In the JournalsPerspective

CDC: Smoking rate among US adults reaches all-time low

In 2017, 14% of adults reported cigarette smoking “every day” or “some day”  — the lowest level ever recorded, down from 15.5% in 2016, and a 67% decrease since 1965, according to a report in MMWR.

The CDC also observed a “particularly notable decline” among young adults in recent years: about 10% of young adults aged 18 to 24 years smoked cigarettes in 2017, down from 13% in 2016.

Researchers used the 2017 National Health Interview Survey for their analysis, which also showed one in five adults still used some kind of tobacco product in 2017.

“Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, noncombustible, and electronic products,” Teresa W. Wang, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues wrote.

According to a CDC press release, smoking cigarettes and other combustible tobacco products causes 480,000 deaths each year, making it still the most common preventable cause of death and disease in the United States.

“This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment — and it demonstrates the importance of continued proven strategies to reduce smoking,” CDC Director Robert Redfield, MD, said in the press release. “Despite this progress, work remains to reduce the harmful health effects of tobacco use.”

National Cancer Institute Director Norman E. Sharpless, MD, put the impact of cigarette smoking into some historical perspective.

“For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States. Eliminating smoking in America would, over time, eliminate about one-third of all cancer deaths,” he said in the press release.

Other survey results showed tobacco use was highest among people who were:

  • uninsured (31%), insured by Medicaid (28.2%), or received some other public insurance (26.8%);
  • non-Hispanic American Indian/Alaska Native (29.8%), multiracial (27.4%), white (21.4%), or black adults (20.1%);
  • lesbian, gay, or bisexual adults (27.3%);
  • widowed, separated or divorced (23.1%); and
  • Single, never married, or not living with a partner (21%).

The use of any tobacco product was highest among those adults who had a:

“The persistent disparities in adult smoking prevalence described in this report emphasize the need for further research to accelerate reductions in tobacco use among all Americans,” Sharpless said.

Smoking 
In 2017, 14% of adults reported cigarette smoking in the last 30 days — the lowest level ever recorded, down from 15.5% in 2016, and a 67% decrease since 1965, according to a report in MMWR.
Source:Shutterstock

As a courtesy to its readers, and in advance of the Great American Smokeout on Nov. 15, some of Healio’s coverage of research into smoking cessation can be found below. – by Janel Miller

Smokers endorse metabolism-informed care for smoking cessation

Metabolism-informed care — a treatment strategy that matches normal metabolizers with a non-nicotine-based therapy such as Chantix and slow nicotine metabolizers with nicotine replacement therapy patch — was an acceptable option for patients who wanted to stop smoking, according to findings published in Nicotine & Tobacco Research. Read more.

Personalized invite increases smoking cessation attendance

Sending a personalized risk letter and invitation effectively increased attendance to Stop Smoking Services in the United Kingdom, according to recent findings. Read more.

Patient navigation, financial incentives improve smoking cessation rates

A multicomponent intervention that included patient navigation and financial incentives for biochemically confirmed smoking cessation significantly increased rates of smoking cessation among adult smokers, according to findings published in JAMA Internal Medicine.

Read more.

'Cold turkey,' other methods effective for smoking cessation in patients with inflammatory bowel disease

By using the cold turkey and other smoking cessation methods, patients with inflammatory bowel disease were more likely to successfully quit smoking, according to a poster presented at an Advances in Inflammatory Bowel Disease meeting. Read more.

Twitter, CDC ads effective at helping smokers quit

A Twitter account that shared daily automated messages and encouraged group communication, was twice as likely to help smokers quit than nicotine patches and government websites alone, according to data published in Tobacco Control. Read more.

Low-dose CT screening program may influence smoking behavior

Patients who participated in lung cancer screening with low-dose CT achieved a greater smoking cessation rate after a year than those who did not participate in the program, according to study findings presented at the American Thoracic Society Annual Meeting. Read more.

Lack of cessation program knowledge may keep smokers from quitting

The extent of Medicaid coverage for smoking-cessation medications may be a major barrier in getting low-income people to stop smoking, according to research published in Preventing Chronic Disease. Read more.

Hookah 
“Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, noncombustible, and electronic products,” Teresa W. Wang, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues wrote.

Source:Adobe

E-cigarette use unlikely to help smoking cessation

Abstinence from tobacco was less likely in cigarette smokers who used e-cigarettes after being discharged from the hospital, according to findings published in Annals of Internal Medicine. Read more.

Weight concerns affect women's attempts to quit smoking

Smokers who think that tobacco helps control their weight are less likely to be affected by anti-smoking policies, compared with those who do not believe it controls weight, according to recently published data. Read more.

