Few Smokers Who Want to Quit Seek Healthcare Provider Help

Approximately half of US adult smokers tried to quit in 2022, but fewer than 40% used counseling or medication, and half received assistance or advice about quitting from clinicians, based on a review in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Previous research has shown that clinician intervention and evidence-based treatment increase the odds that smokers can quit successfully, but the extent to which these interventions are applied in practice has not been well studied, the researchers noted. 

Although great progress has been made in reducing cigarette smoking in the United States, disparities remain, both in use and in cessation, with an estimated 28.8 million adults reporting cigarette smoking in 2022, said lead author Brenna VanFrank, MD, MSPH, in an interview.

“Cigarette smoking remains the leading preventable cause of death and disease in the United States,” said VanFrank, Senior Medical Officer, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

In a new review, the researchers examined data from the 2022 National Health Interview Survey. The study population included 27,651 adults aged 18 years and older. Current smoking was defined as currently smoking each day or some days and ever having smoked at least 100 cigarettes. The survey assessed the individuals’ interest in quitting, past-year quit attempts, recent quitting success, receipt of healthcare professional advice about quitting, use of counseling to help quit, and use of medication to help quit. 

In 2022, approximately two thirds (67.7%) of the 28.8 million adult smokers in the United States wanted to quit, half (53.3%) tried to quit, but only 8.8% were successful. Of those who reported trying to quit, 38.3% used counseling or medication. Of these, 36.3% used medication, 7.3% used counseling, and 5.3% used both. 

Indicators of smoking cessation varied by health characteristics and sociodemographic factors, with the highest prevalence of attempts to quit smoking in the past year among adults aged 18-24 years and the lowest among those aged 45-64 years (74.4% vs 47.5%). 

Rates of successful quitting were highest among individuals with higher levels of education and income, and use of smoking cessation treatment was highest among White adults (42.7%), followed by non-Hispanic adults of another race, Black adults, and Hispanic adults (33.6%, 32.6%, and 28.8%, respectively). 

Smokers of menthol cigarettes had similarly low success rates for quitting (< 10%), although they were significantly more likely than nonmenthol cigarette smokers to express interest in quitting (72.2% vs 65.4%). Smokers of menthol cigarettes also had significantly lower prevalences than smokers of nonmenthol cigarettes of receiving clinician advance to quit and using treatment strategies (both P < .05).

The study findings were limited by several factors including the use of self-reports, which may be subject to bias, and a lack of data on institutionalized adults or adults in the military, which may limit generalizability of the findings to those populations, the researchers noted. 

However, the results suggest that opportunities exist to increase smoking cessation across public health and health care sectors by expanding access to and use of services and supports to help smokers quit, they wrote.

Ensuring Support for All Smokers Seeking to Quit

The takeaway for clinical practice remains that quitting smoking “is one of the most important actions people who smoke can take to improve their health,” VanFrank told Medscape Medical News.

“It is important to ensure everyone has an opportunity to quit smoking and has access to proven treatments to help them be successful,” she emphasized. Strategies that include behavioral counseling, cessation medications, and advice and support from healthcare professionals can increase quit success, she said. Given that tobacco dependence is a chronic, relapsing condition driven by addiction to nicotine, quitting successfully often takes multiple tries, and those trying to quit may need long-term support and repeated treatment, VanFrank added. 

“Health systems changes, such as adoption of treatment protocols and standardized clinical workflows, can systematize clinical treatment delivery, and such changes might also serve to increase treatment access for the 75% of adults who smoke who see a healthcare professional in a given year,” said VanFrank. 

As for additional research, “Continued surveillance of tobacco use and cessation-related behaviors will help us monitor progress and identify continued opportunities to eliminate tobacco product use and tobacco-related disparities,” VanFrank told Medscape Medical News.

“We know a lot about what works to help people successfully quit smoking and what we can do to support people in making quit attempts,” she said. Including equitable opportunities in all commercial tobacco prevention and control efforts has the potential to reduce tobacco-related health disparities, she added. 

Overall smoking prevalence in the United States and the current study shows that most smokers would like to quit, said David M. Mannino, MD, a pulmonologist and professor of medicine at the University of Kentucky, Lexington, in an interview. The lack of success experienced by many smokers seeking to quit emphasizes the highly addictive nature of nicotine products, which cause death and disease when used as directed, said Mannino, who was not involved in the study.

The results of the review were not surprising, and reflect where tobacco treatment has been for the past 20 years, said Mannino. The good news is that smoking prevalence has continued to drop in the United States over the past 15 years, he said. However, some bad news is that use of e-cigarettes/vaping is still increasing, especially in younger populations, and new nicotine delivery systems, such as pouches (Zyn) are addicting a new generation, he noted. 

Always Ask About Smoking

In practice, “clinicians should always ask patients about cigarette smoking, as well as vaping and other nicotine use, advise them to quit, and refer them to tobacco treatment experts,” Mannino emphasized.

The bottom line is that better treatments are needed for tobacco/nicotine addiction, Mannino told Medscape Medical News. “Although we have come a long way, we have a long way to go as millions of smokers in the US and globally would like to quit,” he said.

Tobacco related disease continues to be the number one cause of morbidly and mortality in the United States, and although many current smokers want to quit, most are not successful, said Jamie Garfield, MD, professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, in an interview. 

“This review highlights the sheer number of current cigarette smokers who want to quit, how many of them attempted to quit, and how many of those were successful,” said Garfield, who was not involved in the study. Understanding the characteristics of individuals who are more or less likely to successfully quit smoking can help public health and health care sectors to increase smoking cessation by expanding access to and use of services and supports, she said. 

“We have to do better to control the sale of tobacco products and make tobacco cessation more accessible to everyone,” Garfield told Medscape Medical News. In addition, clinicians need to be consistent in asking patients about tobacco use, she said. “If we don’t ask, we will not know who needs help.” Behavioral counselling helps, as does pharmacotherapy, and the two together are more effective than either alone, she added. 

Cessation services need to be tailored to the many demographic groups who use tobacco products, said Garfield. “Just as marketing campaigns directed to older adults will be different from those directed to young adults, so too must cessation resources,” she said. “Providers need better options to choose from with regard to cessation resources and behavioral counselling sessions. They need to be aware of what motivates one group of people to smoke and how they can be inspired to quit, including which pharmacotherapies are affordable, available, and will work; the same strategies will not work for all people,” Garfield emphasized.

The study was supported by the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion. The researchers had no financial conflicts to disclose. Mannino disclosed serving as an expert witness for on tobacco use and tobacco-caused disease on behalf of people suing the tobacco and vaping industries. Garfield had no financial conflicts to disclose.