What you need to know to quit smoking
Tobacco use, still the leading cause of preventable death and disease in the country, leads to 540,000 deaths in the U.S. each year. Most smokers — nearly 70 percent — say they want to quit, and recent data show an increasing number of people quitting successfully. In 2016, 59 percent of adults who ever smoked quit, an increase from 50.8 percent in 2005. Nevertheless, annual quit success rates remain low — at roughly 7 percent — underscoring the highly addictive nature of nicotine, the ineffectiveness of the “cold turkey” approach, or not using available treatments, and the multiple attempts it can take to successfully quit.
Online quitting resources are increasingly important to tobacco users. In 2017, more than one-third of all smokers looked online for information about quitting smoking, a proportion that has more than doubled over the past 12 years. This translates to 12.4 million smokers who turned to the internet for help quitting in 2017. Evidence shows that online quit smoking programs help smokers succeed. For example, following the EX Plan by BecomeAnEX®, a free digital quit-smoking program developed by Truth Initiative® in collaboration with Mayo Clinic, quadruples a smoker’s chance of quitting.
Nearly 70% of smokers say they want to quit.
In 2016, approximately 15.5 percent (37.8 million) of American adults were current smokers, including 13.5 percent of women and 17.5 percent of men. Quit attempts and rates of successfully quitting are similar among men and women. Chances of success increase with each quit attempt.
- In 2015, 66.7 percent of male smokers were interested in quitting smoking and 55.3 percent had made a quit attempt in that year. Only 7.2 percent successfully quit.
- In 2015, 69.4 percent of female smokers were interested in quitting smoking and 55.6 percent had made a quit attempt that year. Only 7.6 percent successfully quit.
Quit attempts and quit rates decrease with age, possibly because of increased difficulty changing behaviors that have been established over many years, according to data from 2015.
QUITTING AND PREGNANCY
The most recent data on smoking during pregnancy show that in 2012 and 2013 combined, about 15.4 percent of pregnant American women were current smokers. An analysis from 2011 found that 55 percent of women who smoked during the three months before they became pregnant successfully quit smoking while pregnant. However, 43 percent of postpartum women return to smoking after approximately six months.
Smoking while pregnant can harm the child and mother. Quitting smoking increases babies’ oxygen intake and lung development, and decreases risk for premature birth, low birth weight and possible miscarriage.
- About 5 percent (5.4 percent) of teens in grades eight, 10 and 12 reported smoking a cigarette in the past 30 days.
- More than half (54.6 percent) of high school students who admitted to smoking cigarettes had not tried to quit during the past year.
- More female (52.8 percent) than male (39.7 percent) students had attempted to quit in the past year.
DISPARITIES IN QUITTING
Quitting disparities exist among certain populations, including in communities with lower income and education levels, racial and ethnic minority groups, those with mental health conditions and the LGBT community.
- Fewer smokers with lower-income quit successfully (5.6 percent) than those living at or above the poverty line (7.9 percent), despite similar rates of quit attempts. Smokers with low incomes may face more barriers to quit-smoking treatments and use treatments at lower rates.
- Quit rates for individuals suffering from severe psychological distress are approximately half of the general population, showing the need for more targeted interventions for those with mental health problems.
- In 2015, adult smokers with a private health plan had higher rates of successfully quitting (9.4 percent), compared with those with any other type of insurance coverage. Adult smokers with private insurance also had the highest rate of quit attempts in the past year (57.2 percent), compared with those enrolled in federal insurance programs or who are uninsured.
- Rates of quit attempts and successfully quitting generally increase as education level rises, with 50 percent of adult smokers across all education levels attempting to quit, according to data from 2015. Education might help by increasing awareness, access to quit-smoking tools and the affordability of services.
- A stronger set of tobacco control policies — including broader quitting treatment coverage, tax increases, comprehensive marketing restrictions, smoke-free laws, strong graphic health warnings, a higher intensity media campaign and stronger youth access enforcement — would reduce the smoking rate among the bottom two-fifths of income earners by nearly a quarter in just a few years. By 2065, smoking rates among the lowest-income groups would drop by almost 45 percent, avoiding more than 1.5 million deaths.
Lesbian, gay and bisexual individuals have higher rates of tobacco use and lower quit attempt rates than the general population.
- More than one-fifth (20.5 percent) of lesbian, gay and bisexual adults are current smokers, compared with 15.3 percent of heterosexual adults, according to the 2016 National Health Interview Survey.
- About two-thirds (66.7 percent) of gay, lesbian and bisexual adult smokers are interested in quitting smoking, and 48.4 percent attempted to quit in the past year, but both rates are lower than those who identify as heterosexual.
Rates of quit attempts and successfully quitting vary by racial and ethnic background. Among white, black, Hispanic and Asian-Americans, black Americans report the most interest in quitting, but have the lowest success rate. Asian- Americans have the highest quit rate and rate of success.
Additionally, evidence indicates that adult menthol smokers are less likely than non-menthol smokers to successfully quit smoking. The mint flavoring makes cigarettes easier to smoke and harder to quit.
- Certain groups smoke menthol cigarettes at higher rates, including young people, women, sexual minorities, those with mental illness and racial and ethnic minorities, especially African-Americans.
- Nearly 90 percent of all African-American smokers use menthol cigarettes.
- Research shows that if menthol cigarettes were banned nationally, almost 39 percent of all menthol smokers and 44.5 percent of African-American menthol smokers would try to quit.
HEALTH EFFECTS OF QUITTING SMOKING
- Quitting smoking before age 40 reduces the risk of death associated with continued smoking by 90 percent. Quitting before age 30 avoids more than 97 percent of the risk of death associated with continued smoking.
