Health Goes Up In Smoke When Temptation Is Cheap

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Mark Bush stood on 125th Street, Harlem’s main thoroughfare, smoking a Newport in the morning sun. He took his time with the cigarette, smiling and saying hello to passers-by, taking several drags after most smokers throw their butts away, right down to the filter.

“There’s a lot of smoking in Harlem,” said Bush, 38, who lives at 139th Street and Lenox Avenue and buys a pack of menthol cigarettes a day. “People smoke to get pressure off their minds.”

East and Central Harlem, predominantly minority, low-income communities, are numbers three and four on the list of New York City neighborhoods with the most adult smokers – 27 and 26 percent, respectively. While there are many reasons for upper Manhattan’s high rate, including stress, a phenomenon known as the “Five Dollar Man” – an illegal street vendor of untaxed packs or single cigarettes – has undercut the city’s otherwise largely successful efforts to lower smoking rates throughout the city.

Two communities on Staten Island, the South Shore and Mid Island, share the highest smoking rate in the city: 33 percent. However, the largely residential borough appears not to have Five Dollar Men, and smoking habits there puzzle public health officials. In 2006, 27 percent of Staten Island residents smoked – unchanged from the 2004 rate – bucking citywide trends in smoking reduction.

At 25 percent, the southeast Bronx rounds out the top five for highest smoking rates. Meanwhile rates are lowest in southwest Queens, northeast Bronx and Chelsea, at 11 percent. (See Department of Health statistics here.)

The Five Dollar Man usually sells packs for $4 to $5 or “loosies” at 16 to 50 cents apiece, prices significantly lower than taxed packs, which average $7 in New York City. The vendors tend to operate on 125th Street, Frederick Douglass Boulevard and 116th Street.

“Newports! Marlboros!” they were overheard saying to passers-by. “Loosies, four for a dollar!”

Bootleggers operate in many of the city’s poorer neighborhoods, including the south Bronx, Washington Heights, East New York, Bedford-Stuyvesant and Bushwick. It was Harlem, however, that formed the case study for a report published in August in the American Journal of Public Health. Dr. Donna Shelley, a professor at Columbia University’s School of Public Health and former head of the city’s Bureau of Tobacco Control, was lead author on “The $5 Man: The Underground Economic Response to a Large Cigarette Tax Increase in New York City,” which showed that “perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation.”

“Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase,” says the report.

A majority of the study’s 104 participants – all from central Harlem – had bought cigarettes on the street, which are originally purchased by smugglers for as little as $2 a pack on Indian reservations, the Internet and in states such as Virginia and North Carolina, and then transported into New York City, distributed to street vendors and sold illegally.

“The $5 man approaches me every day like they do everyone else,” said Geoffrey Quinn, a 49-year-old from central Harlem. “You can buy cigarettes on any corner,” he added, sitting on a bench on 125th Street and smoking a Marlboro.

Police are trying to respond. One officer in Harlem, who asked not to be identified, estimated that the 28th Precinct conducts 80 to 100 illegal cigarette-targeted operations per year, resulting in 350 to 400 arrests, which he said is typical of other precincts in the area. He said three-quarters of the sweeps are on the streets and one-quarter takes place in bodegas and other retail establishments.

“The money is great” for the sellers, said 28th Precinct Officer Gabriel Garcia, 26, noting that tax-free cigarette peddlers are typically carrying $500 to $600 when they are arrested. The reward is too high and the “penalties are too low to stop,” Garcia said. The offense is a misdemeanor with a maximum penalty of $2,000 and 60 days in jail. However, fines are typically under $100 and jail time is no more than several days, the two officers said. The NYPD did not respond to a request for data on its Harlem efforts.

Smoking rates in Harlem are around 50 percent higher than the New York City average of 17.5 percent, according to the City’s 2004 Community Health Survey, which provides the most recent smoking data for specific neighborhoods.

The results are deadly: mortality rates in East and Central Harlem are the first- and third-highest in the city. That statistic is linked to tobacco use and the illnesses it causes, including heart disease, stroke, emphysema and lung cancer, according to at least three medical studies of Harlem in the past nine years. Indeed, smoking is the leading cause of preventable death in Harlem. “It’s pretty stark compared to the city,” said Shelley, the Columbia expert.

More than half of smokers in Harlem are trying to quit, but the odds are against them. Community Districts 10 and 11, according to 2006 Census data, are largely black and Hispanic (85 percent), poor (32 percent of residents are below the poverty line), and undereducated (more than half of residents have a high school diploma or less), the three groups that have the hardest time quitting, according to a 2007 City Health Department study.

Fewer blacks stopped smoking than any other group between 2002 and 2006 – a 14.9 percent reduction, compared to 20 percent of all city residents.

“I want to quit now – this isn’t worth it,” said Quinn, the Harlem smoker. “I’m stressed. It’s hard to stop.”

Harlem’s high prevalence of four other groups particularly prone to smoking – those living with HIV/AIDS, drug users, the homeless, and the mentally ill – also contributes to the area’s smoking rate, said Michelle Odlum, program coordinator at the Manhattan Tobacco Cessation Program, which provides resources and training to healthcare centers in Harlem in partnership with Columbia.

The Department of Health’s vigorous citywide effort to reduce smoking – which includes a $3.00 per pack cigarette tax, indoor smoking bans, free cessation services, a telephone “Quitline” and an advertising campaign – has shown strong results, decreasing tobacco use from 21.5 to 17.5 percent between 2002 and 2006. Results in Harlem, however, have been less impressive, with East Harlem’s rate actually rising from 22 to 27 percent between 2002 and 2004.

Health workers in Harlem are partnering with the city to lower smoking levels. At the Harlem Hospital Center’s Quit Smoking Program, Harlem’s city-funded cessation center, anyone can receive free tobacco counseling and nicotine replacement products like patches, gum, lozenges, inhalers, and prescription drugs. “Some impacts are being made,” said Eugenia Graham, 44, program director for the Quit Smoking Program. “Exceptional efforts by the city have pulled out all the big guns.”

Graham, who said her mother died from smoking-induced lung cancer, estimates that 45 percent of those receiving treatment in 2007 at Harlem Hospital quit, which averages 110 enrollees a month.

Tarik Barbee, Office Manager at the Barbee Family Health Center, a health clinic with stop-smoking services on 145th St., was less enthusiastic about the city’s success in reducing central Harlem’s smoking rate, despite its good intentions.

“The city is not really making a dent,” said Barbee, 44, a Harlem native. “It won’t stop, it’s a business,” he added, noting the prevalence of tobacco ads in Harlem, tax-free cigarettes, and pressures of life in the area.

For Dr. Shelley, Harlem and communities like it need more focused attention – like that of the Barbee Center – to lower the smoking rate.

“We need to better link these communities” to services, Shelley said. “The challenge of public health is getting the message to the right people.”

– Lawrence Delevingne

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