Georgia epidemiology report, Vol. 21, no. 6 (June 2005)

June 2005

volume 21 number 06

Tobacco-Related Deaths in Georgia

Introduction Tobacco use, a risk factor for many chronic diseases, is recognized as one of the most common preventable causes of death in the United States (1). Cigarettes are harmful not only to smokers but also to non-smokers exposed to secondhand smoke (2). Nationally, the percentage of people who smoke has declined over the past 35 years, falling from 40 percent in 1965 to 23 percent in 2000 (3, 4, 5). However, many people continue to smoke. Tobacco use is responsible for more than 440,000 deaths, more than 5 million years of potential life lost, and $75 billion in direct adult medical costs in the United States every year (1, 6).
This report estimates the number of Georgians 35 years of age and older who die every year because of tobacco-related illnesses.
Methods Deaths among adults 35 years and older were counted for 18 smoking-related conditions, based on ICD-10 codes for causes of

death. Mortality data from 2001 were obtained from the Office of Health Information and Policy of the Georgia Division of Public Health.
Smoking-attributed deaths were estimated using an attributablefraction formula as defined in the Smoking Attributable Morbidity, Mortality, and Economic Costs application developed by the Centers for Disease Control and Prevention (7). The smokingattributable fractions of adult deaths for 18 smoking-related diseases were calculated using sex-specific smoking prevalence and relative risk (RR) of death for adult current and former smokers aged >35. The adult smoking prevalence estimates for 2001 were obtained from the Georgia Behavioral Risk Factor Surveillance System. The age-adjusted RR estimates for adults aged >35 years were obtained from the second wave of the American Cancer Society's Cancer Prevention Study (CPS-II) sixyear follow-up.

Table 1. Tobacco-Related Deaths in Georgia, 2001

Disease Category
Neoplasms Trachea, Lung, Bronchus Other neoplasms Total Neoplasms

Relative Risk* for Current Smokers

Male Current Smoker
23.3 6.8

Female Curent Smoker
12.7 5.6

Male

No. of Smoking Deaths

Deaths Number %

2,598

2,306 89

1,137

587 52

3,735

2,893 77

Female

Total

No. of Smoking Deaths

Deaths Number %

1,584

1,128 71

812

214 26

2,396

1,342 56

No. of Smoking Deaths

Deaths Number %

4,182

3,434 82

1,949

801 41

6,131

4,235 69

Cardiovascular Diseases Ischemic Heart Disease
Aged 35-64 years Aged 65+ years Cerebrovascular Disease Aged 35-64 years Aged 65+ years Other Heart Disease Other diseases of circulatory system Total Cardiovascular Diseases

2.8

3.1

1,675

1.5

1.6

3,507

682 41 569 16

3.3

4.0

411

160 39

1.6

1.5

1,233

128 10

1.8

1.5

2,812

840 30

3.2

3.3

1,038

303 29

10,676

2,682 25

649 4,059
339 2,252 3,678 1,466 12,443

242 37 411 10
153 45 123 5 338 9 277 19 1,544 12

2,324 7,566
750 3,485 6,490 2,504 23,119

924 40 980 13
313 42 251 7 1,178 18 580 84 4,226 18

Respiratory Diseases Pneumonia, Influenza Bronchitis, Emphysema Chronic Airway Obstruction Total Respiratory Diseases

1.8

2.2

17.1

12.0

10.6

13.1

621 272 1,186 2,079

148 24 248 91 975 82 1,371 66

854 271 1,211 2,336

117 14 217 80 899 74 1,233 53

1,475 543
2,397 4,415

265 18 465 86 1,874 78 2,604 59

Total Adults 35+ years

16,490

6,946 42

17,175

4,119 24

33,665

11,065 33

Other neoplasms are: Lip, Oral cavity, Pharynx, Esophagus, Pancreas, Larynx, Cervix, Bladder, Kidney and Renal pelvis. Other diseases of circulatory system are: Hypertension, Atherosclerosis, Aortic aneurysm and Other diseases of arteries, arterioles and capillaries. * Disease-specific rate of death among smokers divided by rate of death among non-smokers Mortality data were taken from the Georgia Vital Statistics Report

