SALT LAKE CITY — Utah has the lowest tobacco use rates in the nation — something the Utah Department of Health is very proud of, but also something it keeps a close eye on.
"We do a lot of work with lawmakers that makes it harder for kids to start and easier for adults to quit," said Adam Bramwell, spokesman for the state's Tobacco Prevention and Control Program. Legislation, including tighter regulation and higher taxes, as well as advertising, are the most effective ways to keep cigarette use rates continually low, he said.
In the years since 1998, when a statewide campaign was put into action to reduce smoking rates, Bramwell said Utah's youths have benefited the most. But specific programs have also been implemented to target populations where smoking rates are disparate.
One such program involves the Utah Division of Substance Abuse and Mental Health, where a large portion of clients being treated for other addictions or mental illness also smoke.
"There have been major changes to the culture and to a system that has been around for a long time," said Dave Felt, manager of a program called Recovery Plus, an initiative that promotes health and wellness in people with mental illness and/or substance abuse throughout Utah.
He said the goal is to make all treatment facilities in the state tobacco-free.
"If we could successfully implement this, we would be close to impacting 20 percent of the smokers in the state," Felt said, adding that tobacco use often goes hand-in-hand with other substance abuse, and up to 80 percent of people with mental illness also use tobacco.
The division has already seen success treating smoking as an addiction by cutting it out altogether.
At the Promise of Women and Families North and South programs in Utah County, work and classroom breaks have been decreased to less than five minutes, and, instead of calling them "smoke breaks," exercise or relaxation techniques are often encouraged. No smoking is allowed on the premises or at any time that a person is involved in treatment, Felt said.
"We're changing the culture to one that encourages not smoking instead of turning a blind eye to it," he said. Recognizing that smoking tobacco is "a significant addiction" and treating it that way, he said, helps people quit their other dependencies as well.
And the addiction potential of tobacco is huge, said Glen Hanson, director of the Utah Addiction Center, a University of Utah professor of pharmacology and senior adviser for the National Institute on Drug Abuse for the National Institutes of Health. He said the factors of nicotine and tobacco addiction "satisfy all the criteria for a disease" and should be treated as such.
"Tobacco companies did everything they could to derail that way of thinking," Hanson said. "It delayed our response for decades, and, in the process, many people died and suffered a great deal."
As a leading cause of preventable death, disease and disability in Utah, the reduction of tobacco use remains an important public health priority. In addition to contributing to cancer, heart disease and respiratory diseases, tobacco use causes or worsens most chronic diseases and can lead to death, according to the health department. Survey data show that about 200,000 Utahns smoke.
Since the U.S. surgeon general issued its first report on smoking and health 50 years ago in January 1964, the health industry has made strides in the treatment of tobacco use and addiction. A recent essay in the Journal of the American Medical Association estimates that 8 million Americans have avoided premature death as a result of tobacco control efforts implemented as a result of the report.
Some of that is due to health campaigns, but Hanson said, "Most of that has come from the fact that people have recognized that smoking is a filthy, dirty habit and nothing good comes of it." He said smokers have been kicked off airplanes, out of restaurants and public parks, hotel rooms and rental cars, and many families force smokers to get their fix outdoors, despite weather conditions.
"Society doesn't like it," he said. "It's no longer the cool thing to do, and people have figured that out."
The trouble is, the longer a person smokes, or the earlier he or she starts, the harder it becomes to quit.
Hanson said human biology and genetics have come into play, indicating a person's predisposition to addiction. And while there are pharmacologic helps available — nicotine gum, transdermal patches and prescription medications that help to alter the brain's response to the addictive properties of tobacco — quitting depends largely upon a person's motivation.
In the mid-1990s, approximately 17 percent of teenagers in Utah smoked cigarettes. Today, according to 2013 health department data, only 4.4 percent of youths smoke. Less than 10 percent of adults in Utah smoke.
"That's something we're really proud of," Bramwell said.
However, electronic cigarettes have become a concern, as more and more teens are experimenting with them than with traditional cigarettes. Long-term effects of the electronic or vapor cigarettes remain unknown, and the devices have not been researched as effective cessation tools.
The state of Utah offers public programs to aid in smoking cessation, including an anonymous help line, 1-800-QUIT-NOW, where people can call to get access to counseling or other help, including medication and nicotine replacement therapy.
"Every day I hear of people who do quit. It can be done. It's an amazing accomplishment, and the number of smokers in Utah continues to go down," Bramwell said.
While it may take some people multiple tries to quit, he said, "it is a lot easier and less costly to prevent health problems than to treat them and that is what we want to help people to do."
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