The Surgeon General's 1990 Report on The Health Benefits of Smoking Cessation Executive Summary - Foreword

NOTICE

This issue of MMWR Recommendations and Reports (Vol. 39, No. RR-12) is a reprint of the Executive Summary of the Surgeon General's report entitled The Health Benefits of Smoking Cessation, released September 1990. The report is included in the MMWR series of publications so that the material may be readily accessible to the public health community. Foreword

More than 38 million Americans have quit smoking cigarettes, and nearly half of all living adults who ever smoked have quit. Unfortunately, some 50 million Americans continue to smoke cigarettes, despite the many health education programs and antismoking campaigns that have been conducted during the past quarter century, despite the declining social acceptability of smoking, and despite the consequences of smoking to their health.

Twenty previous reports of the Surgeon General have reviewed the health effects of smoking. Scientific data are now available on the consequences of smoking cessation for most smoking-related diseases. Previous reports have considered some of these data, but this Report is the first to provide a comprehensive and unified review of this topic.

The major conclusions of this volume are:

1. Smoking cessation has major and immediate health benefits for men and women of all ages. Benefits apply to persons with and without smoking-related disease.

2. Former smokers live longer than continuing smokers. For example, persons who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with continuing smokers.

3. Smoking cessation decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.

4. Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birthweight baby to that of women who never smoked.

5. The health benefits of smoking cessation far exceed any risks from the average 5-pound (2.3-kg) weight gain or any adverse psychological effects that may follow quitting.

With the long-standing evidence that smoking is extremely harmful to health and the mounting evidence that smoking cessation confers major health benefits, we remain faced with the task of developing effective strategies to curtail the use of tobacco. Two broad categories of intervention are available: prevention of smoking initiation among youth and smoking cessation. Resources for tobacco control are limited, and policymakers must decide how best to allocate those resources to smoking prevention and cessation.

The goal of public health is to intervene as early as possible to prevent disease, disability, and premature death. From that standpoint, prevention of smoking initiation should be a major priority. More than 3,000 teenagers become regular smokers each day in the United States. Because of the strength of nicotine addiction, some have argued that public health efforts should focus on smoking prevention rather than smoking cessation. However, this need not be an "either-or" situation.

Public health practitioners have categorized interventions into primary, secondary, and tertiary prevention. Primary prevention generally refers to the elimination of risk factors for disease in asymptomatic persons. Secondary prevention is defined as the early detection and treatment of disease, and is practiced using tools such as Pap smears and blood pressure screening. Tertiary prevention consists of measures to reduce impairment, disability, and suffering in people with existing disease.

Smoking cessation falls under the category of primary prevention as does the prevention of smoking initiation. Smoking cessation meets the definition of primary prevention by reducing the risk of morbidity and premature mortality in asymptomatic people. In addition, parents who quit smoking reduce or eliminate the risk of passive-smoking-related disease among their children and reduce the probability that their children will become smokers. Thus, there should be no debate about the need for smoking prevention versus cessation--both are important.

Public awareness of the health effects of smoking has increased substantially through the years. Nevertheless, important gaps in public knowledge still exist. Some smokers may have failed to quit because of a lack of appreciation of the health hazards of smoking and the benefits of quitting. In the 1987 National Health Interview Survey of Cancer Epidemiology and Control, respondents were asked whether smoking increases the risk of various diseases (lung cancer, cancer of the mouth and throat, heart disease, emphysema, and chronic bronchitis) and whether smoking cessation reduces the risk. Thirty to forty percent of smokers either did not believe that smoking increases these risks or did not believe that cessation reduces these risks. These proportions correspond to 15 to 20 million smokers in the United States. Clearly, our efforts to educate the public on the health hazards of smoking and the benefits of quitting are not yet complete.

As we continue and intensify our efforts to inform the public of these findings, we must make available smoking cessation programs and services to those who need them. Although 90 percent of former smokers quit without using smoking cessation programs, counseling, or nicotine gum, smokers who do need this assistance should have it available. We endorse the view expressed in the Preface to the 1988 Surgeon General's Report that treatment of nicotine addiction should be considered at least as favorably by third-party payors as treatment of alcoholism and illicit drug addiction. Good smoking cessation treatments can achieve abstinence rates of 20 to 40 percent at 1-year followup. Those success rates, combined with the enormous health benefits of smoking cessation, would likely make payment for some smoking cessation treatments cost-beneficial. For example, research by the Centers for Disease Control suggests that a smoking cessation program offered to all pregnant smokers could save $5 for every dollar spent by preventing low birthweight-associated neonatal intensive care and long-term care.

This Report should galvanize the health community to stress repeatedly at every opportunity the value of smoking cessation to the 50 million Americans who continue to smoke. James O. Mason, M.D., Dr.P.H. William L. Roper, M.D. Assistant Secretary for Health Director Public Health Service Centers for Disease Control

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