Two new studies published today in the New England Journal of Medicinefind huge health benefits of smoking cessation. “Smoking remains a huge public health problem in the United States, but smokers who quit between the ages of 25 and 34 regained nearly the same life expectancy as people who had never smoked. The message to smokers is clear: The sooner you quit, the greater the health benefits,” noted Matthew L. Myers, President,Campaign for Tobacco-Free Kids in an interview earlier today.

According to Myers, these studies are a timely reminder that the battle against tobacco is far from over. The researchers hope that the conclusions of these studies can accelerate progress by implementing proven strategies to help smokers quit and prevent kids from starting to smoke in the first place. These include expanded health insurance coverage for tobacco cessation treatments, media campaigns that encourage smokers to quit and discourage kids from smoking, tobacco tax increases and strong smoke-free air laws.

Health care reform
Despite the enormous health benefits of quitting and surveys finding that most smokers (about 70%) want to quit, only a small percentage succeed in doing so each year. To help more smokers quit, Myers feels that President Obama’s Administration should more effectively enforce the requirement in the health care reform law that all new private health insurance plans cover smoking cessation therapies, without cost-sharing.

A recent study by theGeorgetown University Health Policy Institute found that many health plans are falling short, with confusing language, gaps in coverage and cost-sharing requirements that appear to conflict with the law.

Myers “Campaign for Tobacco-Free Kids” feels that the Centers for Disease Control and Prevention (CDC) needs to continue the highly successful media campaign it launched in March 2012. The CDC campaign, called Tips from Former Smokers. The CDC campaign features real people suffering as a result of smoking and exposure to secondhand smoke. Their compelling stories send a powerful message: Quit smoking now. Or better yet ? don?t start.

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The CDC campaign more than doubled the number of smokers seeking assistance from smoking cessation quitlines and led to a 428% increase in visitors to the Smoke-free website. based on the results of the 2012 campaign, the CDC is planning a similar campaign this year. Myers feelsthat the United States Congress should support the Prevention and Public Health Fund that was created by the health reform law and is providing funding for the CDC campaign and other tobacco prevention and cessation initiatives.

Tobacco epidemic
The two new studies demonstrate both the huge scope of the tobacco epidemic and the tremendous health benefits from reducing tobacco use.[1] In the first study, Prabhat Jha, M.D, director of the Centre for Global Health Research (CGHR), an independent, not-for-profit organization co-sponsored by St. Michael?s Hospital (Toronto, Canada) and the University of Toronto, Canada, and his co-workers found that smoking on average reduces a person’s life expectancy by at least 10 years. But smokers can significantly extend their life expectancy by quitting. Those who quit between the ages of 25 and 34 lived about 10 years longer on average. Those who quit between 35 to 44, 45 to 54, and 55 to 64 gained 9, 6 and 4 years of life, respectively.

Smoke like men die like men
The second studyshowsthat death rates among female smokers ? previously documented to be lower than those among male smokers ? have increased and converged with those of men for lung cancer, chronic obstructive pulmonary disease (COPD) and other tobacco-related diseases. [2]The researchers attributed this increase in large part to a convergence in smoking patterns among men and women since the 1960s, with women starting to smoke earlier in adolescence and until recently smoking more cigarettes per day.The study authors conclude that the relative and absolute risk of death from smoking continues to increase among women.Lead author Michael J. Thun, Vice President, Emeritus, Surveillance and Epidemiology Research, American Cancer Society,writes that this finding confirms a prediction that “women who smoke like men die like men.”

