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Cancer Trends Progress Report – 2009/2010 Update

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In the Report
Introduction
Trends-at-a-Glance
Summary Tables
Prevention
Age at Smoking Initiation
Youth Smoking
Adult Smoking
> Quitting Smoking
Clinicians’ Advice to Quit Smoking
Medicaid Coverage of Tobacco Dependence Treatments
Fruit and Vegetable Consumption
Red Meat Consumption
Fat Consumption
Alcohol Consumption
Physical Activity
Weight
Sun Protection
Secondhand Smoke
Pesticides
Dioxins
Tobacco Company Marketing Expenditures
Early Detection
Diagnosis
Treatment
Life After Cancer
End of Life



Quitting Smoking
Prevention: Behavioral Factors

Adult attempt-to-quit rates for both men and women, and for most subgroups, have not changed. In contrast to quitting attempts, recent successful quitting rates differed by gender. Women showed no change, while the rate for men declined.

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The Effects of Quitting Smoking on Cancer Risk

Quitting smoking has major and immediate health benefits for men and women of all ages. Quitting smoking dramatically reduces the risk of lung and other cancers, coronary heart disease, stroke, and chronic lung disease. For example, ten years after a person quits smoking, his or her risk of lung cancer is decreased to about one-third to one-half that of a person who continues to smoke; with continued abstinence from smoking, the risk of lung cancer decreases even further.

While quitting smoking is beneficial at any age, the earlier in life a person quits, the more likely he or she will avoid the devastating health effects of continued tobacco use. Few smokers can quit successfully on their first attempt; most will require several attempts before they are able to permanently quit. This emphasizes the need for smokers to begin trying to quit as early in life as possible.

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Measures

Attempt to quit:  Percentage of current everyday smokers (aged 18 years and older) who quit smoking for one day or longer during the past 12 months.  

Successful quitting:  Percentage of current smokers and recent former smokers (aged 25 years and older) who quit for 3 months or more during the past 12 months and are not currently smoking.

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Period – 1998–2008

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Trends

Quit Attempts of One Day or Longer

Between 1998 and 2008, adult attempt-to-quit rates have not changed for men and women overall. There has also been no change in rates among adults aged 18–24 years or among those aged 25 years and older, and among population subgroups considered by level of education and by poverty status.

Attempt-to-quit rates have also not changed among non-Hispanic Whites and non-Hispanic Blacks.  However, Hispanic attempt-to-quit rates rose significantly from 35.5 percent in 1998 to 41.8 percent in 2008.

Recent Successful Quitting of 3 Months or Longer

Between 1998 and 2008, there was no significant change among those aged 25 years and older in the rate of successful quitting for 3 months or longer. However, while women showed no significant change, the rate for men fell significantly over this period, from 11.6 percent in 1998 to 8.6 percent in 2008.

During this period, there were also no significant changes in the rate of successful quitting for 3 months or longer by race/ethnicity, poverty level, or level of education.

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Most Recent Estimates

Quit Attempts of One Day or Longer

In 2008, 41.5 percent of smokers aged 18 years and older (38.8 for men, 44.4 for women) stopped smoking for one day or longer because they were trying to quit. Attempt-to-quit rates were higher among 18–24-year-olds (52.3 percent) than those aged 25 years and older (39.9 percent).

The proportion of those attempting to quit was very similar among Hispanics (41.8 percent), Non-Hispanic Whites (40.9 percent), and non-Hispanic Blacks (42.8 percent). These proportions by poverty level were also similar (40.7 percent for greater than or equal to 200 percent of the poverty level and 42.2 percent for less than 200 percent of the poverty level). By education level for those aged 25 years and older, the corresponding percentages were 40.1 for those with less than a high school education, 37.2 for those with a high school education, and 42.1 for those with greater than a high school education.

Recent Successful Quitting of 3 Months or Longer

In 2008, 8.6 percent of current smokers aged 25 years and older successfully quit smoking during the past 12 months (8.6 percent for men, 8.7 percent for women).

