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Statistics related to tobacco use in the United States are almost too big to comprehend: 50 million users. $350 billion in healthcare costs. More than 480,000 deaths per year. And unfortunately, these numbers are climbing.
Similar to diabetes, cancer, obesity, and mental health, tobacco use is a lifelong condition. If healthcare providers were empowered to treat it as such, they could improve the lives—and prevent the deaths—of millions of Americans.
To do this, tobacco must become the top preventive service priority for all stakeholders: doctors, patients, health plans, employers. One in 5 people who walk into their next primary care visit is affected by tobacco use. Most of them want to quit, but we still lack a collective plan and motivational path to help them.
Today’s tobacco user: It’s not just cigarettes
The FDA deems tobacco as these four categories:
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Combustibles, such as cigarettes, cigars, pipes, roll-your-own, and hookahs;
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Electronic nicotine delivery systems, including e-cigs, vapes, cartridges, pods, mix-your-own, and heat-not-burn products;
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Smokeless products, including chew, snuff, and pouches;
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New and future products, including dissolvables, nicotine gels, pouches, and other items that aren’t previously regulated.
Primary care providers are well versed in the management of chronic, treatable conditions.
“You should just stop!” doesn’t work with obesity, mental health, or any other chronic condition, and it doesn’t halt tobacco use, either.
Smoking, vaping, and any other form of tobacco use must be continually treated. Cessation reduces chances of a major coronary event by more than 50%, reduces stress, can decrease back pain, and improves treatment outcomes and prognosis of cancer patients. Providing behavioral science-based solutions could dramatically reduce health risks, not to mention the financial costs.
Healthcare providers = superheroes
So why do healthcare providers have the greatest power to defeat tobacco? For one, most users are already seeing someone who could help them—85% of adults saw a healthcare professional in 2020.
Physicians also wield influence: It’s thanks to them that we have such high success rates with colonoscopies, influenza vaccines and other preventive services. (While half the eligible U.S. population gets the flu vaccine and 67% gets a colorectal cancer screening, less than 1% of the tobacco user population is enrolling in a health plan or employer-offered program for tobacco cessation.)
Empowering healthcare providers includes making it easy for them to click and help patients at the point of care. Behavior change therapy requires an ongoing relationship with a professional, and virtual treatment makes this even more accessible. Telemedicine, apps, and other tools help create clear paths to quitting—and much like patients use continuous glucose monitoring for diabetes or a Fitbit, or tools like breath sensors help give users the science and motivation to quit for good.
The time is now
There has been a Covid-era increase in tobacco use, with higher cigarette sales and fewer people seeking help to quit. In 2020 there were almost three times the number of tobacco-related deaths versus Covid deaths.
Not only is tobacco the biggest cause of preventable death and healthcare claims in this country, like poverty and diabetes, it also disproportionately harms populations most affected by health inequities. It affects spouses, children, and thousands of others who don’t use it themselves: In 2020, 60,000 tobacco-related deaths in the U.S. were caused by secondhand smoke.
Half of cigarette users make a solo attempt every year to quit, but only about 1% succeed. Much like health experts have been speaking about “harm reduction” and treating drug addiction as a chronic condition, it’s time to rethink how we view and treat tobacco users, too.
Moving forward, tobacco-free
10% of U.S. healthcare costs are attributed to tobacco use. If a system, company, or health plan hasn’t made tobacco its top preventative service priority, then it’s ignoring the most significant way to reduce preventable deaths and healthcare costs.
Getting patients to quit and remain tobacco-free requires ongoing treatment that’s customized, flexible, easy to use, and free to the user. With collective effort and the proper tools to treat tobacco use as a chronic condition, we can spark a wave of positive change.
It’s time for primary care doctors to light the way.
