November is Lung Cancer Awareness month and the Great American Smokeout is Thursday, Nov. 15. The Centers for Disease Control has just issued new figures on trends in smoking and quitting. If you smoke, love, or live with a smoker, here is what you need to know about smoking realities behind the numbers.
1. The U.S. Centers for Disease Control reports this month that the rate of smoking was stagnant from 2010 (19.3 percent) to 2011 (19.0 percent). 
What you need to know: While adult smoking rates in the general population were cut in half between 1965 and 2004, from 42.4 percent to 20.9 percent, the ratio of heavy and dependent smokers who meet the psychiatric definition of "nicotine dependence" is steadily rising. Some subsets of smokers, like those with clinical depression and other psychiatric or substance abuse problems, still show rates of smoking unseen in the general population since the release of the Surgeon General's report in 1964. These types of smokers are just not showing the rates of cessation found in the overall population of smokers. [1, 2]
That helps explain the stubborn lack of progress in smoking rate reduction since 2004.
2. The CDC also reports this month that while about 70 out of every 100 smokers would like to quit, only about 6 out of every 100 smokers reported successfully quitting in the past year!  About 70 percent of smokers who are trying to quit do not use any form of counseling or medication such as NRT (nicotine replacement therapy). 
What you need to know: While it is true, as some public health officials point out, that there have been cuts in public health funding for anti-smoking campaigns, it is also true that recent studies have questioned the effectiveness of the approaches that are being funded. These primarily consist of giving out nicotine patches, with minimal telephone counseling, for those still struggling to quit. 
Cognitive-behavioral treatment (CBT) has been shown to be far more effective than just offering NRT by itself or paired with brief structured or motivational interventions.  Yet today's struggling smokers are almost never offered this effective clinical smoking cessation service despite research showing excellent economic returns for cessation. 
3. The CDC also reports this month that while the proportion of smokers who light up more than 30 cigarettes per day has significantly declined, the proportion of smokers lighting up 1-9 cigarettes per day rose.
What you need to know: Many of these "light" smokers are still struggling to quit and many, in truth, might be better described as "incomplete quitters" instead of "occasional smokers." Many, instead of quitting, have trained themselves to wait to smoke, which can be as highly reinforcing as playing a slot machine is for a gambler.
4. The benefits of quitting smoking are clearer than ever. A study of over a million women in the U.K. published in The Lancet last month found that two out of every three deaths of women smokers in their 50s, 60s and 70s were caused by their smoking.  These women lost "at least 10 years of lifespan." Women who quit before age 40 avoided 90 percent of this excess mortality; women who quit before age 30 avoided 97 percent. While the benefits are best if you quit early, other research shows that even later in life there are important benefits from quitting such as greater independent living and fewer doctor visits.
What you need to know: Although the sooner you quit, the better, there can be many quality of life benefits to quitting later in life as well.
Dr. Daniel Seidman is director of smoking cessation services at Columbia University Medical Center and author of Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit, with a foreward by Dr. Mehmet Oz (Simon & Schuster 2010). For more details about the book, go to www.danielfseidman.com.
(1) CDC, Current Cigarette Smoking Among Adults -- United States, 2011 Weekly November 9, 2012 / 61(44);889-894 -- http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a2.htm?s_cid=%20mm6144a2.htm_w
(2) Renee D. Goodwin, Katherine M. Keyes, Deborah S. Hasin. Changes in Cigarette Use and Nicotine Dependence in the United States: Evidence From the 2001-2002 Wave of the
National Epidemiologic Survey of Alcoholism and Related Conditions. American Journal of Public Health: August 2009, Vol. 99, No. 8: 1471-1477.
(3) CDC, Quitting Smoking Among Adults-United States, 2001-2010, November 11, 2011 / Vol. 60 / No. 44 -- http://www.cdc.gov/tobacco/data_statistics/mmwrs/byyear/2011/mm6044a2/highlights.htm
(5) Hall, S. M., Humfleet, G. L., Munoz, R. F., Reus, V. I., Robbins, J. A., et al. (2009). Extended treatment of older cigarette smokers. Addiction, 104, 1043-1052.
(6) Kenneth E. Warner, David Mendez, and Dean G. Smith The Financial Implications of Coverage of Smoking Cessation Treatment by Managed Care Organizations Inquiry, Vol. 41, No. 1 (March 2004) pp. 57-69
(7) The Lancet, Early Online Publication, 27 October 2012, The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Kirstin Pirie, Richard Peto, Gillian K Reeves, Jane Green, Valerie Beral, for the Million Women Study Collaborators -- http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext
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