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Comment by hn_throwaway_99 | Hacker News Reader

The plummeting rates of smoking in the US is one of the rare areas where this country really shines when it comes to social welfare. Even many European states that have what I'd consider much more progressive social welfare systems have smoking rates that are appalling, often 3x or more the US rates.

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Smoking risks is one of the few thing in which it cannot be overstated. Unlike other forms of safety-ism.

Smoking tobacco, as far as I know, does not make one spontaneously explode.

To say otherwise, in my view, would be overstating the risks of smoking.

I can't remember where I read that, but someone had made an interesting observation that stayed with me, and your comment makes me think of it (perhaps you're referring to the same article?)

What if instead of slowly dying of cancer, smoking had a tiny tiny chance of making you die by exploding your face? Exact same probability of dying, just very violent and graphic.

Chances are barely anyone would smoke. Yet, same death rate.

To answer your point, I think smoking is worse than making your head explode, it has a much greater societal cost in healthcare than if you were to die there and then, and creates much more suffering.

Not because of how violent and graphic, but because there's a chance the death is immediate. Cancer is always a long, long time away.

It's like saying if you put $100 in your 401k every month, there's a chance (equal to the number of new retirees) you instantly get $2M dollars.

Many more people would understand the immediate gain instead of the 30 year slog.

Funny, I had the exact same thought over Covid death rates during the early pandemic. People would have been a lot less skeptical of the precautions if your head exploded immediately after catching it (assuming you were part of the ~1% that were destined to die from the symptoms eventually).

Fewer would smoke, but I'd wager it would be popular with the young. I think it all boils down to feedback. The more abstract something is, the harder it is to fathom. So if you lessen the feedback, by, for example, delaying the negative effects, people won't react. Take the other popular vice, alcohol. If hangover was immediately present, I don't think we would have the drinking culture that we have today. How many vow to never drink again, on the day after. Yet, people drink again.

If you’re around something explosive you might!

Smoking is thought to be one of the leading causes of spontaneous human combustion.

Yeah it’s really quite something. I end up having to increase my dosage on asthma meds for a week or two every time I go to Europe. Some of the cooler places to go are sadly a bit smokier than I like.

That may also be due to the heavy use of diesel cars in Europe and their higher emissions of nitrates and sulfates. It is very noticeable when walking along a busy avenue in Sweden compared the USA.

It's definitely from going into smoky bars, though I doubt the diesel helps.

> Even many European states that have what I'd consider much more progressive social welfare systems have smoking rates that are appalling, often 3x or more the US rates.

Which countries are those? I ask because it would be nice to compare the incidence of the top smoking-related diseases between the countries.

France is a smokers country for instance.

France is an interesting comparison. As I understand it, smoking is highly class correlated in the US, but much less so in France.

I have a PhD and studied for a time at one of France's premier universities: my advisor smoked, and one graduate student in his lab smoked. All told, probably 10-20% incidence. In America I've worked with or around close to 100 physicists, and only one of them was a smoker.

That may explain something.

The other day I watched a French movie - "Other peoples' children". I had to check and re-check and check again if this was an old movie re-launched or something. In the movie the actors all started smoking at private dinners (with, in this case, a small child living in the house), women with cigarettes held vertically in that stupid-looking way, like in an old fifties tobacco ad. I couldn't understand why that was made part of a movie which was supposed to be "slice of life". It looked completely wrong. I can't imagine people smoking inside houses now, none of the people I know who still smoke will actually smoke inside. None. And everyone just grabbing a cigarette inside that living room? I think I even saw a cigarette scene inside a restaurant too.

No one in my family smokes but my childhood best friend's mom smoked a lot inside their apartment (not a very big space), and I spent so much time over there. It was sad, they always had a smell about them because of this. They were indoor kids and I spent years of my youth at their place playing video games and D&D. I didn't know any better as a kid but I think back on it and wonder how much that affected my lungs. I stopped going over so much around my senior year of highschool (mid-90s) and then eventually lost touch in the late 90s because our lives went in different directions so my lungs have probably recovered a lot from whatever damage that did. Now I hate the smell of cigarette smoke and can smell it from a good distance away.

IMO this is because France was reluctant to increase the price of tobacco. I remember going to NYC in 2010 and a packet of cigarettes was 15$, nearly 3 times what I used to pay in France. Now they’ve set tobacco prices increase in motion, I expect the number of smokers to drop significantly. In the UK where tobacco prices have been on par with the US, I notice much fewer smokers than in France, and most of them seem to be foreigners

I believe around 20% of respondents in the Netherlands said they smoked in 2020.

