While the culture of smoking has changed dramatically in the years since California became the first state, in 1995, to pass a smoking ban, the nasty habit continues to cost the state billions of dollars and kill more people than AIDS, Alzheimer's or diabetes.

A new study (pdf) of old data from the Institute for Health & Aging, School of Nursing University of California, San Francisco, calculated that the costs of healthcare, loss of productivity and premature death amounted to $18.1 billion. The report curiously uses data from 2009, because that is when the broad range of information it analyzes was available then. The study updates previous reports done by the same group using data from 1999 and 1989.

Nearly 4 million Californians were still smoking in 2009, including 146,000 adolescents. Around 15% of deaths in the state, 34,363, were attributed to tobacco, and men suffered the most. They accounted for 59.8% of the deaths and 60.3% of years of potential life lost. Because they work and earn more, men accounted for 76% of the value of lost productivity.

Bad things also happen to more men because they smoke more. Male smokers outnumber females 2.4 million to 1.4 million. 17.2% of adult men are smokers, compared to 10.1% of adult women. Both sexes are considered light smokers, smoking just some days or fewer than 10 cigarettes a day. 59.7% of males and 61% of females are light smokers. Only 17.7% of adult males are heavy smokers, firing up a pack a day, compared to 11.3% of women.   

The cost of smoking worked out to $487 per Californian, and $4,603 per smoker. The costs varied by locale, ranging from $374 per resident in Orange County to $1,002 in Lake County. Direct healthcare costs are responsible for 54.4%, or $9.8 billion, of total smoking costs. Loss of productivity from premature death accounted for 37.6% of the costs and lost productivity from illness was 7.9%.   

None of this is good. But all of it is better than a decade before.

Although total costs increased 15% since 1999, they actually declined 22% when inflation is taken into consideration. Smoking is down to 13.1% of the population from 24.9% in 1984, mirroring the national decline from 42.4% to 20.6% between 1965 and 2009. Deaths were down to 34,363 in 2009 from 43,137 a decade earlier, even as the population increased. 

Smoking is responsible for one in five California deaths and is the leading cause of preventable death in the state, as well as nationally. Seventeen times as many people die in the state from smoking as AIDS. Smoking kills five times more often than diabetes, influenza and pneumonia, and three times as often as Alzheimer's and unintentional injuries.

Dead smokers most often got cancer (13,514 deaths), followed by cardiovascular disease (10,490) and respiratory diseases (10,331).  

California's decline in smoking is not part of a worldwide trend. The World Health Organization (WHO) calls tobacco an epidemic. One billion people smoke and 6 million die annually from it, more than 600,000 from second-hand smoke.

But it is all in a good cause. The Tobacco Atlas estimates that the global tobacco industry generates revenues approaching $1 trillion a year. The combined profits of the six top U.S. tobacco producers was $35.1 billion in 2010, comparable to the combined profits of McDonald's, Microsoft and Coca Cola.

The human costs of supporting this thriving industry have been evident for years, but the futility in reducing the health consequences are best evidenced by the fact that California is about as good as it gets.  

‒Ken Broder

To Learn More:

$18 Billion Tobacco Toll in California (by Elizabeth Fernandez, University of California, San Francisco)

Study: Tobacco Use Toll Drops in California, But Smoking Still More Deadly Than AIDS (by Laura Dudnick, San Francisco Examiner)

Is Smoking Good for the Nation’s Economy? (by Noel Brinkerhoff, AllGov)

Young People Giving up Cigarettes for a Good Chew and a Hit from the Hookah (by Ken Broder, AllGov California)

The Cost of Smoking in California, 2009 (by Wendy Max Hai-Yen Sung Yanling Shi Brad Stark, University of California, San Francisco) (pdf)