MD Anderson cancer experts identify five critical advances to combat tobacco use as America observes a major anti-smoking milestone
Fifty years ago this month, The U.S. Surgeon General jumpstarted America’s efforts to combat lung cancer and other diseases caused by smoking with the release of the 1964 U.S. Surgeon General’s Report on Smoking and Health.
The landmark report shined the light on the dangerous consequences of smoking and causally linked it to lung cancer and several other health diseases and complications. It led to mandatory health warnings on tobacco products and the eventual ban of smoking ads on TV and radio. Not only did the report have a major impact on public attitudes, it mobilized individual smokers and non-smokers, communities, health care organizations, policy makers and educators to join forces and address the issue.
“This document was the first of its kind and was followed by many other reports of the Surgeon General on Smoking and Health,” said Ellen R. Gritz, Ph.D., professor and chair of Behavioral Science at MD Anderson.
As a contributor to the first Surgeon General’s Report on Women and Smoking (1980) and eight additional Surgeon General Reports on Smoking and Health, Gritz has witnessed many advances in smoking-cessation since the initial report.
Its impact was reflected recently in a paper published last week in the Journal of the American Medical Association (JAMA) that showed eight million lives were saved as a result of tobacco control efforts.
Five key areas contributed to smoking decline
Several anti-tobacco efforts have contributed to the smoking decline in the U.S. Fifty years ago, more than 50 million Americans smoked cigarettes and other tobacco products. Today, adult smoking rates have decreased by more than half since 1965, and there is a steady decline among children and adolescent smokers. Rates have been reduced by half, but still about 43 million people smoke due to the increased population and millions more exposed.
MD Anderson experts have identified five critical developments to curb smoking and combat lung cancer.
- Taxation - Excise tax increases at the federal and state level have made the products less affordable and accessible to youth and lower-income people.
“Taxation is the single most important factor in reducing smoking rates,” said Gritz.
- Regulation and legislation – Key laws and regulations have played a major role in helping smokers quit. Regulations include imposing mandated warnings on tobacco products and prohibition of TV and radio advertisements. Most recently, bans on smoking in public places and further restrictions on the sale and distribution of cigarettes to minors are considered victories.
“We are making progress with actions like insurance coverage for smoking cessation treatment and federal community transformation grants like the one implemented in Austin promoting comprehensive tobacco control programs,” said Lewis Foxhall, M.D., vice president of health policy at MD Anderson.
- Medications to help smokers quit – The Federal Drug and Alcohol Administration (FDA) approved three over-the-counter nicotine replacement agents (patch, gum, lozenge), two prescription nicotine replacement agents (inhaler and nasal spray), and two prescription drugs – bupropion and varenicline – all shown to have a strong positive effect on smokers trying to quit.
- Educational programs for kids and adults - Programs like the national effort with Tobacco Free Kids and MD Anderson’s ASPIRE and Tobacco Free Teens app – all aimed at educating youth and adolescents on smoking prevention – have a significant impact in reducing the number of new smokers. Broadbased widely disseminated comprehensive education campaigns addressing the serious harms of tobacco to the general public have been effective.
“Educational programs, along with policies and campaigns have changed the social norms in our society making tobacco use less socially acceptable, particularly among youth,” said Alexander Prokhorov, M.D., Ph.D., professor of behavioral science at MD Anderson.
- Cessation programs for smokers – There are a variety of resources and programs to help smokers quit. MD Anderson’s Tobacco Treatment Program – one of the leading tobacco research and clinical programs in the country aimed at cancer patients – uses counseling and pharmacotherapy tailored to the individual patient.
“Together, these different efforts create a comprehensive package to help people quit smoking and prevent them from starting,” said Gritz. “Continuation of the combined strategies and bold actions will be critical to reversing this epidemic.”
MD Anderson tobacco efforts
Efforts of MD Anderson scientists, researchers and clinicians over the years have helped uncover new information that is being applied in successful smoking and tobacco-cessation areas.
- Investigating the neurological links to tobacco use to determine what brain mechanisms trigger smoking.
- Examining genetic predispositions that make people more susceptible to smoking, or identifying smokers more tolerant of cessation drugs and therefore more likely to achieve success.
- Strengthening behavioral counseling methods so they are better tailored to smokers.
- Increasing health care provider involvement in anti-smoking efforts. This initiative is based on research that shows providers are extremely helpful in encouraging smokers to quit.
- Targeting groups more susceptible to smoking including people with lower socioeconomic status, minorities and youth before they begin using tobacco products.
MD Anderson also played a pivotal role in the National Lung Screening Trial (NLST). The cancer center was one of 33 sites that participated in the National Cancer Institute study, recruiting more than 700 participants. Results from the NLST showed a 20 percent reduction in lung cancer deaths for high-risk smokers who underwent the low-dose helical CT scan. As a result, MD Anderson launched the Lung Cancer Screening Program in June 2011 to screen heavy smokers for lung cancer. Screening can reduce deaths from lung cancer, but it is not a substitute for quitting.
Lung cancer is one of the cancers being targeted by MD Anderson’s Moon Shots Program – a ten year effort to rapidly decrease cancer deaths. Tobacco control is one of three initiatives of the lung cancer moon shots. Later this year, MD Anderson will announce details of its End Tobacco plan to help significantly reduce lung cancer deaths and other tobacco-related diseases.
For more information, visit MD Anderson’s 50th anniversary page.