Unequal Progress—The Epidemiologic Case for Cessation Interventions Targeting Vulnerable Populations

July 28, 2011: Cessation: Emerging Interventions and Innovations

Michael Fiore, M.D., M.P.H., M.B.A., University of Wisconsin School of Medicine and Public Health

Dr. Fiore began his remarks by sharing data from the National Health Interview Survey indicating that smoking prevalence among adults in the United States appears to be flattening while tobacco use continues to be the leading cause of preventable illness, death and economic burden. Four populations in particular continue to smoke at very high rates: the poor; the least educated; those with co-morbid mental health or addictive disorders; and certain racial and ethnic minorities such as Native Americans. Dr. Fiore showed several graphs indicating the smoking rates for these populations:

• an estimated 8.2 million smokers are below the poverty level;
• an estimated 22.3 million smokers have only a high school education or less;
• an estimated 4.6 million smokers are alcohol dependent; and
• an estimated 9.1 million smokers have serious psychological distress.

While the 2008 Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence states that "interventions found to be effective in this Guideline have been shown to be effective in a variety of populations..." there are still large inequities in the use of effective cessation treatments across populations. There are several contributing factors: the patchwork of insurance coverage; costs of treatment; logistical barriers including the location of health care institutions and lack of transportation; the Clinical Practice Guideline is not the Standard of Care; and there is a failure to effectively communicate with underserved tobacco users.

Dr. Fiore concluded his remarks with an analogy to the treatment of polio over 60 years ago, and like the eradication of this deadly disease, it is possible to make smoking a thing of the past if those populations that have historically been left behind are effectively reached.

Dr. Fiore introduced the first panel presentation.