ACCC Recognizes National Cancer Prevention Month: A Focus on Smoking + Taxes

In 1899, former congressman Willard Duncan Vandiver of Missouri said, "I’m from a state that raises corn, cotton, cockleburs, and Democrats, and frothy eloquence neither convinces nor satisfies me. I’m from Missouri. You have to show me." Missouri is now commonly referred to as “the show me state,” and, if the story of Vandiver is to be believed, he is the reason why. The origin of its unofficial slogan is not the only thing that makes Missouri unique. At $0.17 per pack of 20 cigarettes, Missouri has the lowest cigarette tax in the United States—an amount considerably lower than the national average of $2.14. This has contributed to the state receiving failing grades from the American Lung Association in its State of Tobacco Control report in the following categories:

• Smoke free air
• Tobacco prevention and cessation funding
• Tobacco taxes
• Flavored tobacco products.

“Through the years, there has been multiple efforts to increase that tax rate, and they have just consistently failed,” said Ben Morris, MSED, RT(R)(T)(CT), assistant director at the Branson Cancer Center—a satellite location of CoxHealth, Hulston Cancer Center in Springfield, Mo. “There is sufficient data that establishes a direct correlation between tobacco tax and tobacco usage.” According to the American Lung Association, every 10 percent increase in the price of cigarettes reduces cigarette use by nearly four percent among adult smokers and about seven percent among youth smokers. “If Missouri got to just under the national average, which would be an astronomical increase, if we went from $0.17 and increased it a hundred-fold to $1.70, think about what that would do to our smoking rates in the community,” Morris said.

According to Morris, Taney County—where the Branson Cancer Center is located—has a 35 percent smoking rate. “That is huge, the state average is 14 percent,” he explained. “We see an abnormally high number of patients with lung cancer because of the tobacco utilization in the county.” Further, Morris wagers that certain cultural components have impacted the prevalence of smoking in Missouri. “We know that children of parents who smoke have a higher propensity to become smokers themselves, so there is an issue of generational smokers,” he said. “We have seen a large influx of electronic cigarettes within the community as a result.”

The Use of Electronic Cigarettes

Reports from the Centers for Disease Control and Prevention (CDC) indicate that electronic cigarettes have been the most used tobacco product among young Americans since 2014. Additionally, about 1 middle schooler out of every 30 middle schoolers and about 1 high schooler out of every 7 high schoolers reported using electronic cigarettes in the past 30 days when surveyed in 2022.

Morris and his colleague conducted a similar survey at their local schools. “We asked how many students smoked or vaped in the last 30 days,” he said. “In one rural school the answer was nearly 50 percent.” Based on the current rate of smoking among young Americans, 5.6 million individuals, who are younger than 18 and are currently alive, will die prematurely from a smoking-related illness.

Understanding the danger tobacco smoking poses to youths, CoxHealth now conducts tobacco cessation trainings in local schools aimed particularly at combating teen smoking. Morris is hopeful that these trainings can reduce teen smoking in local schools and ultimately impact Missouri’s smoking rates. “There is no negative associated with presenting more information to these teens. The only outcome is a positive one,” Morris said. Additionally, Morris contends that obtaining frequent lung cancer screenings plays in a key role in prevention efforts.

The Importance of Cancer Screening

“Our main campus in Springfield, over the last several years, has had a robust low-dose lung cancer CT screening program,” Morris said. “If we can catch those cancers earlier, then people have a better chance of surviving them.” If detected early, the five-year survival rate for many cancers is as high as 90 percent. Recognizing the importance of screening, CoxHealth is currently using a Health Resources and Services Administration grant to help bring health resources to underserved individuals in rural communities. “The goal of the grant is to provide screenings to rural patients,” Morris said. “Empirically, you see more early-stage lung cancers that are asymptomatic, so screenings are of the utmost importance.”  

Additionally, CoxHealth and Hulston Cancer Center leadership are committed to ensuring their employees understand the risks associated with tobacco use. “One thing a former CEO did was invest some of his own dollars to encourage employees, who were current smokers, to stop smoking,” Morris said, adding, “If they met certain criteria, they would win a thousand dollars of his own money. We had two employees in our Branson location who went through that program, and they quit smoking.”

According to the CDC, there was a 27 percent drop in cancer-related deaths in the U.S. from 2001 to 2020. While this achievement should be celebrated, there is still work to be done. More than 40 percent of all diagnosed cancers and nearly half of all cancer-related deaths in the U.S can be attributed to preventable causes, such as smoking. Thus, the continued effort toward preventing cancer must be characterized by actions not words—embodying the ethos of one former congressman from Missouri.