For the same period, Iceland though was close to the US, with a reported rate of 12% of respondents saying they smoked.

> said they smoked

"Smoked cigarettes right? :D"

Netherlands: stares in Dutch

"Smoked cigarettes right? :o"

Austria

Yeah Austrian restaurants were an absolute shocker for me. There are so many places where the 'non-smoking area' absolute reeks of second hand smoke.

Coming out from a night out with your clothes smelling like cigarettes felt like going back 30 years in time.

I'm not sure when you have been there last. The smoking ban passed a few years already, I haven't smelled cigarette smoke inside in a long time. Patios on the other hand is a different story altogether where sadly smoking is still allowed.

Indeed I now realize it may not be very up to date. I was there pre pandemic perhaps this is now changed as you say.

Most of Eastern and Southern Europe, for sure. Whenever I visit and go to a bar I have a mild shock at the smoke everywhere.

> The plummeting rates of smoking in the US

Do you consider vaping in this statistics? I can't find a definite answer.

Amazing that I scrolled this far to see any mention of vaping. I don't believe the stat can include vaping - it's anecdotal, but nearly 100% of the amigas I know vape. No amigos however, strangely enough. I think it's an anxiety thing. No amigos or amigas that smoke cigarettes habitually though.

I still see more cigarettes than vapes at bars, but the gap is closing. The annoying part is people seem to think they can vape indoors at the bar, whereas 95% will go to the covered patio to smoke. So vapes are more likely to get into your lungs second hand, and their long term effect on your lungs is entirely unknown. Hooray!

Me and my buddies would hang out with travelling Europeans at local hostels in the US, but are like "eh but then we'd have to hang out with smokers"

I worked for a big MNC a few years back with big offices in Europe.

We’d meet for senior leader meetings and it was pretty stark. None of the US people smoked and 80% of the Europeans did (small sample).

When a European VP had her birthday we joked and asked her if her colleagues bought her a carton of smokes.

If only BigSugar could have a day in court like BigTobacco. Sugar addiction is the next big social health care type of thing I'd like to see recognized. Yes, opiates are bad right now, but I don't think anyone would have ever denied it out side of the people making/selling. Great majority people do not even recognize sugar as a problem.

no one is getting stage 4 lung cancer from sugar. Or having their jaw removed due to mouth cancer . Or hooked up to one of those oxygen machines due to irreversible lung damage. Sure, there are risks with obesity, not not as lethal or causal as with tobacco products. Fats are also a major contributor too, like steak.

It’s addictive and leads to obesity. Obesity is a leading cause of cancer.

There doesn’t seem to be any relationship between dietary fat and cancer.

https://pubmed.ncbi.nlm.nih.gov/12566141/

There is a huge relationship between obesity and cancer.

You disregard diabetes rather lightly there. Diabetes can result in amputations, blindness, heart attacks, strokes and other fun things.

Sure there are other food choices that lead to obesity, but sugar is certainly high on the list.

One thing in common though is that telling a smoker to "just quit" is about the same as telling someone who likes sugar to "just stop". Personally I'm working to "reduce my intake", slowly but surely.

Edit:but for sure there's no such thing as second-hand-sugar and that a Huge difference between the two.

> there's no such thing as second-hand-sugar

Which makes this a truly personal choice.

“Smoking is a choice, don’t ban it” always irks me because it’s a choice smokers make for themselves and everyone else in a 30m radius around them from forcing others to breathe in their polluted air.

> there's no such thing as second-hand-sugar

But there absolutely is such a thing as a "food desert"

    an urban area in which it is difficult to buy affordable or good-quality fresh food.

particularly within the USofA, places where lack of finnacial resources across communities, lack of affordable public transport, and lack of shopping options essentially doom large groups of people to low grade high sugar foods.

Good governments that are orientated toward the well being of their citizens population tend to enact limits on sugar in food, improve transport, subsidize good food etc.

Often with the evil socialist goal of better health, improved job options via transport, reduced universal health costs, and more taxpayers ..

I still see this idea brought up but it feels like the tide has turned against the idea of "food deserts" with a lot of studies undermining it, and worth looking into if you're interested.

