The number of heavy smokers in the United States has decreased significantly over the decades, with the greatest decline occurring in California. That drop may explain why lung cancer deaths have declined faster in California than in the rest of the United States, the authors of a new analysis say.
Between 1987 and 2007, the lung cancer death rate per 100,000 Californians declined from 109 to 77. The rate for the remaining United States was 102 deaths per 100,000 people in 2007.
There was also a nationwide decline in the number of moderate smokers, though not as dramatic as that of heavy smokers.
California may have outpaced the rest of the states in terms of the drop-off in heavy smoking because of the state's aggressive anti-smoking policies over the years, the researchers said. It was the first state to restrict smoking in the workplace, in 1976, and the first to introduce a well-funded tobacco control program, in 1989.
Study researcher John P. Pierce of the Moores UCSD Cancer Center at the University of California, San Diego, said the rate of lung cancer would go down in the rest of the country if we achieved further declines in heavy smoking.
Pierce and his colleagues analyzed two large, national surveys to gauge smoking habits in the United States, and in their state in particular. The surveys spanned the decades between 1965 and 2007. A total of 139,176 people responded in California and 1,662,353 in the rest of the United States.
In 1965, the percentage of adults who smoked heavily — at least 20 cigarettes per day — was 23.2 percent in California and 22.9 percent in the rest of the country. By 2007, these numbers had dropped to 2.6 percent in California and 7.2 percent in the rest of the United States.
Between 1965 and 2007, the number of moderate smokers in California dropped from 11.1 percent to 3.4 percent. Nationwide, the drop was from 10.5 percent to 5.4 percent.
The attrition of heavy and moderate smokers is attributable to a combination of people quitting as they get older and fewer people starting at younger ages, the researchers said. Only a small fraction of young people today will ever smoke 10 or more cigarettes per day, the researchers predicted.
California has the second lowest smoking rate in the United States. (Utah is No. 1.) Eleven percent of people smoke in California, compared with 17.9 percent in the United States as a whole.
"If we want to reduce health care costs, like [the cost of] lung cancer, we need to be aggressive in changing the norms of smoking," Pierce said.
He noted a recent survey in California found 30 percent of people did not have any contact with smokers. "There's no exposure and it's not accepted in a lot of places, and so people are much less likely to smoke," Pierce said.
Another way California may have reduced smoking rates was to increase the tax on cigarettes in 1989 and use the money to fund the tobacco control program. While other states have started similar programs, they are years behind, Pierce said.
The researchers reported their results in the March 16 issue of the Journal of the American Medical Association.
Pass it on: The drop in lung cancer deaths in California may be attributed to the dramatic decline in heavy smokers in that state.
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