One of the most heavily stressed goals in the city's sweeping new public health plan is to help as many New Yorkers as possible quit smoking. It's an instance of the health department getting its priorities right and pursuing enlightened policy. In 2002, the last year for which New Yorkers' causes of death were tabulated, smoking killed more city dwellers (approximately 10,000) than alcohol, suicide, homicide, motor vehicle accidents, illegal drugs, and breast cancer combined. That is, smoking-related illnesses like lung cancer and other forms of cancer, heart disease, and stroke were responsible for nearly one out of six of the deaths in the city, according to Dr. Thomas Frieden, commissioner of the city's Department of Health and Mental Hygiene.
The city's new public health plan, unveiled in April, announced a goal of reducing the percentage of New Yorkers who smoke from 22 percent (in 2002) to 18 percent in 2008; freeing 240,000 individuals from their addiction. If successful, the health department has asserted, this one public health push alone will prevent 80,000 premature deaths among New Yorkers.
It sounded ambitious; but then the health department announced, on May 12, that the number of smokers in New York City had already declined a whopping 11 percent from 2002 to 2003 -- the fastest drop in smoking rates ever recorded anywhere in the nation. In just one year, 100,000 New Yorkers had kicked the habit. This was a decline in the percentage of New Yorkers who smoke from 22 to 19 percent -- making the goal of 18 percent by 2008 seem, if anything, too modest. These new findings come from surveys conducted at the city's behest by the survey unit at Baruch College.
Commissioner Frieden attributes the unprecedented drop to "[t]he increase in the cigarette tax, implementation of the Smoke Free Air Act, our nicotine patch distribution program, and public education about the health risks associated with tobacco." The decline in smoking will prevent 30,000 premature deaths, he said.
The increase in the cigarette tax and the ban on smoking in bars enacted last year undoubtedly played a major role in the decline. The aggressive anti-smoking measures the health department has pursued under Bloomberg, including advertising and the nicotine patch program cited by Frieden, probably account for the rest.
The nicotine patch program, a one-time give-away by the city of six-week supplies of nicotine patches to 35,000 New Yorkers last year, was notably successful, according to a report released by the health department last month. Eleven thousand, or 33 percent, of the participants are now ex-smokers. "The results far exceeded our expectations," Frieden said of the program.
"If you think about everything we did in the New York City Health Department last year, there's no single program that saved anything like this number of lives," he told the New York Daily News.
Most of the smokers who took advantage of the patch offer were black, Latino, or Asian, and/or from low-income neighborhoods. Women and young adults participated at high rates. Roughly 8,500 of the participants were from Brooklyn, 7,500 from Queens, 6,300 from the Bronx, 6,200 from Staten Island, and 5,000 from Manhattan. The city also made follow-up phone calls to participants and provided free counseling to those who wished it, then interviewed the participants after six months to determine the program's success rate.
"Most New Yorkers who smoke want to quit and try to quit each year," said Frieden. "But four of five who tried to quit did so without the benefit of medications or counseling, which we know greatly increase quit rates. Most people who want to quit should receive medications. Doctors should advise their patients to quit and provide medications to virtually all patients who are trying to quit. And families who want to assist their loved ones to quit should encourage them to try medication or counseling. Simply put: Drugs to help people quit smoking work!"
Nicotine patches are estimated to double the likelihood that a smoker trying to quit will succeed.
Although the "patch hotline" was a one-time offer timed to coincide with the enactment of the city's year-old laws prohibiting smoking in bars and restaurants, would-be quitters who lack insurance coverage will still be able to get free stop-smoking aids, including the patch and the stop-smoking drug Xyban, through the New York City Health and Hospitals Corporation's 14 free smoking-cessation clinics, located in Manhattan, the Bronx, Brooklyn, and Queens. Some community clinics and other participating healthcare providers will also offer the services and medications gratis to those who qualify.
Since the city's new health initiative does not have a budget associated with it, it is not clear how much funding will got to the smoking-cessation programs, or if they will be sufficient to reach the ambitious goals set for 2008. If they are anywhere near as successful as the nicotine patch trial, however, they will be a bargain at almost any price: Considering the $2.7 billion in direct medical costs and then the $2.0 billion in lost future earnings, tobacco use costs New York City an estimated $4.7 billion annually.
Aside from the New Yorkers it kills prematurely, the health department estimates smoking has disabled another 240,000 city residents through chronic bronchitis, emphysema, stroke, and heart disease, among other debilitating illnesses. And exposure to second-hand smoke has been demonstrated to contribute to heart disease and cancer beyond a reasonable doubt.
New Yorkers can call the city's help line at 311 for more information about clinics offering stop-smoking aid, including times of operation.
Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF