Approaches to Promote Health Behavior Change and Smoking Cessation, with Hasmeena Kathuria, MD

Hasmeena Kathuria, MD

Credit: Boston Medical Center

The Centers for Disease Control and Prevention cites tobacco use as the leading cause of preventable disease, disability, and death in the United States, with 2021 data suggesting about 28.3 million US adults smoke cigarettes and more than 16 million people live with at least one disease caused by smoking.¹

Like other chronic diseases, tobacco dependence is a relapsing disorder frequently requiring repeated intervention and long-term support. Thus, many patients struggling to quit rely on support from health care providers, a topic discussed by Hasmeena Kathuria, MD, associate professor of medicine at Boston University School of Medicine and director of the Tobacco Treatment Center at Boston Medical Center, in a session at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston.

In this Q&A interview with the HCPLive editorial team, Kathuria discussed the current state of smoking cessation in the US, behavioral approaches to reduce tobacco dependence, and other key takeaways from her presentation at the conference.

HCPLive: Can you tell me a little bit about the current state of tobacco cessation programs and what we know about their benefit for promoting health behavior change?

Kathuria: So getting people to stop smoking is the greatest health benefit there is. So that really needs to be a priority in all clinical encounters and state programs. We know that if people stop smoking at any age, there's benefits. If we can get people to stop smoking before the age of 35, their mortality is the same as somebody who's never smoked. But even if we can get people to stop at greater than 65, there continues to be that benefit.

HCPLive: Looking at these programs, what do we know about what makes them successful?

Kathuria: Successful programs are ones where clinicians bring up that topic. We know that electronic health record approaches, for instance, where you're screening everyone for tobacco use, for cigarettes, and really all tobacco products, are the first place to start, and then treating tobacco use disorder as a chronic disease. Traditionally, we offer treatment for people who say that they're ready to set a quit date in 30 days, but we know that only 70% to 80% of people are ready to set a quit date. If we offer treatment to all people, similar to diabetes and high blood pressure, we don't say ‘Do you want to be treated for your diabetes?’ We discuss with patients how best to treat their diabetes. So I think those are things that are really important, to screen everybody and to offer tobacco treatment to everybody who smokes, regardless of clinical condition, and regardless of their readiness to stop smoking.

HCPLive: Looking at it from a behavioral standpoint, what changes should be encouraged to decrease tobacco dependence?

Kathuria: I think the most important thing is when we talk to patients, we use non-stigmatizing language. People who smoke want to smoke, and it's just a very powerful addiction. Many times patients will tell me ‘Well, you know, you probably think that I did this to myself’ and we want to make sure that when we talk to people, we understand where they're coming from. With behavioral approaches, it really depends on where they are in their readiness to quit. So if somebody is ready to stop smoking, offering treatment, which includes counseling and medications, but even if patients aren't ready to quit, to kind of get them to that point, asking ‘Are you willing to take a medication that may help you quit one day?’ rather than absolutely making people say that they need to stop right now.

HCPLive: Beyond behavioral changes, what are some of the pharmacologic treatment options for tobacco dependence?

Kathuria: There are 7 FDA-approved medications. There's several studies that show varenicline is more effective than the other medications that we have, particularly studies that have compared varenicline to nicotine patch or varenicline to bupropion. So, that's our first medication that we recommend, but some people don't want medications and prefer that instead of the pill form, they want the nicotine patch or nicotine gum or lozenge. Usually our first line is varenicline or combination nicotine replacement therapy.

HCPLive: Despite our best efforts, what issues still remain when it comes to tobacco dependence and shortcomings to reduce it and where do you see more work that needs to be done?

Kathuria: When you look at tobacco dependence in the 1960s, about 50% of the US population smoked cigarettes, and now it's about 12% to 13%. But really, when you take a deeper dive into who's smoking, it's people who are socio-economically disadvantaged, so people who experience mental health disease, people who experience homelessness, people who have other substance use disorders. For instance, people who have opioid use disorder, they smoke at rates as high as 80% to 90%, so that's something that we really need to understand. Black people, their patterns of smoking are different. Instead of daily smoking, they smoke intermittently, they smoke fewer cigarettes a day, yet they die from tobacco-related disease at a much higher level than White people. Making sure that we are including all people who smoke and who smoke intermittently, who smoke fewer cigarettes, that's really important. And then, of course, the concern with youth and adolescents and vaping and other products, so really to try to do more studies on getting effective treatment for other nicotine products is important.”

This transcript has been edited for clarity.

Kathuria has no relevant disclosures.

Reference:

1. US Centers for Disease Control and Prevention. Data and Statistics. Smoking & Tobacco Use. November 2, 2023. Accessed April 20, 2021. https://www.cdc.gov/tobacco/data_statistics/index.htm