Surgeon General Scolds Docs for Failing to Help Patients Quit Smoking

Alicia Ault

January 23, 2020

The US Surgeon General is calling on all physicians to help patients stop smoking, noting that two thirds of adult smokers say they want to quit, but only 40% report that their doctor has advised them to stop.

"I've got to own this as the nation's doctor, and our health providers in this room and in this country need to own this stat," said Surgeon General Jerome Adams, MD, at a press briefing releasing a new report on smoking cessation.

"Smoking is the number one preventable cause of death, disease, and disability in the United States," he said. "So why are 40% of our health providers out there not advising smokers to quit when they come in?"

In the first US Surgeon General report on smoking cessation in 30 years, the 700-page report suggests smoking cessation-related quality measures that include physician reimbursement would increase treatment.

The evidence also suggests that using electronic health records to prompt clinicians to inquire about smoking would increase cessation treatment.

EHRs could be used to "empower and enable" physicians to advise people to quit, said Adams. Physicians also need "the education and the confidence to be able to have that conversation, because too many of them look at someone and say, 'Nope, too hard, too much effort, no, that's not what they're here for today,' " he said.

However, "simply asking, advising, and referring can be enough to get someone on the pathway to quitting," Adams said.

34 Million Still Smoke

The new report is the first on the topic released since 1990, and the 34th on tobacco control since the first one was issued in 1964, said Adams. Since that first report, adult smoking has declined 70%, but some 34 million Americans (14%) still smoke, he said.

In addition, Adams said that many subpopulations have been left behind, noting, "Cigarette smoking remains highest among LGBTQ adults, people with disabilities or limitations, American Indians and Alaska Natives, and people with mental health conditions or substance use disorders."

He also noted that 40% of cigarettes are consumed by those with a mental illness or a substance use disorder.

Quitting is beneficial at any age and can add as much as a decade to life expectancy, the report notes. Quitting also reduces the risk of 12 cancers, cuts the risk of chronic obstructive pulmonary disease, and reduces cardiovascular and stroke morbidity and mortality.

Pregnant women who quit also reduce their own morbidity and mortality risk and that of unborn children and infants, the report says.

"We know more about the science of quitting than ever before. We can, and must, do more to ensure that evidence-based cessation treatments are reaching the people that need them," said Adams.

Less than one third of those who have quit have used US Food and Drug Administration (FDA)-approved cessation medications or behavioral counseling, Adams said.

Barriers to Care

Despite the existence of five nicotine replacement therapies (NRTs) and two non-nicotine oral medications, and more widespread availability of proven counseling methods — including web- or text-based programs — barriers to access remain.

These include a lack of insurance coverage for comprehensive, evidence-based smoking cessation treatment, which, when offered, increases availability and use.

"These are cost effective-interventions," said Adams. "It's penny-wise and pound foolish to not give someone access to what we know works," he said.

Because of the diversity of e-cigarette products and the variety of ways they are used, coupled with little research, it's not currently possible to determine whether they are, or are not, useful smoking cessation tools, the report notes.

However, experts who compiled the report found some evidence to suggest that e-cigarettes containing nicotine may be "associated with increased smoking cessation compared with the use of e-cigarettes not containing nicotine."

Asked whether the report's conclusions might be interpreted as supportive of e-cigarettes, Adams said the report focused on smoking cessation, not initiation.

"I'm terribly concerned about the clear data that shows youth are initiating tobacco product use with e-cigarettes," he said.

The Trump Administration's current proposal to partially restrict sales of some flavored e-cigarettes "reflects the science," and "a balance between a desire to really make sure that people aren't initiating with these products, but also a desire to again try to maintain a pathway for adults who want to use these products to quit to use them," Adams said.

The focus, said Adams, should not be on e-cigarettes and whether they do, or do not, work.

"People want to quit," he said. "We know what works. Not enough of them are getting it, and there are terrible disparities in who is and who is not getting access to effective and evidence-based treatment — that's the story here."

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