Abstract 1883: Smoking and lung cancer in the United States: Geographic variations by state over time
Authors: Clarke Tainya C. , Hernandez Monique , Arheart Kristopher , Dietz Noella , Lee David J. , Fleming Lora E. 
Published: July 2012

Abstract
Introduction: Years of research have confirmed a causal association between lung cancer and chronic exposure to tobacco products. It is estimated that active smoking is responsible for approximately 90 % of lung cancer cases. In 2009, lung cancer accounted for approximately 28% of all cancer deaths. However, there have been significant improvements in controlling population exposures to these carcinogens. Our research reviewed the implementation of smoking bans across the United States and correlated prevalence and incidence rates of lung cancers across states over the last six years.
Methods: Lung cancer data were obtained from the Cancer in North America (CINA) database. Prevalence and incidence of current smokers by state, race, and gender were obtained from the CDC's morbidity and mortality weekly report (MMWR) for the years 2004, 2006 and 2008 as well as other websites. Current smokers were defined as individuals who smoked more than 100 cigarettes in their lifetime and currently smoke every day or some days. ArcGIS 9.3 was used to spatially display tobacco and lung cancer rates by state. Visual representation of data included map series for comparisons across multiple years and graphical chart illustrations embedded in maps to show race/ethnic comparisons by state. All geographical data was analyzed at the state level.
Results: Tobacco initiation was delayed among women, and country wide data demonstrated an increase in lung cancer among women and a decrease among men between 2004 and 2006. Despite a decline in incidence among men, the age-adjusted death rate for lung cancer was higher for men (67.0 per 100,000 persons) than for women (40.0 per 100,000 persons). In 2006, Kentucky (a state with a thriving tobacco industry where the only smoking related state laws prohibit smoking in government offices, universities, and the state capitol, except in designated smoking areas) had the highest age-adjusted lung cancer incidence rates in both men (124.8 per 100,000) and women (76.6 per 100,000) while Utah had the lowest age-adjusted cancer incidence rates in both men and women (32.0 per 100,000 and 24.7 per 100,000 respectively).
Conclusion: The states with the lowest smoking rates are those that have implemented smoking bans in workplaces, restaurants, and bars. The decrease in smoking rates has not been evenly distributed across all sectors of society; there are notable gender and racial disparities in the number of smokers and in the number of people enrolled in smoking cessation programs. Increasing bans on public smoking, increased cost of cigarettes, and improved access to smoking cessation programs are apparently linked to decreased sales and use of tobacco products as observed at the state level. In the long term this should lead a decrease in the number of lung cancer cases associated with tobacco products.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1883. doi:10.1158/1538-7445.AM2011-1883