Health Activists in Kentucky Struggle to Break Tobacco’s Grip

Consumption levels in the Bluegrass State have remained high due to the state’s unique economic, historical, and cultural characteristics.

Shortly after Teresa Spaw’s last chemo session, she returned to her job as a hospital administrator in Russell Springs, Kentucky, where she witnessed firsthand the grip smoking had on her coworkers.

Having recently lost a lung to cancer, Spaw was the director of administrative services at Russell County Hospital when he tried to help them implement a tobacco-free plan that would make the hospital premises smoke-free. “It was 2011. My head was still bald from chemotherapy, so I covered it with a scarf as I sat in a conference room and listened to people say things like, “I have a right to smoke.” Nothing but me is getting hurt here.”

Spaw, who was 58 at the time, knew it wasn’t correct. Her father, a lifelong smoker who died at age 40, passed away from lung cancer. Even though her young kid detested being in Spaw’s second-hand smoke environment and she was “terrible with money,” she continued to buy cigarettes. After several years, Spaw’s son, then a high school student, received the devastating news that his mother had cancer from doctors.

Spaw relates that her son told her, “Mom, I knew it was horrible because no one can look at you without sobbing.

So when her coworkers tried to convince her that smoking only harms the smoker, Spaw says, “I just wanted to scream.” Because “everyone who knew and loved me received a front-row seat to the horrific world of illness,” she says, “no one is in it alone.”

Though Spaw’s hospital did eventually ban smoking, experts say his situation is common in many parts of Kentucky. The adult cigarette smoking rate in Kentucky is significantly higher than the national rate, despite data showing that the percentage of smokers has decreased nationally and a seminal government report identifying the risks of smoking being published over 60 years ago. According to experts, Kentucky’s high smoking rate is the result of a complex interplay between the state’s agricultural past, its strongly established economic interests, and its reputation as a tobacconist to the world.

A recent survey found that about 14% of American adults smoked cigarettes frequently, whereas another survey found that over 23% of Kentuckians smoked cigarettes regularly in 2018. However, public health centres offer free cessation resources, including nicotine patches.

Also, statistics on youth use aren’t ideal: 26.1% of Kentucky high school students in 2019 have used e-cigarettes or another electronic vapour product during the past 30 days, according to data published by the anti-smoking group Truth Initiative. This is lower than the national rate of about 33%. A significant percentage (over 6%) of respondents reported current use of chewing tobacco, snuff, or dip, and 7.9% reported current use of cigars, cigarillos, or small cigars.

This has a price tag attached to it. The non-profit Campaign for Tobacco-Free Kids estimates that 8,900 adults in the state die prematurely from smoking every year and that 119,000 kids under the age of 18 will die prematurely from smoking.

Industry giants like Altria and R.J. Reynolds Tobacco Co. continue to spend heavily in Frankfort, the state capital, in part to prevent smoking restrictions from being enacted. This is despite the fact that the amount of tobacco grown in Kentucky is a fraction of what it was a decade ago and 27 states have laws that mandate smoke-free workplaces, bars, and restaurants.

The American Heart Association’s director of government relations in Kentucky, Shannon Smith, claims that Big Tobacco “spends roughly $274.3 million yearly on advertising in Kentucky, resulting in $1.92 billion in annual expenses from smoking-related ailments.” ‘Millions more have been spent by industry lobbyists to influence state legislators to block localities from implementing (anti-smoking) legislation that safeguards the health of their inhabitants,’ she claims.

But R.J. Reynolds parent firm Reynolds American Inc. spokesman Kaelan Hollon argues the tobacco giant and Kentucky health campaigners are on the same side in one essential respect: neither wants smokers or vapers under the age of 21.

“No young person, period, should ever use tobacco products, including vapour,” Hollon says. “record lows,” she writes, “showing an 81% drop from 1997.” This is the case for teen smoking in Kentucky.

According to Hollon, e-cigarettes are safer than traditional cigarettes and can aid smokers in giving up the habit because they have been studied by the National Academy of Sciences, Engineering, and Medicine. While there is some evidence that e-cigarettes can help individuals kick the habit, the analysis from 2018 indicated that they likely increase the risk of conventional smoking among kids and young adults.

According to Hollon, the excessive taxes on high-tech products in Kentucky are bad for the general people. Each pre-filled e-cigarette cartridge costs the state $1.50, and open, refillable vaping devices are taxed at a rate of 15%.

According to Hollon, Kentucky is “incentivizing smokers to maintain their use” of cigarettes rather than moving to vapes and other items that could lessen harm or help them stop. There could be huge public health benefits for the people of Kentucky if we encouraged less dangerous alternatives to cigarettes.

Proponents argue that most non-profit programs to persuade adults to quit smoking and urge adolescents not to start are drowned out by the tide of Big Tobacco financing and the state’s underfunding of public health activities.

“About 25 years ago, I started working in this field full-time. In Kentucky, the tobacco wars are very real “Director of the University of Kentucky’s collaboration BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments), Ellen J. Hahn, makes this claim. The tobacco business is thriving.