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Results More than 11,000 adults of age 35 and older in Georgia died from tobacco-related illnesses in 2001, accounting for about one-third of deaths among Georgians in this age group in 2001. About 3,400 died from lung cancer, 1,900 from ischemic heart disease, 1,900 from chronic airway obstruction, and 600 from strokes (Table 1).
Adult male and female smokers lost an average of 16.1 and 16.8 years, respectively, because they smoked.
Conclusions The burden of tobacco-related illness in Georgia is high. Continued efforts to reduce the burden of tobacco-related illness in Georgia are needed.
References: 1. Centers for Disease Control and Prevention. Tobacco
Information and Prevention Source (TIPS). http:// www.cdc.gov/tobacco/issue.htm 2. National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph no. 10. Bethesda, MD. US Department of

Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 99-4645, 1999. 3. US Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411, Prepublication version, January 11, 1989. 4. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS), Nationwide Prevalence Data, 2000. http://www.apps.nccd.cdc.gov/brfss/index.asp 5. Centers for Disease Control and Prevention. Cigarette Smoking Among Adults United States, 2000. MMWR 2002;51: 642-645. http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5129a3.htm 6. Centers for Disease Control and Prevention. Annual SmokingAttributable Mortality, Years of Potential Life Lost, and Economic Costs United States, 1995-1999. MMWR 2002; 51: 300-303. 7. Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC): adult SAMMEC and maternal and child health (MCH) SAMMEC application, 2002. http://www.cdc.gov/tobacco/sammec

Smoking Cessation in Georgia

Introduction The Surgeon General's report on the health consequences of smoking indicates that smokers enjoy immediate and longterm health benefits by quitting smoking (1). Physicians play an important role in tobacco cessation. They can assess tobacco use, advise tobacco users to quit, and treat patients for tobacco dependence (2). Physician interventions can increase 12-month cessation rates by an average of six percent, particularly when combined with cessation counseling and self-help materials (3).
This report describes the percent of Georgia smokers who have tried to quit tobacco and the percent of adult Georgia Tobacco Quit Line users who have remained tobacco free after receiving cessation counseling.
Methods Data on adult smoking prevalence and quit attempts were obtained from the Georgia Behavioral Risk Factor Surveillance System (BRFSS) for 2002 (4). Data on the cessation status among users of the Georgia Tobacco Quit Line were obtained from surveys conducted in 2002 and 2003 by Free & Clear (formerly Group Health Cooperative) on behalf of Georgia's tobacco use prevention program (5, 6).
Results More than one in five adult Georgians (23 percent) smoke. Adult smoking rates are higher among those 18 to 24 years of age and among those of low socio-economic status. Many smokers want to quit. Over half of adult smokers in Georgia (55 percent) stopped smoking for one day or longer during

the previous 12 months because they were trying to quit. NonHispanic Black smokers (73 percent) were more likely than nonHispanic White smokers (54 percent) to stop smoking for one day or longer. Moreover, smokers between the ages of 18 and 24 (72 percent) were more likely than smokers between the ages of 35 and 44 (55 percent) and those between 55 and 64 years of age (44 percent) to stop smoking for one day or longer (Figure 1).
The Georgia Tobacco Quit Line (GAQL) has been providing cessation services in Georgia since November 2001. It is a statewide, toll-free telephone resource that provides appropriate educational materials, tobacco cessation counseling, and referrals for follow-up assistance to tobacco users in the state based on an individual's readiness to quit. GAQL has received an average of 930 calls for assistance per month. Findings from surveys of a sample of GAQL users indicate that 73 percent had made at least one attempt to quit tobacco after their initial call. Of these, 22 percent had not used tobacco for 30 days or more (Figure 2).
Discussion The smoking prevalence in Georgia has not changed since 1993. Nevertheless, many smokers, especially young smokers, want to quit. Quitting tobacco is not easy; it usually requires several attempts. Quitting smoking is facilitated by a variety of aids and support systems. Three of the more important external components that support the process of quitting smoking are physician intervention, counseling services, and self-help materials. 1. Physician intervention is a common key component of the
cessation process. Physicians can assess whether their patients