Researchers recommend varenicline for smoking cessation in patients with HIV

Adding varenicline to individualized counseling was a safe and effective way for patients with HIV to quit smoking cigarettes, according to a recent randomized controlled trial in France. Read more.

Disclosures: Redfield is director of the CDC. Sharpless is director of the National Cancer Institute. None of the authors reported any relevant financial disclosures.

Editor's note: This story has been been updated to reflect a revision to the original source press release.

In 2017, 14% of adults reported cigarette smoking “every day” or “some day”  — the lowest level ever recorded, down from 15.5% in 2016, and a 67% decrease since 1965, according to a report in MMWR.

The CDC also observed a “particularly notable decline” among young adults in recent years: about 10% of young adults aged 18 to 24 years smoked cigarettes in 2017, down from 13% in 2016.

Researchers used the 2017 National Health Interview Survey for their analysis, which also showed one in five adults still used some kind of tobacco product in 2017.

“Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, noncombustible, and electronic products,” Teresa W. Wang, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues wrote.

According to a CDC press release, smoking cigarettes and other combustible tobacco products causes 480,000 deaths each year, making it still the most common preventable cause of death and disease in the United States.

“This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment — and it demonstrates the importance of continued proven strategies to reduce smoking,” CDC Director Robert Redfield, MD, said in the press release. “Despite this progress, work remains to reduce the harmful health effects of tobacco use.”

National Cancer Institute Director Norman E. Sharpless, MD, put the impact of cigarette smoking into some historical perspective.

“For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States. Eliminating smoking in America would, over time, eliminate about one-third of all cancer deaths,” he said in the press release.

Other survey results showed tobacco use was highest among people who were:

  • uninsured (31%), insured by Medicaid (28.2%), or received some other public insurance (26.8%);
  • non-Hispanic American Indian/Alaska Native (29.8%), multiracial (27.4%), white (21.4%), or black adults (20.1%);
  • lesbian, gay, or bisexual adults (27.3%);
  • widowed, separated or divorced (23.1%); and
  • Single, never married, or not living with a partner (21%).

The use of any tobacco product was highest among those adults who had a:

“The persistent disparities in adult smoking prevalence described in this report emphasize the need for further research to accelerate reductions in tobacco use among all Americans,” Sharpless said.

Smoking 
In 2017, 14% of adults reported cigarette smoking in the last 30 days — the lowest level ever recorded, down from 15.5% in 2016, and a 67% decrease since 1965, according to a report in MMWR.
Source:Shutterstock

As a courtesy to its readers, and in advance of the Great American Smokeout on Nov. 15, some of Healio’s coverage of research into smoking cessation can be found below. – by Janel Miller

Smokers endorse metabolism-informed care for smoking cessation

Metabolism-informed care — a treatment strategy that matches normal metabolizers with a non-nicotine-based therapy such as Chantix and slow nicotine metabolizers with nicotine replacement therapy patch — was an acceptable option for patients who wanted to stop smoking, according to findings published in Nicotine & Tobacco Research. Read more.

Personalized invite increases smoking cessation attendance

Sending a personalized risk letter and invitation effectively increased attendance to Stop Smoking Services in the United Kingdom, according to recent findings. Read more.

PAGE BREAK

Patient navigation, financial incentives improve smoking cessation rates

A multicomponent intervention that included patient navigation and financial incentives for biochemically confirmed smoking cessation significantly increased rates of smoking cessation among adult smokers, according to findings published in JAMA Internal Medicine.

Read more.

'Cold turkey,' other methods effective for smoking cessation in patients with inflammatory bowel disease

By using the cold turkey and other smoking cessation methods, patients with inflammatory bowel disease were more likely to successfully quit smoking, according to a poster presented at an Advances in Inflammatory Bowel Disease meeting. Read more.

Twitter, CDC ads effective at helping smokers quit

A Twitter account that shared daily automated messages and encouraged group communication, was twice as likely to help smokers quit than nicotine patches and government websites alone, according to data published in Tobacco Control. Read more.

Low-dose CT screening program may influence smoking behavior

Patients who participated in lung cancer screening with low-dose CT achieved a greater smoking cessation rate after a year than those who did not participate in the program, according to study findings presented at the American Thoracic Society Annual Meeting. Read more.

Lack of cessation program knowledge may keep smokers from quitting

The extent of Medicaid coverage for smoking-cessation medications may be a major barrier in getting low-income people to stop smoking, according to research published in Preventing Chronic Disease. Read more.

Hookah 
“Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, noncombustible, and electronic products,” Teresa W. Wang, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues wrote.

