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Jan 9, 2024
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Introduction to Public Health Issue Brief: Smoking and
Tobacco use in Maryland
Isabelle John
Background
Currently, smoking and tobacco use stand as the most preventable cause of disability and death
in the United States of America. Cigarette smoking in particular accounts for 1 of 5 deaths in the
United States and is responsible for more than 480,000 deaths per year. Over 41,000 of them
include deaths by secondhand smoke.
1
Some of the disease risks include cancer, cardiovascular
diseases, metabolic diseases, respiratory diseases, as well as perinatal conditions.
1,2
Smoking and
tobacco usage currently stand at a higher risk for men, adults aged 25-64, impoverished adults,
and adults with lower levels of education. Tobacco additionally disproportionately impacts those
who are socioeconomic marginalized.
Health Risks and Mortality
Currently, more than 16 million Americans live with a disease or illness caused by smoking.
3
These diseases linked to smoking include but are not limited to cancer, stroke, heart disease,
diabetes, lung diseases, and chronic obstructive pulmonary disease (COPD). Smoking
additionally increases the risk for erectile dysfunction, immune diseases, and tuberculosis.
Smoking overall has the potential to do damage to every organ in the body. Additionally,
smoking accounts for 90% of all lung cancer deaths as well as 80% of all COPD deaths. In
regard to perinatal conditions, smoking and tobacco use increase the risk for early delivery,
stillbirth, ectopic pregnancy, and low birthweight.
2
Smoking can also reduce fertility for both
men and women.
Demographic Impacts
Men are increasingly more likely to smoke and use tobacco than women. This could be due to a
number of factors including but not limited to differences in male physiology, cultural
expectations, and behavioral differences. Results from neuroimaging studies suggest that
smoking activates men’s reward pathways more than women's
(NIH).
4
2018 surveys indicated
that 15.6% of American men reported to be smokers whereas only 12% of American women
reported to be smokers. American Indians/Alaska Natives showed the most smokers for any
racial group, followed by mixed race and non-Hispanic white Americans. Indigenous people
have many cultural practices and traditions surrounding the use of tobacco however a great deal
of smoking in this demographic can be attributed to industry targeting in their communities. For
example, “Red Man Chewing Tobacco” has been targeting native people since the turn of the
20th century.
5
Adults aged 45-64 are the most likely to smoke as compared to any other age
group. This is largely cultural as most research regarding the dangers of cigarette smoking and
tobacco use was shared with the public after this age group began use. At this point it was
effectively too late. In the United States overall, the number of smokers decreases with education
level. Those with no degree smoke the most while those with a graduate degree smoke the least.
A similar trend persists with income where adults making less than $35,000 a year smoke the
most and those making over $100,000 a year smoke the least.
6
By region, Midwesterners and
southern Americans are increasingly more likely to smoke than Americans living in the west and
the northeast. Largely, efforts to decrease smoking have been carried out through education as
the tobacco industry is hard to stop economically. As a result, those without access to higher
education may not be able to access this information as opposed to those who do. Education and
income have an almost direct correlation therefore explaining the following statistic.
Additionally, this spread of information was less popular with more conservative state
governments as they are opposed to legislation that will negatively impact the economy or
industry in any way ultimately leading to higher rates of cigarette usage in middle America.
Figure 3: Cigarette use among adults in the United States by state/territory
Source: Behavior Risk Factor Surveillance System 2018 (CDC)
Maryland Statistics
Figure 1: Percentage of adults who smoke in Maryland as compared to the United States
Source: Americas Health Rankings (United Health foundation)
The above graph depicts the percentage of adults in both Maryland and the United States overall
who reported smoking at least 100 cigarettes in their lifetime and currently smoke. Maryland has
consistently remained below the national average and has been on a steady decline since 2011.
This decline could be attributed to money received from the Tobacco Settlement wherein many
tobacco companies voluntarily agreed to marketing restrictions and obligations to ongoing
payment to the state. As of 2016, the state of Maryland has received $2.56 billion in settlement
payments and has since used this money to fund the Tobacco Use Prevention and Cessation
Program, the Cancer Prevention, Education, Screening and Treatment Program, and other anti-
tobacco and public health programs, including Medicaid.
7
The racial groups in Maryland with
the highest percentage of smokers are American Indians/Alaska Natives, Whites, and those of
multiracial backgrounds. In regard to education, Maryland residents who did not receive a high
school education had the highest rates of smoking as compared to other levels of received
education. The age demographic in Maryland with the most smokers is 45-64. Men have higher
rates of smoking and tobacco use within the state compared to women. Lastly, the most striking
trend is that smoking, and tobacco use decreases with increasing income brackets. Those earning
less than $25,000 a year and can thus be classified as impoverished had the highest rates whereas
those earning $75,000 a year reported the lowest rates.
5,7
Each of the above statistics highly
reflect issues presented throughout the nation in regard to differences in culture, education, and
community targeting. Maryland in particular has a difficult history of geographical segregation
by race and income which directly impacts education level. The communities within the state
that are largely populated by marginalized groups, such as the Black Butterfly, are
disproportionally targeted. Data does not indicate a correlation between rates of cancer and
cigarette usage by demographic for the state of Maryland however rates of Asthma
–
which was
indicated to be a risk factor of smoking
–
appears to be the most prevalent among American
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Indians/Alaska Natives as well as those earning less than $25,000 a year thus supporting the
conclusions above.
Figure 2: Smoking population trends in Maryland by income
Source: Americas Health Rankings (United Health foundation)
Conclusions
From the above findings, it is fair to conclude that smoking and tobacco use is a major public
health concern within the state of Maryland. A large proportion of the population is being
impacted by smoking, not only first but also second hand. Additionally, the at risk populations
are clearly defined by race, class, education, and income. All of these factors can be targeted
based on experience of discrimination and socioeconomic disadvantage.
Sources
1.
CDC. (2021, September 30).
Health topics - tobacco - polaris
. Centers for Disease
Control and Prevention. Retrieved March 1, 2023, from
https://www.cdc.gov/policy/polaris/healthtopics/tobacco/index.html
2.
CDC. (2020, April 28).
Tobacco-related mortality
. Centers for Disease Control and
Prevention. Retrieved March 1, 2023, from
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_
mortality/index.htm
3.
CDC. (2022, October 13).
Extinguishing the tobacco epidemic in Maryland
. Centers for
Disease Control and Prevention. Retrieved March 1, 2023, from
https://www.cdc.gov/tobacco/stateandcommunity/state-fact-sheets/maryland/index.html
4.
NIDA. 2021, April 12. Are there gender differences in tobacco smoking?. Retrieved from
https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/are-there-
gender-differences-in-tobacco-smoking on 2023, March 1
5.
Truth Initiative. (2020, May).
Tobacco use in the American Indian/alaska native
community
. Truth Initiative. Retrieved March 1, 2023, from
https://truthinitiative.org/research-resources/targeted-communities/tobacco-use-american-
indianalaska-native-community
6.
CDC. (2022, March 17).
Current cigarette smoking among adults in the United States
.
Centers for Disease Control and Prevention. Retrieved March 1, 2023, from
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.ht
m
7.
Maryland Attorney General. (n.d.).
Frequently Asked Questions About the Tobacco
Settlement
. Maryland Attorney General - Tobacco FAQ. Retrieved March 1, 2023, from
https://www.marylandattorneygeneral.gov/Pages/Tobacco/faq.aspx