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use tobacco, briefly educate them about the health effects of tobacco use, advise against its use, and provide pharmacological treatment for cessation, when needed. 2. Behavioral counseling services, such as those provided by the Georgia Tobacco Quit Line, can increase tobacco abstinence rates especially when combined with physician advice and monitoring. A trained professional makes an initial assessment of an individual's readiness to quit. Counseling services are then provided and usually include motivational messages pertaining to changing behaviors and education on techniques for problem-solving and skill-building. 3. Self-help materials help motivate and reinforce individuals to quit on their own or in conjunction with other external aids. Materials such as pamphlets and brochures are tailored to an individual's readiness to quit, are written in an easy to understand manner, give general information on tobacco's effect on health and on possible strategies for quitting tobacco, and provide smokers with alternatives for using tobacco, such as squeezing a stress ball or chewing gum.
Physicians should continue to regularly advise their tobacco-using patients to quit, help them set a date for quitting, refer them to cessation counseling sessions, and provide educational materials on quitting. These combined activities should help reduce the health burden of tobacco use in Georgia.
The articles were written by Argelia Figueroa, M.Sc. and Kenneth E. Powell, M.D., M.P.H.

1. US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General Executive Summary. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 2004.
2. National Cancer Institute. Population Based Smoking Cessation: Proceedings of a Conference on What Works to Influence Cessation in the General Population. Smoking and Tobacco Control Monograph No. 12. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 00-4892, November 2000.
3. US Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Baltimore: Williams & Wilkins, 1996.
4. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS), Nationwide Prevalence Data, 2000 and 2002. http://www.apps.nccd.cdc.gov/brfss/ index.asp
5. Zbikowski SM, Bush T, Yepassi-Zembrou P, McAfee T, O'Hara A, Hantz K. Georgia Tobacco Quit Line: Quit Status Report Year 1. Group Health Cooperative Center for Health Promotion. Tukwila, WA, 2002.
6. Zbikowski SM, Hantz K, Bush T, Mahoney LD, Traff S, McAfee T. Georgia Tobacco Quit Line: Evaluation Report Year 2. Group Health Cooperative Center for Health Promotion. Tukwila, WA, 2003.

References:

Percent
Percent

Figure 1. Percentage of current smokers who quit* for >1 day in past year by age, Georgia adults 18+ years, 2001
100

80

72% 68%

60

55% 57%

52%

44%

40

20

0

18-24

25-34 35-44 45-54 55-64 65+

years

years years years years years

*BRFSS Question: During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? Source: BRFSS 2001

Figure 2. Percentage of quit line users by number of days without smoking, Georgia 2002-2003

100

80

60

49

40

27

20

0

22 2

None

1 - 6

7 - 29

30+

Number of days

Source: Free and Clear, 2002 and 2003

Division of Public Health http://health.state.ga.us
Stuart T. Brown, M.D. Acting Director
State Health Officer

Epidemiology Branch http://health.state.ga.us/epi
Paul A. Blake, M.D., M.P.H. Director
State Epidemiologist
Mel Ralston Public Health Advisor

Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. Editor
Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H. Susan Lance, D.V.M., Ph.D.
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June 2005

Volume 21 Number 06

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for March 2005

Selected Notifiable Diseases
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for March 2005
2005 39 1155 11 2 43 475 10 1 9 0 0 1 0 4 0 68 48 3 6 4 18 0 26

Previous 3 Months Total

Ending March

2003 12

2004 10

2005 92

7926

7560

6153

7

11

24

0

0

7

64

47

143

3476

2978

2649

0

1

38

1

2

23

17

20

77

0

0

2

0

0

0

0

0

8

0

0

0

1

0

11

0

0

0

27

32

199

29

18

104

8

17

22

55

67

45

73

43

28

69

62

97

0

0

0

16

27

63

Previous 12 Months Total

Ending in March

2003 43

2004 39

2005 151

30218

30424

28667

28

26

56

0

0

7

283

249

416

14445

13168

12136

0

1

52

12

11

29

61

99

155

0

0

2

0

0

0

0

0

8

0

0

0

1

0

13

0

0

0

177

212

458

153

85

207

43

70

54

163

259

224

205

243

92

204

248

326

0

0

0

82

99

148

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.

** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

AIDS Profile Update

Report Period
Latest 12 Months: 06/04-05/05 Five Years Ago: 06/00-05/01 Cumulative: 07/81-05/05

Total Cases Reported* <13yrs >=13yrs Total

8

1,463 1,471

9

1,257 1,266

224

28,427 28,651

Percent Female
25.1
26.6
19.2

Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood Unknown

33.2

6.4

2.0

11.3

1.8

45.4

30.7

11.1

2.7

17.5

1.9

36.0

45.6

16.0

4.9

14.3

1.9

17.2

Race Distribution (%) White Black Other

21.4 76.3

2.2

19.4 76.0

4.7

32.0 65.5

2.6

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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