"I went ahead and made up my mind I have got to do this," said Mr. Smith, 53, of Augusta, who was motivated in part by higher insurance costs for smokers through the State Health Benefit Plan.
Unfortunately, not many long-term smokers seem to be following. After years of steady decline, the percentage of adults who smoke has remained about the same since 2004 at about 20 percent, according the Centers for Disease Control and Prevention. Despite getting about $400 million in excise taxes and funds from the settlement agreement with the tobacco companies, Georgia will spend about $3.2 million this fiscal year on tobacco control.
The state does not cover nicotine replacement therapy or medications to help state employees or those on Medicaid quit, although it does pay for counseling and operates the Georgia Tobacco Quit Line, a spokeswoman for the Georgia Department of Community Health confirmed.
The city of Augusta, however, has stepped forward to provide lunchtime classes and coverage for the smoking cessation drug Chantix, Human Resources Director Rod Powell said.
After a flurry of tobacco control initiatives in the late '90s and early part of this century, tobacco control activity has largely stalled as states have cut back on their spending, said Terry F. Pechacek, the associate director for science in the Office on Smoking and Health at CDC.
Meanwhile, the tobacco industry continues to promote its products through advertising in stores and entertainment venues, counteracting cigarette tax increases through direct-mail coupons to smokers, and developing new brands that are more attractive to young people, he said. In fact, for every dollar public health spends on tobacco control, the industry counters with $20, about $12.5 billion each year, said Paul Billings, the vice president of national policy and advocacy for the American Lung Association.
"That's what I call stacking the deck against public health," he said.
Georgia is one of only six states that does not cover nicotine replacement therapy or medication for Medicaid recipients or its state employees, the lung association noted.
"Certainly in Georgia there are barriers," said June Deen, the director of advocacy for the lung association in Georgia and South Carolina. "We know a higher percentage of the Medicaid population smoked than the population at large. And we're one of a very few states that offer no service or treatment to those Medicaid recipients who wish to quit smoking. We also offer very little in the way of treatment to state employees who wish to quit smoking and they're a rather large employer in our state."
Getting help to those on Medicaid gets results, advocates said, pointing to Massachusetts. Two and a half years after offering comprehensive smoking cessation treatments to its Medicaid population, the rate of smoking dropped 26 percent among MassHealth recipients, according to a study by the Massachusetts Department of Public Health.
The benefits of tobacco control have been calculated as high $40 in savings for every dollar spent, Pechacek said.
"Failure to invest in effective tobacco prevention and control strategies is leaving potential savings on the table in times of budget crisis," he said.
"It's kind of pennywise and pound-foolish not to treat this addiction when we know there are ways to effectively do that," Deen said.
The Georgia Medicaid Pharmacy and Therapeutics Advisory Council has proposed adding smoking cessation counseling with over-the-counter medication, but it would cost more than $8.5 million a year, according to an e-mail from Joye Burton, the media relations manager for the Georgia Department of Community Health. The agency is investigating what it would cost to add smoking cessation drugs and aids to the State Health Benefit Plan. The Legislature has also consistently refused to raise the state's tobacco tax of 37 cents, among the lowest in the nation, Burton said.
But in fact, that $400 million that comes to Georgia from the tobacco companies is really money from smokers themselves, many of whom want help to quit, Pechacek said. About 45 percent of smokers try to quit each year but only 1 in 10 succeeds, he said.
"In this issue of health equity, we recognize that the people who are paying the tax deserve service back," Pechacek said. "That $400 million, we need to recognize, is like a user fee."
In partnership with its provider Blue Cross/Blue Shield of Georgia, Augusta city employees can now attend lunchtime classes to help with their weight and to quit smoking, Powell said. Pfizer is providing its "Beat the Pack" class for free and having it at lunchtime makes it convenient for employees, 15 of whom have signed up so far but more are expected, he said. The payoff would be less illness and absence, which might result in lower premiums in coming years, Powell said.
"The premium that everybody pays is tied to the medical costs. So if the costs go up, we all pay more," he said.
But there is a larger benefit to getting employees to quit.
"The other part of that is we want healthy employees," Powell said. "They're going to be more productive, they are going to take less sick leave, they're going to be at work more. And then long term, when they retire, we want them to have a healthy retirement."
Still, cost is an issue for many who want to quit, not only the cost of cigarettes but increasingly from health insurance that charges smokers more, said Cheryl Wheeler, the coordinator of the cancer registry at University Hospital, facilitator for the American Cancer Society's Fresh Start smoking cessation program.
"Health always plays a role in it but I'm really seeing the cost and the restrictions at the workplace really being equally as important to people that I'm seeing now," she said.
Smith works for the Georgia Department of Transportation and the State Health Benefit Plan adds a $60 surcharge per month if someone in the household uses tobacco. That higher cost finally got to him last year and led him to Wheeler's Fresh Start class.
"It was worth it," he said. He is getting used to coffee and meals without a cigarette after but still misses them when picking up dead animals off the road, he joked.
"I've gotten used to the smell now," Smith said.
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
BY THE NUMBERS
Adults who smoke (unchanged since 2004)
Smokers who try to quit each year (only 1 in 10 succeed)
Amount tobacco companies spend on advertising
Excise taxes and funds coming to Georgia from settlement agreement with the tobacco companies
Amount Georgia will spend on tobacco control this fiscal year
Georgia's tobacco tax
Sources: American Lung Association, CDC, Georgia Department of Community Health