By Susan T. Cookson and Kent Woerner
Special to Tribune
District 2 Public Health
One of the 10 public health achievements of the last century was recognizing that tobacco use is a health hazard.
The 1964 Surgeon General’s report named the health risks of smoking and in 2006, the American Cancer Society (ACS) won a major court case against “Big Tobacco.” Since last year, Big Tobacco has been required to post eye-catching signs on cigarette packs, like “Smoking kills, on average 1,200 Americans. Every day.”
And yet, tobacco use is not gone. The data on our Public Health District 2 (13 counties in Northeast Georgia, including Rabun County) show no real change in the number of adults using tobacco from 2013 to 2017 (the most recent data), with 1-in-5 adults smoking cigarettes, more men than women, and 4 percent using smokeless tobacco (chew, snuff, or dip).
And unfortunately, 13 percent of high school students smoke, and 1-in-10 use smokeless tobacco — higher than among our adults.
Among middle school students, 4 percent smoke and 4 percent use smokeless tobacco (Georgia Department Public Health, 2013).
The latest fad is e-cigarettes or vaping. Although 4 percent of adults in our Public Health District 2 report using e-cigarettes (Georgia Department Public Health, 2017), officials do not know how many young people use them.
The 2021 National Youth Tobacco Survey found more than 2 million middle and high school students reported using e-cigarettes in 2021, with more than 8-in-10 of them using flavored e- cigarettes.
These youth think vaping is less harmful than cigarettes. But, vaping still has nicotine and scientists still do not know all the chemicals that e-cigarettes contain. Research has shown that nicotine may be as addictive as heroin (Blaha, Johns Hopkins University, 2024).
“I personally know this is true, as Oct. 30 th is the anniversary of my sister-in-law’s death from lung cancer despite her many attempts to quit smoking,” said Susan T. Cookson, MD, MPH, the Rabun County Board of Health physician.
More Georgia women die from lung cancer than from breast cancer. Georgia’s men die at even a higher rate from lung cancer than Georgia’s women, 39/100,000 compared with 27/100,000 (U.S. Cancer Statistics, CDC, 2018-2022). But besides cigarettes causing lung cancer deaths another cause of death from cigarettes is Chronic Obtrusive Pulmonary Disease (COPD or emphysema). In Rabun County of the 10 top causes of premature deaths for the last 10 years (2013-2022), COPD was the cause of premature deaths for seven of those years. COPD was not a cause for any of those 10 years for Georgia as a whole (Georgia Department of Public Health). Smokeless tobacco also causes deaths from oral cancer, esophageal cancer, and pancreatic cancer.
Lung cancer is more common in smokers than non-smokers, and lung cancer is less deadly when found early. Therefore, the U.S. Preventive Services Task Force recommends that current or past (those smoking in the last 15 years) smokers 50-80 years old, with at least a 20-pack-a-year smoking history, get annual low-dose chest CT (computed tomography) screening for lung cancer. A 20-pack-year smoking history is smoking one pack (or 20 cigarettes) a day for 20 years, two packs a day for 10 years, or other combinations to equal 20 or more. Check the American Lung Association Lung Cancer Screening Insurance Checklist to see what your insurance pays for this screening.
But if you quit, many of these tobacco-related deaths can be prevented.
A recent large study showed that if you quit smoking, especially before age 50, your risk of lung cancer was much less than if you continued smoking (Park, JAMA Network Open, 2024).
Nov. 21, the third Thursday of November, is the Great American Smokeout. The ACS has the Empowered to Quit program to help you quit smoking. It is an email-based program that can help you once you make the decision to quit and plan your Quit Day.
You can sign up to quit up 30 days or less from this important, life-changing decision at Tobacco Cessation Program | American Cancer Society. ACS will continue to send you emails and tools to support you along your quit journey.
The Public Health District 2 also has support available. Call the Quit Line 1-877-270-STOP (7867), or Español: 1-877-2NO-FUME (66-3863), or visit: www.quitnow.net/Georgia.
In addition, because of the numbers of our young people vaping the Georgia Tobacco Use Prevention Program has partnered with Truth Initiative to offer This is Quitting for young people 13-24 years old in Georgia. You can now text VAPEFREEGA to 88709 to sign up for the free and confidential program.
Public health’s anti-smoking campaigns also exist to change the public outlook and to prevent us from starting tobacco use. Close to 95 percent of smokers tried their first cigarette before they were 21 years old.
“We are all committed to educating, intervening, and preventing the use of tobacco and nicotine by the next generation. Join this commitment today,” Cookson said.
Susan T. Cookson, MD, MPH, is the Rabun County Board of Health physician and Kent Woerner is a Rabun County Board of Health member.