Stop-Smoking Breakthroughs: Past, Present and Future

The majority of Americans who smoke want to quit. But stopping can be hard. That’s because cigarettes and other tobacco products contain a drug as addictive as heroin or cocaine – nicotine.

Getting more smokers to quit – and ensuring others never start – is vital, as tobacco use is deadly, causing 1 in 5 deaths in the United States. Cigarette smoking alone is responsible for at least 30% of all cancer deaths and 87% of lung cancer deaths.

As part of its efforts to help Americans stop smoking, the American Cancer Society hosts the annual Great American Smokeout – and has been doing so since the 1970s. A lot has changed, though, over the years, and researchers have made major breakthroughs that now help make it easier for people to stop smoking.

Lee Westmaas, Ph.D., director of tobacco control research at the American Cancer Society, is an expert in the field of smoking cessation and below shares his insights into how much progress researchers have made and what’s next for stop-smoking strategies.

Q. The Great American Smokeout began in the 1970s. What are the biggest breakthroughs researchers have made since that time about the most effective ways for quitting smoking?

A. The most important breakthroughs since that time are the development of nicotine replacement therapies and other medications to help smokers quit. The first set introduced was the nicotine patch, inhaler, and gum. Then came bupropion -- marketed as Zyban or Wellbutrin -- which helps smokers curb their cravings. Chantix came out next and is now the most effective medication for curbing smoking cravings. When you couple these medications with newer behavioral strategies – like the toll-free quit lines available in all states launched in the 1990s – success rates are even higher. In fact, research shows that quit lines are one of easiest and most effective ways to access one-to-one help for quitting.

Q. Even though the health consequences of smoking are more well-known than they were in the 1970s, about 44 million American adults still smoke cigarettes – but the majority of them want to stop and have actually tried before. Are researchers looking into new ways to help people drop the habit?

A. It would be great to have even more effective medications to help people stop. The search for better medications is ongoing. The newest way that researchers are studying to try to help people is through the use of smartphone technology. Smokers can use their smartphones to get encouragement or support from friends and family, for example, when they have a craving or relapse. And there is even research that is looking into nicotine vaccines to help people never start smoking in the first place.

Q. According to a 2012 report from U.S. Surgeon General, people are very unlikely to start smoking after age 25. In fact, 99% of smokers started smoking by age 26. Now, a new report from the CDC finds that tobacco products like e-cigarettes and hookahs are becoming more popular among middle- and high-school students. What has research shown to be the best ways to keep young adults from starting smoking?

A. We found that the one of the best ways are policy actions, like raising the price of cigarettes, and also ensuring that young kids can’t buy cigarettes by making sure merchants don’t sell to them. Sting operations in the past have shown that some merchants were, and probably still are, selling to underage youth. Additionally, smoke-free laws that prohibit smoking on university campuses and bars, for example, all converge to create a culture where smoking is not the norm – and not the cool thing to do.

Advertising is also a big factor, including movies that glamorize smoking. Cutting back in those arenas is another way of preventing kids from starting smoking. Studies show that kids who watch more movies with smoking featured are more likely to smoke. Even household restrictions on smoking help – such as if a parent smokes, ensuring he or she doesn’t do it in front of the kids. If we can get parents to quit, it will trickle down to their kids.

Q. Getting back to e-cigarettes, a first-of-its-kind study came out recently that found e-cigarettes to be nearly as useful as nicotine patches as a smoking cessation tool. But clearly more research needs to be done, and the FDA does not currently regulate e-cigarettes -- meaning it is hard to know how much nicotine they actually contain. What are the next steps for assessing the viability of e-cigarettes as a stop smoking tool?

A. The problem is that we don’t yet know if e-cigarettes are a safe alternative to existing smoking cessation products and we also don’t know whether they can, in fact, help people quit. We absolutely still need more research about its effectiveness. That was one study -- we need more.

Q. A recent study published in JAMA Internal Medicine found that people were most likely to search the term “smoking cessation” on Google on Mondays. It is clear that the Internet has allowed for new insights into Americans’ smoking and quitting habits, but has it also made way for new smoking cessation strategies? If so, is it proving to be an effective medium for helping smokers to quit?

A. The advent of the Internet has played a significant role in the creation of new tools to help people quit smoking. Research has shown that web-based computer interventions, such as ones by becomeanex.org and smokefree.gov, provide quitting strategies, encouragement and support and have a positive effect. And as smartphones came on the market, researchers started using those devices to disseminate the same types of online intervention programs. I actually have a new that just came out, in which we find most of the stop smoking apps are not good because they don’t follow the recommended guidelines for helping smokers quit. The National Cancer Institute’s NCI QuitPal app looks to be a good one, but hasn’t been evaluated yet. There is still more research needed to assess the effectiveness of smartphone apps.

Q. What about the growth in the popularity of social networking websites – has this played a role in encouraging – or discouraging – smoking cessation in the United States?

A. It is possible they may be a double-edged sword. If a smoker wants to get support for quitting using a social networking platform, such as Facebook, they might be able to get the encouragement they need from friends or family who are supporting their efforts. But on the opposite side, if a smoker has friends on such sites who smoke, they may not be supportive and may not want the person to quit. So they could potentially be a negative influence. However, researchers have not yet formally studied the major networking sites to investigate such theories. The online QuitNet community, though, which is dedicated to smokers who want to stop, has been proven effective. The more a smoker uses the community to get support, the more likely she or he is to actually quit.

Q. You are currently investigating how social support in general affects smoking cessation. Can you explain more?

A. I have been researching the impact of social influences on smoking cessation. In one of our studies we found that women smokers were more likely than men to be told they should stop smoking by their friends, family or healthcare providers. Perhaps social networks and health care providers are reluctant to recommend quitting to men, or to offer them help for quitting because of stereotypes of men as independent and tough and possibly unwelcoming of such advice. Still, social influences are important. In another study, we found that men who said the reason they were trying to quit was because their spouse wanted them to, were more likely to reduce their smoking.

Q. Are you working on any other research right now that could have exciting implications for Americans who are trying to stop smoking?

A. I have been focusing on smoking in cancer survivors and trying to understand some of the motivations behind continued smoking or quitting and if getting a cancer diagnosis – regardless of whether the cancer is caused by smoking – is a moment that can be used to get people to stop smoking. When a smoker gets a cancer diagnosis they are primed to want to change their behavior, so it might be a very good time to introduce that idea. But studies show providers aren’t doing that enough. I am currently looking at data from the American Cancer Society’s Study of Cancer Survivors. The participants were diagnosed about nine years ago and 9% currently smoke. What I think is happening is that the longer a person is away from the diagnosis the less likely he or she is to want to quit. I am now investigating whether this is in fact the case.

I also want to look into whether continuing to smoke after surviving cancer has negative effects on a person’s emotional state. There is evidence from other research that smoking makes people more depressed over time. Studies also show that among cancer survivors, depression goes down over time. But my hypothesis is that this decrease in depression is greater in non-smokers than in smokers. We should be able to answer that with our data.