By 1995, scientists had been studying tobacco addiction for more than 20 years, and had identified effective ways to treat it. That research formed the basis for the United States Public Health Service (USPHS) Clinical Practice Guideline, first published in 1996. Unfortunately, at this time, few primary care providers routinely asked about smoking or offered their patients proven help to quit. Most smokers wanted to quit, but very few used effective treatments and the vast majority were unsuccessful when they tried.
In addition, effective treatments had not yet been identified for two important high-risk populations—pregnant smokers and adolescents.
The Robert Wood Johnson Foundation (RWJF) sought to bridge the gap between what the scientific evidence was showing and what medical practitioners were doing. That meant getting the evidence into the hands of practitioners—in a way they could implement it in their practices.
The Foundation program staff gave special emphasis to research and research partnerships to discover effective treatments for pregnant smokers and teens. In addition to identifying effective treatments, RWJF supported research to better understand smokers' behaviors.
What Is Known About Adult Smoking Cessation in the General Population
Michael Fiore, Ph.D., Director of the Wisconsin Center for Tobacco Research and Intervention, and co-director of RWJF's Addressing Tobacco in Health Care national program, a principal investigator at Wisconsin's project in RWJF's program, Partners with Tobacco Use Research Centers, and a Robert Wood Johnson Foundation Innovator Combating Substance Abuse, highlighted the following key facts about tobacco cessation in a 2002 article in the Journal of the American Medical Association co-authored with D.K. Hatsukami, PhD, and T.B. Baker, PhD:
- Quitting improves health, even after 50 years or more of smoking.
- Treatment helps. Smokers who are treated by a clinical professional using an evidence-based intervention are more likely to have long-term success. Smokers who try to quit on their own succeed only about 5 percent of the time. Using a recommended intervention increases successful cessation rates to 15 to 25 percent.
- Cessation counseling is effective when it provides social support and training in skills for handling nicotine withdrawal and everyday stress without smoking. Better results are seen with more intensive counseling—either face-to-face or via telephone—but even one to three minutes of brief primary care advice and counseling boost population quit rates.
- Medications also help. The seven medications approved by the U.S. Food & Drug Administration (FDA) and recommended for use in the USPHS guideline are safe and effective. These medications (bupropion, nicotine patch, nicotine gum, nicotine lozenges, nicotine inhaler, nicotine nasal spray and varneicline) work by either mimicking the positive impact that nicotine has on the brain of a smoker or lessening symptoms of nicotine withdrawal that typically occur a when a smoker stops using tobacco. Their use is not advised for some groups of smokers, including pregnant women and those with cardiac conditions.
(See Program Results on Innovators Combating Substance Abuse and a Programee Profile of Fiore.)
(See later sections for efforts focused specifically on pregnant smokers (Strategy 1.2), young smokers (Strategy 1.3). Strategy 2 focuses on building capacity to delivery treatment. The following sections focus on building demand for treatment: 3.1 on policy supports and incentives; 3.2 on access to treatment, 3.3 on affordability of treatment and efforts to expand coverage; and 3.4 on making treatment more appealing.)
Key RWJF-Sponsored Initiatives: Action to Put Research Into Practice
- Partners With Tobacco Use Research Centers (1999–2008) helped translate the research findings of the Transdisciplinary Tobacco Use Research Centers (TTURCs) into policy and practice. TTURCS were established in 1998 by the National Cancer Institute (NCI) and the National Institute on Drug Abuse (NIDA), both part of the National Institutes of Health (NIH), to integrate scientific studies of tobacco use, prevention and treatment across disciplines. See Program Results for more information about RWJF's part.
- TreatTobacco.net (2001–03) is a Web-based database offering practical support for the treatment of tobacco dependence. The site—aimed primarily for practitioners—gives one-stop access to the latest research on tobacco-cessation treatment. (See Program Results.)
- Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy sponsored 42 studies of interventions to help pregnant women quit smoking and remain smoke-free. The program disseminated the results by creating a coalition of more than 60 organizations and developing almost 70 products. The dissemination office supported five case studies of health systems changes designed to increase the delivery of evidence-based treatments to pregnant smokers and led the development of the National Partnership to Help Pregnant Smokers Quit. See Program Results for more information.
- Tobacco-Free Nurses (2002–08) built capacity for tobacco cessation in two ways:
- By helping nurses quit smoking, enabled them to serve as more effective quitting counselors for their patients.
- By providing training, tools and resources tailored to nurses' varied roles as cessation counselors in inpatient and outpatient settings. See the Guide for Nurses, for example.
- See Program Results for more information.
Key RWJF-Sponsored Initiatives: Advocacy and Communications Around What Works
- National Tobacco Cessation Collaborative (2002–09), an outgrowth of the joint RWJF-American Cancer Society Center for Tobacco Cessation, is a coalition of tobacco-cessation organizations dedicated to increasing successful cessation among tobacco users in the United States and Canada. NTCC's first major initiative was the Consumer Demand Roundtable. RWJF published two reports: one on the second roundtable meeting; the other a summary of findings from all the roundtable meetings. There is also a video, "Calling All Smokers," on the RWJF Web site.
- The National Action Plan for Tobacco Cessation (2003), co-funded by RWJF, the Agency for Healthcare Quality and Research, and the American Legacy Foundation was a federal committee that made six recommendations to reduce tobacco use, including for the development of a government-funded network of state telephone quitlines, which was put into effect by Health and Human Services Secretary Tommy Thompson in 2004. Michael C. Fiore, M.D., M.P.H., chaired the committee and received a 2003 Innovator Combating Substance Abuse award from RWJF to implement key components of the plan. (See his Programee Profile.) Fiore was the lead author of a seminal article in the February 2004 American Journal of Public Health, "Preventing 3 Million Premature Deaths and Helping 5 Million Smokers Quit: A National Action Plan for Tobacco Cessation."
- Smoking Cessation Leadership Center (2002–11) works with a variety of health professional organizations and institutions to increase their motivation and capability to refer smokers into treatment and their leadership to promote effective cessation treatments and policies. It has a special focus on smokers with co-occurring mental health and substance abuse problems.
- North American Quitline Consortium (NACQ) (2007–10), funded through a series of RWJF grants. NACQ is organized to assure high-quality, cost-free cessation treatments (1-800-QUITNOW) to smokers in all 50 states, the District of Columbia and Puerto Rico.