Jason Pace doesn’t remember how or why he became a smoker.
The 43-year-old Springfield resident’s habit began as a teenager with smokeless tobacco, which eventually led to smoking as a college student at Miami University. More than 20 years later, Pace was among the 28 percent of Clark County adults who were smokers in 2015.
With increased smoking rates affecting the overall health of the community, Clark County health officials are working to improve public education, institute tobacco-free policies at businesses and create smoke-free zones at local parks.
“It can affect every square inch of your body,” said Sarah Dahlinghaus, a public health educator with the Clark County Combined Health District.
Cigarette smoking causes more than 480,000 deaths each year across the United States, nearly one in every five deaths. Smoking can lead to 17 chronic diseases and 13 types of cancer, according to the U.S. Department of Health and Human Services. Secondhand smoke can also cause health problems for both children and adults.
“Research has shown that nicotine is by far the most addictive substance known to man,” said Marcy Ivory, the tobacco education coordinator for Community Mercy Reach, which specializes in drug addiction recovery services.
Recently, Pace’s 7-year-old son, Isaiah, saw an anti-smoking commercial on TV where a person with a tracheotomy discussed smoking.
“He would say: ‘That’s going to happen to you, Daddy,’” Pace said. “After awhile you can’t tell him to be quiet because he’s probably right.”
Pace hasn’t had a cigarette since Super Bowl Sunday.
“It was just time,” Pace said. “I just needed a push. It takes time out of your day. It costs money. It’s just not a good thing.”
Smoking rates increase
In 2010, about 23 percent of adult residents in Clark County were smokers, less than the Ohio average of 24 percent, according to County Health Rankings data.
Five years later, Clark County’s smoking rate has increased to about 28 percent, seven percent higher than the state average of 21 percent. The smoking data for 2015 was collected using county level data from federal sources between 2006 and 2012, according to the County Health Rankings website.
The most recent local data — the health district’s 2015 Behavior Risk Factor Surveillance System Survey, which polled about 800 Clark County residents with land line telephones — showed 45 percent of adults in Clark County have smoked at least 100 cigarettes in their lifetime.
Of those people, about 44 percent of those residents said they currently smoke. On average, those residents reported smoking about 15 cigarettes per day, which is less than one pack of 20 cigarettes.
Additionally, 9 percent of Clark County residents indicate they use other forms of tobacco, such as e-cigarettes.
New task force
As part of the $95,000 Creating Healthy Communities grant received by the health district, one of the focus areas is tobacco prevention, Dahlinghaus said.
A Tobacco-Free Living Task Force has been created to help reduce and prevent smoking in Springfield and Clark County.
The task force will focus on general smoking education, including participation in more national media campaigns and awareness efforts for smoking-related conditions, such as lung cancer and obesity.
The district participates in several national media campaigns, including the upcoming Kick Butts Day on March 16. The district is also hoping to perform more education in schools, Dahlinghaus said.
“Education and awareness is a proven, effective tactic,” Dahlinghaus said.
It’s important to also educate about the side effects of smoking, she said.
“We just say smoking is bad, and we don’t actually say it can cause lung cancer,” Dahlinghaus said.
The district will also focus on implementing smoke-free zones throughout both Springfield and New Carlisle, including playgrounds and shelters at local parks.
“Anywhere children and families are, there doesn’t need to be smoke there, even if it’s outside,” Dahlinghaus said.
As part of the Help Me Grow program, the health district helps pregnant women quit smoking early in their pregnancy. The women – many of whom are referred by those who make it through the program — can receive vouchers for diapers, Dahlinghaus said.
“We really try to hit every demographic,” Dahlinghaus said.
As the only smoking cessation educator in Springfield, Marcy Ivory isn’t surprised by the high smoking rates in Clark County.
She’s been working for 14 years to help residents stop.
Before placing residents into a six-week class, they fill out an assessment to allow for individualized plans to quit smoking.
