Overcoming “Cessation Stasis”: The Need to Address Inertia

No one can doubt the importance of smoking cessation as a fundamental preventive initiative (1,2). The dramatic reductions in morbidity and mortality that follow cessation argue that cessation interventions should be an integral part of clinical care. But despite a substantial reduction in smoking rates in recent decades, there is now disconcerting, if not dispiriting, news regarding a decline in cessation rates in the United States. In this issue of the Journal, Leventhal and colleagues (3) report that declines in smoking have slowed following decades of reductions, particularly among minority, disadvantaged, and rural groups. Their conclusions are based on a careful analysis of successive iterations of the Tobacco Use Supplement of the Current Population Survey, affording a robust examination of population smoking behaviors and a nuanced understanding of cessation activities among groups typically not captured in standard cessation research. Their findings reveal that there was virtually no change in cessation activities from 2014 to 2019 and that sociodemographic disparities in cessation behaviors were prominent. Overall interest in cessation remained constant: 77.1% of smokers voiced a desire to quit, but sustained cessation rates (7.5%) were unchanged (3). More disquieting, rates of smoking cessation have declined among the most vulnerable segments of the population, where rates of smoking and smoking-related disease are high. Equally concerning, only a minority of smokers (34.4%) employ smoking cessation treatments when attempting to quit, and predictable discrepancies in the use of cessation supports exist among racialized and disadvantaged communities. Many of the conventional approaches intended to support cessation—quit lines, subsidized nicotine-replacement therapy, and digital treatment applications—attracted only modest use. The findings identify real challenges for clinicians and public-health organizations. How can we address our failure to provide supported cessation opportunities to those who have interest in cessation but receive little assistance? In clinical settings, inadequate approaches to addressing tobacco addiction are, sadly, commonplace. The introduction of integrated cessation programs in hospital settings has been recommended for decades (4-6). Evidence of their clinical significance and their ability to reduce cost and subsequent use of health-care resources continues to accumulate (7-10). Smoking cessation at the time of cancer diagnosis can enhance quality of life, reduce treatment complications, and prolong survival (11). Recommendations for the incorporation of smoking-cessation services as a standard of cancer care abound and should be heeded (12-14). Barriers remain but can be overcome; the time to ensure the systematic integration of smoking-cessation services in clinical settings is long overdue (15-17). Notwithstanding our ability to increase the likelihood of smoking cessation success, the challenge of smoking cessation is substantial. How can we combat the activities of an industry unrivalled in its ability to evade regulation and to cause enormous human loss? Although efforts to assist smokers should be expanded and systematized, it is equally important that as clinicians we advocate for much more robust and far-reaching regulation of the tobacco industry—an industry unparalleled in its record of duplicity and destruction. None. Role of the funder: Not applicable. Disclosures: The author has no conflicts of interest to disclose. Author contributions: Writing, original draft, revisions—AP. No new data are presented in this editorial.

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