BETHESDA, MD. – Tobacco cessation programs that employ telephone quit lines and counseling and nicotine replacement therapy are highly effective, and they should be offered to more smokers and users of smokeless tobacco, according to a panel of physicians, other health care providers, and community advocates at a conference on the prevention, cessation, and control of tobacco use sponsored by the National Institutes of Health.
The 14-member panel was charged with issuing a consensus statement on the state of the science after sifting through the available evidence and listening to several days of presentations from the public. The NIH committee found ample evidence that tobacco-related illnesses are a huge burden in the United States–leading to 440,000 deaths each year–and also that there are many successful strategies for preventing use or helping people quit. But there are huge and numerous barriers blocking tobacco users from taking advantage of prevention and cessation programs, the committee added.
Of the 44.5 million adult smokers in the United States, 77% would like to quit, and 40% make an attempt in any given year, according to the panel. But only 5% succeed, mostly because those attempting to quit cannot access effective treatments.
“To increase demand for treatments, we must motivate smokers to want them, expect them, and use them,” said Dr. David F. Ransohoff of the University of North Carolina at Chapel Hill, and chairman of the NIH panel, in a statement.
One of the biggest challenges is stopping people from starting. The data show that most smokers begin in adolescence. Effective strategies to keep children from picking up the habit include raising taxes to increase cigarette prices, passing–and then enforcing–laws to prohibit minors' access to tobacco, and creating smoke-free zones, said the panel. Restricting tobacco ads and promotion and disseminating antitobacco mass media campaigns also work, the committee said.
“Tobacco is a legal product, but it's illegal to sell that product to youth, so simply enforcing the law of not selling tobacco products to youth would help a great deal,” said panelist Stephen B. Thomas, Ph.D., director of the Center for Minority Health at the University of Pittsburgh.
The committee also found that reimbursement for smoking cessation counseling or nicotine replacement products increased physician intervention and encouraged more patients to make use of the services. Patients also are more apt to seek out and use the services when discussions of smoking and quitting are made a routine part of every primary care visit or before every hospital discharge, the panel said.
There was some concern among antitobacco activists that the panel might endorse an idea making the rounds–that people trying to quit smoking could reduce the level of harm by switching to smokeless tobacco. But the committee found limited evidence to support this notion and reiterated in their statement, “Use of any tobacco product must be discouraged.”
The committee also stated that people with psychiatric conditions–especially schizophrenia and major depressive disorder–are more likely to be smokers and to have a harder time quitting, with more severe withdrawal symptoms.
Going forward, patients and providers should be made more aware of the benefits of cessation and the resources for quitting, and reimbursement policies should be established, said the panel.
One antitobacco organization, the Campaign for Tobacco-Free Kids, said it was pleased with the panel's deliberations and statement. “For the most part, they hit all the major issues and, in our opinion, got most of it right,” said Matt Barry, director of policy research for the Washington-based campaign.
Copies of the consensus statement can be found at http://consensus.nih.gov