Meanwhile, experts claim that due to those fights and the COVID-19 pandemic, e-cigarettes, vaping, and flavoured cigars have fallen out of favour among Kentucky’s youth and young adults.

Smith claims that vaping has led to “a new generation of youth becoming addicted to nicotine,” which has persisted even while attention has been focused on the COVID-19 pandemic. In her words, the issue “has been propelled by Big Tobacco, which controls a sizable portion of the market for popular e-cigarette brands. Fruit, candy, and mint scents are used to promote these addictive goods to teenagers because research shows that these tastes are particularly appealing to this demographic.”

A landmark surgeon general’s report on smoking and health in 1964 contributed to the national trend of a drop in smoking from more than 40% in the 1960s to some 14% now. There is also the acceptance of the Master Settlement Agreement, a legal settlement reached in 1998 between major tobacco firms and most states in the United States. The agreement reduced tobacco advertising and established a schedule of billions of dollars in annual payments from tobacco firms as part of a settlement of lawsuits brought by states seeking reimbursement for health care expenditures incurred due to tobacco use.

More than $126 million was allocated to Kentucky’s MSA in 2021. However, according to Hahn, the vast majority of state-funded programs receive the money, rather than health care initiatives related to smoking, and only a small portion is allocated to anti-smoking public relations campaigns or programs to assist individuals quitting.

Hahn claims that state lawmakers have made decisions contrary to the CDC’s recommendation that the state spends more than $50 million on tobacco cessation and control. According to her, Kentucky’s already meagre budget for anti-smoking public health programs dropped to $2 million in the most recent fiscal year.

For as long as Hahn can remember, state funding has been inadequate.

Tobacco was once one of the state’s most lucrative agricultural exports, but as smoking rates declined nationally, so did Kentucky’s harvest. Experts, however, agree that the annual cash injection from cigarette lobbyists is money well spent. There are fewer limitations on cigarette use in Kentucky compared to other states.

The Truth Initiative claims that despite certain local bans, smoking is legal in most public and private venues across Kentucky. Caretakers are not authorized to smoke cigarettes in the presence of minors, but they are not prohibited from doing so under state legislation. In addition, Kentucky’s cigarette tax is among the lowest in the country at $1.10 a pack.

Spaw, who is a local ambassador for the American Lung Association and battled for the hospital smoking ban in Russell Springs, recalls fighting for similar restrictions at an elementary school and the high school of a neighboring district. Nervous, She claims, “I stuttered while I talked.”

Repeatedly, audience members who smoked pushed back.

As a result, “many people said they will not attend ball games or parents will be angry they can not smoke on (school) grounds,” she said. The meetings were filled with worry and stress.

Hahn, who teaches at the College of Nursing at the University of Kentucky, isn’t shocked by this. She claims that Kentuckians’ sense of self is “still attached to the product” and that pro-tobacco lawmakers are “a tremendous hurdle” to people quitting smoking.

The state of Kentucky’s reliance on tobacco may be traced back through its historical past. The use of tobacco by native Caribbean peoples was noted by 15th-century explorers, who promptly brought it to Europe. Tobacco was established as a commercial crop by early North American colonists, and when those colonists eventually settled in western Kentucky, they found that the plant did particularly well there.

For the better part of the nineteenth and twentieth centuries, Kentucky played a pivotal role in the U.S. tobacco market, contributing to the rise of the United States as a world power. Yet while the smoking rate in the Bluegrass State remains high, and shows little sign of abating anytime soon, Smith is hopeful for progress.

The previous normal legislative session in the state saw several bills submitted with the goal of strengthening “the powers of towns and counties to oversee the marketing and sale of tobacco products in their communities,” she says. In turn, this would help such areas cut down on tobacco use, save money on healthcare, and boost the health of their residents as a whole.

But lawmakers, Smith says, have to hear from constituents.

She argues that “creating grassroots support” is the most effective tactic. To combat the growing number of young people who are vaping, “community members and leaders are eager to have tools in their local toolbox.”

But Spaw knows well that in a state addicted to smoking, the pride of cultivating tobacco, and the money that comes with it, it is a challenging sell to get dedicated smokers to quit like she did and to get youngsters to put down the nicotine-filled vape pen.

Growing up, she adds, tobacco fields extended across the countryside, and farmers boasted of big crops making for a joyous Christmas. The principal of her high school maintained an ashtray on his desk, and there was a designated smoking space for pupils. Spaw, himself, says, “I liked smoking.”

But the price for her enjoyment – a lung – was far too great. She hopes that those who use tobacco and e-cigarettes will know that assistance is available when they are ready to quit.

Spaw adds, “If I could talk to everybody who has a problem with tobacco, I would say, ‘If you think you don’t have the resources, look, you can get them.'” She blames the tobacco industry’s big players for “having access to millions of dollars and can afford to invest heavily in advertising their product. You should prioritize your health above all else.”

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