By Michelle Andrews

Seventy percent of smokers say they’d like to quit, and now, just three days into the new year, many may already be struggling to stick to their resolution to make 2012 a smoke-free year.

If quitting were easy, after all, chances are good that nearly one in five adults wouldn’t still be smokers, a figure that hasn’t budged much in several years.

Smoking is such a familiar health hazard that some experts say it doesn’t get the attention it deserves; the focus is often on other lifestyle-related conditions, especially obesity.

But smoking is still the No. 1 cause of preventable death in this country. Nearly half a million people die prematurely because of smoking-related illnesses, including lung cancer, heart disease and chronic obstructive pulmonary disease, according to the Centers for Disease Control and Prevention.

Scrambling to address budget problems, states this year will spend less than 2 percent of their tobacco-tax and tobacco-settlement billions on programs to help people quit smoking or prevent them from starting, according to a recent report by a coalition of public-health organizations.

Local Smoking cessation resources:

• King County’s Tobacco Prevention Web page.
• Seattle Cancer Care Alliance’s Smoke Free Life.
• Washington State Department of Health Tobacco Prevention and Control Program.
• Washington’s Tobacco Quite Line: Free Help for Tobacco Users.
• American Lung Association of Washington.
• American Cancer Society.

In the past four years, state spending on tobacco prevention and cessation has declined by 36 percent, to $457 million.

Tobacco-related health-care spending is nearly $100 billion annually, according to the CDC.

“It’s a travesty,” says Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. “These programs more than pay for themselves.”

Carrots And Sticks

While public funding falters, a growing number of companies offer smoking-cessation programs to their workers. Last year, two-thirds of companies with 200 or more workers offered such programs, while 31 percent of smaller companies did so, according to the Kaiser Family Foundation’s annual survey of employer-sponsored health benefits. (Kaiser Health News is an editorially independent program of the foundation.)

More From This Series: Insuring Your Health

At the same time that they offer a helping hand to quit, more companies are also penalizing employees who don’t kick the habit by hitting them with higher health insurance premiums.

At firms with more than 20,000 employees, 24 percent vary premiums based on whether someone smokes, as do 12 percent of companies with 500 or more workers, according to the 2011 survey of employer-sponsored health plans by human resources consultant Mercer.

Public-health advocates generally agree that this punitive approach isn’t ideal. “The issue isn’t smokers, it’s smoking,” says McGoldrick. Charging people higher premiums may just make smokers drop their coverage, he says.

But employers argue that charging smokers more is only fair. “The cost of medical care for smokers is considerably higher,” says Helen Darling, chief executive of the National Business Group on Health, an employer group. “Employers are increasingly saying that if someone costs the pool more, they should pay more.”

Darling points out that companies that go this route typically offer free smoking-cessation services and give employees plenty of notice before implementing the change.

A Quitter’s Story

For Tommy Piver, 59, the combination of pricier cigarettes and looming health insurance penalties finally motivated the two-pack-a-day smoker to give up the habit he’d started at age 13. Increased taxes had caused the price of a pack of cigarettes at the gas station near his home in Naples, Fla., to double within a year, to $5. Then he got a notice that his insurance carrier was going to triple the health insurance premium and reduce the amount it covered for all sorts of care from 90 percent to 70 percent for smokers.

“Kicking and screaming,” Piver quit on Jan. 1, 2010. About a week later, he saw a television ad for an online stop-smoking program developed by Legacy, a nonprofit created under the settlement between the states and the tobacco industry. Piver joined the free EX program and hasn’t had a cigarette in two years.

The EX campaign is an “excellent, science-based tool” for smokers who want to quit, says Thomas Glynn, director of cancer science and trends for the American Cancer Society.

Another option is a national toll-free line, 1-800-QUIT-NOW, which routes callers to free support services, including free medication in the handful of states that provide it, says Glynn.

The 2010 federal health law expanded coverage for smoking cessation, though not to the degree that advocates wanted. Under the law, states must provide tobacco-cessation coverage for all pregnant women in their Medicaid programs at no cost.

But anti-smoking activists would like broader Medicaid coverage requirements: Although 19 percent of adults smoke overall, 31 percent of adults living below the poverty line are smokers.

The health law also requires that new health plans – those that have either just begun or have changed their benefits sufficiently to lose grandfathered status under the law – screen adults for tobacco use and provide free stop-smoking interventions.

Exactly how much intervention is required isn’t spelled out in the law; that will be up to federal rulemakers to decide. Smokers typically make several attempts to quit before they succeed.

Advocates hope that federal guidelines will provide coverage for more than a single four-session counseling module, for example, or a standard 12-week round of medication. “Data is accumulating that 12 weeks is not enough,” says Glynn.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

In the previous five years, the 7 percent of retailers were caught selling tobacco to underage teens. This year the number caught jumped to 15 percent of the time.

Overall, there were 70 sales (from 63 establishments) to minors across Seattle over 468 retailer inspections this year, Public Health – Seattle King County officials said.

King County saw a similar jump in illegal sales to minors, from an average of six percent between 2006 and 2010 to 12 percent in 2011, officials said.

