Still Blowing Smoke 

Ostracized, criticized, and taxed, smokers puff away.

Smokers are catching it from all sides.

They are banned from restaurants that admit children.

They are banished from the workplace to huddle on loading docks and in outdoor areas to smoke in the cold, heat, and rain.

They are easy tax targets. Cigarette taxes were raised this year from 18 cents to 68 cents a pack in Mississippi and from 62 cents to 67 cents a pack in Tennessee — less than New York's $2.75 per pack but more than North Carolina's 35 cents a pack. In Memphis, a pack of cigarettes costs from $3.50 to $6.

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Smokers are bombarded with remedies for quitting — from hypnosis to Zyban and Chantix — and with public service ads that say smoking is bad for their health.

Syndicated columnist George Will called them stupid.

In gentler language, they were called out by President Barack Obama, who is himself trying to quit smoking. He recently signed a law bringing tobacco products under federal control for the first time.

Smokers' insurance costs are rising because smoking leads to diseases such as lung cancer, emphysema, and heart disease that are expensive to treat and drive up the cost of health benefits for all employees.

And still they smoke. About 20 percent of Americans and 25 percent of Tennesseans smoke, according to the American Cancer Society. And 90 percent of them begin on or before their 18th birthday. Smoking remains popular among some college-educated Americans and even physicians, who are well aware of the risks.

"I never worried about the health effects, and I still smoke and I still don't care," said Memphian Greg Withrow, 29, an insurance claims adjuster who started smoking at the age of 25 when he was in art school in Scotland. "Everyone I was hanging out with started smoking at the same time they'd just banned smoking in the clubs. At the time I started, my plan was to die of lung cancer before graduating college so I wouldn't have to pay off my student loans. Unfortunately, that plan didn't work."

Amy Dobbins, 26, said she started smoking two years ago when she was at a bar on Beale Street with a friend.

"I started smoking because of stress and responsibilities," she said. "Now it keeps me mellow and from feeling awkward. I only smoke when I'm stressed and drink. I go through, like, one pack in two weeks."

Obama focused on young smokers when he signed the Family Smoking Prevention and Tobacco Control Act in June.

"They're exposed to a constant and insidious barrage of advertising where they live, where they learn, and where they play," he said.

They're also exposed to a lot of hypocrisy.

Obama's smokers-as-victims statement downplays individual choice and responsibility. The 80 percent of Americans who do not smoke or use other tobacco products are exposed to the same temptations as those who do.

The advertising "barrage" was much more intense a generation or two ago, when cigarette companies were major sponsors of television programs and famous athletes endorsed smoking. Two of the icons of tobacco advertising have been dead for a decade or more. The Marlboro Man, an American cowboy with a jut-jawed profile and a cigarette in his mouth, was gone by 1999, along with some of the models that portrayed him and died of lung disease. Joe Camel, a shades-wearing hipster created to lure young smokers, met his demise in 1997. Camel, a brand of the R.J. Reynolds Tobacco Company, has a new "smokeless, spitless" product called Snus that comes in "frost" and "mellow" flavors.

click to enlarge Omar Suboh - MEEJAHOR | DREAMSTIME.COM

The president is not the only government official who is denouncing smoking while indulging in its profits and pleasures. At both the state and federal levels, government's response to smoking is two-faced. There may be no better example of this than Mississippi.

In 2008, Governor Haley Barbour, a former lobbyist for cigarette makers, named a committee to study his state's tax structure. It recommended increasing the cigarette tax, then the third-lowest in the country. In May, Mississippi increased its tax to 68 cents a pack.

Mississippi is famous for, among other things, its landmark multi-billion-dollar settlement with Big Tobacco in 1997 to reimburse the state for Medicaid funds. It is also a notoriously unhealthy state with a disproportionate number of fat people, poor people, and people with respiratory diseases. Its obesity rate, currently 32 percent, has led the nation for five years.

Later this year, Mississippi state agencies will hold an unusual auction. In April, a state and federal task force discovered thousands of cases of contraband cigarettes — 30 truckloads by some published reports — in a warehouse in Mississippi.

So what did Mississippi do with the bootleg cigarettes? Burn the evil weed? Dump them in the Mississippi River? No, the Mississippi Tax Commission will sell the contraband cigarettes to the highest bidder. The sale could reap unpaid taxes of as much as $5 million, according to the state auditor's office. One state lawmaker rationalized the sale by saying most of the brands ultimately will be sold in other states. Or perhaps another country. America's three leading exports are food, weapons, and tobacco products.

click to enlarge Dr. Robert Klesges - RTIMAGES | DREAMSTIME.COM

At the federal level, some people think smoking should be banned in public housing projects, where exposure to second-hand smoke is especially high.

"Children in densely populated public housing suffer the worst," wrote Dr. Jonathan Winickoff, chairman of the American Academy of Pediatrics Tobacco Consortium, in a guest column in Newsweek magazine recently.

