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Smoking Cessation Health Article

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So You Want To Quit Smoking

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HEALTH CARE SYSTEM SUPPORT FOR TREATMENT OF TOBACCO-USE

Several guidelines recommend that health care systems institutionalize the consistent identification, documentation, and treatment of every tobacco users. Another recommendation is to provide full insurance coverage for medication and counseling related to tobacco use. Data show that reducing cost barriers not only increases the use of more effective treatments but also increases the number of people who successfully quit.

Tobacco-dependence treatments are both clinically effective and highly cost-effective relative to other medical and disease prevention interventions. Treatment of tobacco use costs $2,600 per year of life saved compared with $62,000 for mammograms and $23,000 for the treatment of hypertension.

Model Clinical Treatment Programs. Group Health Cooperative (GHC) of Puget Sound, a Seattle-based managed care organization, provides comprehensive coverage for smoking cessation. Treatment includes telephone or group behavioral counseling and medications to support the quit process. This program enrolls 8 percent of all smokers in GHC into the treatment program each year and has a 30 percent long-term quit rate. Smoking has declined at a faster rate among GHC enrollees than among the general population of Washington State. It is estimated that this program paid for itself within four years.

SPECIAL POPULATIONS

Pregnant Women. If a woman is pregnant or nursing it is especially important for her to quit smoking—to protect her own health and the health of the baby. Counseling is the primary treatment recommended for pregnant women. A pregnant woman who is a heavy smoker and unable to quit should consult her physician about the possible use of medication.

Young People. Since most tobacco use begins during adolescence, it is important to prevent onset of tobacco use and to encourage cessation at a young age. Half of adolescent smokers say they want to stop smoking cigarettes completely and about six of ten report that they seriously tried to quit in the past year. Unfortunately, adolescent tobacco users can become addicted to nicotine within the first weeks of use, and most adolescents experience symptoms of nicotine withdrawal when they try to quit. Therefore, adolescents are as likely to relapse as adults are. It is unclear which interventions will help adolescents quit. However, some adolescent prevention and cessation programs show promise in increasing quit rates.

POPULATION APPROACHES TO CESSATION

The Community Preventive Services Task Force reviewed the effect on cessation of population approaches, including media campaigns, cigarette tax increases, and clean indoor air laws, and found that media campaigns and price increases promoted cessation. Clean indoor air policies decrease the number of cigarettes smoked per day; though the impact on cessation is less clear.

CESSATION ACTIVITIES IN THE UNITED STATES

California and Massachusetts have developed comprehensive programs that include media campaigns, community interventions, and state-sponsored telephone quit lines. These programs have been successful in increasing smoking cessation. Oregon has collaborated with managed care organizations to improve treatment and also provides telephone counseling and medication to Medicaid clients. Florida has developed a very successful media campaign and community intervention that reduced smoking by young people.

Comprehensive programs directed at both young people and adults that focus on decreasing initiation, increasing cessation, and decreasing exposure to ETS have proven effective. In California, comprehensive tobacco-control programs and policies have been associated with accelerated declines in cardiovascular disease and deaths from lung cancer compared to the rest of the nation.

State Roles. The Center for Disease Control and Prevention's 1999 Best Practices for Comprehensive Tobacco Control Programs suggests that comprehensive state programs include the following (1999):

Community programs to reduce tobacco use.
Chronic disease programs to reduce the burden of tobacco related disease.
School programs to reduce tobacco use by young people.
Enforcement of clean indoor air and minors' access laws.
Statewide programs.
Counter-marketing campaigns.
Cessation programs.
Surveillance and evaluation.
Administration and management.

Combining individual, systems, and population-based approaches that increase cessation offers the best opportunity to reduce morbidity and mortality from tobacco use, which is the leading preventable cause of death in the United States. The clinician's role is to assess every patient's tobacco use and interest in quitting, advise those who smoke to stop, offer individual, group, or telephone counseling, and encourage patients to use effective medications. The role of the health care system is to implement system changes to support routine tobacco treatment by clinicians and to monitor the effect of treatment through quality performance measures.

Employers also play a role, which consists of providing insurance coverage for cessation services, providing treatment services at the worksite, and establishing smoke-free buildings or campuses. Finally the role of the government is to increase the price of tobacco products, implement media campaigns, enact clean indoor air policies and laws, regulate tobacco products, and ensure insurance coverage of tobacco use treatment.

CORINNE G. HUSTEN

ABBY C. ROSENTHAL

MICAH H. MILTON

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Author Info: CORINNE G. HUSTEN, ABBY C. ROSENTHAL, MICAH H. MILTON, The Gale Group Inc., Macmillan Reference USA, New York, Gale Encyclopedia of Public Health, 2002