Tobacco addiction: implications for treatment and cancer prevention.

The American Society of Clinical Oncology and the National Cancer Institute convened a symposium in June 1996 on tobacco addiction. Additional support for the symposium was provided by the American Medical Women's Association and the American Society of Preventive Oncology. The goals of this conference were to describe the burden and public health consequences of tobacco addiction, to describe the state of science for the treatment of nicotine dependence, and to explore new strategies to increase quit rates and to prevent the uptake of tobacco use. This article summarizes and integrates the meeting presentations on tobacco addiction and includes the topics of smoking prevalence; psychobiologic aspects of nicotine dependence; and implications for disease, treatment, and prevention. Comments on regulatory approaches and national strategies for reducing dependence are also summarized in presentations by Dr. David Kessler, former Food and Drug Administration Commissioner, and Dr. C. Everett Koop, former U.S. Surgeon General.

Impact of the American Stop Smoking Intervention Study on cigarette consumption.

OBJECTIVE: To obtain an early estimate of the effectiveness of the American Stop Smoking Intervention Study (ASSIST). DESIGN, SETTING, AND PARTICIPANTS: Seventeen American states funded through ASSIST are compared with 32 others regarding per capita cigarette consumption from 1989 to 1995. California, which already had an extensive tobacco control programme, was omitted. ASSIST states were selected competitively (not randomly) based on their proposals' merit, state smoking prevalence, and geographical distribution. INTERVENTIONS: Comprehensive tobacco control programmes, emphasising policy interventions, were implemented in the ASSIST states beginning in 1993. MAIN OUTCOME MEASURES: Trends in aggregated per capita cigarette consumption and inflation-adjusted average price/pack of cigarettes in the intervention states were compared. Percentage change in per capita consumption is also compared with percentage change in inflation-adjusted cigarette price by state in each group from 1992 to 1994. RESULTS: Per capita consumption and inflation-adjusted cigarette price were nearly identical in both groups of states before 1993, when full funding for the ASSIST interventions began. However, by 1996 smokers in the intervention states were consuming about 7% less cigarettes per capita (P<0.05, beginning in 1994), and in 1994 the average price was over $0.12/pack higher in the intervention states. All but three states (all intervention) showed decreases in cigarette price. Nonetheless, 76% of the intervention and 55% of the comparison states showed some decrease in consumption despite decreases in price. The relationship between changes in price and consumption was considerably diminished in the intervention group. CONCLUSIONS: These interim results suggest that the ASSIST programme is associated with a substantial difference in tobacco consumption in a third of the United States, and that increased price from taxation may not be the only programme influence.

Do dentists and physicians advise tobacco users to quit?

To examine dentists' and physicians' effectiveness in advising patients who use tobacco to quit, the authors estimated the percentages of smokers in the United States who visited a dentist or physician in the preceding year, the percentages of those who were advised by their health care provider to quit and the percentages of those who planned to quit smoking. They also estimated the percentage of smokeless tobacco users who were ever advised by their dentist or physician to quit. The results of the study indicate that dentists and physicians may not be maximizing their opportunities to advise their patients who use tobacco to quit, or they are not adequately communicating to their patients the importance of quitting.