EDITORIAL: Smoking has become a habit of the poor, raising the importance of public health work in Maine

June 24--There's good news about smoking rates in Maine and the U.S. Overall, they have dropped significantly over recent decades. Except among the poor.

This emphasizes the need for continued investment in smoking prevention and cessation work, which is funded largely through the Fund for Healthy Maine, money the state receives as part of a settlement with tobacco companies. A Republican budget plan, presented on Thursday, would transfer $10 million out of this fund to pay for schools, in exchange for eliminating a 3 percent surtax on annual income over $200,000, which was approved by voters in November. This is one of many reasons (taking money from social service programs is another) that this plan should be rejected.

Lawmakers have approved legislation to raise the legal age for tobacco purchases in Maine to 21. Raising the tobacco purchase age is an important step in reducing youth smoking rates, and, because nicotine is a gateway drug, avoiding other addictions.

According to the U.S. Surgeon General, nine of every 10 smokers in the country today started smoking before they turned 18.

Further reducing Maine's smoking rate, which topped 30 percent in 1990, is especially important to rural areas, where poverty, lack of employment, disability and other stresses make it especially difficult for smokers to quit.

In Maine, 19.5 percent of adults were smokers in 2015. Among those who earned more than $75,000 a year, the smoking rate was only 6 percent. But, a third of those earning less than $25,000 were smokers, according to data from America's Health Rankings. College graduates were more than six times less likely to smoke than those who have not completed high school.

This disparity has many implications. Adults who receive their health insurance through Medicaid, the federal insurance program for low-income Americans, or who have no health insurance are twice as likely to smoke as those with private health insurance. This means that all Americans pay for the tobacco-related diseases that afflict smokers.

On a human level, low-income Americans have higher lung cancer rates than their more affluent peers. They are also more likely to delay medical care -- often because they lack health insurance -- so they are diagnosed at later stages of diseases, which lessens their chance of recovery.

A study by researchers from several federal health agencies found that men of the lowest socio-economic status were two-thirds more likely to die from lung cancer than their better-advantaged peers. Disadvantaged women were 14 percent more likely to die from lung cancer. Researchers measured social advantage, or status, based on several factors including income, education, labor force skills and housing quality.

They also assessed differences among rural and urban populations. Residents of rural areas are 18 to 20 percent more likely to die from cancer than those in urban areas. Smoking was a significant contributor to the higher mortality rate.

These patterns hold true in Maine. Cigarette use among adults is highest in Washington, Aroostook, Piscataquis and Oxford counties, which are poorer and more rural than the state average. Tobacco use was lowest in Cumberland County, which has the highest median household income in the state and is the most urban.

The risk of premature death follows a similar pattern with the highest rates in Washington, Piscataquis and Aroostook counties. Residents of Cumberland County are the least at risk of premature death. The cancer rate is highest in Washington, Somerset and Piscataquis counties; it is lowest in Hancock and Sagadahoc counties.

Smoking prevention and cessation efforts that are easily accessible -- both in terms of cost and time -- are most effective at reaching these at-risk population. The Fund for Healthy Maine supports a telephone help line, free nicotine therapy products and primary care providers, often the first to counsel patients about their tobacco use.

The state will never have the financial resources to combat tobacco company marketing efforts. So maintaining funding for prevention and cessation is vitally important to improving the health, of both the people and economy, of rural Maine.

If you are a smoker who would like to quit, call the Maine Tobacco Help Line at 1-800-207-1230.

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