In the 60 years since public health researchers first established that cigarettes cause lung cancer, the percentage of Americans who smoke has dropped from 40 to 20. Yet despite all we now know about tobacco’s disabling and deadly effects, 46 million Americans still smoke. The figure attests to the tenacity of the addiction and the critical need for more effective prevention and treatment interventions.
A large portion of today's smokers belong to subpopulations that have not benefited as much as the general population from health information and clinical advances. People with psychiatric disorders, for example, smoke at roughly twice the average rate of the population as a whole. Smoking is particularly prevalent—ranging from about 50 to 90 percent—among individuals with schizophrenia, bipolar disorder, depression, and substance use disorders. High school dropouts are about three times as likely to smoke as those with college degrees. Of particular concern are the rates and intensity with which pregnant women who have dropped out of high school smoke, thereby incurring health risks for their children as well as themselves. Ethnicity influences smoking, too. An estimated 32 percent of Native American adults smoke, compared with 22 percent of white adults, according to 2008 data from the Centers for Disease Control and Prevention.
NIDA-supported researchers are working to develop highly effective treatments for every smoker. Some of their efforts on behalf of groups with elevated smoking rates have shown:
- Bupropion can help people with schizophrenia quit (see "Bupropion Helps People With Schizophrenia Quit Smoking");
- Smokers with depression respond well when motivational feedback from a computer program precedes medication and behavioral therapy (see "Standard Treatments Help Depressed Smokers Quit");
- Low-income pregnant women show improved quit rates and increased fetal growth when abstinence is rewarded with vouchers exchangeable for retail items (see "Vouchers Boost Smoking Abstinence During Pregnancy").
The impressive reduction in smoking rates over the past half-century has been incremental, propelled by public health interventions, therapeutic advances, and educational programs. The challenge now is to extend that progress to the hardest-to-reach individuals and groups and those with the most severe smoking addictions. To that end, NIDA continues its efforts to fill research gaps, translate knowledge into new treatments, and expand access to effective, research-based prevention interventions and cessation therapies.