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Cancer Trends Progress Report – 2007 Update

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Prevention
Age at Smoking Initiation
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Quitting Smoking
Health Professionals’ Advice to Quit Smoking
Secondhand Smoke
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Quitting Smoking
Prevention: Behavioral Factors

Adult attempt-to-quit rates are stable, similar for men and women, and show no-significant change for young adults while beginning to show a small significant rise for those 25 years of age and older. However, successful quitting for those 25 and older appears to be falling overall for men while showing no-significant change for women. Hispanics showed a rise in attempts to quit while White non-Hispanics and Black non-Hispanics were stable and showed no significant change, respectively.

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The Effects of Quitting Smoking on Cancer

Ten years after quitting smoking, a person's risk of getting lung cancer is about one-third to one-half that of people who continue to smoke. The longer the time off cigarettes, the lower the risk. Quitting also reduces the risk of getting cancers of the larynx, esophagus, pancreas, bladder, and cervix.

The sooner one quits smoking, the better. Long-term smokers who stop smoking at around 50 or 60 years of age are less likely to get lung cancer than are people who continue to smoke. Quitting at around age 30 lowers this risk even more.

The quickest non-cancer health benefit of quitting is a lower risk of coronary heart disease. This risk is cut in half within 1 year after quitting. After 15 years, the chance of getting the disease is similar to that of people who never smoked.

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Measures

Those persons (aged 18 and older) who attempted to quit smoking for one day or more during the past 12 months among current cigarette smokers.

Those persons (aged 25 and older) who successfully quit smoking cigarettes 3 months or longer but less than 12 months ago, among current cigarette smokers who attempted to quit during the past 12 months and former smokers who completely quit less than 12 months ago.

Previous versions of the Cancer Trends Progress Report have concentrated on those adults 25 years of age and older because quitting in that age group overlaps less with initiation of smoking. However, the Healthy People 2010 (HP 2010) goal is stated more generally to apply to all current smokers 18 years of age and older. Previous versions of the report used the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to track progress in quitting smoking. The current NHIS data now provides enough data points to make it appropriate to switch to it for consistency with HP 2010. It also allows a more refined look at trends over the most recent period of time using the joinpoint method. This transition is nearly seamless in that the two data sources show consistent trends for attempts to quit and successful quitting for the period of time they both cover.

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Period – 1998–2006

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Trends

Adult attempt-to-quit rates are stable, similar for men and women, and show no-significant change for young adults while beginning to show a small significant rise for those 25 years of age and older.

Among Hispanics 18 and older, those attempting to quit smoking for one day or more rose, while the trend for non-Hispanic Whites was stable and a no-significant change was observed for non-Hispanic Blacks.

However, successful quitting for those 25 and older appears to be falling for both genders combined and for men, while showing no significant change for women.

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Most Recent Estimates

In 2006, 43.1 percent (40.8 for men and 43.4 for women) of adult smokers (aged 18 and older) stopped smoking for one day or longer as they were trying to quit. Among the 18 – 24-year-olds, 51.1 percent attempted quitting, while only 41.9 percent of those 25 years of age and older attempted quitting. For those 18 and older, among Hispanics and black non-Hispanics, the corresponding percentages were 45 and 45.1, respectively, while it was 42.4 for White non-Hispanics.

In 2006, 8.6 percent (8.5 for men and 8.6 for women) successfully quit for 3 months or more among current smokers 25 years of age and older who tried to quit smoking during the past 12 months and former smokers who quit less than 1 year ago.

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Healthy People 2010 Target

Increase to 75 percent the proportion of adult smokers (aged 18 and older) who stopped smoking for a day or longer because they were trying to quit.

There are no Healthy People 2010 targets for the other quit measure in this report.

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Groups at High Risk for Not Quitting

Older smokers (aged 65 years and older) are much less likely to try to quit. However, once they do quit, this group is more likely to be successful for 3 months or longer.

Blacks have higher rates of trying to quit than Whites—as seen here—but generally lower rates of successfully quitting for 3 months or longer.

Smokers with lower levels of education and lack of access to valid treatment due to lack of health insurance are less likely to be successful quitters.

Blue-collar and service workers are not as successful in quitting smoking as white-collar workers even though they have the same rate of quit attempts.

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Key Issues

Studies show that most smokers want to quit.

Efforts to reduce smoking are most effective when multiple techniques are used, including educational, clinical, regulatory (such as clean indoor air laws, which don't allow smoking in work areas and public places), and economic interventions (for example, increasing excise taxes), along with media campaigns and other social strategies. Factors related to smoking in the social environment play the largest role for predicting long-term quitting versus relapse.

Several methods utilizing combinations of nicotine replacement products and/or prescription anti-depressants and other new prescription medications with behavior therapy have been shown to be effective in reducing smoking, but research shows that only a small percentage of smokers utilize these products and methods to help them quit. In addition, many who do use these nicotine products and other medications do not use them as directed for maximum success. Most of these products have been shown in clinical studies to be about twice as effective as not using them for smokers wanting to quit smoking. However, the general success rate is typically not higher than 10 – 20 percent. The refore, to provide a comprehensive approach to helping smokers quit, it is important for new products to be developed and for more people to use these products as directed for maximal success, coupled with the environmental efforts as mentioned above (e.g., increase clean indoor air laws, increase cigarette taxes, media campaigns, and social strategies).

Lack of health insurance is a barrier to cessation. In 1998, only 50 percent of Medicaid recipients were covered for one or more tobacco dependence treatments and few studies have examined the effectiveness of cessation treatments for the poor.

The HHS recently launched a national initiative to provide quitline support. Callers are automatically routed to a state-run quitline if one exists in their area. If there is no state-run quitline, callers are routed to the National Cancer Institute (NCI) quitline.

CDC has recommended minimum levels of tobacco control funding for states. Only three states met or exceeded this minimal funding level for 2005, while 10 states fund at least half this level and the other states fund below half. Most states have actually had recent funding cuts for tobacco control, likely contributing in part to the recent decline in smoking cessation.

Recently, the tobacco industry has been increasing their marketing and promotion of smokeless tobacco products, generating controversy over whether smokeless products can help smokers transition to quitting. Smokeless tobacco products have not been shown to prevent smokers from quitting tobacco use, thus their use should not be encouraged, nor should they be thought of as a “safer” substitute for those who can't quit smoking. Smokers who delay or defer quitting altogether by supplementing smoking with smokeless products greatly increase their risk of lung cancer.

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Additional Information on Quitting Smoking

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National Cancer InstituteDepartment of Health and Human ServicesNational Institutes of HealthUSA.gov