At the first class, the participants set a quit date sometime in week four, Ivory said. The plan also supplies a free month of nicotine gum, patches and lozenges, she said.
The class also focuses on overcoming the psychological aspect of smoking, including changing routines to help with quitting, she said.
“It’s way more challenging than the physical aspect for most people,” Ivory said. “If you currently smoke in the home and in the car, you’ve got to focus on quitting those two things prior to quitting.”
Participants will also write a goodbye letter to nicotine, as well as learn diet and exercise can help people stop smoking.
Each participant also receives a carbon monoxide screening both before and after the program, she said.
“Typically, there’s a drastic change,” Ivory said.
Success rates for the Mercy Reach program were typically between 90 and 95 percent, Ivory said, but the numbers have dropped in recent years.
“We’re trying to handle higher levels of addiction,” Ivory said. “I’m working with the people who have tried several times.”
After six weeks, Ivory often stays in touch with graduates to help them stay smoke free, she said.
Many smokers are suffering from major illnesses, such as Chronic Obstructive Pulmonary Disease, much earlier, said Ivory, who also performs bedside consulting at local hospitals.
“I’m not surprised if someone in their late 30s or early 40s has the diagnosis,” Ivory said.
Health is the main reason people typically choose to quit, she said.
Habit and boredom
Over the last 20 years, Pace, a married father of two, has had several jobs that were conducive to smoking, he said.
“Everybody’s got a different reason why they smoke,” Pace said. “I was smoking out of habit and boredom.”
Pace said he put down his cigarettes for good after the Super Bowl. A few weeks earlier, his wife Amanda signed him up for smoking cessation classes with Ivory at Community Mercy Reach.
Pace understands the risks of smoking but said he’s probably not as concerned with the consequences as he should be, he said.
Pace was smoking about a pack of cigarettes per day, spending about $200 per month on his addiction, he said. He hopes to use the savings to make update his new home in Northridge.
Pace hasn’t had any withdrawals at this point but said changing routines has been difficult. He would typically smoke on the back porch of his house, as well as in the car. He’s working to find things to fill that time, he said, like cleaning.
“I haven’t had do something outside of my comfort zone in awhile,” Pace said. “It was just time. I would rather do other things. It was just a matter of having the wherewithal and strength to do it, but I haven’t put the time in before. … My heart wasn’t in it.”
Ohio received mixed reviews for its public policies from the American Lung Association’s annual State of Tobacco Control report.
The state received an F for tobacco prevention and cessation funding. The state provided about $12 million during the 2016 fiscal year for tobacco control programs, an increase of about $4.4 million.
It also received an F for tobacco taxes, currently about $1.60 per pack, according to the ALA.
The state received an A in smoke-free air as smoking was prohibited in workplaces, restaurants, bars and other buildings in 2006. The state received a C in access to cessation services because while Medicaid covers all seven recommended cessation medications, some barriers to coverage remain, the report says.
Several employers in Clark County, including the Sheriff’s Office and Community Mercy Health Partners, have enacted policy to not hire smokers.
Companies are nervous to enact smoke-free policies due to backlash, Dahlinghaus said, but it’s perfectly legal to have non-smoking policies in housing, work sites and restaurants.
“People don’t like to be told what they can’t do, which is understandable,” Dahlinghaus said, “but work sites have every right to write the policies how they want to. If it says ‘We won’t hire smokers, then they won’t hire smokers.’ Smoking is not a protected right.”
The district is working to help local businesses to enact non-smoking policies, she said. The key is allowing current employees time to get help, she said.
“It’s very difficult to ask people to quit,” Dahlinghaus said.
Five cities in Ohio last year enacted ordinances increasing the minimum age of people who can purchase cigarettes from 18 to 21 years old. Those cities include four Columbus suburbs – Upper Arlington, Bexley, Grandview and New Albany – and Cleveland.
