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Quitting

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Governments should subsidize all aspects of individual and group level cessation while simultaneously employing strong population-based cessation strategies.

Availability of nicotine replacement therapy (NRT), cessation programs and quit lines, 2012

At any age, quitting smoking benefits health; smoking cessation is one of the best ways to add years to a smoker’s life. Most smokers will make many attempts to quit over a lifetime, and resources should be more easily available to increase their chances for success.

Health professionals should always try to get smokers to stop. People should be asked if they smoke; they should always be advised to stop; and they should be offered assistance in doing so. Several interventions are useful as smoking cessation aids, including counseling and support, nicotine replacement therapy, and the use of medications.

Most people who successfully quit say that simply stopping (“going cold turkey”) was the most effective strategy. Although nicotine replacement and treatment with medicines has been shown to lead to higher sustained quit rates, relatively few people use these approaches, and their impact on a population level has been small. Population-based approaches such as raising prices (see Taxes), limiting advertising (see Marketing Bans), and restricting public smoking (see Smoke-free Policies) have been very effective in reducing tobacco use. In New York City, where such measures have been aggressively pursued, smoking rates have dropped by one-third. A recent Australian study found that three-fourths of the smoking decline there was due to increased taxation, stronger smoke-free laws and mass media campaigns.

It is also crucial to reach teenagers and other young smokers with smoking cessation messages and aids. The younger someone is when they stop smoking, the greater the benefit in terms of year of life saved. Smokers lose a decade of life because of their habit, and someone who quits before the age of 40 reduces their chance of death from tobacco-related illness by 90%.

Sources

Center for Disease Control and Prevention. Global Tobacco Surveillance System Data (GTSSData). Atlanta, GA. 2008-2010 [cited 2014 June 26].

Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. The New England journal of medicine. 2014 Jan 2;370(1):60-8. PubMed PMID: 24382066. Epub 2014/01/03. eng.

Shields M, Garner RE, Wilkins K. Dynamics of smoking cessation and health-related quality of life among Canadians. Health reports. 2013 Feb 20;24(2):3-11. PubMed PMID: 24257905. Epub 2013/11/22. eng.

Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, et al. 21st-century hazards of smoking and benefits of cessation in the United States. The New England journal of medicine. 2013 Jan 24;368(4):341-50. PubMed PMID: 23343063. Epub 2013/01/25. eng.

Vidrine JI, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, et al. Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings. JAMA internal medicine. 2013 Mar 25;173(6):458-64. PubMed PMID: Q Pubmed Central PMCID: PMC3858085. Epub 2013/02/27. eng.

Gollust SE, Schroeder SA, Warner KE. Helping smokers quit: understanding the barriers to utilization of smoking cessation services. The Milbank quarterly. 2008 Dec;86(4):601-27. PubMed PMID: 19120982. Pubmed Central PMCID: PMC2690372. Epub 2009/01/06. eng.

Smith AL, Chapman S. Quitting smoking unassisted: The 50-year research neglect of a major public health phenomenon. JAMA : the journal of the American Medical Association. 2014;311(2):137-8.

Smith AL, Chapman S, Dunlop SM. What do we know about unassisted smoking cessation in Australia? A systematic review, 2005-2012. Tobacco control. 2013 Sep 11. PubMed PMID: 24026163. Epub 2013/09/13. Eng.

Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, Rigotti NA, et al. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature. Drugs. 2013 Apr;73(5):407-26. PubMed PMID: 23572407. Pubmed Central PMCID: PMC3662024. Epub 2013/04/11. eng.

Kaur K, Kaushal S, Chopra SC. Varenicline for smoking cessation: A review of the literature. Current therapeutic research, clinical and experimental. 2009 Feb;70(1):35-54. PubMed PMID: 24692831. Pubmed Central PMCID: PMC3969980. Epub 2009/02/01. eng.

Sacks R, Coady MH, Mbamalu IG, Johns M, Kansagra SM. Exploring the next frontier for tobacco control: Nondaily smoking among New York City adults. Journal of environmental and public health. 2012;2012:145861. PubMed PMID: 22685481. Pubmed Central PMCID: PMC3363994. Epub 2012/06/12. eng.

Wakefield MA, Coomber K, Durkin SJ, Scollo M, Bayly M, Spittal MJ, et al. Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011. Bulletin of the World Health Organization. 2014 Jun 1;92(6):413-22. PubMed PMID: 24940015. Pubmed Central PMCID: PMC4047797. Epub 2014/06/19. eng.

Smokers want to stop

Percent of smokers who intend to quit, or have tried to

 
In many countries, most current smokers would like to give up smoking. In Malaysia, up to 71% of current smokers intend to quit smoking, and nearly 50% of smokers made attempts to quit in 2011

Benefits of quitting

Former smokers’ risk of death, by age at quitting: UK Million Women Study, ages 55–63

 
Health benefits of cessation emerge rapidly and quitting smoking at any age is beneficial to health. Former smokers who stop smoking at about 30 and 40 years old reduce their risk of dying from lung cancer by 97% and 90%, respectively.

“WE DO NOT HAVE A PRODUCT THAT MEETS THE NEEDS…OF EX-SMOKERS. Many…will resume smoking, and the product that they choose could cause a swing in market share. These quitters…are dissatisfied with certain aspects of a product that previously met their needs…a textbook example of a market opportunity.” –Philip Morris Report, 1998

96M

“Of the 445 million people… who live in the world’s 100 largest cities, only about 96 million (in 21 cities) have access to appropriate cessation support.”

–World Health Organization, 2013

Jan Jones’s 1988 report to Dr. Ed Gee at Philip Morris suggests that the industry develop brands specifically targeted towards recapturing quitters: “These quitters (and those who are soon to become quitters) are dissatisfied with certain aspects of a product that previously met their needs… a textbook example of a market opportunity.”

“Our estimates of China’s burden of mortality attributable to smoking… suggest that substantial health gains could be made—a 40% relative reduction in smoking prevalence and almost 13 MILLION SMOKING-ATTRIBUTABLE DEATHS AVERTED AND MORE THAN 154 MILLION LIFE YEARS GAINED BY 2050 —by extending effective public health and clinical interventions to reduce active smoking” -David Levy et al, British Medical Journal , 2012

Those who have smoked cigarettes since early adulthood but stop at 30, 40, or 50 years of age gain about 10, 9, and 6 years of life expectancy, respectively, as compared with those who continue smoking.

United States

In the USA, 85% of smokers say they have tried to quit at least once in their lifetime.

Jan Jones’s 1988 report to Dr. Ed Gee at Philip Morris suggests that the industry develop products that decrease social pressures in order to capture new smokers: “Taking measures to create a socially acceptable cigarette product could extend the social circle of smokers, alter the meaning (stigma) associated with the behavior, and thereby significantly alter the product life cycle of cigarettes”

Jan Jones’s 1988 report to Dr. Ed Gee at Philip Morris suggests that socially acceptable products may help recapture quitters: “It appears that a number of smokers have considered quitting. Smokers who buy by the pack rather than by the carton often explain their choice as “not knowing when I might quit.” If a socially acceptable product became available, the change in behavior may be simply a change of brand. The top ranking of any new product concept thought to reduce health risks or social pressures support this position.”

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