The Department of Housing and Urban Development allows local public housing authorities to make their buildings smoke-free but does not require it. Robert Lipscomb, head of the City of Memphis Division of Housing and Community Development, said there are no such restrictions in Memphis.

"We've got to be careful about the rights of people and singling out one class of people," Lipscomb said. "We waste a lot of different dollars on a lot of different things. This is a slippery slope. What else do you control just because people are getting a subsidy?"

Lipscomb, a runner and nonsmoker, is not unmindful of the problem. His mother and brother both died of lung cancer. He recalls his mother's death as "horrible," but he also remembers her asking for a cigarette when she was being rushed to the hospital.

What is it that makes smoking irresistible to 20 percent of the American population?

In Tennessee, a tobacco-growing state with a tobacco leaf in its state seal, 24 percent of the population smokes, including 84,000 high school students who smoke or use smokeless tobacco, according to the American Cancer Society.

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John Chiaramonte, director of government affairs for the American Cancer Society in Tennessee, says peer pressure, rebellion against parents, giveaways of tobacco products, and positive depictions of smoking in movies, television, and photographs get young people started.

In HBO's Sex & the City, Carrie Bradshaw, played by actress Sarah Jessica Parker, battled with her smoking habit. In fashion designer Jean Paul Gaultier's splashy fall show last year in Paris, models traipsed up and down the runway carrying cigarettes in stylish holders.

Chiaramonte predicts that banning candy and fruit-flavored cigarettes, requiring larger and more graphic health warnings on cigarette packs, and prohibiting marketing terms such as "light" and "low tar" will further cut the smoking rate.

"The fact that 2 percent of the population has quit smoking in less than two years is pretty significant," he said.

The ban on smoking in public places and offices is not universal. Tunica casinos and some Memphis bars and restaurants that limit admission to those over age 21 remain bastions of smokers' rights. Indeed, nonsmokers can sometimes feel like they are in the minority at watering holes like Zinnie's or the P&H. Research studies say the "congregating effect" reinforces smoking.

Harshit Shroff, 25, a recent graduate of Christian Brothers University, knows the risks but has been smoking since 2003. He says it relaxes him.

"It only harms people after a very long term, and I do not intend to continue for long," he said.

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Shroff, who smokes three or four packs a week, said he has quit before and could quit again if he wants to.

"I stopped for three months without any medication," he said. "I think quitting is more a matter of mentally being strong."

Omar Suboh, 23, said he started smoking when he was 17 because "my job sucked, and it gave me a reason to take a break at work." He became concerned about health risks two years ago when he started coughing up phlegm when smoking. He tried to quit but still smokes three or four cigarettes a week.

"Obviously, they are extremely addictive," Suboh said. "But also, I think, it's partly because I didn't practice self-control."

Dr. Matthew Ninan is skeptical of an optimism that recalls Mark Twain's line that quitting smoking was easy because he had done it hundreds of times. Ninan, who says he has been called "an anti-smoking Nazi," is a lung cancer and thoracic surgeon at the University of Tennessee Health Science Center. Business is robust, and he expects it to remain so for the next 20 to 30 years. Lung cancer is the biggest cancer killer among both men and women.

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"It is a daily challenge for me to work with people who have been smoking for 30 or 40 years," he said. "The vast majority of smokers start when they are in school. Nicotine is a highly addictive substance, and it becomes very difficult to quit. It is extremely difficult even in the face of lung disease and heart disease."

Ninan says some of his professional peers smoke.

"Certainly, smoking is not uncommon among physicians," he said. "Many of them are not daily smokers, but they do smoke cigars recreationally."

Ostracism of smokers goes too far in some cases and not far enough in others, says Dr. Robert Klesges, a psychologist and professor of preventive medicine at UTHSC. He says it makes no sense to ban smoking in outdoor stadiums or within 30 feet of an airport terminal because there is no danger from second-hand smoke in such an area. Hotels, on the other hand, don't go far enough. They advertise "non-smoking" instead of "smoking" rooms, a subtle but important difference.

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"The more you make it look like very few people are doing it, the more you encourage people to quit," he said.

The most effective bans create an environment where "it's too big a pain in the neck to smoke."

Tobacco companies, Klesges says, are outstanding marketers, usually staying one step ahead of anti-smoking efforts. A relatively new product is called snus, advertised on the Camel SNUS website as being "spitfree tobacco" that "can be enjoyed almost anywhere regardless of the growing smoking bans and restrictions." Advertising carries a warning that "this product may cause gum disease and tooth loss." Klesges said that where snus has been introduced in the military, "they can't keep it on the shelves."

Coupons for free samples of snus have been distributed in Memphis. A Flyer nonsmoking intern tried it and described an initial "burning" sensation that went away and left a pleasant "minty" taste. Camel says the product delivers a "tingle."

(Additional reporting by Bianca Phillips, Hannah Sayle, and Erica Walters)

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