Smoking at All-Time Low in US, but Many More Should Quit

Pam Harrison

November 14, 2016

ATLANTA — Smoking rates among US adults are at an all-time low, but millions still remain at risk for entirely preventable deaths.

Tobacco causes at least 12 different cancers as well as other health issues, and smokers who want to quit need help to do so, the Centers for Disease Control and Prevention (CDC) emphasized at a press briefing.

"Most Americans who continue to smoke want to quit and the health care system should do everything possible to help them," said CDC Director Tom Frieden, MD, MPH.

"Most people know smoking causes lung cancer, which is the leading cause of cancer death," he commented.

But the problem is much bigger than that. "Tobacco use continues to cause an enormous amount of disability and death from cancer; cancers linked to tobacco make up 40% of all cancers that are diagnosed in this country, and tobacco use will kill 6 million current smokers unless we implement programs to help them quit," he said.

"Reducing tobacco use prevents cancer and prevents deaths and saves money," he said.

Currently, over 36 million people in the United States still smoke.

The press briefing was based on the November 11 issue of Morbidity and Mortality Weekly Report.

Good News First

There is good news on the nonsmoking front. Only about 15% of US adults smoked in 2015 — down from nearly 21% of adults who smoked a decade earlier.

"If you look at only the years 2009 and 2015, the number of adult cigarette smokers declined by 10 million," Dr Frieden continued.

"That's a remarkable number and it represents literally millions of people who will not develop cancer or die from it [because they quit]," he added.

Indeed, some 1.3 million deaths from cancers linked to tobacco use have been avoided since 1990, the result of a reduction in tobacco use as well as early detection and treatment of some cancers, he noted.

"Despite this, tobacco continues to cause too many health problems and too many deaths," Dr Frieden emphasized.

Progress in getting people to quit smoking has also been inconsistent across the United States, where large disparities remain among groups of people who use tobacco as well as those affected by tobacco-related cancers.

For example, men have higher rates of tobacco-related deaths than women.

"Unfortunately, male smoking rates have not decreased as quickly as female smoking rates in recent years, so this difference is likely to grow in the future," Dr Frieden observed.

African American men and women also have higher tobacco-related cancer deaths compared with other racial groups; even for the same stage of diagnosis, outcomes are worse and mortality is higher among African Americans than among other racial groups.

This trend is likely related to both the quality of care they receive and the poor consistency of follow-up, as Dr Frieden observed.

Much Remains to Be Done

Much can be done to help people who want to quit, Dr Frieden commented.

"We can fund comprehensive cancer and tobacco control programs that do what works to reduce tobacco use," he suggested.

Healthcare professionals and the healthcare system can make smoking cessation treatments available to every smoker who wants to quit.

States and communities can also continue to protect nonsmokers from second-hand smoke by ensuring that all indoor public places and worksites casinos are smoke free.

He also told Medscape Medical News that it's a mistake to think that only hard-core smokers are still smoking and nothing will ever get them to quit.

"You might think that, but that's not what the data shows," he said.

"When we look at the data, we see that there is a shift from heavier smokers to lighter smokers, so not only are fewer people smoking, but a larger proportion of current smokers are light smokers and they are more likely to be 'some days' smokers rather than 'every day' smokers, so we're seeing really good progress being made here too," Dr Frieden elaborated.

He also reminded the press that it's wrong to assume that smokers know how bad tobacco is for them.

"What we've learned over and over again is that smokers underestimate what the risks of smoking are," he said.

Cessation Treatment

Making smoking cessation treatments "widely available saves lives and saves money," Dr Frieden commented.

Currently, there are seven US Food and Drug Administration–approved smoking cessation treatments, all of which have been proven to double or even triple a person's chances that they will quit if they want to.

With few exceptions, "everyone who wants to quit should get one of these seven medications," Dr Frieden said.

In addition, Dr Frieden noted that some people have been able to quit by using e-cigarettes when other strategies didn't seem to help.

"Whatever gets people to stop smoking regular cigarettes can be very helpful, so if people are able to quit smoking using electronic cigarettes, that's a good thing," he said.

On the other hand, e-cigarettes are an extremely bad idea for anyone under age 18 years because they contain nicotine.

"Nicotine is addictive," Dr Frieden cautioned.

"And it's likely a proportion of kids who start using e-cigarettes will progress to conventional cigarettes and become addicted to nicotine and tobacco for life."

e-Cigarettes are also a bad idea if they enable smokers to continue to smoke regular cigarettes but are just used in situations where smoking is banned.

Dr Frieden has disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. 2016;64:1205-1211. Full text

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