Remarks by Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality
The American Legacy Foundation, Women's Policy, Inc., and the Congressional Caucus on Women's Issues' Briefing—Who's Smoking and Who's Quitting: Women, Smoking Trends, and the Impact of Social Networks, Washington, DC, June 18, 2008
Hello, everyone. It's good to see you all here. Thank you, Cindy, for inviting me to be a part of this very important briefing.
I must say that I actually have mixed feelings about being here. I am extremely happy that we are meeting on the issue of women and smoking. At the same time, I am not very happy that meetings of this nature are still necessary.
Deaths due to smoking are preventable. Yet, the grip of tobacco addiction has millions of women unable to overcome their dependence, leaving them susceptible to illness, disability, and premature death.
One hundred seventy-eight thousand (178,000) women die of tobacco-caused diseases every year. There has been a 600-percent increase in lung cancer deaths among women since 1950, and in l987 lung cancer surpassed breast cancer as the leading cause of cancer deaths among women.
I'm sure you have seen the recent study on life expectancy for women. Generally, what they suggest is that, while life expectancy is at record highs, it is actually declining for women in some parts of the country.
One study led by researchers at the University of Washington indicates that one of the primary reasons for this trend, driven by increases in deaths from diabetes, lung cancer, emphysema, and kidney failure, is the long-term effects of smoking.
Perhaps even more disturbing is the fact that girls and young women continue to pick up the habit, at a rate of about 19 percent. The latest Centers for Disease Control and Prevention (CDC) surveys show that 23 percent of female high school students and 9 percent of girls in middle school had smoked at least one cigarette in the past 30 days.
In addition, about 22 percent of women continue to smoke during pregnancy. Rates of smoking among pregnant women are significantly higher in populations with less education and income. Smoking in pregnancy is associated with 20 percent of all low birth weight babies, 14 percent of preterm deliveries, and 10 percent of all infant deaths.
The neonatal cost attributable to maternal smoking exceeds $366 billion annually in the United States. Clearly, for the sake of these women, their babies, and rising health expenditures, we must renew our commitment to help all women, but particularly pregnant women, quit smoking.
The numbers suggest that smoking cessation is a priority for health care professionals. Nearly 67 percent of women smokers age 18 and older said they received advice to quit during checkups in the past 12 months, according to the latest National Healthcare Quality Report, by AHRQ.
Even so, there is still a lot of work to be done to get that final 20 percent to kick the habit and to convince young women that it's not worth the risk.
Fortunately, there is stronger evidence about the clinical effectiveness of tobacco cessation strategies. Science that has recently been synthesized in the 2008 update of the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence.
The 2008 Guideline update was supported by a collaborative of eight Federal and private-sector, nonprofit organizations:
- The Agency for Healthcare Research and Quality.
- The Centers for Disease Control and Prevention.
- The National Cancer Institute.
- The National Heart, Lung, and Blood Institute.
- The National Institute on Drug Abuse.
- The Robert Wood Johnson Foundation.
- The American Legacy Foundation, and
- The Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health.
The 2008 Update was developed by a 24-member, private-sector panel of leading national tobacco treatment experts, chaired by Dr. Michael Fiore of the University of Wisconsin Center for Tobacco Research and Intervention. I am pleased to be joined by a member of the panel today, Dr. Patricia Nez Henderson.
The 2008 Update and its predecessor documents in1996 and 2000 were innovative in the identification of evidence-based strategies for systems-level changes for the treatment of tobacco dependence.
Great strides in tobacco cessation have been made since the first Guideline in 1996. Smoking prevalence among adults has dropped from 25 to 21 percent. Ten years ago, only four States had quitlines. Today, every State has a quitline coordinated through a national system--1-800-QUIT-NOW.
We must continue to build on this success. A new Federal Interagency Collaboration on Tobacco and Young, Low SES Women is in the early stages of development. Recommendations in the 2008 Update will provide guidance for this initiative.
And since 2001, AHRQ, CDC, and many, many (more than 60) other agencies have been collaborating as part of the National Partnership to Help Pregnant Smokers Quit. The goal of this partnership is to ensure than all pregnant women and new mothers in the United States are screened for tobacco use and receive best-practice cessation counseling as part of their care.
The 2008 Update recommends counseling as an effective tobacco use treatment strategy. In fact, it says counseling significantly increases the effectiveness of tobacco cessation medications, and it increases abstinence among adolescent smokers.
While the 2008 Update recommends counseling for pregnant smokers, it does not recommend the use of medication. Studies of the effectiveness of medication use were inconclusive and other studies suggested possible safety concerns.
The 2008 Update provides strong evidence about effective strategies for tobacco cessation. We must renew our commitment to assure that these treatments and strategies are available to all women.
What has happened to tobacco use over the last 40 years is one of the great stories in health care. Even so, about 75 percent of women smokers say they want to quit. This means significant progress on this front can still be achieved, as long as we continue improving our efforts and using our health systems more effectively to intervene at every opportunity.
Current as of June 2008
Smoking Prevention and Cessation Efforts Targeted to Women. Remarks by Carolyn Clancy at The American Legacy Foundation, Women's Policy, Inc., and the Congressional Caucus on Women's Issues' Briefing—Who's Smoking and Who's Quitting: Women, Smoking Trends, and the Impact of Social Networks, June 18, 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/sp061808.htm