State of Oklahoma: Smoking, lack of care contribute to poor health
Ongoing coverage: State of Oklahoma
Oklahoma City — The patients who worry Jessica Deaton most are the ones she never sees.
Deaton, a registered nurse, heads the colon cancer prevention program at the Oklahoma City Indian Clinic. The American Cancer Society expects colon cancer to kill about 750 Oklahomans this year, but the majority of those deaths could be avoided if people older than 50 got regular screenings.
In 2007, only about 14 percent of the older patients who used the clinic for primary care were screened for colon cancer, Deaton said. Last year, about 64 percent either had a colonoscopy or a take-home test. It's a welcome improvement, but many people who don't come in for primary care still are getting diagnosed only when the cancer has spread and caused symptoms, she said.
“Unfortunately, a lot of our colon cancer cases still come through the ER,” she said.
The problem isn't limited to Oklahoma City or to American Indians. All Oklahomans are at a higher risk of dying from preventable causes than most Americans.
Oklahoma ranks 45th out of the 50 states on health outcomes, according to the annual America's Health Rankings report. The state is one of the 10 worst for eight of the most common causes of death, based on age-adjusted rates from the Centers for Disease Control and Prevention.
Oklahoma also did worse than the national average on less-common causes of death, like infant mortality, homicide and drug overdoses.
The state's poor health scores mean that Oklahomans are more likely to die young than their peers in other states, and spend more of their lives with conditions that limit their ability to work or enjoy themselves.
It wasn't always this way. In the early 1990s, Oklahomans were about as likely to die prematurely as other Americans and actually had a slightly lower risk of dying of cancer.
The risk of dying young has generally fallen since then, both in Oklahoma and nationwide, but the decline has been slower in Oklahoma. So, while today's young Oklahomans have a better shot at living to old age than their parents and grandparents did, they still are at a higher risk of dying young than their peers in other states.
Health outcomes are complex and influenced by many factors, but experts say two things hurt Oklahomans' health most: poor health behaviors and a lack of preventive care.
Oklahomans are less likely than other Americans to get some types of health care that could prevent deadly cancers or reduce the odds of complications from other diseases. The state ranks last on screening for colon cancer, and is in the bottom half on testing for breast and cervical cancers. Oklahomans also rank in the bottom 10 when it comes to seeing a doctor for diabetes or getting their cholesterol checked — both screenings that could prevent heart problems.
Oklahoma teens are less likely than youth in other states to get vaccinated against HPV, which can cause cancers in the cervix, penis, anus and throat. The state ranks 36th for vaccination of teen girls and 32nd for teen boys. Increasing the number of young people who get the vaccine before they become sexually active could help reduce the state's cancer rates in the future, said Dr. Daniel Nader, a lung specialist at Cancer Treatment Centers of America in Tulsa.
People without insurance tend to skip screenings and preventive care, and often will ignore symptoms for some time because they can't afford to see a doctor, Nader said. About 16 percent of Oklahomans don't have insurance, according to the U.S. Census Bureau. Expanding Medicaid to cover more low-income people could increase the odds they'll get screened and avoid a late-stage cancer diagnosis, he said.
“Usually if they become symptomatic, they're going to wait until they're physically destitute,” he said.
Smoke still lingers
If you pick a health behavior, the odds are that it's going to be one where Oklahomans are behind the country overall.
Oklahoma has a low rate of binge drinking — a point in its favor — but scores poorly on smoking and measures related to nutrition and exercise. The state ranks 36th on smoking, which is an improvement from previous years, but is in the bottom 10 on obesity, physical inactivity, and fruit and vegetable consumption.
About 19.6 percent of Oklahoma adults still smoke, though that's down from about 29 percent in 2000. Smoking can cause heart disease, cancer, chronic lower respiratory disease and stroke — four diseases that are killing Oklahomans at higher rates than other Americans.
While smoking rates have gone down over the past two decades, much of that trend has been in young people, Nader said. That's a promising development for the future, but it won't be reflected in cancer statistics for decades to come.
“Cancer's more commonly going to occur in an older population, and when you look at our elderly, smoking in this age group has remained quite high,” he said.
Part of the problem is that Oklahoma has been more lenient than some states on smoking in public places and has lower cigarette taxes, said Dr. Jeff Sparling, an interventional cardiologist at Integris Heart Hospital. When cigarettes become more expensive and less convenient to use, more smokers quit and fewer young people get addicted, he said — and other people breathe in less secondhand smoke.
“It's actually a safety issue for Oklahomans that are nonsmokers,” he said.
The Legislature took a good first step by passing a $1-per-pack cigarette tax last month, said Bob McCaffree, associate director for policy at the Oklahoma Tobacco Research Center. The tax will raise the price of cigarettes by 15 percent, which research suggests could cut Oklahomans' cigarette consumption by 6 percent or more. Young people are particularly likely to cut back or quit smoking, he said.
“Price is the most important thing,” to reduce cigarette consumption, he said. “The higher the tax, the more effective.”
The state could do more to deter young people from smoking if it raised the age to buy cigarettes to 21, because nearly 90 percent of smokers start before age 19, McCaffree said. Older youth are less susceptible to peer pressure, so they're less likely to muscle through the unpleasantness of smoking long enough to become addicted, he said.
“Your first cigarette is never enjoyable,” he said.
Effecting change
Five states have raised the minimum age to buy tobacco to 21. Three of those states — California, New Jersey and Hawaii — are in the bottom 10 for smoking, though it isn't clear if that's due to raising the age or to other stringent anti-smoking policies. The other two, Oregon and Maine, rank 19th and 37th, respectively.
The biggest step Oklahoma could take to improve residents' health would be to pass anti-tobacco legislation, Sparling said. Cities and counties also could build more trails and other places where residents can get out to walk, to try to reduce the toll of obesity, he said.
About 32.8 percent of Oklahomans are obese, putting the state 42nd in the country. Obesity is linked to a higher risk of heart disease and stroke, and to some cancers, though the evidence that extra weight causes cancer isn't conclusive.
“At the end of the day, how you live your life and the habits you develop, good and bad, matter more than the pills you take,” Sparling said.
About half of cancer cases and deaths are preventable by avoiding tobacco, maintaining a healthy weight and exercising, said Dr. Robert Mannel, director of Stephenson Cancer Center. Unfortunately, many people struggle to do those things, he said.
“If I could create a pill to reduce your cancer risk by half, I would be a billionaire,” he said. “We have that pill that does that, we just don't want to swallow it.”
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