Cigarette City

What's life like in the nation's smokiest city for women? Bars don't bother to ventilate, officials spend peanuts on prevention and smoking is a "civil right." Why have so many towns given up on fighting our deadliest habit?

It's Sunday night, and Anna Boeck feels as though she's been sucking on an exhaust pipe since Friday. The 21-year-old veterinary-medicine student knew she'd be around cigarette smoke when she applied for a part-time bartending job at an Irish pub in Galveston, Texas. Who wouldn't? But the money was great—"it's hard to get a good job down here," she says—and Boeck is no antismoking moralizer. Her friends smoke, her coworkers smoke and now most of her customers smoke. "Their feeling is, It's my choice, my life, my right," she says.

But within weeks of taking the job, she felt the effects. The bar, in the middle of the main club district in this Gulf Coast town of about 57,000, is a narrow hole-in-the-wall that traps smoke even when the front door is propped open. Patrons gather by the long row of taps at the bar, trying to blow their cigarette and cigar smoke at an angle away from Boeck's face. Still, a cloud hangs around the neon beer signs that dimly light the room. Boeck checks to see if anyone has reset the air filter that's supposed to clear up the smoke. No one has. "The other bartenders smoke, and they don't notice it," she says.

Even when the "smoke eater" is on, Boeck's throat is raw. Contact lenses and allergies have made her ultrasensitive; she squirts Visine in her eyes twice a night and sucks down water to keep her nasal passages from drying out. When the bar hosted a graduation party for some seniors at the local university, the celebratory cigars gave her a sore throat that lasted a week.

It's possible Boeck is working in one of the smokiest spots in America. Bars have up to six times more secondhand smoke than any other workplace, and when it comes to smoking among women, Galveston is number one, according to SELF's most recent Healthiest Cities for Women report ranking 200 of the nation's largest metro areas. That matters, because researchers say women might be more susceptible than men to the cancer-causing properties of cigarettes. An analysis of data from the Centers for Disease Control and Prevention (CDC) in Atlanta found that women in the Galveston area average 199 cigarettes a month. The national average is half that. And in SELF's least smoky place—Ventura, California, where public smoking is largely banned—women light up only 18 times a month.

All along this strip of the 2-mile-wide island, young tourists and students lean over pool tables with cigarettes dangling from their lips; they exhale under strobe lights while music blares; they get progressively drunker and blow smoke in their sweetie's face as they shout a drink order. Returning home after 2 A.M., Boeck showers and tosses her work clothes in a separate room. "At the end of the night," she says, "I reek."

Where you live and what you breathe

Six years ago, when states sued tobacco companies to recover the costs of smoking-related illnesses, policymakers broadcast lofty goals: They would pour billions in settlement money into prevention and cessation programs. But over time, only six states (Arizona, Arkansas, Delaware, Hawaii, Maine and Mississippi) have stayed committed to those goals, according to the American Lung Association in New York City. Twenty percent of women still smoke, down only 3 percent since 1990. While smoking rates have indeed dropped in areas with strict antitobacco policies, in some states as many as one in three people smoke.

This year, states will collect $19.5 billion in tobacco taxes and settlement money, but less than 3 percent of those resources are earmarked for prevention. Instead, most states are using the money to plug holes in their budget. In New Hampshire and South Carolina, for instance, the entire tobacco-prevention budget was cut last year. Florida downsized its program by 97 percent. Earlier this year, when the lung association graded states on tobacco-prevention efforts, 38 states received an F.

This is how states and cities are responding to the country's biggest public health menace. Tobacco kills about 440,000 people every year—140,000 more than the obesity epidemic and more lives annually than AIDS, alcohol, car accidents, murders, suicides, illegal drugs and fires combined. And one in eight people who die of tobacco-related illnesses are nonsmokers, says James Gray, a spokesman for the American Cancer Society, Texas Division, in Austin. In April, for the first time ever, two officials from the CDC advised Americans at risk for heart problems to avoid any building that allows indoor smoking, saying one exposure of as few as 30 minutes could be lethal.

Still, smoking remains a fiercely protected privilege in areas such as Galveston; state and local policies barely curtail secondhand smoke, provide little motivation for smokers to quit and make it harder for quitters to succeed. "This is the government's job: to protect the welfare of the people," Gray says. "Secondhand smoke is one of the leading causes of death in the country, and most of those cases can be prevented. We have an opportunity in the states to save tens of thousands of lives."

"I enjoy smoking regardless of the bronchitis," says Julie Morreale. "I won't quit," she jokes. "I'm not a quitter."