Kicking the habit: Adult smoking rate in US is falling fast

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NEW YORK (AP) — The smoking rate among U.S. adults has been falling steadily for decades but the latest survey from the Centers for Disease Control and Prevention finds the 2015 decline is the biggest in more than 20 years.

The government report says the rate of smoking among adults in the U.S. fell two percent, to 15 percent last year, from 17 percent in 2014.

The usual decline is 1 point or less in a year and it’s not clear why last year was different.

Smoking is the nation’s leading cause of preventable illness and the CDC estimates it causes more than 480,000 U.S. deaths each year.

About 50 years ago, roughly 42 percent of U.S. adults smoked. Experts attribute recent declines to the anti-smoking advertising campaigns, cigarette taxes and smoking bans.

The role of electronic cigarettes is unclear.

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4 comments

  • Daniel Hammond

    Insurance smoking fee could spur another vice: Lying about doing it

    Thanks to the Affordable Care Act, Americans looking to buy health insurance no longer have to answer questions about whether they’ve suffered diabetes, cancer or heart problems.

    Do you have a chronically sore back, a bum knee or a growing paunch? Don’t worry. Starting next year, insurers no longer will be allowed to hold such pre-existing troubles against you.

    But insurance companies may still ask about one health-related issue: tobacco use. If applicants ’fess up that they smoke or chew tobacco regularly, insurers can charge them up to 50 percent extra for premiums. That could amount to hundreds of dollars per month for some consumers.

    Des Moines tobacco shop owner Rich Bartlett expressed annoyance when he heard about the rule last month.

    “There’s a lot of people who make bad lifestyle choices. Why focus on one bad lifestyle choice?” he said. “You would think something like obesity could be in the same category. To just focus on smokers doesn’t seem fair.”

    Bartlett, who is a smoker, noted that the state and federal governments already have repeatedly raised cigarette taxes. Those taxes now run $2.36 per pack in Iowa, plus a 6 percent sales tax. That adds up to about $900 per year for a pack-a-day smoker, he said, which should be enough of a penalty.

    The premium surcharge will mainly affect people who buy their own health insurance instead of obtaining it through an employer or a government program.

    Some policies offered through employers also require a smoker surcharge.

    Full 50% surcharge allowed in Iowa

    Some states declined to let insurers charge extra premiums to tobacco users.

    Some other states lowered the allowed amount of the surcharge. But Iowa and most other states are allowing the full 50 percent surcharge.

    Iowa insurers vary in how much extra they’ll charge.

    CoOportunity Health, a new Iowa insurance carrier, is charging 49 percent extra. Cliff Gold, the company’s chief operating officer, said the premiums are justified because of the increased medical costs many tobacco users incur.

    Gold noted that tobacco users can avoid the extra premiums by agreeing to participate in tobacco-cessation efforts. For CoOportunity policyholders, that would entail participating online in three 20-minute educational sessions over two months. Participants also would be offered free stop-smoking aids, such as nicotine replacement patches or gum.

    “We certainly hope that people will go through with that process,” Gold said.

    Tobacco users who participate in the education sessions but fail to kick the habit would qualify for the lower premiums until the beginning of the next year, Gold said. Then, they could either retake the tobacco-cessation classes or pay the higher premium.

    Wellmark Blue Cross and Blue Shield, which is Iowa’s largest health insurer, has set its 2014 premiums about 15 percent higher for people who say they use tobacco.

    “We’re trying to find a balance, because the more you charge, the more you’re encouraging people to not tell you the truth,” said David Brown, a Wellmark vice president.

    Brown doubts that increased health insurance premiums would lead many people to quit smoking. He noted how taxes have pushed up the habit’s cost. A pack of cigarettes can now fetch $7 or $8.

    “If that hasn’t put you over the edge, I don’t know if this will,” he said of the insurance premiums.

    Agent: ‘No way of enforcing’ honesty

    Both insurers acknowledged they will have to trust applicants to report their tobacco use truthfully.

