The Journal of the Arkansas Medical Society Med Journal March 2020 Final 2 - Page 16

Scientific Article Abby Holt, MPH MLIS; 1 Donald McCormick, MSHI; 1 Robert Delongchamp, PhD, MPH; 1,2 Margarete Kulik, PhD; 2 Kristyn Vang, MPH; 1 Joseph Bates, MD, MS 1,2 1 1Arkansas Department of Health UAMS Fay W. Boozman College of Public Health 2 Changes in Smoking Behavior and Lung Cancer in Arkansas Since 1972 Disclaimer: Opinions expressed in this paper are those of the authors and not the Arkansas De- partment of Health or UAMS. Abstract L ung cancer remains the leading cause of cancer death in Arkansas and is largely de- termined by historical smoking patterns. This paper examined smoking behaviors over time, policy reforms since the Tobacco Set- tlement Proceeds Act of 2000, and patterns in lung cancer incidence and mortality in Arkansas. Results showed that as the cigarette excise tax increased, the number of cigarette packs sold decreased over time. Findings also showed that the risk of developing lung cancer has decreased among men and increased among women. Solu- tions include targeting cessation programs to- wards women and increasing the excise tax on tobacco, a tax that has not increased since 2009. Cigarette smoking peaked during the 20th century despite health warnings as early as 1929 by Surgeon General Hugh S. Cumming and later from the 1964 Surgeon General’s Report. 3 It was reported that the increase in technology for mass production, together with the extraordinary scale of advertising, created a consumer culture that fueled the smoking epidemic. 3 Marketing of tobacco products to men and women impacted cigarette smoking as early as the 1920s. The U.S. entrance into World War II fueled male use rates by providing soldiers cigarettes as part of the K-ration food pack- age, while women at home were introduced to gender-specific branding featuring femininity. 4 Product marketing towards women increased in the 1970s when Philip Morris began market- ing Virginia Slims as containing less tar and be- ing a “healthier” alternative for smokers who were worried about their health. These mar- keting campaigns resulted in increased smok- ing among adult women and adolescent girls. Women were again targets of tobacco marketing in the 1990s, when Philip Morris introduced the 1996 revamped Virginia Slims campaign “It’s a Woman Thing” and the 1999 “Find Your Voice” campaign. 5 From 1995 through 1998, total do- mestic advertising and promotion of cigarette use increased by 37.3%, from $4.90 billion to $6.73 billion. 6 Introduction Lung cancer is largely determined by histor- ical smoking patterns and remains the leading cause of cancer death in Arkansas. 1 Even 25 years after quitting smoking, former smokers have a threefold higher risk of developing lung cancer than those who have never smoked. 2 There has been a progressive decline in lung cancer inci- dence and mortality over time in the U.S., a trend associated with decreases in smoking patterns since the early 1960s. 3 In Arkansas, the trends are declining, but at a slower pace. 1 208 • The Journal of the Arkansas Medical Society The sale of cigarette packs sold in Arkansas was calculated from the 1972 – 2017 Arkansas Legislative Tax Handbooks setting out the sale of cigarette excise stamps. The “diamond” marker on the excise tax line graph denotes a change in the cigarette excise tax per pack.