Cigarette smoking in 2018 hit its lowest rate ever in the United States, but physicians and public health officials need to do more to promote FDA-approved smoking-cessation methods to patients who smoke, according to the Surgeon General's 34th Smoking Cessation report.
Smoking hits all-time low, but some patients are having trouble quitting
According to the report, the number of U.S. adults who smoke cigarettes dropped from 42% in 1964 to its lowest rate ever at 13.7% in 2018. The report confirmed that quitting tobacco has major health benefits at any age. For instance, the report found smoking-cessation can add a decade to a person's life expectancy and reduce the risk of heart disease, lung disease, and 12 different types of cancer.
But an estimated 34 million U.S. adults still smoke cigarettes, and smoking remains the leading cause of preventable death and disease in the United States, according to the report.
There's some good news. The report found that about 70% of adult smokers want to quit, and more than 50% attempt to drop the habit each year. But U.S. Surgeon General Jerome Adams said those patients are not being connected with FDA-approved smoking cessation methods, such as medications and behavioral counseling.
The report found that 44% of adults who smoke cigarettes said they did not receive smoking-cessation advice from their clinicians, despite the fact that 84% of smokers said they saw a health professional that year. And those rates varied by race and type of insurance coverage.
For instance, white adults were more likely to report receiving smoking-cessation advice from a health care professional than black, Asian, and Hispanic adults, according to the report. White adults also were more likely to use smoking-cessation medications and behavioral counseling.
In addition, about 66% of Medicare beneficiaries received smoking-cessation advice from a health care professional, compared with 59% of Medicaid beneficiaries, 57% of adults covered by private insurance, and 44% of uninsured adults.
And Adams, speaking about the report, also noted that there's not yet enough evidence around e-cigarettes to recommend the devices as a successful smoking-cessation tool. In fact, the report noted that early data suggest e-cigarettes are actually introducing some young adults and teenagers to tobacco and cigarette smoking.
Overall, Adams said, "The biggest take-home from this report is that far too many people who want to quit aren't getting access to the cessation treatments that we know work."
He noted that the percentage of Americans not receiving smoking cessation advice from a health professional was "a shocking statistic to me, and it's a little embarrassing as a health professional." Adams recommended that doctors and public health officials take more time to discuss FDA-approved cessation methods with patients, particularly populations with high smoking rates such as gay and transgender people, Native Americans, and people with mental health conditions.
Adams said, "It's easy for me, who lives in the suburbs, to think that no one smokes anymore—when I look around, I don't see anyone smoking, and we're at historically low numbers," Adams said. "But the fact is many groups have been left behind by the progress we've made over the last several decades."
David Abrams, a professor of social sciences in New York University's school of public health, said the report confirmed that "more resources, priority science and urgency is needed to find out how with whom and under what conditions we can use vapes to help any smokers at any age to switch if they are unable to or don't want to stop using nicotine but don't want to die" (Johnson, Modern Healthcare, 1/23; O'Donnell, USA Today, 1/23; Guerguerian, NBC News, 1/23; Kaplan, New York Times, 1/23).