Smokers Don't Get Treatment They Need to Quit

Not enough Americans have access to methods that could help millions of smokers quit the habit, a government report concluded Wednesday.

Experts say that quitting methods are available that could triple generally low quit rates for nearly 45 million adult Americans who still smoke. But a lack of awareness of the treatments and a shortage of insurance coverage to pay for them mean that many smokers don’t have access.

Meanwhile, 46 million Americans with no health insurance are largely on their own when it comes to finding ways to kick the habit.

“Most adult smokers want to quit,” says David F. Ransohoff, MD, who chaired the National Institutes of Health panel that issued the report. “This gap represents a major national quality-of-care problem,” he says.

Disease from tobacco use kills approximately 440,000 Americans each year. An estimated 4 million high-school-aged kids also smoke, and researchers are now expressing concern that smoking rates in that group are no longer on the decline.

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Effective Treatments

Adults who try to quit on their own only succeed about one time in 20. Quitting methods including nicotine replacement therapy, prescription drugs, telephone quit lines, and in-person counseling and support groups can double or triple quit rates, if smokers know about them.

Research shows that combinations of pharmaceutical treatments -- along with counseling -- work better than either alone, according to the report.

“Smokers may not realize that there are effective treatments out there,” says Marilou G. Tablang-Jimenez, MD, a psychiatrist and member of the NIH panel.

Increasing the price of cigarettes has been proven to drive down smoking rates, says Marshall Chin, MD, an associate professor of medicine at the University of Chicago, and another member of the panel. Many states have raised excise taxes on cigarettes, but overall, policy makers have “lacked the political will” to raise prices across the board, he notes.

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Insurance Lacking

The report also pegged lack of insurance coverage as a major barrier to treatment. Ransohoff pointed out that many doctors cannot easily bill insurers for counseling patients or referring them to quit programs. That holds some physicians back from taking an active role in helping patients quit, he says.

"The reimbursement is not available for that time to spend with the patient,” says Steven B. Thomas, director of the Center for Minority Health at the University of Pittsburgh.

Larry Akey, a spokesman for the America’s Health Insurance Plans, the industry’s largest lobbying group, says that insurers are increasingly covering smoking cessation. But compliance with the programs is generally low.

“The real question is effectiveness and the desire to cover effective treatments in a way that we can help people quit tobacco and still hold the line on premiums,” he tells WebMD. Akey adds that an increasing number of insurers are covering smoking-cessation programs for members.

“It may not be as extensive as some advocates would hope, but it’s certainly more extensive than it was a few years ago,” he says.

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By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: NIH State-of-the-Science Conference on Tobacco Use: Prevention, Cessation, and Control, June 14, 2006. David F. Ransohoff, MD, chair of NIH panel; professor of medicine, University of North Carolina. MarshallChin, MD, associate professor of medicine, University of Chicago; member, NIH panel. Marilou G. Tablang-Jimenez, MD, psychiatrist; member, NIH panel. Larry Akey, spokesman, American’s Health Insurance Plans.