The Law

In Washington State, selling tobacco to a minor is prohibited by law and results in a fine for retailers of $100 for the first offense, the officials said. The fine for a clerk is $50.

Repeat offenders within a two year window are fined up to $1,500 and may have their license to sell tobacco products suspended.

Retailer compliance checks are conducted throughout the year by Public Health and the Washington State Liquor Control Board, as well as the U.S. Food and Drug Administration (FDA) due to new federal laws around tobacco and cigarettes.

Fast Facts About Teen Smoking:

• 90 percent of current smokers became addicted before they were 19 years old.

• About a third of all kids who become regular smokers before adulthood will eventually die from smoking.

• Tobacco use is the leading cause of death in King County, leading to 1,990 deaths per year and $343 million in medical care costs, lost productivity and other expenses.

Public health officials encourage anyone who witnesses a merchant or other adults providing tobacco to a minor is encouraged to call Public Health’s Tobacco Prevention Program at 206-296-7613 to file a confidential complaint or text the information to 206-745-2548.

To learn more:

• Visit Public Health – Seattle & King County’s web site at www.kingcounty.gov/health/tobacco

Cancer often takes a heavy toll not only on people’s bodies but on their finances as well. And just as some types of cancer are more deadly than others, some types cause more financial pain, as recent research from Seattle’s Fred Hutchinson Cancer Research Center shows.

Washington State's Tobacco Quit Line Web page

Due to budget cuts, Washington State Tobacco Quit Line, which has helped more than 89,000 residents kick the habit over the past six years, will no longer be able to provide services to the general population.

This means they will no longer be able to obtain counseling with a Quit Coach or receive medications, such as nicotine patches, to help them quit.

However, residents of King County (at least until next spring) and some other groups will be able to get help other coverage sources.

Covered groups include:

• Washington adults insured by Medicaid Fee-For-Service plans

• Washington adults with coverage for phone-based cessation counseling through their employer or health insurance

• King County residents – through March 2012

The King County benefit persists because it is funded through an program from Public Health – Seattle & King County and the U.S. Department of Health and Human Services called the Communities Putting Prevention to Work (CPPW) initiative.

The King County benefit includes a call with a Quit Coach for all adult residents.

Other populations in King County have additional benefits; these populations include:

• Pregnant adults

• Uninsured adults

• Adults covered by non fee-for-service Medicaiddults referred Veteran’s Administration

• Adults covered by Indian Health Services.

While there is a tendency to think of infectious diseases like HIV/AIDS when we think about global health, said Dr. Lawrence Corey, president and director of the Hutchinson Center and a leading HIV expert, cancer takes far more lives in the developing world than HIV.

In fact, of the 7.6 million cancer deaths estimated to occur worldwide each year, 65 percent occur in middle- and low-income countries, Dr. Corey noted.

Indeed, the risk of developing cancer for a person living in the developing world is roughly the same as that of someone living in the developed world, Dr. Corey said. “Just like in the U.S., it is unlikely that a family (in the developing world) is untouched by cancer.”

Many of the leading cancers are the same as those seen in the developed world, lung cancer, particularly among men, and breast cancer among women, Corey said.

But, in addition, there is a high rate of cancer due to infectious agents: liver cancer, due to hepatitis B and C infections; stomach cancer, due to infection by the bacteria Helicobacter pylori; and cervical cancer due to infection with the human papilloma virus (HPV), Dr. Corey said.

HIV infection, too, is a major factor behind the rising cancer rates seen among young people in countries like South Africa, Dr. Corey said. These HIV-related cancers include: cervical, anal and liver cancer; Kaposi’s sarcoma; and lymphomas.

So in addition to tackling issues like smoking and promoting screening for breast and cervical cancers, addressing these infectious agents with vaccines and treatment is needed to reduce cancer rates in the developing world, Dr. Corey said.

Two panelists, Amal Khaleef, a care nurse specialist on the West Bank, and Dr. Saud Al Kharusi, an oncologist and acting head of the National Oncology Center at the Royal Hospital in Oman, agreed that too often patients in their countries do not seek care until their diseases is far advanced.

Part of the problem is the stigma associated with cancer, they said. Cancer is not discussed, so public awareness about the benefits of screening and treatment is low, Khaleef said. “They call it ‘that’ disease; they can’t even say its name,” she said.

The fourth panelist, Dr. Yermek Akhmetov, head of the Nuclear Medicine and Radiology Center at the Republican Diagnostic Center in Kazakhstan said his country had made some progress in raising cancer awareness using public education programs developed by international organizations. Still, it is hard to reach people in his largely rural country, he said.

Despite the challenges, the world’s experience with fighting HIV/AIDS, shows that difficult diseases like cancer can be tackled even in resource-poor nations in the developing world, Dr. Corey said.

HIV/AIDS treatment regimens, which require screening, frequent monitoring and daily medications, are just as demanding as the treatment regimens for many cancers, he noted.

“HIV has shown you can treat chronic diseases in the developing world,” Dr. Corey said.

To learn more:

• American Cancer Society’s Global Cancer report.

• Read the article the Hutchinson Center’s Quest magazine about an effort to tackle infection-related cancers in Uganda.

• Visit the World Affairs Council’s website.