The many ways in which smoking affects health in Appalachia

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What do heart disease, cancer, COPD, and stroke all have in common? For one, they’re all among the leading causes of death in the United States. But they have similarities beyond that: trends over time, geographic variation, and even risk factors.

Digging a little deeper into the geographic variation component, in the Health Disparities report, we see that mortality due to each of these four causes is higher in the Appalachian Region than in the country as a whole:

Heart disease – 17 percent higher in Appalachia than in the U.S. overall
Cancer – 10 percent higher
COPD – 27 percent higher
Stroke – 14 percent higher

A common risk factor for each of these is smoking, which is more prevalent in the Appalachian Region than in the U.S. overall: nearly 20 percent of all adults in Appalachia report being cigarette smokers, a figure higher than the 16 percent reported for the country as a whole.

Let’s consider again the four causes of mortality mentioned above. Where in Appalachia are these mortality rates the highest? Among the five subregions, Central Appalachia has the highest rate for three of the four causes of death, with the lone exception here being stroke mortality (Southern Appalachia has a rate of 47.3 deaths per 100,000, which is slightly higher than the 47.2 per 100,000 found in Central Appalachia).

And where within Appalachia is smoking the most prevalent? Again: Central Appalachia, where 25.2 percent of residents report being cigarette smokers. The spatial pattern couldn’t be clearer: areas that report a higher prevalence of smoking also report higher levels of negative health outcomes.

The research team picked up on this—smoking’s correlation with the four leading causes of mortality, as well as a multitude of other health conditions—and dedicated one of three issue briefs to it. The brief offers a wide range of strategies and recommendations so that stakeholders throughout the Region can begin work on reducing the prevalence of smoking in their communities.

The four primary recommendations set forth in the report are the following:

  • Prevent smoking initiation among youth.
  • Increase access to tobacco cessation interventions.
  • Launch anti-tobacco campaigns.
  • Reduce exposure to secondhand smoke.

Focused strategies and examples are included for each of these four recommendations. For example, for the first recommendation—preventing smoking among youth—the brief details the importance of tobacco prevention in schools, and it also suggests raising the minimum age to purchase tobacco products to 21. For the second recommendation—increasing access to cessation interventions—the brief suggests incorporating telehealth quitlines, as well as reducing out-of-pocket costs for cessation treatments.

To learn more about these strategies and recommendations, please visit the smoking issue brief.

Beyond Mortality

Despite the focus up to this point on mortality, what’s important to remember about smoking is that not only does it lead to premature death, it also affects quality of life—and not just for smokers, but also those exposed to smoke (see recommendation #4 above).

So let’s take a look at several indicators included in the Health Disparities report that aren’t focused on mortality.

The first is physically unhealthy days, which is the number of days per month the average adult reports feeling physically unhealthy or of poor physical health. With a rate of 4.1 days per person per month, Appalachian residents experience more of these days than the average American (3.6 days per person per month). Averaged out over the course of a year, that’s six more days per person per year that the average Appalachian resident reports being physically unhealthy compared to the average U.S. resident.

Another is physical inactivity, an indicator explored in the previous blog post, which showed that that levels of physical inactivity are higher in Appalachia than in the country overall. Not being physically active can contribute to a wide range of health issues, including not just the causes of mortality noted earlier, but also diseases stemming from obesity and diabetes.

Smoking plays a part in both of these variables in that smokers are more likely to get sick and report being physically unhealthy—due to compromised immune systems—and also, due to the difficulty that might accompany exercise, report higher levels of physical inactivity.

But smoking’s reach doesn’t stop there. Let’s take a look at two other variables from the Health Disparities report: low birth weight and infant mortality. By nature, these two measures are related to one another, as babies born with low birth weights are more likely to have birth defects, which sometimes may lead to premature death. And what is one of the primary risk factors for a child to be born with a low birth weight? For the mother to have smoked during the pregnancy—or, for her to have been exposed to large amounts of secondhand smoke.

As the issue brief so bluntly puts it: “Residents of Appalachia die sooner than residents in the rest of the United States, and they’re more likely to die from smoking-related diseases.”

The effects of smoking go beyond mortality: it makes smokers’ days less healthy, less enjoyable. But not only that, it also puts other people in the community at risk.

Explore the health disparities data to see where your county, state, or subregion rank in the variables mentioned here. Take a look at the Bright Spot case study of Wirt County, WV and read about a successful health messaging campaign program, one that included an anti-tobacco message painted on a barn. Or look at the one for McCreary County, KY, where community leaders engaged with work sites and restaurants to voluntarily establish smoke-free policies. And if you’d like to learn how you can help your community decrease smoking and increase overall health, check out the issue brief on smoking here.