The Surgeon General on Thursday issued a new report on smoking cessation, outlining the economic impacts of smoking addiction in the U.S. and detailing science-based strategies that have proved to be effective for both individuals and healthcare systems in curbing smoking rates.
"Smoking Cessation: A Report of the Surgeon General," released by the U.S. Department of Health and Human Services, is the 34th Surgeon General's report on tobacco and the first since 1990 to focus solely on getting people to quit smoking.
Although cigarette smoking among American adults is at an all-time low of 14%, it remains the leading cause of preventable disease, disability and death in the U.S. About 34 million American adults currently smoke cigarettes; Surgeon General Jerome Adams said Thursday that translates to a cost of about $300 billion per year.
"This is not just a toll on our personal and physical health," said Adams. "It's a toll on our economy and our nation."
WHAT'S THE IMPACT
According to the report, more than half of smokers attempt to quit in a given year, but they face significant challenges, including visits with providers who fail to adequately educate them on the health benefits of quitting and the interventions that may empower them to do so.
Adams said that 40% of smokers who see a health provider aren't advised by the provider to quit -- a practice that, if implemented, could significantly curb healthcare costs and improve people's health.
"Another challenge is that disparities in smoking cessation behaviors persist in our nation," said Adams. "It's easy for me in the suburbs to believe that no one smokes anymore, but the truth is that many groups have been left behind by the progress we've made over the past several decades."
In particular, the LGBTQ community, racial/ethnic minorities, and people with mental health or substance abuse disorders remain quite vulnerable to tobacco addiction, with smoking rates remaining higher among those groups, according to the report.
"One of the problems is we think people in these populations don't want to quit, or can't quit," said Adams. "We know based on the report that's not true. They're trying to quit. They want to quit."
Among the strategies providers and health systems should employ are the promotion of behavioral counseling and FDA-approved smoking cessation medications. Both counseling and medication are effective on their own, but their success rates increase greatly when implemented in tandem.
Smoking cessation can be increased by raising the price of cigarettes, adopting comprehensive smoke-free policies, implementing mass media campaigns, requiring pictorial health warnings and maintaining comprehensive statewide tobacco control programs, the report found.
In addition, insurance coverage for smoking cessation treatment that is comprehensive, barrier-free and widely promoted increases the use of these treatment services, leads to higher rates of successful quitting and is cost-effective, officials said.
POTENTIAL ROLE OF E-CIGARETTES
Also addressed in the report was the potential role of electronic cigarettes in smoking cessation. E-cigarettes and vaping have been subjects of some controversy recently; earlier this month, HHS announced a new enforcement policy that targets vape products especially enticing to young people, as the government takes steps to curb the prevalence of vaping among America's youth.
The policy is fairly specific when it comes to the types of e-cigarette products it will target. In the federal crosshairs are pod- or cartridge-based e-cigarettes, such as the popular Juul product, and vape flavors such as mint that are likely to appeal to children.
E-cigarettes that operate on an open tank system -- in which users add flavors manually -- have a little more leeway under the new enforcement policy, although manufacturers of open tank e-cigarettes will still be required to apply for FDA clearance. Open tank products are generally larger and more cumbersome than the Juul, rendering them far less attractive to children, who tend to sneak vapes into school bathrooms.
The primary reason for the more relaxed enforcement of open tank systems is to keep products on the market that may allow adults to transition away from traditional, combustible cigarettes -- a cessation strategy acknowledged in the new report.
"The report says e-cigarettes are a changing and diverse group of products, and it's difficult to make generalizations on the effectiveness of them for cessation," said Adams. "Evidence shows e-cigarette use can help with smoking cessation. Some studies say certain e-cigarettes may be associated with quitting in some smokers. One hundred fifty experts say, right now, that more research is needed on whether e-cigarettes in general are effective."
Several lung injuries and deaths were linked to vaping in 2019, though the source of these sudden and startling injuries seems to have been linked to vitamin E acetate, a solution most commonly found in black-market THC vaping cartridges, and rarely found in e-cigarette products. Although vitamin E acetate seems to be the most likely culprit, health officials caution it's too soon to rule out other causes.
THE LARGER TREND
Smoking cessation efforts, from the health system, the community or the patients themselves, could ultimately be a strong investment that allows the hospital to retain more reimbursement dollars and curb readmissions, according to Mount Sinai research from 2019.
Readmissions occur for almost 20% of patients hospitalized in the U.S. and are associated with patient harm and expenses. Rates of unplanned readmission within 30 days after discharge are used to benchmark a hospital's performance and quality of patient care. Yet clinicians are often poorly equipped to identify patients who will be readmitted, and many readmissions are thought to be preventable.