 First, the good news. Smoking is on the decline in the United States with about 20% of American adults reporting that they currently smoke, down from a peak level of nearly 60% of men and 30% of women in the 1950s. Unfortunately, not all of the news is good—smoking is now increasing in certain groups, particularly adolescents.1
Tobacco use, which includes cigarettes, cigars, pipes and smokeless (chewing) tobacco, remains the most preventable cause of death in the United States, leading to over 400,000 deaths each year and costing billions of dollars in medical expenses.2 The Centers for Disease Control and Prevention (CDC) recommends that all health care providers ask patients whether they smoke or chew tobacco, and then to advise all smokers to try to quit. The stakes are high, and the health benefits of changed behavior are beyond dispute.3
A Vital Sign
Smoking and tobacco use are such an important part of an individual’s health status that some have called it a fifth vital sign, suggesting that it be tagged as a major factor for overall health similar to high blood pressure or high temperature.4 Tobacco use can lead to various cancers, heart and cardiovascular disease and chronic spine pain.5-10
Perhaps no other health risk factor has been the subject of so much health science research. Peto and Doll first discovered that physicians in Great Britain who smoked had higher incidence rates of lung cancer11 and that those who smoked the most were at the greatest risk for developing cancer. A major breakthrough in public awareness of the problem came in 1964, when U.S. Surgeon General Luther Terry produced the first report warning that smoking was a key risk factor for developing lung cancer and other diseases.12 Today, numerous studies not only confirm this but indicate smokers have a greater risk of overall poor health and disability and have much higher health insurance costs, lost days from work and lowered productivity.13, 14
In 1998 several state Attorneys General settled a suit against large tobacco companies to recover costs paid by state Medicaid agencies for tobacco-related illness in what is referred to as the Master Tobacco Settlement.15 Money from this billion dollar windfall to those states was to be used to start schools of public health and generate advertising against smoking.16 The verdict is still out as to how much good has come from the Master Tobacco Settlement.
How Your Health Care Provider Can Help
Unfortunately, only about 40% of smokers report that their primary care physician has advised them to quit smoking or using tobacco.17 A study at 9 chiropractic colleges found similar rates of patients who stated that their interns had advised them on cessation. Of these, even fewer were given information on cessation beyond being advised to quit.18
However, health care providers have consistently been found to be powerful “cues to action” when it comes to getting patients to make a quit attempt.19 The CDC report by Fiore and others states that all health care providers should urge patients to quit.3 In addition, it doesn’t seem to matter what kind of provider conveys the message. For example, orthopedic surgeons are not usually thought of as being on the front lines of anti-smoking programs, but some have admirably risen to the call. Responding to the fact that 90% of their failed surgeries and post-surgical infections occurred in smokers, Rechtine and colleagues at an orthopedic spine clinic were able to significantly increase the number of quit attempts in their patients by prioritizing tobacco cessation with patients.20 Along the same lines, a study at one chiropractic college increased the amount of information given to patients by 25% in one month when an education campaign was delivered aimed at interns and clinic staff.21
It’s important to remember that stopping smoking is helpful not only to the person who stops but to those around them as well. Researchers at the University of Missouri–Kansas City found that adolescents who had a significant other who smoked were much more likely to smoke. When at least four significant others smoked, adolescents were 161 times more likely to smoke themselves.22 Therefore, when your doctor urges you to quit, it’s important to remember that this is not only for your own health but also for the potential preventive effect on your family. In addition, there are now numerous studies indicating that second-hand smoke is a significant factor for increased risk of disease. |
