Surgeon General Releases New Report on Smoking Cessation

The US Surgeon General, Jerome M. Adams, MD, MPH, has released the first report since 1990 that focuses solely on smoking cessation in the United States. Smoking accounts for the deaths of half a million Americans each year and is the leading cause of preventable disease, disability, and death in the country.

The report outlines progress made by smoking cessation efforts in the last 30 years. Although 34 million Americans still smoke today, 70% of that population has expressed the desire to quit. In 2018, cigarette smoking among American adults was reported to be an all-time low of 14%.

“This decline represents one of the greatest public health achievements of the past century,” Adams said. “We know more about the science of quitting than ever before.”

Not only does smoking take a physical toll on the country, it also imposes a great financial burden. “Smoking-related illnesses cost the US more than $300 billion each and every year…helping more people quit using the tools detailed in this historic report is the fastest approach to helping improve our nation’s physical health as well as our nation’s fiscal health,” Adams said.

Disparities among smokers pose challenges to solving the crisis. For example, 40% of all cigarettes consumed in the country are smoked by individuals diagnosed with a mental illness or substance use disorder. “Many groups have been left behind in the progress we’ve made over the last several decades,” Adams said. Cigarette smoking is also highest among LGBTQ adults, American Indians and Alaska Natives, and people with disabilities or limitations.

The report outlines potential steps to address these hurdles, with contributions from 150 experts in academia, education, and medicine to the 700-page document. In it, the authors note that interventions at the individual, health-system, and population levels can all be effective in increasing smoking-cessation rates.

More than half of adults who smoke try and quit each year but are unsuccessful. One major impediment is the lack of intervention at the health-system level. “Over 40% of smokers who see a health provider each year aren’t advised by those health providers to quit,” Adams said.

Some population-level interventions that have repeatedly proved effective are the CDC’s “Tips from Former Smokers” campaign, displaying pictorial warnings on packets, raising the price of cigarettes, and implementing smoke-free policies at workplaces. All of those interventions “are proven to save money and save lives.”

Although the FDA has approved 7 drugs to aid with smoking cessation, those treatments and others, such as behavioral counseling, are being underutilized. Smokers lack access to approved treatments when providers do not recommend them or payers refuse to provide coverage, Adams argued.

Funding for additional population interventions remains crucial to lowering smoking rates. “Fully funded state tobacco control programs have been shown…[to] significantly decrease the number of people who are smoking and help prevent disease, death, disability, and skyrocketing healthcare costs,” Adams said. These programs would act as foundations to advance population-level interventions.

Researchers endorse a comprehensive approach when it comes to tackling the health crisis. They argue a single change will not be sufficient to solve the problem.

Additional interventions could include those that are text or internet based. “We need to get with the times,” Adams said. This approach will be useful to target youth smokers, who are increasingly being introduced to addictive tobacco products via e-cigarettes. “One thing is clear,” Adams said, “1 in 4 of our young people is initiated to tobacco product use with e-cigarettes.”

Preventing initiation among youth is a top priority, especially as new research is being conducted into the safety of the product.

“E-cigarettes are a continually changing and diverse group of products that are used in a variety of ways,” Adams explained. “Therefore, it is difficult to make generalizations about their effectiveness for cessation based on studies of a particular e-cigarette, and there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.”

The authors of the report note that further research into the long-term effects, efficacy, and safety of e-cigarettes needs to be conducted.