Two recent studies in the NEJM (January 24, 2013) highlight some good news and some bad news on cigarette smoking. Let’s start with the bad news – cigarette smoking remains the single biggest risk to people’s health. A survey of 200,000 smokers showed their mortality rate is three-fold higher than non-smokers. And there is more bad news. While it is commonly thought that very few people start smoking once they’ve gotten through their teenage years, this is not exactly the case. In fact, 15% of all women smokers start smoking at age 26 or older. In contrast to a half century ago, women have caught up with men in almost all aspects of smoking, including the prevalence of this habit and its health consequences. Actually, more women die of lung cancer than of breast cancer.

OK, this information is pretty sobering, so let’s look at the good news. Quitting smoking helps. At any age. Those who stop smoking between ages 25 and 34 gain 10 years of life. If they stop between ages 55 and 64, they gain 4 years. So it is never too late to stop.

Smoking is more prevalent among lower socioeconomic groups and those with less education, so smoking rates in the Medi-Cal population are higher than in those with commercial insurance.

There are several take home messages:

• We need to continue to educate people of all ages about the benefits of stopping smoking. It is never too late to stop.
• A significant number of people start smoking in their mid-20s or older, so appropriate warnings should be offered to those at risk.
• While treating hypertension, diabetes, obesity, and other conditions is important, helping our patients stop smoking will have more impact on their long-term health than any other preventive measure.

Richard Fleming, MD