Most Smokers Want to Quit; Few Get Help



Most smokers in the United States want to quit, but when they try, they do so without medications or formal counseling from health professionals, according to a new study by the Centers for Disease Control and Prevention.

In 2010, 69% of adult cigarette smokers said they wanted to quit, and 52.4% had recently tried to do so for more than 1 day.

Copyright milosluz/istockphoto.comThe study shows that the 45.3 million Americans who still smoke are as interested in quitting as they were 10 years ago.

Still, 68.3% of current smokers who tried to quit did so without using evidence-based cessation counseling or medications, and fewer than half (48.3%) of those who saw a health professional in the past year reported receiving advice to quit.

"What this means is that there’s significant room for improvement in this arena because use of these treatments can double or triple success rates," Dr. Tim McAfee, director of the Office of Smoking and Health, said during a press briefing on the report, which appears in the Nov. 11 Morbidity and Mortality Weekly Report (MMWR 2011 Nov. 11;60:1513-9).

Among those who visited a health care provider, women (51.7%) were more likely than were men (44.8%) to have received a health professional’s advice to quit. More than half of those aged 65 years and older (57%) received such advice.

Among the various racial groups, Hispanics were the least likely to have received advice, at 34.7%, compared with 50% of whites and 46% of blacks, according to the study, which was based on 2001-2010 National Health Interview Survey data.

When asked by reporters how the overall 48% counseling rate stacks up with previous years, Dr. McAfee said it’s lower than in their previous surveys, but added that the current survey had changed and that an earlier question on tobacco use had been removed.

"We’re not sure if this is a real trend or an artifact in the way the survey questions were administered," he said.

Ann Malarcher, Ph.D., lead author of the study, said other national data sets that examine whether smokers receive advice to quit are showing no change over time. Those data sets show counseling rates as high as 60%.

One of the more troubling findings in the report is that non-Hispanic blacks had the highest level of interest in quitting and the most quit attempts in the past year, but also the lowest rate of successfully quitting, at 3.3% vs. 6% for whites and 9.5% for Hispanics.

One possible explanation for the lower success rate is that blacks were less likely to use counseling and/or medication than were whites (21.6% vs. 36%). In addition, blacks are three times more likely than whites were to smoke menthol cigarettes (76.7% vs. 23.6%), which has been found to reduce the likelihood of quitting, Dr. McAfee said.

The report, which was released 1 week ahead of the Great American Smokeout set for Nov. 17, also found marked differences in successful smoking cessation by education level and insurance status. Just 3.2% of smokers with less than a high school education quit smoking, compared with 11.4% of those with a college degree. Notably, 7.8% of those with private insurance reported quitting, compared with 4.6% receiving Medicaid, 5.5% with Medicare, and 9.3% in the military.

One encouraging piece of news in the report is that there has been an annual increase in quit attempts over the last 10 years for smokers aged 25-64 years, Dr. McAfee said. During the same period, quit attempts remained stable among younger smokers, aged 18-24 years, and those aged 65 years and older.

Overall, 6.2% of smokers reported stopping smoking. It’s hard to say how this compares with previous years because other surveys didn’t typically ask this, although it is a new measure required for the Healthy People 2020 objective, Dr. Malarcher said.

"Why we added that measure for these objectives is that we really want to look at recent success," she said. "We hope to move the needle and get more people to quit each year over time."

When asked how those who quit smoking did so, Dr. McAfee responded, "We’re not sure, but of those who made a quit attempt, just under one-third received counseling and medication."

He acknowledged the controversy over the use of varenicline (Chantix) and advised smokers to ask their physician. He added that the smoking-cessation drug is effective and that data on the reported neuropsychiatric effects are mixed. Notably, a study reported last week that varenicline was eight times more likely to be linked with suicidal behavior or depression than were other nicotine replacement products (PLoS One 2011 Nov. 2; [doi:10.1371/journal.pone.0027016]), while two recent Food and Drug Administration–sponsored studies found no relationship between varenicline use and the risk of psychiatric hospitalization.

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