The Journal of the Arkansas Medical Society Med Journal March 2020 Final 2 - Page 19
6. Women and smoking: A report of the Surgeon
General. MMWR Morb Mortal Wkly Rep. 2002;
7. John Engberg et al. Evaluation of the Arkan-
sas Tobacco Settlement program: Progress
through 2011 – summary. 2012; RAND Corpo-
8. Bureau of Legislative Research. Arkansas leg-
islative tax handbook. Little Rock, AR: Office of
Economic and Tax Policy; 2016.
Source: 1970-1978, ICD-8 lung cancer code 162.1; 1979-1998 ICD-9 lung cancer codes 162.2-162.5, 162.8-162.9; 1999-2016 ICD-10 lung cancer
code C34 group from the CDC Wonder Compressed Mortality File https://wonder.cdc.gov/
per individual is declining, the risk of developing
lung cancer and dying from the disease has in-
creased over the last 50 years. 3 Sadly, a female in
Arkansas was more likely to die of lung cancer in
2015 than in 1970.
In general, the rise in lung cancer incidence
in women is troubling. Lung cancer incidence in
women increased after targeted-marketing cam-
paigns that began in the 1960s and 1970s. 3,12 While
the risk of lung cancer has increased in women,
lung cancer incidence among men has steadily
declined since 1997. This is associated with the
fact that women began smoking in large numbers
about 25 years after men were smoking heavily. 6
In Arkansas, female adult smoking prevalence
peaked in 2013 – an indication that lung cancer
incidence and mortality rates have yet to peak in
women and will continue to rise. Recent mortality
trends, 1999 to 2015, show that lung cancer deaths
are decreasing in men, but not yet in women.
Smoking is the leading preventable cause
of lung cancer, and while great strides have
been made to reduce tobacco use in Arkansas,
lung cancer remains the leading cause of can-
cer death in both men and women. 1 Even when
heavy smokers quit smoking, the risk of devel-
oping the disease remains threefold higher than
those who have never smoked cigarettes. 2 If Ar-
kansans had the same smoking rate as the U.S.,
we could save 403 lives per year from lung can-
cer and save approximately $26 million per year
in direct cancer treatment costs. 9-11
Thus, the challenge continues to reduce
the use of tobacco products, including novel
electronic devices that deliver nicotine by inha-
lation. Cessation programs should target wom-
en since their risk of developing lung cancer
continues to increase. The most effective public
policy to reduce cigarette consumption would
Volume 116 • Number 9
be to increase the excise tax on tobacco. The
federal and Arkansas taxes on tobacco have not
increased since 2009.
1. Arkansas Department of Health. Arkansas Can-
cer Facts and Figures. https://www.healthy.ar-
CancerFacts2017.pdf. Accessed April 4, 2019.
2. Tindle HA, Stevenson Duncan M, Greevy RA, et al.
Lifetime smoking history and risk of lung can-
cer: Results from the Framingham Heart Study.
J Natl Cancer Inst. 2018;110(11):1201-1207.
3. U.S. Department of Health and Human Ser-
vices. The health conse-
quences of smoking: 50
years of progress. A report of
the Surgeon General. Print-
ed with corrections ed. At-
lanta, GA: U.S. Department
of Health and Human Ser-
vices, Centers for Disease
Control and Prevention,
National Center for Chron-
ic Disease Prevention and
Health Promotion, Office
on Smoking and Health;
9. Centers for Disease Control and Prevention.
Behavioral Risk Factor Surveillance System:
Arkansas results. http://www.cdc.gov/brfss/
brfssprevalence/index.html. Accessed April
10. Delongchamp R, Holt A, Faramawi MF, et al.
Differences between Arkansas and the Unit-
ed States in prevalence of risk factors explain
variations in ischemic heart disease mortality
rates among pre-Medicare (45-64) and Medi-
care (65-84) age groups. European Journal of
Environment and Public Health. 2019; in press.
11. Cipriano LE, Romanus D, Earle CC, et al. Lung
cancer treatment costs, including patient
responsibility, by disease stage and treat-
ment modality, 1992 to 2003. Value Health.
12. Pierce JP, Lee L, Gilpin EA. Smoking initiation
by adolescent girls, 1944 through 1988. An
association with targeted advertising. JAMA.
4. Joseph A, Muggli M, Pearson
K, Lando H. The cigarette
to promote tobacco to
the U.S. military. Mil Med.
5. Toll BA, Ling PM. The Vir-
ginia Slims identity crisis:
An inside look at tobac-
co industry marketing
to women. Tob Control.
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