    The enforcement issue is particularly thorny because of the way federal officials worded the question that insurance applicants must answer. The applicants are not asked a yes-or-no question about whether they use tobacco or not. Instead, they are asked if they use tobacco four or more times a week.

    “Isn’t that the dumbest question ever? There’s no way of enforcing it. None,” said Janis Van Ahn, a Johnston health insurance agent.

    Even if insurers could test applicants for the presence of nicotine, an applicant could claim that a positive result stemmed from the three Marlboros he allows himself each Friday night outside his favorite bar.

    How would an insurer disprove such a tale? Hire a private investigator to trail Mr. Three-Cigs-a-Week? Not likely.

    West Des Moines health insurance broker Lynn Schreder said agents were stunned to learn earlier this year about the tobacco question’s wording.

    “We were like, ‘Are you kidding me? Are we supposed to enforce this with a straight face?’ ” she said. “Why are they even bothering?”

    The situation is different in the life insurance marketplace. Before consumers can purchase those policies, they routinely undergo urine or saliva tests that check for nicotine.

    But such a test would be useless for health insurance purposes because of the way the new question is worded.

    “If you say you’re not a smoker, it’s kind of the honor system,” Schreder said. “I’m not going to come back and track you and follow you to see if you’re smoking.”

    Gold, the CoOportunity Health executive, agreed that it would be hard to judge the truthfulness of applicants who deny regular tobacco use.

    But he said such people could wind up in serious trouble if they are caught somehow.

    If they falsify their insurance applications, he said, “they’re committing fraud, and theoretically, they could be prosecuted.”

    Cancer Society opposed surcharge

    Surprisingly enough, the American Cancer Society opposed letting insurers charge extra to tobacco users.

    “It is a bit counterintuitive, but when you get down to it, we’re anti-smoking for sure, but we’re not anti-smoker,” said David Woodmansee, an associate director of the national group.

    Woodmansee, who is the Cancer Society’s point man on the Affordable Care Act, expressed fears that smokers would decline to purchase insurance after seeing the high premiums they face for 2014.

    They could be allowed to make that choice, because people whose premiums would amount to more than 9.5 percent of their income will be exempted from the new requirement that most Americans obtain health insurance next year.

    The situation could leave people without coverage for serious illnesses related to smoking, Woodmansee said. “In fact, tobacco users tend to need health insurance more than nonsmokers do.”

    He added that if the higher premiums induce smokers to lie on their insurance applications, they could later be unable to seek medical help if they decide to try quitting.

    “It really creates a Catch-22,” he said.

    Similarly, the Cancer Society has mixed feelings about the three-smokes-a-week loophole in the Affordable Care Act’s definition of a smoker. Of course, he said, the organization wants people to avoid any smoking, because even an occasional cigarette or dip of chewing tobacco can lead to addiction.

    On the other hand, he said, he would not want someone to go without health insurance because of premiums that were inflated by a Saturday night cigarette now and then.

    Bartlett, the Des Moines tobacco shop owner, pays about $550 per month for a health insurance policy for himself, his wife and their three children. He hasn’t looked into where his rates are headed for next year.

    If need be, he said, he could quit smoking to avoid a surcharge. He’s done it before, but it isn’t easy, especially when he stands in front of a wall of cigarette cartons all day at work.

    Bartlett predicted that instead of giving up cigarettes, many people will turn to another common bad habit.

    “They’ll just lie,” he said. “You know they will.”

  • Daniel Hammond

    Manufacturing the science to meet the agenda, in black on white. Does anyone still have doubts?

    ”Bal laughs when asked about the role of scientific evidence in guiding policy decisions. “There was no science on how to do a community intervention on something of this global dimension,” he says. “Where there is no science, you have to go and be venturesome—you can’t use the paucity of science as an excuse to do nothing. We created the science, we did the interventions and then all the scientists came in behind us and analyzed what we did.”

    Read under the title :
    Tobacco Control: The Long War—When the Evidence Has to Be Created

    milbankDOTorg/uploads/documents/0712populationhealth/0712populationhealthDOThtml