Source:Adobe

E-cigarette use unlikely to help smoking cessation

Abstinence from tobacco was less likely in cigarette smokers who used e-cigarettes after being discharged from the hospital, according to findings published in Annals of Internal Medicine. Read more.

Weight concerns affect women's attempts to quit smoking

Smokers who think that tobacco helps control their weight are less likely to be affected by anti-smoking policies, compared with those who do not believe it controls weight, according to recently published data. Read more.

Researchers recommend varenicline for smoking cessation in patients with HIV

Adding varenicline to individualized counseling was a safe and effective way for patients with HIV to quit smoking cigarettes, according to a recent randomized controlled trial in France. Read more.

Disclosures: Redfield is director of the CDC. Sharpless is director of the National Cancer Institute. None of the authors reported any relevant financial disclosures.

Editor's note: This story has been been updated to reflect a revision to the original source press release.

    Perspective
    Cliff Douglas

    Cliff Douglas

    This CDC report indicating that cigarette smoking among adults in the U.S. fell to a historic low of 14% in 2017 is great news. This translates to 3.5 million fewer smokers than in 2016, many of whom will avoid dying prematurely from tobacco-related cancer and many other diseases. But with more than 34 million adults in the U.S. still smoking cigarettes, and growing disparities when it comes to who is still smoking, the CDC report also highlights we have a significant challenge that requires a determined effort for the foreseeable future.

     

    Here at the American Cancer Society, we know that there are several million Americans using e-cigarettes and a sizeable percentage of these people are using them in an attempt to quit using traditional, combustible tobacco products. We encourage primary care physicians to remind their patients that, to date, no e-cigarette has been approved by the FDA for use in smoking cessation. While the American Cancer Society does not recommend using e-cigarettes for smoking cessation, we do encourage primary care physicians to support those individuals who choose to use e-cigarettes in an attempt to quit smoking, especially if the patient is unwilling to use FDA-approved cessation options. That said, smokers who use e-cigarettes should be strongly discouraged from using e-cigarettes and combustible cigarettes concurrently, since such “dual use” largely eliminates the health benefits that come from switching completely to the e-cigarettes. It is understood that some smokers engage in a transition period during which they start using e-cigarettes while still smoking. In such cases, the smoker should be given positive support and encouraged to switch completely as soon as they can.

     

    The most effective, proven approach to get patients to stop smoking and overcome nicotine addiction continues to be combining an FDA-approved nicotine replacement therapy with evidence-based behavioral counseling. Perhaps just as importantly, primary care physicians need to ask every patient about their tobacco use and offer them support to quit if they wish to. Time and again, research has shown that health care practitioner guidance is one of the most effective ways to get a patient to try and quit and ultimately succeed in doing so. 

    • Cliff Douglas, JD
    • Vice President, tobacco control, American Cancer Society

    Disclosures: Douglas is employed by the American Cancer Society.

    Perspective
    David G. Hill

    David G. Hill

    I would be remiss if I didn’t recognize the role of the larger public health community played in bringing cigarette rates down to these record lows. But it is not time to become complacent. Though the CDC report has a lot of such positives, there are some negatives that concern me. The CDC report makes it abundantly clear there are geographical regions of the United States and population groups that still have an extraordinarily high number of smokers. We must continue pushing cessation efforts until everyone has quit smoking.

    I know there are a lot of constraints on primary care physicians’ time. But they need to find time to discuss smoking cessation at each visit with their patients who are smokers and make an appointment that is exclusively dedicated to discussing the addiction. When that appointment comes, suggest medications, such as Chantix (varenicline, Pfizer), bupropion, and nicotine replacement therapy. If using nicotine replacement, use both short- and long-term nicotine replacement therapies combining patches with gums, sprays, inhalers, or lozenges. PCPs should also provide patients with behavioral counseling as studies show we can increase quit rates by up to 50% if we offer the counseling or some mechanism that addresses the psychological and behavioral components of addiction. Here at the American Lung Association we also have a program called ‘Freedom from Smoking’ accessible from our website (www.lung.org) available to anyone and may be used along with medications and nicotine replacement therapies.

    Patients may say they want to try to quit combustible cigarettes by using e-cigarettes. This is not an FDA-approved smoking cessation method, even though it is sometimes advertised as such. We know that cigarettes are the deadliest product on the market, so saying something is safer than that is not really saying much. Patients may also try to tell you they want to quit ‘cold turkey.’ If they do, be sure to schedule them for a follow-up appointment rather quickly because the success rate of this method is well less than 10%.

