From Mad Men to smartphone apps: 50 years of tobacco control

On Thursday, November 20, smokers nationwide will be encouraged to give up tobacco as part of the Great American Smokeout. To many of us, it seems odd that anyone still needs encouragement to stop smoking.  After all, tobacco use is the leading preventable cause of death and illness in our society. Every year, an estimated 480,000 Americans die prematurely due to smoking. Yet one in five adults in our country continues to smoke.  With this track record, how will we ever eradicate tobacco use? Only through ever-assertive and creative efforts from researchers, public health officials, health care systems, and providers.

The good news is that many people have successfully quit smoking.  When the first Surgeon General’s report on smoking was released in 1964, more than 40 percent of adults in this country smoked (52 percent of men and 34 percent of women).  Just watch an episode of Mad Men to be quickly reminded how prevalent smoking was back then. Even pregnant women and hospital visitors smoked without a second thought or disapproving stare. From this perspective, it is easy to see how far we’ve come in 50 years. In fact, the tobacco control movement is arguably considered the most successful public health story of our time.

I’m particularly proud of Group Health’s role in this national story. In 1982, Group Health was one of the first U.S. health care organizations to implement an institution-wide smoking ban. This occurred more than a decade before The Joint Commission mandated that hospitals be smoke-free. In the 1990s, scientists at the Center for Health Studies (now Group Health Research Institute) showed how providing full insurance coverage for cessation treatment improved quit rates, leading Group Health to provide all members with comprehensive coverage for counseling and medications—ahead of other insurers.

When I arrived at Group Health in 1998, there was an active national debate whether insurance companies should cover nicotine dependence treatment. The two concerns were whether health care costs would go up after people quit and whether any cost benefits, if they did exist, would be too far downstream to benefit insurers. But at Group Health, we knew better. Our own research demonstrated that smoking cessation did not result in higher sustained medical costs for former smokers. And helping people quit smoking was—and is—the right thing to do.

Other research conducted at Group Health led to the evidence-based phone counseling program Free & Clear. Starting in the 1990s, it was offered as standard care to all Group Health members. And it later evolved into the largest provider of tobacco quitline services in North America: Alere Wellbeing, Inc. Today, I and other Group Health researchers continue to collaborate with colleagues at Alere, constantly enhancing this important public health intervention. As a result, quitline callers now receive an integrated phone- and Web-based program that we showed to be effective. And we are exploring how best to leverage the tobacco-quitline infrastructure to offer smokers other public health interventions, such as promoting better oral health care. Other Group Health research addresses testing new forms of counseling and identifying the “active ingredients” that can make cessation treatment programs even more effective. We’re also exploring how mobile-health technologies—like smartphone apps—can help deliver individually tailored nicotine dependence treatment in real time and better connect patients with health care teams to manage the quit process.

After Group Health focused its attention on tobacco control in the late 1980s, our members’ smoking rates declined and have stayed lower than those of other Washington state residents.

But we cannot claim success yet. Important work remains to help current tobacco users break their dependence on nicotine—and to prevent new generations from taking up smoking. But I am confident that reaching these goals won’t take another 50 years. Who knows, I may even put myself out of a job if tobacco use continues to decline. That’s my goal, anyway.

Jennifer B. McClure, PhD
Director of Research, Faculty, & Development and Senior Investigator
Group Health Research Institute