to making serious quit attempts (about 45 percent try seriously to quit each year). If at first a smoker is not successful at quitting (over 90 percent are not), the arduous journey continues with cycles of trying to quit but relapsing to trying again. Some smokers may give up and feel too exhausted or perhaps even a bit ashamed to keep trying or to risk admission of repeated failure to their family, friends, and relatives. All too often a smoker may use unproven treatments or willpower to quit (over 75 percent do that). There are other barriers that a smoker needs to overcome, such as the cost of formal treatment or a lack of ability to discern ineffective from evidence-based treatments. There is no Consumer Reports or Good Housekeeping Award to guide one’s choice of cessation products and services. Perhaps a lucky smoker may eventually quit on his or her own or with the use of an effective cessation product or service. Finally, the journey ends when the smoker either quits for good or suffers and dies from a smoking related cause (about one third to one half of lifetime smokers will die of a smoking-related disease).
Now that research has helped us understand so much of this journey, the challenge is to put what we know into practice and policy, and there is not a moment to lose as over 430,000 of our friends and fellow U.S. citizens die prematurely each year from their smoking addiction (that equals three fully loaded jumbo jets crashing with no survivors every single day, including weekends and holidays).
There is substantial room to find more leverage points to improve the overall cessation outcome rate at every step of the way along a smoker’s journey to freedom from their addiction. This opportunity can only be fully realized with strong political will to do the right thing by designing cessation policies that support a comprehensive, systems approach to cessation intervention. This approach should provides aggressive, direct-to-consumer marketing and education campaigns to improve smoker’s health literacy about the dangers of smoking and the best tools for quitting. It should also cover the critical leverage points along the entire smokers’ journey, from being a slave to smoking to eventual freedom from tobacco addiction, and should provide interventions tailored to the smoker’s needs. This can be achieved through cessation policies that support a comprehensive care management network as well as cessation policies that ensure adequate resources and aligned financial incentives at federal, state, and local levels across both the delivery systems within the health care industry and across the broader public health system.
Effective cessation programs are available but greatly underutilized, despite the social climate that is making it more difficult to smoke (e.g., bans in worksites, higher taxes). Decades of research, clinical practice guidelines, and meta-analyses provide solid evidence of the efficacy and cost effectiveness of smoking cessation interventions. Interventions include behavioral and pharmacological options ranging in intensity and cost from minimal (e.g., self-help) to maximal (e.g., inpatient treatment).
Less than 50 percent of the over 45 million current U.S. smokers make a quit attempt each year. Of those that try to quit, over 75 percent do so on their own without evidence-based programs and, of those, over 95 percent relapse. Using even a minimal intensity/brief cessation program generally doubles the likelihood of success. There is also a dose-response relationship such that use of more intensive programs and use of combined pharmacological and behavioral programs can triple to quadruple the likelihood of success.
As indicated by the available scientific evidence and computer simulation modeling (see work of Levy, Appendix J, and Mendez, Appendix K), even a conservative increase in the reach (number or percentage of smokers out of all current smokers who make a quit attempt each year) and a modest improvement in effectiveness (percent of smokers who use evidence-based programs and thereby increase their chances of maintenance of cessation) can play a very significant