The raw data still appears to suport the notion:

https://www.ers.usda.gov/data-products/food-environment-atla...

and the various initiatives started to address the issue haven't yet had time to make significant changes in enough of the areas worst off:

https://en.wikipedia.org/wiki/Food_desert

https://www.theguardian.com/environment/2022/apr/29/us-food-...

It's a good start, with a way to go:

> On Sept. 28, the White House is hosted a conference on hunger, nutrition and health — the second conference of its kind in five decades — and introduced a 40-page national strategy as a roadmap toward the goal of ending hunger and increasing healthy eating by 2030.

https://journalistsresource.org/home/food-insecurity-health/

> Edit:but for sure there's no such thing as second-hand-sugar and that a Huge difference between the two.

Obesity can cause epigenetic changes that are passed down to offspring.

True, and a person's diet choices can absolutely impact others. From a parents choice of what to feed their children to a school's selling out of all health for cheap corporate shit meals, even down to a road trip participants insistence on specific eating location. We are not always perfectly in control of our eating choices. Sure in a perfect world we'd all have the time and space and money to carry our own food but as someone who grew up with crohns' disease I think people strongly underestimate how make situations reduce eating choice to only cheap, bad, sugar filled processed foods. Every pizza or ice cream party (of which my school had many), every birthday, every sleep over, every time my brother cried about wanting to eat out. Forcing yourself to eat natural healthy food in America often involves the choice to not eat.

Consumption of sugar increases rates of cancer and all-cause mortality. This study[1] found that only 5g/day increases in sugar consumption raised rates of cancer.

> Or having their jaw removed due to mouth cancer . Or hooked up to one of those oxygen machines due to irreversible lung damage.

There are plenty of people who lost extremities and/or their sight due to diabetes. They'll be hooked up to insulin pumps, or they'll need regular insulin injections or they'll die. Others can get cancer, as well. Some might need machines just to move around, or will need serious surgeries to keep themselves from eating to death.

[1] https://www.sciencedirect.com/science/article/pii/S026156142...

Fat is such a complex topic it would be hard to spend enough time refuting the last statement. But, in short it depends on what kind of fat (body fat? (if you're in a catabolic state, you will be "eating" your own fat; and this too has different types, depending on what your diet was!),trans,polyunsaturated,saturated,mono), how active you are, how much you consume, whether you're in ketosis/adapted, as well as a host of genetic factors,which determine your lipase production. Mostly agree on the "like steak" part, though that too would take a long time to, umm, break down.

It's really tough to become obese by eating steak, even if it has a high fat content. You just can't physically stuff yourself with that much meat. Carbohydrates, especially simple sugars, are absolutely the main culprit behind the obesity epidemic.

There may be other problems with certain fats. In particular there is growing evidence that highly processed seed oils are problematic, although that hasn't been definitively proven yet.

For 20 years we’ve been eating fewer carbs and getting fatter (on average)

http://2.bp.blogspot.com/-0OuoFyJtZuI/VkofY-qgeOI/AAAAAAAAbb...

I don't think your data is accurate. Where did that chart come from? And not all carbs are created equal. From an obesity perspective, 100 kcal of sugar in soda pop appears to be far worse than the same amount of sugar in fruit.

https://doi.org/10.1093/ajcn/nqab270

Mostly likely here: https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-p...

It would be interesting to see massive warnings about sugar related illnesses on packaging.

Is it really that bad a thing though? Nicotine has several benefits even if smoking may not. There was a recent HN discussion on how current higher levels of adult ADHD may be because of the decrease in smoking. I am a very occasional smoker, maybe I smoke around a pack a year. I dont see any particular problems at my level of smoking. You might inhale a far higher level of carcinogens simply driving to work or hanging around a parking lot.

Too bad opioid addiction and deaths are way up.

That's probably due to insurance companies charging huge amounts more health insurance for smokers.

The smoking rate in Canada is far lower than the United States, despite having universal healthcare. I think it's more cultural than financially driven (though aggressive taxation of tobacco could be a factor if that's a thing in the US, too).

Sources I can find suggest that Canada and the US are comparable (10% CA, 12% US). Your point is still valid that it's culture.

You both could be right.

Especially in places like NYC, cigs are very expensive.

Well, legal cigs. There is a healthy black market in NYC.

IIRC the difference when applying for insurance on the healthcare marketplace for 2023 was like $5/month (out of $700 total - so less than 1% more).

