Men’s Smoking Rates Have Declined Sharply in North Texas Since 1996

Men’s smoking rates in the Dallas-Fort Worth Area have decreased since 1996 while women’s rates have barely budged, according to a study released Monday by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Most of the decline in smoking rates has occurred in the past decade. For example, the men’s smoking rate in Dallas County rose slightly from 1996 to 2002 from 28.3 percent to 29 percent and then dropped sharply to 18.1 percent in 2012.

“We know what works in tobacco control. It’s taxation. It’s smoking bans. It’s advertising bans, among other measures,” said IHME Director Dr. Christopher Murray in a statement. “We now need to understand what is happening on the ground in these counties that is leading to such great success in parts of New York, Iowa, and Texas, and near total stagnation in parts of Montana, Oklahoma, and Mississippi.”

The study will be published in the journal Population Health Metrics.

Arlington and Fort Worth are among 20 of the 50 largest U.S. cities that do not have comprehensive smoking bans. Smoking is banned in Arlington’s restaurants, AT&T Stadium, the University of Texas at Arlington, and many businesses. However, there are no comprehensive prohibitions for the city’s workplaces and bars. Smoking is prohibited in Fort Worth’s workplaces and restaurants, but not in bars. Dallas has a comprehensive smoke-free prohibition.

“It is difficult to quit smoking because tobacco is so addictive,” said Frederick P. Cerise, MD, Parkland’s president and chief executive officer. “Policy interventions including environmental changes are important to keep people from starting and to help individuals stop smoking.”

Parkland has been a smoke-free campus since 2008 and operates a smoking cessation clinic.

“It is always good to know that the DFW Metroplex is helping to set the tone for the country in wellness and especially when it comes to smoking cessation,” said Dr. Stephen Mueller, a pulmonologist at Methodist Charlton Medical Center. “I think the stand banning public smoking taken by Metroplex communities, following the leadership from Dallas officials and physicians, have helped people who we’re hoping to quit or needed a push to quit smoking.”

Texas has resisted a statewide smoking ban. Rep. Myra Crownover, R-Denton, and Sen. Rodney Ellis, D-Houston, have introduced smoke-free legislation in each of the past four legislative sessions. The House passed the legislation in 2007 and 2011 but the measures never gained traction in the Senate.

Despite the success of anti-tobacco interventions, smoking persists among those with the least education. In 1966, more than 45 percent of high school dropouts smoked, compared with about 33 percent of college graduates.

By 2011, fewer than 8 percent of college graduates smoked, compared with more than 36 percent of those without a high school diploma. Unfortunately, those smokers also generally occupy the lowest rung of the economic ladder and can least afford to support the habit.

New England Journal of Medicine researchers estimated tripling tobacco taxes worldwide would reduce the number of smokers by one-third and prevent 200 million premature deaths this century. Although smoking prevalence has decreased worldwide, the number of cigarette smokers has increased in the past 30 years because of population growth.

According to the most recent figures from the Global Burden of Disease study, coordinated by IHME, tobacco smoking was linked to 465,000 deaths and 12 percent of total health loss in the U.S. Globally, tobacco led to 5.7 million deaths and 5.5 percent of total health loss. These estimates do not include the effects of secondhand smoke.

IHME also calculated county-level data on several other health measures. Among the findings:

  • Life expectancy rose significantly from 1985 to 2010, especially for men. For example, men in Dallas County gained nearly six years of life expectancy to age 76 during that period, while women gained three years to age 80.
  • Hypertension increased for both genders from 2001 to 2009. In Dallas County, more than 40 percent of women and more than 37 percent of men have high blood pressure. Those rates grew by 3 and 4.4 percentage points during that decade.
  • Obesity rose sharply from 2001 to 2011. In Denton County, the rate rose by more than 11 percentage points for women to more than 35 percent while the men’s rate rose more than 9 percent to 36.2 percent.
  • Women generally got sufficient physical activity in 2011 while the rate for men fell slightly, compared with 2001. For example, more than 57 percent of women in Collin County did so, which was an increase of five percentage points in a decade. However, the rate for men in that county dropped about three percentage points to 60 percent.
  • While the poverty rate essentially was flat in Texas from 1989 to 2012, it rose in all four counties locally. About 18 percent of Texans are below the federal poverty level. More than 19 percent of Dallas County residents live in poverty, compared with 7.8 percent of Collin County residents.

Dr. Tricia Nguyen, executive vice president for population health at Texas Health Resources, said advances in medical care and technology have boosted life expectancy. When that’s paired with the obesity rate increases, she said healthcare costs will rise by $4.6 trillion by 2020, citing estimates projected by the Centers for Medicare and Medicaid Services.

“It is interesting to see the correlation between lower rates of poverty and increase in life expectancy and higher rates of physical activity, lower rates of smoking and lower rates of hypertension,” Nguyen said.

Dr. Carl Couch, the president of Baylor Quality Alliance, said the data was both encouraging and signaled a “considerable opportunity to improve population health.”

“Clearly healthier personal lifestyle choices represent a great opportunity,” he said. “But also good solutions are likely multifactorial, and very much dependent on what the individual decides.”

The effects of these individual decisions will ultimately have an impact on healthcare costs in the future. Those are difficult to predict: As Crouch notes, even if it’s against the law to ride in a vehicle without a seat belt, the onus is still on the passenger or the driver to lock the belt in place.

“My own adherence to proper treatment for high blood pressure means me taking that pill, and then being sure that it has lowered my pressure to under (control),” he said. “Those choices are cheaper than healthcare interventions, and ones no one can make but me.”

Steve Jacob is founding editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

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