To get a feel for how prevalent cigarette smoking is locally, think of it this way.
Indiana and Kentucky continue to have high smoking rates compared to rest of the nation. Cigarette use in most local counties matches or exceeds those statewide rates.
In Kentucky – where the tobacco industry was a social and political force for generations – one in four adults (25.9 percent) smoke, the highest percentage in the nation, according to 2015 Centers for Disease Control and Prevention statistics.
The Foundation for a Healthy Kentucky placed the rate for Henderson and Union counties at 34 percent.
Indiana isn’t far behind the Commonwealth. The CDC reported cigarette use among Hoosier adults in 2015 at 20.6 percent, and except for Warrick County, local rates were at least that or higher.
Smoking-related illnesses in Indiana kill about 11,100 people per year, and smoking costs Hoosiers nearly $3 billion a year in health care costs.
None of this is news to local health care providers. Dr. David Harris, a pulmonary care physician with Deaconess Health System, worked in California and Utah before coming to Evansville. He said smoking rates here aren’t in the same ballpark with those other places, and the addiction is gripping.
Harris’ specialty often is the first to diagnose a patient with lung cancer.
“Most people who smoke know what the potential risks are,” Harris said. “They may even know they can develop any number of other cancers in other parts of their body. But the addiction is strong enough that when they are asymptomatic, the addiction almost always wins. When people really and truly want to stop smoking is when they start developing symptoms -- wheezing, shortness of breath, frequent infections. But even with those illnesses they are being faced with and have to deal with every day, it’s still very hard to stop smoking.”
Dr. Brian Maddox, a general care physician with Methodist Family Medicine in Henderson, hails from Jasper, Tennessee and recently finished his three-year residency just outside New York City, on Long Island.
Maddox found practicing medicine in this region to be unlike anything he's seen before.
“I certainly feel like there are days when everybody comes through the door smells like cigarette smoke,” Maddox said. “Patients are smoking, and some come from families who smoke.”Chronic Obstructive Pulmonary Disease – a combination of emphysema and chronic bronchitis – is a condition local physicians said they see often, and it’s the third leading cause of death in the U.S.
The bronchitis piece involves coughing up mucus, frequent upper respiratory infections and wheezing, and emphysema is the destruction of lung tissues and blood vessels by toxins in the cigarette, causing shortness of breath.
Smoking also doubles one’s risk of pneumonia, and “often when they do get pneumonia, they will require hospitalization because it tends to be more severe,” Harris said.
Lung cancer, meanwhile, is the leading cause of cancer deaths in the region. As with most cancers, early detection is considered vital to successful treatment. Deaconess and other area health providers offer low-dose CT screening for lung cancer, which the health system says can reduce lunch cancer mortality by 20 percent. Candidates are current and former smokers between 55 and 74.
St. Mary’s Health System provides outpatient pulmonary and cardiac rehabilitation, and more than half of its participants have history with smoking, said Amy Harris, a registered nurse for 29 years.
Among current smokers, the first objective in rehab is establishing a quit date and offering resources to help. Unless that goal is achieved, rehab will have little effect, Amy Harris said. But she’s had success stories over the years.
“We see people that quit,” Amy Harris said. “The education piece is done in a classroom setting, it’s informal, and people get help from one another. There is high accountability for 2-3 months. We have a gym, and (patients) get reminded about shortness of breath. They do a 6-minute walk test when they begin, but we see their distance improve 18-20 percent when they leave.”
However, “nothing is going to work for the patient unless they really want to quit,” Amy Harris said. “That is the biggest factor. They have to want to get rid of that addiction.”
News on smoking is not all bad – smoking among youth has fallen precipitously, and adult rates have dipped some, both locally and nationally.
Yet, local community health surveys still site cigarette use as an ongoing problem. A 2016-18 Community Health Needs Assessment and Action Plan for the Henderson area, prepared by Methodist Hospital, lists reduction of tobacco and e-cigarette use as a priority item.
Its goals include better public education on the topic and referral to a Cooper-Clayton cessation method, written by University of Kentucky researchers. It’s a three-phase approach that involves charting cigarette use, then replacing the nicotine urge with gum or patches, and then a focus on relapse prevention. The method claims a 45 percent success rate among heavy smokers.
Across the region, smoking among pregnant women is a high concern.
In Vanderburgh County, 19.7 percent of women smoked while pregnant during 2014, according to the Indiana State Department of Health. The figure was 10.8 percent for Warrick.
The Vanderburgh County Health Department received a two-year state grant in 2015 to take part of in the Baby and Me Tobacco Free program, an incentive-based effort to wean young mothers off cigarettes. The initial goal was to have 100 participants; so far, there have been 178, with six months still left in the current grant.
Qualifying pregnant women come to the health department for four prenatal sessions. If a carbon monoxide screening shows an expecting mother is smokefree during the third and fourth sessions, she receives a $25 voucher toward diapers at Walmart each time.
Once a baby is born, mothers who test smokefree for at least a year after delivering can receive a $25 voucher a month.
Additionally, “If the birth father comes in and gets off the cigarettes too, it goes to $50 a month.” Said Mary Jo Borowiecki, supervisor of the program with the health department. “If the birth father’s not in the picture but if the girl lives with her mom, and she gets off the cigarettes, same thing.”
Ninety-three percent of mothers in Baby and Me Tobacco Free have delivered healthy babies – defined as weighing more than 5 pounds, 8 ounces. Participants don’t have to live in Vanderburgh County. Mothers have come from surrounding Indiana counties, Kentucky and Illinois.
“If they will drive to us, we will take them,” Borowiecki said.
A promotional effort called Healthy Baby Steps – a collaboration of the Health Department, Deaconess, St. Mary’s, ECHO Community Healthcare, Community Action Program of Evansville and others – has worked in recent years to spread the word about prenatal care and the hazard of tobacco use among pregnant women and young mothers.
Its goal is to tackle infant mortality. The Vanderburgh County rate for 2010-2014 was 8.3 deaths per 1,000 live births. Smoking is often a factor in infant deaths, said Lynn Herr, a Health Department program coordinator.
For people in any phase of life, the effort to stop smoking is worth it, Sally Burch of Henderson said.
Burch, 61, started smoking as a teenager. Over the years,she tried repeatedly to quit, eight times to be exact. She smoked her last cigarette in 2011, and she said two factors were mostly responsible -- the Cooper Clayton method, and the fact that her employer, Methodist Hospital, went 100 percent smokefree.
"I feel better," said Burch, who works in the hospital's supply chain. "Of course I don’t have the little hacky cough all the time. I’m not short of breath. Over the years, I think I’ve cleaned those lungs up."
Burch agreed with health care professionals that the will to quit must be strong and come from within.
"If you’re not ready to quit," she said, "there’s no sense in even trying.”