Tobacco Research: Epic Public Health Transformation but Challenges Remain

Forty-six years ago this month, the U.S. Surgeon General released a report that launched a dramatic change in U.S. public health and the story of tobacco use and control in America. Since the 1964 release of the Surgeon General's landmark report, Smoking and Health, smoking rates have been sliced in half, thanks to the aggressive work of the American Lung Association, among others, whose scientific and lay volunteers and staff have attacked the deadly epidemic of smoking from every imaginable angle. We have seen dramatic changes in the spectrum of impacts that tobacco has on our society: federal and state policy; trade regulations; early detection and better treatment of smoking-related illnesses; research into biologic mechanisms, pharmaceuticals and behavioral treatments for nicotine addiction, epidemiology and public opinion; prevention of tobacco use, and more.

In all cases, research is the bedrock of the strategies that have culminated in today's tempered success with many challenges remaining to win the ongoing battle against the number-one preventable cause of death in America—cigarette smoking.

Today's epidemiologic research data show that quit rates have leveled off, revealing a harsh reality that roughly 15 to 20 percent of adult Americans either have not tried to quit or fall into the category of hard-core nicotine addicts for whom the arsenal of smoking cessation pharmaceutical and behavioral therapy does not work.  As effective tobacco control policies deepen and are sustained throughout the nation, quit rates should increase, based on state-specific experiences to date. As addiction to cigarette smoking involves both behavioral and chemical elements, effective smoking cessation should include behavioral and medical treatments.  Research indicates that behavioral programs like the American Lung Association's gold-standard Freedom From Smoking® are most effective when participants are actively engaged with a facilitator or group of individuals providing support and expert resources. American Lung Association researchers continue to develop culturally appropriate approaches to smoking cessation, including the work underway with American Indians, based at the University of Kansas.

The physical addiction piece of the smoking cessation puzzle is a rich area of study, as scientists continue to develop new understanding to contribute to new smoking cessation strategies and approaches for all smokers and specifically for those who are highly addicted to nicotine. Physicians are experimenting with combinations of pharmaceuticals designed to control nicotine addiction in highly addicted patients and working with some patients on a maintenance therapy of nicotine replacement when current therapies are unsuccessful. It is a controversial approach for smoking cessation; clinicians' experience and subsequent research will measure its efficacy. A nicotine vaccine is an exciting advance that is now in pre-clinical trial stages of development; the vaccine would work by blocking nicotine from reaching the brain.

Smoking is the number one cause of lung cancer.  Treatment of this disease can be dramatically different for individuals based on how early it is detected. Investigators are working on developing several new methodologies to detect cancer in very early stages in both smokers and nonsmokers. More refined blood tests and tissue analysis may reveal biologic markers that could identify which patients would need additional diagnostic procedures and surgeries, which are invasive as well as costly. On a parallel track with the clinical detection is a proposed new classification technique to identify who will need lung cancer treatment and which therapies will be most effective. Concurrently, the National Cancer Institute is in the midst of a clinical trial designed to determine whether screening high risk populations by periodic low dose CT scans is beneficial.

The long-term impact of smoking in America is at once personal and economic. Smoking often turns deadly, claiming lives young and old, affecting families and individuals, and it exacts incredible healthcare costs on the U.S. The annual financial data are staggering: $97 billion in lost productivity and $96 billion in private and public healthcare expenditures.  We cannot expect a softening of the financial burden of smoking-related illness, as nicotine addictions have a firm hold on our current smokers.

The American Lung Association has a long history in  the area of smoking and tobacco control with a foundation of research, and as we look to the future,  we do so with the knowledge that research is progress.