Dr. Hasmina Kathuria
Credit: Boston Medical Center
The Centers for Disease Control and Prevention lists tobacco use as the leading cause of preventable illness, disability, and death in the United States, and 2021 data shows that approximately 28.3 million U.S. adults smoke cigarettes. , it has been suggested that more than 16 million people live with at least one disease. Caused by smoking.1
Like other chronic diseases, tobacco dependence is a relapsing disease that often requires repeated interventions and long-term support. Therefore, in one session, Hasmina Kathuria, M.D., associate professor of Boston University School of Medicine and director of the Tobacco Treatment Center at Boston Medical Center, explained that many patients who struggle to quit are dependent on support from their health care providers. It was discussed. 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston.
In this Q&A interview, HCP Live Kathuria from the editorial team discussed the current state of smoking cessation in the United States, behavioral approaches to reducing tobacco dependence, and other key takeaways from the conference presentations.
HCP Live: Can you tell us a little about the current state of smoking cessation programs and what we know about the benefits of smoking cessation programs for promoting health behavior change?
Katuria: So the biggest health benefit is getting people to quit smoking. So this really needs to be a priority in all clinical practice and national programs. We know that there are benefits to quitting smoking at any age. If you can get people to quit smoking before the age of 35, their mortality rate will be the same as someone who has never smoked. But even if you can stop people past age 65, the benefits still exist.
HCP Live: Looking at these programs, what can we learn about what makes them successful?
Katuria: Successful programs are those in which clinicians address the topic. For example, we know that an electronic health record approach that examines everyone's tobacco use for cigarettes, and indeed all tobacco products, is the first starting point, and then treats tobacco use disorder as a chronic disease. . Traditionally, we offer treatment to people who say they are ready to set a quit date within 30 days. However, it has been found that only 70% to 80% of people are ready to set a quit date. So if you want to provide everyone with the same treatment as diabetes and high blood pressure, you don't say, “Would you like to be treated for diabetes?” Discuss with the patient the best treatment for diabetes. So I think it's really important to screen all smokers and provide tobacco treatment to all smokers, regardless of their clinical status or readiness to quit.
HCP Live: From a behavioral perspective, what changes should be encouraged to reduce tobacco dependence?
Katuria: I think the most important thing is to use nonjudgmental language when talking to patients. Smokers want to smoke, but it's a very powerful addiction. A lot of times patients say to me, “Well, I guess you think I did this to you,'' but when we talk to people, we try to understand where they're coming from. We want to make sure we understand. For behavioral approaches, it really depends on what stage of readiness they are to quit smoking. So if someone is ready to quit, we offer treatment that includes counseling and medication, but even if a patient isn't ready to quit, we recommend that they “take medications that might help.” Do you feel like quitting one day?’ Instead of having people tell you that you absolutely should quit right now.
HCP Live: Besides behavioral changes, what are the pharmacological treatment options for tobacco dependence?
Katuria: There are seven FDA-approved medications. There are some studies showing that varenicline is more effective than other drugs, particularly studies comparing varenicline and nicotine patches or varenicline and bupropion. This is the first medication we recommend, but some people don't want medication and prefer to use nicotine patches, nicotine gum, or lozenges instead of pills. Typically, our first choice is varenicline or combination nicotine replacement therapy.
HCP Live: Despite our best efforts, what problems still remain regarding tobacco dependence and the shortcomings of reducing it? Where do you think more work needs to be done?
Katuria:If you look at tobacco dependence in the 1960s, about 50% of the U.S. population smoked, but now it's about 12-13%. But in reality, if you dig deeper into who smokes, you'll find that it's people who are socio-economically disadvantaged, people who experience mental health illnesses, people who experience homelessness, people with other substance use disorders. These are the people who are suffering. For example, opioid users with opioid use disorder smoke at rates as high as 80% to 90%, so this is something we really need to understand. Black people have different smoking patterns. Smokers and intermittent smokers because they smoke intermittently instead of daily and have much higher mortality rates from tobacco-related diseases than whites, even though they smoke fewer cigarettes per day. We make sure to include everyone. Fewer people are smoking, that's really important. And of course, with concerns about youth and adolescents, e-cigarettes and other products, it is important to do more research on effective treatments for other nicotine products. ”
This transcript has been edited for clarity.
Kathuria has no relevant disclosures.
reference:
1. Centers for Disease Control and Prevention. Data and statistics. Smoking and tobacco use. November 2, 2023. Accessed April 20, 2021. https://www.cdc.gov/tobacco/data_statistics/index.htm
