UW-CTRI Contributes to U.S. Surgeon General Report on Tobacco Cessation

US Surgeon General Dr. Jerome Adams shows his new report
US Surgeon General Dr. Jerome Adams shows the new report on tobacco cessation.

UW-CTRI staff contributed a chapter to the new report from US Surgeon General Dr. Jerome Adams on smoking cessation.

UW-CTRI Research Director Dr. Timothy Baker, Outreach Director Rob Adsit, and UW-CTRI Director Dr. Michael Fiore wrote chapter 7 in the report, “Clinical-, System-, and
Population-Level Strategies that Promote Smoking Cessation.” UW-CTRI Librarian Dr. Wendy Theobald assisted with references. UW-CTRI Associate Director of Research Dr. Megan Piper reviewed chapter 3, “New Biological Insights into Smoking Cessation.”

This 2020 report is the 34th Surgeon General’s report on tobacco and the first since 1990 to focus solely on quitting smoking. Smoking still kills nearly half a million Americans per year.

“This issue is very personal to me,” Adams said. “I lost both of my grandfathers to smoking-related illness. While quitting may be hard, we know… that it is possible. Right now is the right time to quit.”

Beatrice spoke with US Surgeon General Jerome Adams about her journey to quit smoking
Beatrice spoke with US Surgeon General Jerome Adams about her journey to quit smoking. Her young son wrote her a letter encouraging her to quit smoking and, while she has been smoke-free for nearly a decade, she still carries the letter with her for motivation to stay smoke-free. She also shares her story via the Tips From Former Smokers campaign.

Adams reported good news that quitting smoking can significantly improve health and add years of life, no matter what age people are when they quit smoking.

Adams questioned why 40 percent of clinicians don’t fully treat patients for tobacco addiction. He called on them to do much more.

“We’re at historically low numbers, but the fact remains many groups have been left behind. Forty percent of the cigarettes consumed in this country are by people with mental health or substance abuse diagnoses. They want to quit, they can quit, they need our help.” For more on helping people with behavioral health issues to quit smoking, click here.

Dr. Tim Baker
UW-CTRI Research Director Dr. Tim Baker co-wrote a chapter, along with Dr. Michael Fiore and Rob Adsit.

He called on health systems to provide ready, barrier-free help for patients who want to quit smoking. He advocated for graphic health warnings on tobacco products.

Adams said it’s clear that youth use of any tobacco product is unsafe. He expressed concern about youth initiating tobacco use by vaping. He pointed out there is inadequate evidence that vaping leads to smoking cessation.

He called for continued research on tobacco addiction and cessation, as well as policy changes such as mass-media campaigns, smoke-free policies, and fully funded state tobacco-control programs to help people quit. The group also discussed the promise of low-nicotine cigarettes delineated in the new report.

Dr. Michael Fiore and Rob Adsit at the news conference for the Surgeon General's Report on Smoking Cessation
Co-authors Dr. Michael Fiore and Rob Adsit attended the news conference for the Surgeon General’s Report on Smoking Cessation. Dr. Tim Baker was also a co-author.

Major Conclusions of the Report

1. Smoking cessation is beneficial at any age. Smoking cessation improves health status and enhances quality of life.

2. Smoking cessation reduces the risk of premature death and can add as much as a decade to life expectancy.

3. Smoking places a substantial financial burden on smokers, healthcare systems, and society. Smoking cessation reduces this burden, including smoking-attributable healthcare expenditures.

4. Smoking cessation reduces risk for many adverse health effects, including reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer. Quitting smoking is also beneficial to those who have been diagnosed with heart disease and chronic obstructive pulmonary disease.

5. More than three out of five U.S. adults who have ever smoked cigarettes have quit. Although a majority of cigarette smokers make a quit attempt each year, less than one-third use cessation medications approved by the U.S. Food and Drug Administration (FDA) or behavioral counseling to support quit attempts.

6. Considerable disparities exist in the prevalence of smoking across the U.S. population, with higher prevalence in some subgroups. Similarly, the prevalence of key indicators of smoking cessation—quit attempts, receiving advice to quit from a health professional, and using cessation therapies—also varies across the population, with lower prevalence in some subgroups.

Dr. Wendy Theobald
Dr. Wendy Theobald of UW-CTRI assisted with references for Chapter 7 of the report.

7. Smoking cessation medications approved by the FDA and behavioral counseling are cost-effective cessation strategies. Cessation medications approved by the FDA and behavioral counseling increase the likelihood of successfully quitting smoking, particularly when used in combination. Using combinations of nicotine replacement therapies can further increase the likelihood of quitting.

8. Insurance coverage for smoking cessation treatment that is comprehensive, barrier-free, and widely promoted increases the use of these treatment services, leads to higher rates of successful quitting, and is cost-effective.

9. E-cigarettes, a continually changing and heterogeneous group of products, are used in a variety of ways. Consequently, it is difficult to make generalizations about efficacy for cessation based on clinical trials involving a particular e-cigarette, and there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.

10. Smoking cessation can be increased by raising the price of cigarettes, adopting comprehensive smokefree policies, implementing mass media campaigns, requiring pictorial health warnings, and maintaining comprehensive statewide tobacco control programs.

Conclusions from Chapter 7 by Baker, Adsit and Fiore include: 

US Surgeon General Dr. Jerome Adams and Dr. Michael Fiore
US Surgeon General Dr. Jerome Adams and Dr. Michael Fiore

1. The evidence is sufficient to infer that the development and dissemination of evidence-based clinical practice guidelines increase the delivery of clinical interventions for smoking cessation.

2. The evidence is sufficient to infer that with adequate promotion, comprehensive, barrier-free, evidence-based cessation insurance coverage increases the availability and utilization of treatment services for smoking cessation.

3. The evidence is sufficient to infer that strategies that link smoking cessation-related quality measures with payments to clinicians, clinics, or health systems increase the rate of delivery of clinical treatments for smoking cessation.

4. The evidence is sufficient to infer that tobacco quitlines are an effective population-based approach to motivate quit attempts and increase smoking
cessation.

5. The evidence is suggestive but not sufficient to infer that electronic health record technology increases the rate of delivery of smoking cessation treatments.

6. The evidence is sufficient to infer that increasing the price of cigarettes reduces smoking prevalence, reduces cigarette consumption, and increases smoking cessation.

7. The evidence is sufficient to infer that smoke-free policies reduce smoking prevalence, reduce cigarette consumption, and increase smoking cessation.

8. The evidence is sufficient to infer that mass-media campaigns increase the number of calls to quitlines and increase smoking cessation.

9. The evidence is sufficient to infer that comprehensive state tobacco-control programs reduce smoking prevalence, increase quit attempts, and increase smoking cessation.

10. The evidence is sufficient to infer that large, pictorial health warnings increase smokers’ knowledge about the health harms of smoking, interest in quitting, and quit attempts and decrease smoking prevalence.

11. The evidence is suggestive but not sufficient to infer that plain packaging increases smoking cessation.

12. The evidence is suggestive but not sufficient to infer that decreasing the retail availability of tobacco products and exposure to point-of-sale tobacco marketing and advertising increases smoking cessation.

13. The evidence is suggestive but not sufficient to infer that restricting the sale of certain types of tobacco products, such as menthol and other flavored products, increases smoking cessation, especially among certain populations.

To view the news conference video recording, click here.