My employer plan charges $500/yr

That’s probably an exception. My understanding is that usually insurance companies charge MUCH more if you smoke.

Was trying to find out when it even became legal for insurers to even have a tobacco surcharge. That speaks to the power of the tobacco lobby.

I believe (iirc) that legality is quite recent (possibly from the ACA), but I'm pretty sure that is news within the last 20 years.

In that search, I spotted a study that stated the surcharge does not increase cessation but does decrease uptake. Which makes sense, tobacco has a higher relapse rate at 6 months than compared to relapse rates for cocaine or heroin.

High cig prices have a similar effect for youth smoking. Smoking is an infamous example of inelastic demand (that and gasoline were _the_ examples used when I was taught elastic vs in-elastic demand in grade school)

In The Netherlands it's embarrassing. They basically had to beg supermarkets to stop selling cigarettes and then give them a years long transition period.

It could be very easy. Ban the sales of tobacco to everyone born after "YYYY", make cigarettes cost €50 per pack, make smoking when not allowed a €100 fine, deposit all tax from tobacco sales into a national program where people get free "exercise credits" to be redeemed at fitness studios etc.

At €50 per pack people would buy them on the black market.

It definitely was something that surprised me when I moved here. Even among young people, it seems to be fairly popular.

Could another option be a higher `Eigen Risico` for smokers? I don't know if that could even be enforced.

> Ban the sales of tobacco to everyone born after "YYYY"

This is what New Zealand just did: https://www.theguardian.com/world/2022/dec/13/new-zealand-pa...

On the other hand, being constantly ostracised from public spaces isn’t great either… something I find infuriating when I travel abroad. If there were at least a few smoking bars where you don’t have to go out into the cold to smoke I think that would be nice.

Eugh, god, no. It isnt ostracism if you are being asked to go outside because you want to light something on fire.

That being said you arent alone in this desire. The work around appears to be clubs with a membership fee and volunteer bartenders (at least where I live). If its something that pops up for you frequently then it might be worthwhile to pursue.

When all bars allowed smoking, all bars were the same. Then there came a govt ban on smoking in bars. So all bars are the same. (they all wailed loudly, but because it applied equally clientele had nowhere else to go.)

As a non smoker there are now options to go out I never had before. Restaurants are now safe again. (well except for parents who think it's OK for a child to be on a phone playing games at full audio volume, but we'll save that rant for another day.)

> On the other hand, being constantly ostracised from public spaces isn’t great either… something I find infuriating when I travel abroad. If there were at least a few smoking bars where you don’t have to go out into the cold to smoke I think that would be nice.

I'm a smoker, and I absolutely don't want smoking allowed in public indoor places, and some outdoor public places as well. I don't smoke indoors even in my own home.

On the other hand, when I duck down an empty alley and light up, I'm going to be annoyed if someone walking on the main road comes in to complain about how my second-hand smoke is going to give them cancer.

Too many times I have had people go out of their way to inhale my second hand smoke, and then complain about it.

> Too many times I have had people go out of their way to inhale my second hand smoke, and then complain about it.

Too many times I have had people go out of their way to walk in front of my 3 ton truck driving 100 mph in a pedestrian zone to almost get hit, and then complain about it.

> Too many times I have had people go out of their way to walk in front of my 3 ton truck driving 100 mph in a pedestrian zone to almost get hit, and then complain about it.

Maybe you shouldn't be doing 100mph around other people.

Sure, if you stop smoking around other people ;-)

> Sure, if you stop smoking around other people ;-)

Maybe english is not your first language, but you did read what I wrote, right? You did read my post saying that I get annoyed at people who go up to lone smokers and then complain?

You know what that means, right? It literally means "I don't smoke around other people!"

I'm afraid I am unable to simplify it any further.

My point is if you are the user/owner of a device capable of killing (huge car, cigarettes) there’s a big responsibility on you to prevent harm on others.

There’s always a grey area, but generally I’d say in a public space it’s the smoker who should actively move to avoid non-smokers.

What great hyperbole. This is possibly the strongest hyperbole in the _history of the universe!_

If you’re allowed to smoke in the bar then I’m allowed to bring my bucket of rotten fish.

All health issues aside, it’s just disgusting. It smells awful, it makes everything else smell awful. I always hate ending up in an elevator with a smoker, it’s nauseating. It truly is a disgusting habit.

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