It's hard to believe now, but until the first surgeon general report on smoking was published in 1964, few people realized the profoundly negative impact smoking has on health. Even though evidence of smoking's deleterious effects had been accumulating since the 1930s, the powerful tobacco industry successfully countered those findings for decades, claiming that the research was inconclusive.
To produce the 1964 report, Surgeon General Luther Terry charged a committee with reviewing over 7,000 scientific articles. Armed with that evidence, the report concluded that smoking increased a person's risk of death by 70 percent and that smokers were more likely to suffer bad pregnancy outcomes, bronchitis, emphysema and coronary heart disease. The report also determined that smoking cessation could reduce — even reverse — these poor health outcomes.
This was groundbreaking news at the time and "hit the country like a bombshell," according to Terry. Every surgeon general since has reinforced the commitment to reduce smoking, and smoking prevention and cessation goals have remained part of the nation's Heathy People goals.
Since 1964, much has been accomplished. There has been a steady decrease in smoking among adults, from about 44 percent in 1965 to about 22 percent in 2009. Smoking by youth is also on the decline. Yet smoking and tobacco use remain the leading preventable causes of death and disease in the United States. To continue to decrease smoking and hence improve health, we must support targeted interventions for high-risk groups and we must involve all health-care professionals.
As part of that effort, it's important to recognize that vulnerable, health priority populations, such as racial and ethnic-minority groups and people with serious mental illness, suffer disproportionate consequences from smoking. For example, 46 percent of people with bipolar disorder smoke, and nearly 60 percent of people with schizophrenia smoke. Research also shows that people living with HIV who smoke have higher mortality rates than those who do not smoke. Another important finding is that smoking is co-morbid among most clients in substance abuse treatment programs and these programs usually do not include smoking cessation, even though research suggest that treating smoking at the same time as other drug dependency may lead to greater long-term success.
To help raise awareness of such issues, in 2012, APA's Public Interest Directorate Health Disparities Initiative sponsored "Strengthening Psychology's Role in Reducing Tobacco Health Disparities," a meeting at which experts presented data on smoking among vulnerable populations that psychologists are especially trained to serve. While acknowledging the contributions that psychologists have made to smoking prevention and treatment, participants agreed that psychology must become more proactive in supporting smoking prevention and cessation. In particular, the experts agreed psychologists should focus on awareness, education and training; partnerships and collaborations; materials and resources; research; advocacy; and funding and reimbursement.
Quitting smoking is hard and initial success rates are low, but success can be achieved over time. Effective best practices for prevention and treatment exist, are readily available and will work for all populations. Although smoking is not usually the primary reason people seek a psychologist's services, psychologists must strive to address it among clients since smoking undermines our best efforts to resolve clients' problems.
This year, the Public Interest Health Disparities Initiative will release a free smoking app for psychologists and other health-care professionals that will provide profiles on smoking in health priority populations, information on evidence-based interventions, and a clinical toolbox. In addition, the initiative will implement a volunteer Health Equity Ambassadors Program that will support smoking awareness activities. Please contact Patricia DiSandro for additional information.