The corresponding percentages for successful quitting were 11.8 for Hispanics, 9.3 for non-Hispanic Whites, and 4.5 for non-Hispanic Blacks.

By poverty level these percentages were 10.2 for those greater than or equal to 200 percent of the poverty level and 5.6 for those less than 200 percent of the poverty level. By education these percentages were 11.1 for those with greater than high school education, 6.5 for those with less than a high school education, and 5.7 for those with a high school education.

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Healthy People 2010 Target

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

There are no Healthy People 2010 targets for successful quitting for 3 months or longer.  

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Groups at High Risk for Not Attempting or Succeeding in Quitting

Men are less likely than women to attempt to quit smoking.

Adults 25 years of age and older attempt to quit smoking less often than adults aged 18–24 years.

Non-Hispanic Blacks were less likely to successfully quit smoking than Hispanics and non-Hispanic Whites.

Those with less than or equal to a high school education successfully quit smoking less often than those with greater than a high school education.

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Key Issues

Efforts to increase successful quitting are most effective when multiple techniques are used, including clinical (individual or group-based), regulatory (such as smoke-free indoor air laws), and economic interventions (for example, increasing excise taxes). Media campaigns and other social strategies are also effective in increasing successful quitting.

A number of approaches have proven effective in helping smokers quit, including behavioral counseling (individual, group, and telephone-based) and medications. The U.S. Food and Drug Administration (FDA) has approved seven medications for treating tobacco dependence. Behavioral counseling and medication are effective when used alone, but are more effective when used together. Telephone quitlines have been shown to be effective in providing wide access to evidence-based cessation counseling and are effective with diverse populations. However, most people attempting to quit do not make use of these evidence-based strategies. Increasing the proportion of smokers that use evidence-based interventions holds great promise for decreasing the overall prevalence of smoking.

The National Network of Tobacco Cessation Quitlines is a state/federal partnership that provides tobacco users in every state with access to the tools and resources they need to quit smoking. The toll-free number 1-800 QUIT NOW (1-800-784-8669) serves as a single point of access to state-based quitlines. The Smokefree.gov Web site (www.smokefree.gov) offers a variety of tools designed to help people quit smoking. Site features include an online step-by-step cessation guide, phone numbers for telephone support, a link to instant messaging with NCI counselors, facts about quitting and smoking, and self-help materials with links for downloading or ordering. Smokefree.gov was developed by NCI with assistance from CDC. The site is free to the public. Smokefree Women (women.smokefree.gov), an extension of Smokefree.gov, includes a special focus on topics important to women.

Low-income Americans are more likely than other Americans to be addicted to tobacco products. As of 2006, only eight state Medicaid programs provided no coverage for tobacco-dependence treatments. However, only seven states provided coverage for all FDA-approved medications, and only one state (Oregon) provided coverage for all treatments recommended by the Public Health Service’s Clinical Practice Guideline. Additionally, some states employ measures that limit access, including copayments, limitations on number of treatment courses, and not allowing combined treatments. In addition, four states reported providing tobacco-dependence treatment to pregnant women only. Enhanced access to tobacco-dependence treatment among the Medicaid population will assist more low-income tobacco users to quit, and contribute to reducing cancer deaths and cancer-related health disparities in this population. (See chapter on Medicaid Coverage in this report.)

State support of quitlines remains problematic. Between 2000 and 2009, states received $203.5 billion in tobacco-generated funds. CDC has recommended minimum levels of funding for state-level comprehensive tobacco control programs (including quitlines); fully funding state tobacco control programs at the CDC-recommended level would require states to dedicate 15 percent of annual total tobacco-generated funds. Overall, states currently dedicate less than 3 percent of these funds to tobacco prevention and cessation programs; in fiscal year 2009, no state funded tobacco control programs at the CDC-recommended level.

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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