- Among smokers who quit at age 65, men gained 1.4 to 2 years of life and women gained 2.7 to 3.4 years. Quitting smoking at age 65 or older reduces a person’s risk of dying of a smoking-related disease by nearly 50 percent.
- Quitting smoking reduces the risk of chronic obstructive pulmonary disease and decreases the risk of lung cancer and other cancers.
- Smoking increases a patient’s chance of complications with surgery. Patients who quit smoking just before surgery see better and faster healing.30 Even brief periods of abstinence from smoking may improve surgical outcomes.
- A smoker’s body has a harder time healing wounds. Smoking also weakens the immune system. Stopping smoking immediately improves the body’s ability to heal itself.
Most smokers who attempt to quit do so without counseling or medications — commonly called the “cold turkey” method — and are not successful. Only 3 to 5 percent of people quit for longer than 6 months using the cold turkey approach, according to quit-smoking experts. Many supports exist that can help people quit, including medications and counseling, which together can more than triple a smoker’s chance of quitting.
- Based on extensive clinical trials, the Food and Drug Administration has approved these medications for quitting tobacco: nicotine replacement therapy (NRT) gum, NRT inhaler, NRT lozenges, NRT nasal spray, NRT patch, varenicline (Chantix) and bupropion. These medications have been demonstrated to improve quit rates by 50 to 70 percent.
- Providing sufficient training to health care providers in quit-smoking treatments can more than double a smoker’s odds of successfully quitting.
- Social support, such as seeking help from family and friends or building relationships with other smokers through online social networks, is an important factor related to successful quitting.
- Quitting methods that combine counseling and medication are more effective than either alone. Quitting resources should provide multiple options for smokers to choose the method that works best for them.
DIGITAL QUIT TOOLS
- Digital quit tools — specifically those delivered via the internet and text message — have the potential to reduce smoking rates because of their proven effectiveness, broad reach, scalability and relatively low cost.
- Internet quit-smoking programs have demonstrated comparable effectiveness with evidence-based telephone and face-to-face counseling.
- Research on the digital quit-smoking program BecomeAnEX found that smokers who participated in the online community — either actively exchanging messages with others, or even just passively reading comments — were significantly more likely to quit than those who did not use the community. Each month, thousands of EX Community members share information and offer each other support through the platform’s communication channels, including private messages, blogs, message boards and group discussions.
E-CIGARETTES AS QUIT TOOLS
Some smokers have turned to e-cigarettes for help with quitting cigarettes. A recent report by the National Academies of Science, Engineering, and Medicine found that current evidence is limited regarding the effectiveness of e-cigarettes as quitting tools. Some of this uncertainty is likely driven by the relative newness of the products and the large variation in effective nicotine delivery within the product class. Also, no e-cigarette manufacturer has sought approval for use of a product as a quitting aid, so they are not sold with instructions or indications for quitting.
Although there is limited research currently supporting e-cigarette use for quitting, a smoker who switches completely to e-cigarettes from combustible cigarettes will substantially reduce exposure to toxic chemicals and health risk. There is also some evidence that more frequent e-cigarette use may increase an individual’s likelihood to quit. However, concurrent use — also called dual or poly use — of e-cigarettes and combustible tobacco is the most common e-cigarette use pattern among all age groups. Dual use can minimize harms only if such use is of limited duration and not on a long-term basis, leading to the timely quitting of all combustible product use.
So that consumers know which products might help them completely switch from combustible products or quit altogether, the FDA must fully regulate e-cigarettes and develop a properly incentivized pathway for products to be approved as quitting methods.
The Affordable Care Act requires most health insurance plans, including Medicaid expansion, individual insurance plans, small groups plans and employer-provided plans, to cover preventive services that the U.S. Preventive Services Task Force recommends. Health insurance plans are in compliance with this requirement if they cover the following without cost-sharing:
- Screening for tobacco use
- At least two quit attempts per year, including coverage for:
- Four quitting counseling sessions of at least 10 minutes each, including telephone, group and individual counseling without prior authorization
- All seven FDA-approved quitting medications (including both prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by a health care provider without prior authorization
- Traditional Medicaid covers quitting counseling and medications with no cost-sharing for pregnant women. For all other Medicaid enrollees, quitting medications are no longer excludable from coverage. Cost-sharing and coverage of counseling vary by state and plan.
- Medicare covers NRT nasal spray, NRT inhaler, bupropion and varenicline only. Part D plans can cover other quitting medications. Medicare also covers two counseling attempts each year with four sessions of counseling in each attempt. Cost-sharing depends on whether a Medicare enrollee has been diagnosed with an illness that is caused or complicated by smoking.
- TRICARE, the health care program for military services members and their families, covers quitting counseling from TRICARE-authorized providers in the U.S. TRICARE also covers all seven FDA-approved quitting medications (including both prescription and over-the-counter medications) when prescribed by a TRICARE-authorized provider.
ACTION NEEDED: QUITTING TOBACCO
Evidence-based quit treatments lower smoking rates and save lives and money. Research demonstrates the effectiveness of asking about tobacco use, referring smokers to treatment and delivering direct quitting methods by a broad range of health care providers. A large body of research on quit-smoking treatments confirms that a combination of behavioral counseling, medication and social support is the most effective way to treat this deadly addiction. We also know that longer duration and comprehensive services and interventions are more successful in helping people quit. As a result, these services, which are relatively inexpensive, provide a strong return on investment.
INTERESTED IN QUITTING SMOKING?
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