Taking Tobacco Cessation to Heart

February 11, 2020 | Marcus Plescia

February is American Heart Month, and Friday is Valentine’s Day, so it’s a time to reflect on the people we love and care about. It is well-known that heart disease is the leading cause of death in this country, but many are surprised at the toll it takes on young and middle-aged adults. The Centers for Disease Control (CDC) now reports that one in three of the life-changing cardiovascular events that took place in 2016 happened to adults aged 35 to 64. Heart disease is a surprisingly common cause of disability and even death in an age group that is frequently overlooked for public health interventions. If we want to lead long lives for our loved ones, our heart health should be a priority.

Hypertension and high cholesterol are often the focus of American Heart Month, and both are important and under-recognized opportunities for public health to impact heart disease. However, tobacco use is the leading preventable cause of heart disease, particularly in this younger age group. About 16.5 percent of adults aged 25-44 and 16.3 percent of adults aged 45-64 smoke cigarettes, compared to 8.4 percent of adults 65 and older. Smoking cessation reduces the risk of premature death and can add as much as a decade to life expectancy. The risk of coronary heart disease (CHD) is reduced by about half after one year of stopping tobacco use.

Quitting tobacco is no easy feat. Luckily, Surgeon General Jerome Adams recently released a report that provides new and timely public health approaches to help encourage and support tobacco cessation attempts. Whether you want to have a conversation with someone you love about quitting, or you work directly in tobacco policy, here are the main takeaways so you can acquaint yourself with the latest evidence on cessation.

• Behavioral counseling and cessation medication are effective evidence-based strategies, even more so when they’re combined. Well-funded statewide tobacco control program initiatives, such as mass media campaigns and quitlines, produce a significant and fast decline in the number of adults who smoke.
• Quitlines have long been the standard for behavioral counseling, but young adults prefer to access cessation assistance through other means nowadays, mainly texting. We now know that short text messages delivering information on cessation services are effective, particularly if they are interactive or tailored to individual text responses. Texting services allow real-time, live, peer or professional advising or counseling in addition to tobacco cessation information. Internet-based interventions also increase smoking cessation and are most effective when they contain behavior change techniques and interactive components. However, counseling through a standard quitline is still considered effective.
• There is now evidence that restricting menthol tobacco products and other flavored tobacco products encourages smoking cessation, especially among populations more likely to use these products. This is likely helpful for public health practitioners and legislators as they work to draft flavored tobacco restrictions that will address the youth e-cigarette epidemic and promote health equity.
• Combining short and long-acting forms of nicotine replacement therapy increases the likelihood that someone will give up tobacco compared with using single forms of nicotine replacement therapy. However, the report states that there is inadequate evidence that e-cigarettes, in general, increase smoking cessation.

Comprehensive statewide tobacco control programs is perhaps our most important step to encourage and support folks to give up tobacco. The Surgeon General report provides new approaches to encourage tobacco cessation that can be combined with longstanding policy approaches like:

• Raising the price of cigarettes.
• Adopting comprehensive smoke-free policies.
• Implementing mass media campaigns.
• Requiring pictorial health warnings.

In addition to being Heart Health Month, it’s a leap year, providing us with an extra day to get things done this month. We at ASTHO encourage all of you to review the new Surgeon General’s report on smoking cessation and consider how you can use it in your state.