As part of the task force, the health district is researching possible legislation in Springfield and Clark County, Dahlinghaus said. The ordinances are typically voted on by local elected officials, such as city commissioners, she said.
“It’s obviously a big process, a big challenge,” she said. “We would be happy to implement something like that, but we’re in very early stages of research.”
The positives include less use for young adults as well as less chance for 18-year-olds to purchase cigarettes for younger teenagers. More than 20 percent of middle school students in Clark County surveyed by the health district have tried cigarette smoking, even one or two puffs, according to the Community Health Assessment.
“It doesn’t sound like it would make a big difference, but it does,” Dahlinghaus said.
Public policy can be written to include nicotine delivery devices, such as vape pens or e-cigarettes, Dahlinghaus said. In Clark County, there are currently nine e-cigarette specialty stores, not including gas stations, she said.
Without regulations from the Food and Drug Administration, health officials have no idea what kind of harm may be caused by e-cigarettes, she said.
After smoking for more than 30 years, Kevin Mercer, a 50-year-old buyer/planner at Cascade Corp. in Springfield, decided to try a different method to stop — hypnosis.
Mercer, who was smoking about a pack-and-a-half per day, attended an evening seminar last month in Dayton and has been smoke-free ever since, he said.
“You still want to have one,” Mercer said. “but then you think about what they had to say and it just goes away. You just have a quick thought and boom – it’s gone.”
He’s taken prescription drugs like Chantix and Wellbutrin in the past without success, he said.
Mercer’s wife, Deanna, previously used hypnosis and stopped smoking for more than two years, he said. While he was skeptical at first, the treatment has proven effective so far, he said. If you relapse during that calendar year, they’ll perform the hypnosis again the following year for free, Mercer said.
“It works,” Mercer said. “We needed to quit.”
‘Such a waste’
Lisa Behr has smoked for more than 30 years. She thinks about quitting every day, she said.
“It’s the first thing you want when you wake up,” Behr said. “It’s like your body is telling you it’s gotta have that.”
The 54-year-old Springfield resident has quit four or five times in the past she said, including during pregnancy. The psychological aspect of quitting is the hardest part, she said. She hates the tobacco smell on her clothes, she said.
“I would like to quit and I keep thinking, ‘If I could just make up my mind,’ ” she said.
Behr smokes about a pack per day and spends about $60 per week.
“I can’t even think about it because it’s such a waste,” she said.
Family members have had heart and lung issues due to smoking, Behr said. The longer she smokes, the more she thinks about the consequences smoking may have on her health in the future.
“You don’t realize it when you’re 17 or 18 years old and you do it,” Behr said. “You just think its OK because everyone else is doing it.”
By the numbers
$289 to 332.5 billion: Annual smoking-attributable economic costs in the United States estimated for the years 2009–2012.
20.8 million: Number of Americans who died premature deaths caused by smoking and exposure to secondhand smoke between 1965 and 2014.
480,000: Number of annual premature deaths caused by smoking among Americans aged 35 and older.
County Health Rankings
23 percent: Clark County adults who smoked in 2010.
28 percent: Clark County adults who smoked in 2015.
21 percent: Ohio adults who smoked in 2015.
Source: Clark County Combined Health District, County Health Rankings, U.S. Department of Health and Human Services.
The Springfield News-Sun provides in-depth coverage of important health issues, including recent stories on the Clark County health assessment and a wellness accountability program at a local hospital.
Healthy Springfield: About this series
Many readers responded to a report late last year that ranked Springfield as the least healthy city in Ohio. That response — including wanting to make a positive difference — prompted the Springfield News-Sun to take a closer look at the community’s health. This year, the Springfield News-Sun will dig into the public health issues facing the city, including minority health and school lunch programs and efforts to improve them. In March, the News-Sun will investigate obesity in the community.
More online: For more Healthy Springfield coverage, including videos and health maps, log on to SpringfieldNewsSun.com/healthy-springfield.