The decline in U.S. smoking prevalence since the publication of the
first Surgeon General's Report in 1964 has been hailed as one of
the greatest public health accomplishments of the past century.
Forty four million Americans-almost half of those who ever
smoked-have quit, and lung cancer death rates have decreased
greatly as a result. As a nation, we've launched wide-reaching
tobacco control programs in worksites, schools, communities, and
all 50 states, and we've witnessed enormous shifts in social norms,
policies, and public attitudes. Growth in clean indoor-air laws and
smoking restrictions have made quit-smoking cues "persistent and
inescapable," and new data shows that tobacco price increases and
mass media cessation campaigns can significantly increase
population quit rates. Over the last three decades, we have
developed effective clinical treatments-psychosocial and
pharmacological-and seen the publication and update of
authoritative practice guidelines recommending evidence based
treatments that, if universally applied, could double our national
annual quit rate in a highly cost-effective way. Prospects for
preventing and treating tobacco use and addiction have never been
better. Yet the papers in this monograph, Those Who Continue to
Smoke: Is Achieving Abstinence Harder and Do We Need to Change Our
Interventions?, raise important questions about what it will take
to build on the successes of the last century and, in particular,
on the last few decades of research and practice. While efforts to
promote tobacco cessation need to be part of a much broader
national tobacco control strategy that emphasizes prevention, it is
clear that the greatest gains in reducing tobacco-caused morbidity,
mortality, and health care costs in the next 30 to 40 years will
come from helping addicted smokers quit. Further declines in adult
smoking are likely to strengthen prevention efforts as well, since
adult smoking is a critical determinant of social norms and a
vector for youth initiation. In this context, the findings
presented in this monograph have important implications for the
next generation of research and practice to help addicted smokers
quit. Specifically, these papers and the findings they present
indicate that helping more smokers quit will require: (1)
developing more powerful treatments that can break through the 25%
to 30% quit-rate ceiling achieved with our best existing
treatments; (2) refining, targeting and tailoring treatments for
high-risk populations; (3) greatly improving surveillance of
quitting patterns and determinants; (4) developing combined
clinical-public health approaches that harness synergies between
evidence based clinical treatments, and macro-level policy and
environmental cessation strategies; and (5) improving the use of
and demand for treatments that work.
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