Does Tobacco Treatment Decrease the Prevalence of Smoking? And Who Cares?
Several studies have found that the prevalence of smoking, of quit attempts or of long-term abstinence has not increased with the availability of smoking cessation medications. The most recent of these (Zhu, Tobacco Control, Epub ahead of print) concluded that the availability of varenicline did not change the population cessation rate. In that study 11% of smokers used varenicline in 2010-2011. Do we really think an intervention used by 11% of the population can influence the mean incidence of an outcome? It would have to have a huge impact to do so. As importantly, I think these studies highlight the problem of identifying treatment of tobacco dependence as a prevention or public health activity. When I treat smokers, I am not really trying to decrease the prevalence of smoking. I am just trying to help someone not die young. And why should we hold smoking to the criteria of changing population outcomes. Do physicians really think that triple bypass surgery will decrease the incidence of deaths from cardiac disease in the US population? Do they really think bypass surgery is as good at decreasing deaths as good habits? And why do these studies pick on medications? I have asked around and no one can give me data that shows MD brief advice or Quitlines have increased the prevalence of smoking cessation. So I think we need to more and more think of tobacco treatment as treating a problem that a patient has, not as a public health prevention action.