by the Robert Wood Johnson Foundation suggest that a modest 10 percent increase in the cigarette tax would result over a 10-year period in 74 fewer cases of cancer, 240 fewer cases of cardiovascular disease and 277 fewer cases of respiratory disease and save 133 years of life.


Enforce smoke-free rules

Nationally, over 65 percent of the population lives in areas with smoking restrictions in public places. The Surgeon General reports that limiting workplace smoking leads to less smoking among workers. Furthermore, evidence suggests that young people living in areas with smoke-free restaurants are about 40 percent less likely to become long-term smokers.

The Centers for Disease Control and Prevention report that over 20 international studies show that employees of companies with smoke-free policies are nearly twice as likely to stop smoking as those who work in places that allow smoking.

In addition, laws restricting smoking at work and in public places protect non-smokers from an increased risk of lung and heart disease.

So enforcing a smoke-free environment protects the health of non-smokers, reduces the number of children who become smokers, and empowers current smokers to quit.


Promote smoking cessation

Quitting smoking is difficult. Most individuals try numerous times before they finally quit.

Unfortunately, most individuals attempt to quit without support and often without following a proven strategy.

A comprehensive effort with state-level advertising campaigns and school-based programs, incentivized cessation programs at work, and advice and counseling by health care providers offer the highest rate of success for those wanting to quit for good.

State-level efforts can set the tone for reducing smoking behaviors — by providing smoking quit lines, supporting statewide advertising such as the successful “tips from former smokers,” and enforcing smoking laws. However, proven success strategies include establishing smoking intervention efforts through counseling and medication within the medical care system and employers implementing incentivized cessation services for their workers.

The U.S. Department of Health and Human Services reports that advice from health care providers and evidence-based cessation interventions greatly increase the likelihood of success.

Treatment programs are cost-effective ways to quit, and result in reduced health care costs and increased worker productivity. For this reason, it is important to have collaboration among state government, businesses and health care systems.

More than most states, West Virginia is shuddering under the human and economic burden associated with cigarette smoking. The combined strategy of decreasing cigarette sales through a tax increase, protecting our population from second-hand smoke, and using evidence-based programs to help smokers quit are effective means to reduce the burden of smoking and its associated diseases. This proven strategy is a way forward to address the number one cause of death in our state and improve the health and economic well-being of West Virginians.

Gregory A. Hand, Ph.D., M.P.H., is an epidemiologist and founding dean of the West Virginia University School of Public Health. Clay B. Marsh, M.D., is a physician, researcher and vice president and executive dean for health sciences at WVU.

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