(CNN) - Smoking is bad for you, and by now, most of us know it.
It seems that studies on the dangers of smoking come out everyweek. Just recently, after an article appeared in the journalPediatrics, we were introduced to the concept of third-hand smoke,the potentially toxic residue that lingers in curtains, clothing,hair, etc. after the smoke itself blows away.
To recap: Smoking exponentially increases your risk ofdeveloping lung cancer (and other lung diseases, like emphysema andchronic bronchitis) and puts you at higher risk for cancer of themouth, throat, larynx, esophagus, bladder, pancreas, kidney, cervixand stomach. Smoking also elevates the risk of cardiovasculardisease, stroke and insulin resistance. And, as if all that weren'tbad enough, it causes wrinkles.
Yet stand on virtually any streetcorner of any city or town inthe United States, and you will see people smoking.
So, who exactly -- in the face of all the mounting scientificevidence, social stigma and legal bans -- still lights up?
According to the CDC, about 43.4 million Americans (19.8 percentof the population) smoke.
Look around you. If you are in Kentucky, the state with thehighest smoking rate, more than one out of every four people (28.3percent) around you smokes. On the other end of the spectrum isUtah, with just over one person in 10 (11.7 percent) a smoker. Findthe smoking rate in your state »
Here's the good news: "Smoking prevalence in the entire countryhas gone under 20 percent for first time in over 50 years," saidDr. Richard Hurt, director of the Nicotine Dependence Center at theMayo Clinic. "For women, it's 18 percent in most places, and formen it's hovering at about 20 percent. We have gone from one in twomen smoking to one in five -- a very dramatic change -- and one inthree women to one in five."
Here's the bad news: Smoking rates are unlikely to drop to thenational health objective of 12 percent by 2010.
Hurt, who is also a professor of medicine at the Mayo ClinicCollege of Medicine in Rochester, Minnesota, is a formerthree-pack-a-day smoker. Unlike most smokers, he picked up thehabit during college; according to the CDC, about 90 percent ofheavy smokers start in high school. And studies show that theyounger you are when you start, the more likely you'll become aheavy smoker as an adult.
According to the American Cancer Society, each day more than3,500 people younger than 18 try their first cigarette, and 1,100others become regular daily smokers. About one-third of these kidswill eventually die from a smoking-related disease.
Retired radio broadcaster and iReporter Gerald Dimmitt, 65, hassmoked since he was 14.
"I've always smoked a pipe," he said. "I have successfully quitabout 40 times." But, he says, he always restarted, because "itcalms me down."
Dimmitt has even more incentive to quit now, since developinglesions and irritation in his mouth. After speaking to his doctor,he received a prescription for Chantix, a pill to aid with smokingcessation. But when he went to pick up his prescription at thepharmacy, he was charged $139 (because it's not generic) for twoweeks worth. Outraged, he left the Chantix behind.
"If smoking is so dangerous ... why then do they want to charge$139 to make me stop? There is something very wrong with that. Iguess they would rather pay to take care of lung cancer," hesaid.
Some would-be smokers pick up their first cigarette to fitin.
"I started smoking at 12 years old to be part of the 'in' crowd.It never got me into the 'in' crowd, but with my first cigarette, Iwas totally hooked," wrote Lori Jerome, 45, a former bartender andnow full-time university student from Canada.
Said Lisa "Smith," 44, a recently laid-off administrator fromMinnesota, "I began smoking in junior high school because I wantedto fit in with a certain crowd. However, that group of friends islooooong gone from my life and I still have the nasty habit." Smithdidn't want her last name used.
Hurt says the reason many people start, and continue, is peerinfluence. But he also blames targeted promotions by tobaccocompanies (like Virginia Slims targeting women in the 1970s andother brands targeting inner-city minority groups today) and themovies. "There is a lot of research right now that shows thatsmoking in the movies has made a comeback. ... It clearly affectsstart-up smoking among young people."
As for things that prevent children from smoking, Hurt citeshigher cigarette taxes and smoke-free zones, like offices andrestaurants.
"Those two public health policies do three things: reducesmoking among continuing smokers, help people to stop smoking andreduce the chances of our children starting to smoke, because itde-normalizes it. ... The child interprets smoke-free as the socialnorm," he said. That's why children of smokers are much more likelyto become smokers themselves: Smoke-filled surroundings is theirnorm.
Of course, society's perception of smoking has changed a lotsince the days of doctors actually endorsing one brand or anotherin the first half of last century. Dimmitt recalls "ashtrays inchurch pews, smoking in the classroom and blowing pipe smoke allover the students!"
"When I was born, my mother was allowed to smoke in the hospitalroom with me in there," Jerome said. "When I had my adult children,we were allowed to smoke in the day room on the maternity wardfloor, although the babies were not allowed in there. When I had myyoungest children, ages 5 and 8 now, you couldn't smoke in thehospital. How the times have changed."
Now, smokers in some places face smoking bans in certain publicand private spaces, and unspoken -- and sometimes overt --hostilities.
Smith, a mother of six, wrote, "It's so socially unacceptablewhere I live, and none of my current friends or relatives smoke. Infact, I don't even smoke out in public anymore -- unless it's darkand I'm in my car. I feel it's such a disgusting and stinkyhabit."
Dulcie Long, 50, of Denver, Colorado, said, "I won't say I feelactual 'social discrimination,' but it is something I feel a senseof shame about and do my best not to smoke in the presence offriends. None of my friends smoke, and I'm very uncomfortable doingit anywhere near them."
Even Dimmitt switched from a pipe to cigarettes when he wasworking with youngsters so he wouldn't reek so much.
Not only have attitudes towards smoking changed, the profile ofsmokers has changed, too.
"The demographics have changed so much that now, more oftenthan not, it's the disadvantaged who are still smoking compared tothe highly educated, highly trained people," Hurt said. "It ispretty clear that the prevalence of smoking in groups of people isrelated to education status, which is a surrogate for incomestatus. ... When you go down the income ladder, the smokingprevalence rises. Some groups of severely disadvantaged people havesmoking rates of 30 to 40-plus percent."
Hurt says that there is also a much higher prevalence of smokingamong people with mental health disorders like depression,alcoholics, drug users and schizophrenics.
But movers and shakers are not immune. President-elect BarackObama has struggled with, and seems to have conquered, his habit.Former President Clinton was known to sit on the balcony of theWhite House and enjoy a cigar (his wife, Secretary ofState-designate Hilary Clinton, officially made the White House asmoke-free zone). First lady Laura Bush admits to being anex-smoker.
Plenty of celebrities -- like actresses Salma Hayek, KatherineHeigl and Eva Longoria Parker -- have been caught, cigarette inmouth, by the paparazzi. Even actor Patrick Swayze, who is battlingpancreatic cancer, admitted that he continues to smoke.
Which brings us back to the inescapable fact that, worldwide, anestimated 4 million adults die each year of tobacco-causeddiseases. Said Hurt, "This is only product that I know on the faceof the Earth which, if it is used as recommended by manufacturer,kills 60 percent of its customers."
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