West Virginia will need to see drastic changes in policy and community engagement if the state hopes to reduce smoking rates that have remained stagnant, according to a study published by local health officials.
The study, “Comprehensive Tobacco Control Policies in West Virginia — Going from Intersection to Integration,” appeared in the July-August issue of the West Virginia Medical Journal. The study, which compared West Virginia and neighboring states, found that the Mountain State’s adult smoking rate has not declined significantly in nearly two decades, despite a marked decline in surrounding states and across the nation.
“As Appalachia, we wanted to look at it from not just a county but a state perspective and see if we have certain funding and certain smoking rates, and you look at states around us, their funding and their tobacco rates, whether our programs are as effective,” said Dr. Rahul Gupta, chief health officer of the Kanawha-Charleston Health Department and a co-author of the study. “Are the policies we have working, or can they be better tweaked?”
Between 1995 and 2010, the daily smoking rates of adults in Kentucky, Ohio and Tennessee dropped to below 20 percent of the population, and below 15 percent of the population in Virginia and Pennsylvania. West Virginia’s rate never fell below 20 percent during that period, and even increased between 2005 and 2010 to nearly the level recorded in 1995.
The national smoking rate declined from 20 percent to 12.3 percent of the population between 1995 and 2010; West Virginia’s smoking rate in 1995 was 23.7 percent, and decreased slightly in 2005, to 21.3, before returning to roughly 23 percent in 2010.
According to Gupta, the difference between West Virginia and many other states lies in aggressive anti-smoking marketing and comprehensive smoking-cessation campaigns.
“Having a comprehensive tobacco control policy is quite significant,” Gupta said. “The recommendations from [the Centers for Disease Control and Prevention’s] Best Practices is out there; the question is, do we pick and choose from those or look at it more comprehensively and try to apply those in a comprehensive state tobacco control program?”
Nearly 4,000 West Virginians die each year from diseases caused by tobacco, according to the state’s Department of Health and Human Resources. Tobacco use is estimated to cost the state $2 billion annually in lost productivity and health-care costs.
Bruce Adkins, director of the Division of Tobacco Prevention for the West Virginia Bureau for Public Health, said all 55 of West Virginia’s counties have some form of Clean Indoor Air Act, but only 27 county policies are considered “comprehensive,” meaning that they ban smoking inside all public facilities. The state does not have its own indoor air laws, Adkins said.
“Clean indoor air regulations are important, but we miss the point in the comprehensive nature . . . so that you have a superlative effect when you apply all of those polices together,” Gupta said. “That’s really the secret of this recipe, is that it’s not just one thing.”
According to Adkins, the state’s smokeless-tobacco use rate among adult males is 12 percent, and about 7 percent of the population is considered “dual-use” tobacco users, meaning that they smoke and use smokeless tobacco on a regular basis.
“Certain workers, like miners, can’t smoke during work,” he said, “so they actually smoke when they’re not at work and trade their cigarettes for smokeless tobacco when they go into the mines.”
The CDC’s Best Practices guidelines for 2014 recommend funding for West Virginia’s tobacco prevention and control efforts total roughly $27.4 million annually. Currently, funding for these programs totals less than a quarter of that — not quite $6.3 million.
West Virginia contributes nearly $5 million of the smoking-cessation funding from its general fund; the rest comes from the CDC. In fiscal year 2014, which spanned July 1, 2013, to June 30 of this year, the state collected more than $101 million in taxes on tobacco products, according to the State Budget Office.
West Virginia has the second-lowest tobacco taxation rate of the states studied. The lowest, Virginia, allows municipalities to create their own additional tobacco taxes, resulting in much higher taxes for most than the state rate would indicate, Adkins said.
“It has been proven that the states that have passed higher tobacco taxes — the bellwethers, of course, being New York City, California and Washington state — have had their numbers precipitously come down,” he said.
The tax on a pack of cigarettes in West Virginia is 55 cents and was last increased in 2003, according to Adkins. In contrast, neighboring Pennsylvania’s tax is $1.60 per pack, and Ohio’s is $1.25.
Reach Lydia Nuzum at firstname.lastname@example.org, 304-348-5189 or follow @lydianuzum on Twitter.