In another key conclusion, the second study finds that the death rate from COPD continues to increase among both male and female smokers in contrast to a significant decrease in risk among men who never smoked. The authors note that”a plausible explanation for the continuing increase in deaths from COPD among male smokers is that cigarettes marketed since the late 1950s have undergone design changes that promote deeper inhalation of smoke.” Similarly, the study notes that cigarette design changes may also have contributed to an increase of peripheral adenocarcinomas (a form of lung cancer) that has offset declines in other forms of lung cancer.Today, peripheral (lung) adenocarcinoma, which occurs in two main types,one which appears on CT-scan as a localized ground-glass opacity with slowgrowth and the otheras a solid attenuation with rapid growth, is the most common histologic type of lung cancer in many countries.Its incidence has increased over the last 50 years. [3,4,5]

“Light” and “low-tar” cigarettes
The increase of peripheral adenocarcinomas occurred as tobacco companies marketed so-called “light” and “low-tar” cigarettes as a less harmful alternative despite knowing this was not the case. According to Myers, these findings published today in the New England Journal of Medicineare an important reminder that tobacco companies have a long history of manipulating their products in ways that make them more appealing, more addictive or more harmful. They also underscore why the United states Food and Drug Administration (FDA) must aggressively exercise its new authority over tobacco products, including the authority to stop such tobacco industry manipulation that harms public health.

Recent statistics show that tobacco use kills more than 400,000 Americans and costs the nation $96 billion in health care bills each year. While the U.S. has made significant progress in reducing smoking, Myers concludes that these studies remind us that there is still much work to do to win the fight against the nation’s number one cause of preventable death.

Strength and weaknesses
Thun and his co-authors feel that the strength of their study is represented by its size, prospective design, national scope and the 50-year time span. “Our results provide estimates of temporal changes in cause-specific mortality and contemporary risk from smoking in the Unites States,” Thun said. However, the authors considered the fact that the study primarily represented a caucasian population, 50 years of age and older, who where born between 1870and 1954 as alimitation of the study.They further considered that most current smokers in the contemporary cohorts had smoked for at least 30 years aslimiting the range over which they could examine the influence of the duration of smoking. But overall, the authorsnoted that their research confirmshow cigarette smoking continued to increase the risk of death.

Stigmatized behavior< /strong>
In an editorial in theNew England Journal of Medicine,Steven A. Schroeder, M,D.Distinguished Professor of Health and Health Care, Director, Smoking Cessation Leadership Center, UCSF, notesthatthe grim reality is that smoking still exerts an enormous toll on the health of Americans. [5]He concludes thatin terms of health benefits, it is never too late to quit and clinicians in general, and especially those who care for patients with smoking-related illnesses (e.g., oncologists, cardiologists, pulmonologists, emergency physicians, psychiatrists, and primary care physicians), should do more to stimulate quit attempts. In his editorial, Schroeder also writesthatthe importance of smoking as a health hazard needs to be elevated and that,as astigmatized behaviorconcentrated among persons of low social status, smokingneedstobe more visible to those who set health policies and research priorities.

[1] Jha P,Ramasundarahettige C,Landsman V,Rostron B,Thun MJ, Anderson RN,McAfee T,Peto R.21st-Century Hazards of Smoking and Benefits of Cessation in the United States. N Engl J Med 2013; 368:341-350 January 24, 2013DOI: 10.1056/NEJMsa1211128
[2] Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, Hartge P, Gapstur SM. 50-Year Trends in Smoking-Related Mortality in the United States N Engl J Med 2013; 368:351-364 January 24, 2013DOI: 10.1056/NEJMsa1211127
[3] Barsky SH, Cameron R, Osann KE, Tomita D, Holmes EC. Rising incidence of bronchioloalveolar lung carcinoma and its unique clinicopathologic features. Cancer 1994Feb 15;73(4):1163-70.
[4]Tsugane S, Watanabe S, Sugimura H, Urano Y, Matubara S. Recent trends in different histological types of lung cancer in Tokyo based on pathological autopsy records. Jpn J Cancer Res 1987 Feb;78(2):162-9.
Auerbach O, Garfinkel L. The changing pattern of lung carcinoma. Cancer 1991;68:1973-1977.
[5] Schroeder SA. New Evidence That Cigarette Smoking Remains the Most Important Health Hazard. N Engl J Med 2013; 368:389-390 January 24, 2013DOI: 10.1056/NEJMe1213751

Photo: Matthew L. Myers, President, Campaign for Tobacco-Free Kids. Photo courtesy: Campaign for Tobacco-Free Kids;1400 I Street NW, Suite 1200 Washington, DC 20005

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