All Over Albany

Fewer and fewer New Yorkers are smoking

Will there be a day when virtually no one smokes?

We were thinking about that this week after the state Department of Health reported that the percentage of adults who smoke was 14.5 percent in 2014 -- that's the lowest rate on record. And it's the latest point is a long trend of falling smoking rates.

So, why's that happening?

How does the state's smoking rate now compare to the past?

Well, in 2011 it was 18.1 percent. It fell to 16.2 percent in 2012 and was essentially the same in 2013. (see the note at the end about the data)

The big difference is compared to, say, 15 years ago. Harlan Juster, the director of state's Bureau of Tobacco Control, said the New York State adult smoking rate was about 23 percent in 2000. And in 1985, about as far back as the DOH has data, it was about 30 percent.

For some further perspective, Juster points out there's data indicating that in the 1960s about half of all men were smokers. (The famous US Surgeon General's Report about smoking was published in 1964.)

Surveys indicate the number of young people in New York State has also been dropping quickly. / graph: NYS Department of Health

So, why's the rate dropping?

There are at least three big reasons:

Taxes
New York State has the highest excise tax on cigarettes in the nation -- $4.35 per pack, set in 2010. That's risen steadily from $1.11 in 2000.

And there's research that indicates as the price of a pack of cigarettes goes up, the number of smokers goes down.

(Incidentally, New York's high cigarette tax also makes smuggling cigarettes more attractive here.)

Smoking bans
New York State's ban on indoor smoking in workplaces -- including restaurants and bars -- took effect in 2003. And in the time since many institutions have banned smoking not just inside, but everywhere on their property. (That's why you see nicotine refugees huddled up down the block from places like hospitals.)

There's research indicating these sorts of bans prompt more people to try to quit smoking.

Outreach and public eduction
New York State has a wide ranging program aimed at getting people to stop smoking -- it includes graphic advertising warning people about the dangers of smoking, assistance for people looking to quit, and outreach and education programs.

So how much of the decline in smoking can be attributed to each of these reasons?

"That's the big evaluation question that everyone asks and there's no good answer to it," Juster told us, explaining that state is trying to take a comprehensive approach that reduces smoking in multiple ways. And because it's trying all these things all over the place, it's hard to figure out the exact effect of each thing. But the whole package seems to be working.

"You keep prices high, make it hard to smoke indoors where other people are, put negative images and negative emotions on TV ads. And you do all that you kind of create a social norm where tobacco use is not acceptable. And I think we've done that well here."

So, who's still smoking?

There are smokers across every demographic category -- female, male, young, old. But the demos with the highest percentage of smokers are people with low incomes and/or low levels of education, as well as people with mental health problems. And Juster said that's been true for a long time. He said the big challenge now is to bring these people on board with approaches that have been shown to help people quit.

"We really need to do more to help them."

Will smoking end?

It's kind of unbelievable to think there will be a day when virtually no one smokes. But it's also remarkable how fast attitudes change. We remember walking into a smoky restaurant in a different state a few years after New York's smoking ban took effect -- it was jarring at first to experience something that had been the norm just a few years earlier.

So, we asked Harlan Juster if he thought that day would arrive.

He replied that he didn't think it would just on state and local efforts. But if the federal Food and Drug Administration eventually mandates lower levels of nicotine in cigarettes -- to what might be non-addicting levels -- it could be possible.

"Nicotine is the reason people smoke. Eliminate the nicotine and probably no one would be interested."

A few things about the numbers

How does the state figure out how many people are smokers? Well, there's an annual phone survey (including both landlines and mobiles) that asks people across the country all sorts of health questions -- it's called the Behavioral Risk Factor Surveillance Systems or BRFSS -- and it's a weighted survey of adults 18 and older. The Department of Health is able to use the data from those responses for New York State to create estimates of how many people are smokers.

So, that 14.5 percent is actually the midpoint of a range of highly probable rates, in this case 13.3-15.7 percent. (The estimated rate for men was 17.1 percent and 12.1 percent for women.)

The BRFSS is a long running effort, but it made some changes in 2010, so numbers before and after that point aren't directly comparable.

National level: The estimated national percentage of adults who are smokers was 17.8 percent (in 2013).

By the way: A current smoker is defined as "persons who reported smoking at least 100 cigarettes during their lifetime and who, at the time they participated in a survey about this topic, reported smoking every day or some days."

Also: If a person only uses e-cigarettes -- if they "vape" -- they're not considered a current smoker in this survey.