Smoking Cessation—The Role of Healthcare Professionals and Health Systems

Since the first Surgeon General’s report on smoking and health was released in 1964, cigarette smoking among U.S. adults has declined from nearly 43% to a low of nearly 14% in 2018. Despite this progress, smoking remains the leading preventable cause of death and disease in the United States. Additionally, smoking-related illnesses continue to cost the nation more than $300 billion every year.

Tobacco dependence is a chronic, relapsing condition driven by addiction to nicotine. But cessation treatment can help people quit.  The 2020 Surgeon General’s Report highlights the latest evidence on the benefits of smoking cessation. The evidence is clear – one of the most important actions people can take to improve their health is to quit smoking, no matter how old they are or how long they’ve been smoking.

Smoking cessation:

• Reduces the risk of premature death, improves health, and enhances quality of life. Quitting can add as much as a decade to life expectancy.
• Reduces the risk for many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and 12 types of cancer.
• Benefits people already diagnosed with coronary heart disease or COPD.
• Benefits the health of pregnant women and that of their fetuses and babies.
• Reduces the financial burden that smoking places on people who smoke, healthcare systems, and society.

The report highlights the progress made in reducing smoking in the U.S.:

• Nearly 70% of adults who smoke say they want to quit.
• Over 50% of adults who smoke try to quit each year.
• Three in five adults who ever smoked cigarettes have quit.

The report also presents findings that underscore the challenges we face to further reduce smoking:

• Over 40% of adults who smoke do not receive advice to quit from a healthcare professional.
• Fewer than one in three adults who smoke use cessation counseling or FDA-approved medications when trying to quit.
• Fewer than one in 10 U.S. adults successfully quit smoking each year.

Tobacco use and dependence often requires repeated intervention and long-term support to help patients quit. The report outlines an array of effective treatments and resources, including:

• Counseling and medication—Each is effective when used alone, and using them together can more than double the chances of quitting.
• Combining medications—Compared to using a single form of nicotine replacement therapy (NRT), combining long-acting NRT (e.g., patch) with a short-acting NRT (e.g., lozenge) increases the chances of quitting.
• Tobacco quitlines—Proactive counseling from quitlines increases the chances of quitting when used alone or together with cessation medication. Text messaging and web-based cessation interventions can also help people successfully quit smoking.

Many adults who smoke are interested in using e-cigarettes to quit cigarettes. Research is uncertain on whether e-cigarettes, in general, increase smoking cessation. Some research suggests that using e-cigarettes containing nicotine is associated with greater smoking cessation than using e-cigarettes that don’t contain nicotine, and some research suggests that more frequent use of e-cigarettes is associated with greater smoking cessation than less frequent use. However, e-cigarettes are not currently approved by the FDA as a quit smoking aid, and more research is needed on whether e-cigarettes are effective for smoking cessation and to better understand the health effects of e-cigarettes.

The use of any tobacco products, including e-cigarettes, is not safe for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products. In order for adult smokers to achieve any meaningful health benefits from e-cigarettes, they would need to fully switch to e-cigarettes and stop smoking cigarettes and other tobacco products completely. Among those who have switched completely, the ultimate goal should be to also stop using e-cigarettes completely to achieve the maximum health benefit.

The Surgeon General’s Report reviews effective health system and population-level interventions that can promote cessation and extend the reach and use of clinical treatments. Health systems can adopt policies and changes to integrate tobacco dependence treatment into routine care and make it easier for healthcare teams to deliver treatment (e.g., integrating cessation content into electronic health records). Additionally, comprehensive, barrier-free smoking cessation insurance coverage that is widely promoted can increase the use of evidence-based treatments and cessation. Population-level interventions, such as raising the price of cigarettes, adopting comprehensive smokefree policies, implementing mass media campaigns, requiring pictorial health warnings, and maintaining comprehensive statewide tobacco control programs also support and increase smoking cessation.