ATTUD Journal Club Postings

Recent Survey Data on Smoking and Quitting in the US

Two new CDC surveys (MMWR 60:1207-1211, Sept 9, 2011 and MMWR 60:1513, Nov 11, 2011) report some outcomes of interest to TTSs. The first survey reports that now, among daily smokers, 16% smoke less than 10 cigs/day. In addition, other surveys have found that 20% of smokers are non-daily smokers, so when you add the two together then about 1/3rd of smokers are light/nondaily smokers.  As you know, most medications have been tested almost exclusively on smokers of > 10 cigs/day. The only study in light smokers I am aware of showed that light daily smokers benefited from NRT as much as heavier smokers (Drug Alcohol Dependence 77:311-314, 2005). Among those I have talked to, there is a significant divergence of opinion about whether to offer NRT to light smokers. Recent data suggest the biggest effect of NRT is not in withdrawal relief to prevent lapses but is in preventing lapses from becoming relapses (JCCP 74:276-285). Thus it appears NRT has a blocking action similar to varenicline.

If withdrawal relief is not the main mode of efficacy, maybe NRT can work in light smokers. Given its paucity of side-effects, I myself, think it’s worth trying. But more importantly, we need research on whether either behavioral treatment or medications should be done differently with light smokers.

The second survey reports that about half of smokers try to quit each year and that overall this has not changed in the last 10 yrs. To me this is very unexpected. Despite 10 yrs of media, taxes, increasing smoke-free places, stigmatization, etc, quitting has not increased. To me, this suggests a hardening of smokers may be occurring, but other data suggest perhaps not. But not all is bad, 62% of 18-24 yr olds have tried to quit in last year, and smokers living below poverty level, if anything had a higher rate of quit attempts (55% vs 51%). The survey also reports that although many smokers who try to quit use medication (30%), few use counseling (6%). When I compared this with prior surveys, these numbers do not appear to have changed over the last few years. We recently did a study to find out why smokers do not want to attend treatment and it was a complete bust – none of the reasons they said they did not attend actually predicted who would and would not attend (NTR 13:1339-1346).

So comments on using NRT in light smokers, on how to change counseling for light smokers as well as comments on how to make treatment more acceptable to smokers would be welcomed.