    • David G. Hill , MD
    • Director of clinical research, Waterbury Pulmonary Associates, Waterbury Connecticut
      Volunteer medical spokesperson, American Lung Association

    Disclosures: Hill serves as a speaker for Pfizer Pharmaceuticals, the manufacturer of Chantix (varenicline).

    Perspective
    Wayne Tsuang

    Wayne Tsuang

    The report from the CDC, FDA, and National Cancer Institute highlights the lowest ever recorded level of smoking in the United States. This news is very exciting as it represents the hard work and enormous effort over many years that has gone into helping patients with tobacco cessation and to ‘kick the habit’. Credit not only goes to health care teams and policy makers, but also to all the patients who have worked hard to either quit or avoid starting tobacco products altogether.

    There is still much work to do as there are specific populations where further reduction in tobacco use is needed: such as racial minorities, low income, or disabled populations. For primary care physicians, or any health care provider, the most important care that can be delivered is to continue to ask patients about tobacco habits, encourage them to quit, and provide resources in a clinic or community setting. In a busy primary care practice there are many competing issues that need to be addressed with each patient, and when providers do not continue to ask about tobacco use, patients will think less about quitting. There are many approaches to tobacco cessation, which include medications, online interventions, and toll-free quit-lines. Getting just one patient to quit not only helps that patient, but also the friends, family, and co-workers of that patient as they are less likely to be exposed to second hand smoke.

    • Wayne Tsuang, MD, MHS
    • pulmonologist, Cleveland Clinic

    Disclosures: Healio Family Medicine was unable to determine Tsuang's relevant financial disclosures prior to publication.

    Perspective
    Janet Wei

    Janet Wei

    This report highlights the encouraging, progressive improvement rate in smoking among adults. As cardiologists, we are always pleased when risk factors for cardiovascular disease can be reduced. However, with 14% of adults in the U.S. still smoking, there is still room for improvement.

    To get patients to stop smoking, primary care physicians may want to present patients with data such as the study in Circulation that found  women who smoke a pack a day have a sixfold increased risk, and men who smoke the same amount have a threefold increased risk, for a heart attack compared with those who never smoke. Further, PCPs can also allude to a study in BMJ that found advise that even just one cigarette a day increases the risk for heart disease by as much as 50%, and for stroke by as much as 25%. Cardiovascular risk is reduced by smoking cessation, even in smokers with pre-existing cardiovascular disease.

    For long-term smoking cessation, PCPs should prescribe FDA-approved medications such as varenicline and bupropion, or nicotine replacement therapies such as gums and patches and have the patient use them in conjunction with behavioral counseling. PCPs who do not have a substantial amount of time to discuss smoking cessation with their patients can refer patients to a smoking cessation clinic that does the prescribing and counseling for them. PCPs should also encourage the friends, family members and co-workers to support the smoker in his or her efforts to quit, as secondhand smoke has also been tied to cardiovascular disease, lung cancer, chronic sinusitis, pregnancy complications and adult onset asthma.

    If first line smoking cessation strategies fail, are intolerant, or rejected by the patient, PCPs may support the use of e-cigarettes. However, researchers recently reported in Vascular Medicine and the Journal of Applied Physiology that markers for long-term cardiovascular health are impaired by e-cigarette exposure in humans and in mice. Additional research into the cardiovascular risk of using e-cigarettes is limited, evidenced by a review in Nature Reviews Cardiology that found dangers to e-cigarette smoking difficult to ascertain, given the wide variety of devices and ingredients used to make them.

    Thus, e-cigarettes should only be used as a short-term therapy to smoking cessation. The authors of the Nature Reviews Cardiology review concluded, and I would agree, that “for cigarette smokers with known cardiovascular disease who quit smoking by using e-cigarettes, we recommend that they discontinue e-cigarette use when they are confident that they will not return to cigarette smoking.”

    References:

    Benowitz NL, Fraiman JB. Nat Rev Cardiol. 2017;doi:10.1038/nrcardio.

    Franzen KF, et al. Vasc Med. 2018;doi:10.1177/1358863X18779694.

    Hackshaw A, et al. BMJ. 2018;doi:10.1136/bmj.j5855.

    Njølstad I, et al. Circulation. 1996. Feb 1;93(3):450-456.

    Olfert IM, et al. J Appl Physiology. 2017;doi:10.1152/japplphysiol.00713.2017.

     

    • Janet Wei, MD
    • Assistant Professor of Medicine, Barbra Streisand Women’s Heart Center at the Cedars-Sinai Smidt Heart Institute, Los Angeles

    Disclosures: Wei reports no relevant financial disclosures.