Tobacco smoking is the leading cause of preventable disease, disability, and death in the United States (U.S. Department of Health and Human Services [USDHHS] 2014). Smoking harms nearly every organ in the body and costs the United States billions of dollars in direct medical costs each year (USDHHS 2014). Although considerable progress has been made in reducing cigarette smoking since the first U.S. Surgeon General’s report was released in 1964 (USDHHS 2014), in 2018, 13.7% of U.S. adults (34.2 million people) were still current cigarette smokers (Creamer et al. 2019). One of the main reasons smokers keep smoking is nicotine (USDHHS 1988). Nicotine, a drug found naturally in the tobacco plant, is highly addictive, as with such drugs as cocaine and heroin; activates the brain’s reward circuits; and reinforces repeated nicotine exposure (USDHHS 1988, 2010, 2014; National Institute on Drug Abuse [NIDA] 2018).

The majority of cigarette smokers (68%) want to quit smoking completely (Babb et al. 2017). The 1990 Surgeon General’s report, The Health Benefits of Smoking Cessation, was the last Surgeon General’s report to focus on cur-rent research on smoking cessation and to predominantly review the health benefits of quitting smoking (USDHHS 1990). Because of limited data at that time, the 1990 report did not review the determinants, processes, or outcomes of attempts at smoking cessation. Pharmacotherapy for smoking cessation was not introduced until the 1980s. Additionally, behavioral and other counseling approaches were slow to develop and not widely available at the time of the 1990 report because few were covered under health insurance, and programs such as group counseling sessions were hard for smokers to access, even by those who were motivated to quit (Fiore et al. 1990).

The purpose of this report is to update and expand the 1990 Surgeon General’s report based on new scientific evidence on smoking cessation. Since 1990, the scientific literature has expanded greatly on the determinants and processes of smoking cessation, informing the development of interventions that promote cessation and help smokers quit (Fiore et al. 2008; Schlam and Baker 2013). This knowledge and other major developments have transformed the landscape of smoking cessation in the United States. This report summarizes this enhanced knowledge and specifically reviews patterns and trends of smoking cessation; biologic mechanisms; various health benefits; overall morbidity, mortality, and economic benefits; interventions; and policies that promote smoking cessation.

Contents

• Message from Alex M. Azar II, Secretary, U.S. Department of Health and Human Services
• Foreword
• Preface, from the Surgeon General
• Acknowledgments
• Chapter 1. Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation
  • Introduction
  • Organization of the Report
  • Preparation of the Report
  • Scientific Basis of the Report
  • Major Conclusions
  • Chapter Conclusions
  • The Evolving Landscape of Smoking Cessation
  • References
• Chapter 2. Patterns of Smoking Cessation Among U.S. Adults, Young Adults, and Youth
  • Introduction
  • Data Sources
  • Key Epidemiologic Measures
  • Trends in Current and Former Cigarette Smoking
  • Changing Characteristics of Current Cigarette Smokers
  • Key Disparities in Current Cigarette Smoking Among Adults and Youth
  • Cigarette Smoking Cessation Among Adults and Youth
  • Other Tobacco Products: Use and Cessation
  • Clinical Interventions for Smoking Cessation: Prevalence and Trends
  • Key Disparities in Cessation Among Adults
  • Summary of the Evidence and Implications
  • Conclusions
  • References
  • Appendix 2.1. Sources of Data
  • Appendix 2.2. Measures of Cessation
• Chapter 3. New Biological Insights into Smoking Cessation
  • Introduction
  • Cell and Molecular Biology of Nicotine Addiction
  • Vaccines and Other Immunotherapies as Treatments for Nicotine Addiction
  • Insights into Smoking Cessation from the Field of Neurobiology
  • Genetic Studies of Smoking Phenotypes
  • Summary of the Evidence
  • Conclusions
  • References
• Chapter 4. The Health Benefits of Smoking Cessation
  • Introduction
  • Methodologic Challenges
  • Cancer
  • Smoking Cessation After a Cancer Diagnosis
  • Cardiovascular Disease
  • Smoking Cessation After a Diagnosis of Coronary Heart Disease
  • Chronic Respiratory Disease
  • Reproductive Health
  • References
• Chapter 5. The Benefits of Smoking Cessation on Overall Morbidity, Mortality, and Economic Costs
  • Introduction
  • Benefits of Smoking Cessation on Overall Morbidity
  • Benefits of Smoking Cessation on All-Cause Mortality
  • Benefits of Smoking Cessation on Economic Costs
  • Summary of the Evidence
  • Conclusions
  • References
• Chapter 6. Interventions for Smoking Cessation and Treatments for Nicotine Dependence
  • Introduction
  • Literature Review Methods
  • Behavioral and Psychological Treatments
  • Pharmacologic Treatments
  • Teachable Moments
  • Considerations for Subpopulations
  • Emerging Intervention Approaches
  • Summary of the Evidence
  • Conclusions
  • References
• Chapter 7. Clinical-, System-, and Population-Level Strategies that Promote Smoking Cessation
  • Introduction
  • Literature Review Methods
  • Clinical- and Health System-Based Strategies on Smoking Cessation
  • Population-Based Strategies on Smoking Cessation
  • Modeling to Assess the Impact of Policy and Regulatory Changes on Cessation
  • Limitations and Methodologic Gaps
  • Summary of the Evidence
  • Conclusions
  • References
• Chapter 8. A Vision for the Future
  • Introduction
  • Past: Historical Perspective
  • Present: Health Benefits of Cessation
  • Future: Ending the Tobacco Use Epidemic
  • References
• List of Abbreviations

All senior scientific editors and contributing authors have completed and submitted a conflict of interest disclosure form. Unless otherwise noted below, no potential conflicts of interest were reported. Dr. Glenda Lassi reports being employed by AstraZeneca, a research-based biopharmaceutical company. Dr. Marcus R. Munafò reports receiving grant funding from Pfizer and Rusan Pharma and obtaining products for use in research from GlaxoSmithKline, a company that manufactures smoking cessation products. Dr. Judith J. Prochaska reports having served as an ad hoc advisor to Pfizer Inc, a company that manufactures smoking cessation medications.

Suggested citation:

U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020.