WASHINGTON — The percentage of Americans who smoke — 14%, or 34 million people — is at an all-time low, but smoking still remains the number one cause of preventable disease, death, and disability, and doctors could be doing more to help patients quit, Surgeon General Jerome Adams, MD, MPH, said Thursday.
“Forty percent of smokers who see their physician aren’t advised by the provider to quit,” Adams said at a press conference announcing the release of a 700-page report on smoking cessation. “So why are 40% of our health providers out there not advising smokers to quit?”
“We know doctors are busy,” Adams told MedPage Today in an interview after the press conference. “This isn’t about blaming the provider; it’s about empowering the provider and engaging the provider and educating the provider. It only takes a few minutes to help people with the biggest modifiable risk factor they’ve got.”
“I often say you come into the orthopedist’s office because you’ve got a broken ankle, but you’re more likely to die from the fact that you’re smoking,” so even the orthopedist should be talking to that patient about quitting, Adams continued. “At every touchpoint, everyone should be. The tools that the CDC has put out are designed to help empower more people to know what they can do to help folks quit.”
Examples of tools physicians can look at include the Million Hearts protocol and the smokefree.gov website. In addition, Adams said, clinicians should request that prompts be put into their electronic health record systems to make it easier to discuss quitting with patients, and to refer them quickly to cessation services.
At the press conference, Adams discussed highlights from the report, including the fact that although three out of five people who have ever smoked have quit, only one-third of them used FDA-approved interventions such as smoking cessation drugs or behavioral counseling. In addition, “40% of cigarettes consumed in this country are consumed by people with a mental health or substance abuse diagnosis,” he added. “We think people in these populations don’t want to quit or can’t quit, but this report shows it’s not true.”
For example, “a randomized trial of 577 mental health patients in the Veterans Health Administration found that a specialized quitline for smokers referred by a mental health provider outperformed standard state quitlines, with significantly greater 30-day abstinence at 6 months (26% vs 18%) and greater patient satisfaction,” the report said.
The authors also noted that “in the past, many behavioral health clinicians believed that treating nicotine dependence and tobacco cessation jeopardize sobriety or mental health recovery, a misconception that has been actively fostered by the tobacco industry. However, smoking cessation and the delivery of tobacco cessation treatments are associated with enhanced clinical outcomes, including improved sobriety, fewer symptoms of posttraumatic stress disorder, and lower rates of hospitalization.”
Adams also chided health insurers who require prior authorization or high copays for smoking cessation treatments, calling such policies “penny-wise and pound-foolish.” “According to the report, comprehensive, barrier-free coverage and promotion can increase the use of proven treatments and lead to higher rates of successful quitting,” he said.
How can smoking cessation be encouraged in the population at large? The best methods are raising the price of cigarettes, adopting comprehensive smoke-free policies, using mass media campaigns, requiring pictorial health warnings, and maintaining statewide comprehensive tobacco control programs, Adams said.
However, the evidence is inconclusive on whether e-cigarettes are effective in helping people quit, he added. “That said, I have heard powerful accounts from individuals who have used e-cigarettes to quit smoking combustible cigarettes…. It’s important we use the entire body of available science to guide our current recommendations.” But in any case, “e-cigarettes can’t come at the expense of escalating rates of youth use of these products; youth use of any tobacco products, including e-cigarettes, is unsafe.”
Adams tried to de-emphasize the issues around e-cigarettes. “One of the things I really want people to take away from this isn’t the inadequate conclusions around e-cigarettes,” he said. “What I want people to take away is: we know what works. People want to quit, we know what works — not enough of them are getting it. There are terrible disparities in who is and is not getting access to effective and evidence-based treatments. That’s the story here; that’s the headline here; that’s what important for people to know.”
The American Lung Association (ALA) seemed generally pleased with the report, although it downplayed any thought of using e-cigarettes to quit combustible tobacco.
“The American Lung Association emphasizes the importance of quitting tobacco use altogether, rather than switching to another tobacco product, like e-cigarettes,” ALA national president and CEO Harold Wimmer said in a statement. “The Surgeon General’s findings add urgency to ensuring everyone has access to lifesaving, proven quit-smoking treatments, as well as the need for new science and research to ensure both youth and adults can end their tobacco addiction for good.”
Last Updated January 23, 2020