By Thomas J. Glynn, PhD
The American Cancer Society's first Great American Smokeout was celebrated November 18, 1976. Gerald R. Ford was President of the United States, the "War on Cancer" had begun just a few years before, Barack Obama was 15 years old and, according to a Gallup Poll taken that year, 37% of American adults smoked cigarettes.
This year, the 37th anniversary of that first Great American Smokeout, the percentage of Americans who smoke has nearly been cut in half, to 19%. And, those who do smoke use far fewer cigarettes than in 1976, from about 4,000 cigarettes per year for every U.S. adult then, to about 1,200 now.
Certainly, we know that any cigarette smoking is dangerous to the smoker and non-smokers who inhale cigarette smoke. We also know that far too many Americans continue to smoke - 44 million, at last count. Still, astounding progress has been made in combatting what is the nation's largest cause of preventable death and disability.
How do we know what works?
How was such progress made? What actions were taken to achieve such significant changes in the face of the tobacco industry's relentless, illegal, and well-funded efforts to addict men, women, and children to their deadly products? There is no easy answer to that question. But we do know that, over the past 37 years, a wide range of interventions - in communications, education, policy change, and medicine - have been undertaken. Interventions in all of these areas have been effective, but some have been more effective than others.
Research has helped us understand how even the secondhand smoke from cigarettes can be deadly, how cigarette prices affect youth and adult smoking rates, and how to develop medications and treatment plans to help smokers quit.
Approaches to preventing and stopping tobacco use can be divided into two types - individual and population strategies. Individual approaches are usually those that a tobacco user can employ to help in ending his or her habit. Population approaches are broader, often policy-based, strategies that aim to influence entire groups of people to not start using tobacco use or to quit if they already use it.
What works for individuals?
In 1976, when the first Smokeout was held, individuals had little choice or guidance in how they could quit using tobacco, especially cigarettes. There were a few books and magazine articles suggesting quitting methods, but most smokers who wanted to quit were advised to go "cold turkey." Beginning in the early 1980s, however, things began to change as more public places began to go smoke free, products such as the nicotine gum and patch reached the marketplace, and research revealed a number of successful approaches to quitting. Today, smokers who want to quit have a wide range of actions that they can take to help them on their journey to being tobacco-free. These include:
Medications: An earlier blog described in detail how a smoker might go about quitting and noted that there are now 7 medications approved by the FDA as safe and effective aids to quitting. Three of these medications - nicotine gum, patches, and lozenges - are available over-the-counter at most pharmacies and can be helpful in easing the effects of nicotine withdrawal when used as directed. Four other medications - nicotine inhalers, nicotine nasal sprays, Wellbutrin (an antidepressant) and Chantix (which blocks the effects of nicotine in the brain) - are available by prescription. Choosing the right medication for you is often a matter of personal choice and can be discussed with your pharmacist or physician - all work about equally well and can double a smoker's odds of quitting.
Counseling: Brief counseling, whether from a physician, nurse practitioner, pharmacist, or other health care professional, can triple a smoker's chances of successfully quitting when combined with an appropriate medication. Another source of counseling with proven success rates is the telephone quitline, a free service being used by increasing numbers of smokers. It can be accessed anywhere in the U.S. by calling 1-800-QUIT-NOW.
Social support: There is now clear evidence that smokers who wish to quit can increase their chances of success by enlisting the help and support of family, friends, and co-workers. This "team" approach can provide a needed boost when someone trying to quit smoking is tempted to start again. The team can serve as a listening post during the first days after stopping smoking, when nicotine cravings are at their height.
Smoke-free environments: Nearly 50% of the U.S. population is now covered by smoke-free laws in restaurants, workplaces, and bars. Smokers who want to quit should take advantage of this growing network of smoke-free places, since one of the actions that prospective quitters can take to help ensure their success during their quitting process, and for several months afterwards, is to avoid environments where smoking is allowed. The temptation to smoke again is substantially greater in smoky surroundings.
Perseverance: One of the most important findings from recent research on how best to quit smoking is that the smoker needs to view the decision to quit as a process over time and not a single event. This means that it will likely take several serious quit attempts (i.e. not smoking for 24 hours or more) to be successful. And, rather than considering a slip back to smoking during this process as a failure, it should be considered an opportunity to learn from the circumstances of the slip and avoid them next time.
In summary, what works for the individual smoker wishing to quit should involve use of appropriate medications, seeking counseling, assembling a social support team, avoiding smoky environments, and, perhaps above all, persevering.
What works for entire populations?
A broader issue is how entire populations can be influenced to not start tobacco or to quit using it. The goal is to denormalize tobacco use: that is, demonstrate to both children and adults that the tobacco industry is not a "normal" business and that tobacco use, and especially cigarette smoking, is an unhealthy behavior in which most people do not engage.
Some of the most effective strategies include:
Raising prices and taxes on tobacco
Banning tobacco advertising
Adding graphic warning labels to tobacco products
Reducing youth access to tobacco
Providing treatment for tobacco use
Protecting people from tobacco smoke
Taking legal action against the tobacco industry
While some of these and other strategies, e.g. raising cigarettes taxes and increasing the number of smoke-free environments, are particularly effective, and others less so, we do know that using multiple strategies together, and over a long period of time, is most effective.
So, what works in tobacco control depends on whether you're targeting an individual smoker or a whole group of smokers. But we now know that -- 37 years and many successes after the first Great American Smokeout - we have a broad range of interventions that individuals and policymakers can use eliminate tobacco use and its death, disease, and economic disruption.
Dr. Glynn is director of cancer science and trends and director of international cancer control for the American Cancer Society.