More than five million Americans now under the age of 18 will die prematurely from smoking, according to new government projections that reflect increasing tobacco use by teenagers.
But the government also released new figures highlighting huge discrepancies among states in the percentage of adult smokers and the success California and Massachusetts have had in cutting adult smoking rates by a combination of raising taxes and supporting anti-tobacco advertising."These studies show the potential for prevention," said Dr. Michael D. Eriksen, director of the Office of Smoking and Health at the Centers for Disease Control and Prevention, the federal agency that published the research in its Morbidity and Mortality Weekly Report. "The five million deaths is a projection that doesn't have to become reality. This is a wake-up call."
Eriksen said the studies underscored the need for the Food and Drug Administration's recently adopted regulations aimed at curtailing tobacco marketing that appeals to young smokers and at reducing their access to cigarettes. The tobacco industry, which is mounting legal challenges to the FDA's authority to impose the new rules, dismissed the research as old news rehashed to build support for the regulations.
"It's reminiscent of things we've seen before," said Walker Mer-ry-man, a spokesman for the Tobacco Institute in Washington.
The state-by-state adult smoking figures reflect surveys made last year. Utah, where the anti-tobacco stance of the LDS Church is influential and only 13.2 percent of residents 18 or older smoke regularly, is the only state below 15 percent. Fifteen percent is the level the federal government has set as a national target for the year 2000.
Kentucky, a tobacco-growing state with very low tobacco taxes, has the highest rate at 27.8 percent.
Eriksen said Utah's figures provided one benchmark for how much progress is possible. But, he said, Utah's rates could be lower but for tobacco's addictive qualities, which points to the importance of encouraging cessation pro-grams.
"You'd only have 7 percent or 8 percent smoking if we only had those who wanted to doing it," he said, citing previously published research that two-thirds or more of smokers say they wish they could quit.
The report released Thursday on California and Massachusetts said the two states had cut adult smoking rates rapidly by imposing a 25-cents-per-pack tax increase and dedicating some of the new revenue to statewide anti-tobacco advertising. From 1992, the year before the Massachusetts measures, to 1996, the state spent $116 million on tobacco control programs, including $43 million on advertising. The number of cigarettes smoked by the average adult in that state fell 2.2 percent annually, based on state tax receipts.
The decline in the same periods in California, which carried out similar measures in 1990, was 2.7 percent annually. In 41 other states which did not have such programs and for which data was available, smoking rates also fell but at a much slower rate: 0.8 percent annually.
The report cautions that Massachusetts' performance might not have been as good as the 19.7 percent overall decline suggested by the figures because cigarette sales jumped in neighboring New Hamp-shire, indicating that some people may have simply bought their cigarettes out of state rather that quit.
The results are also murkier than health officials would like because a nationwide price war in the tobacco industry cut local cigarette prices. Smokers ended up paying no more for their habit than they had before the taxes once inflation is taken into account.
Still, tobacco critics say, the trends are clear enough to encourage similar programs in Arizona, which began last year, and Oregon, which voted on Tuesday to increase cigarette taxes 30 cents a pack and to step up its tobacco education programs.
Merryman of the Tobacco Institute said that such measures did reduce smoking but that they also had side effects overlooked by their advocates, including encouraging smuggling that can cost a state like California tens of millions of dollars in tax revenue while hurting local retailers.
Some tobacco critics said Thursday that a closer examination of the experience in the two states might lead to renewed disputes over whether anti-tobacco efforts have become overly focused on young smokers. Adult smoking rates in California have actually risen slightly since 1994, when Gov. Pete Wilson and the tobacco industry diverted anti-tobacco advertising money into other health programs and focused on youth smoking issues.