WASHINGTON — The United States surgeon general warned on Thursday that despite the well-known lethal dangers of cigarettes, too many smokers are not routinely advised by their doctors to quit.
In a new report, the surgeon general, Dr. Jerome Adams, urged smokers to use a range of cessation methods that have been proven effective — and cautioned that e-cigarettes have not.
“Forty percent of smokers don’t get advised to quit,” Dr. Adams said in an interview. “That was a shocking statistic to me, and it’s a little embarrassing as a health professional.”
He was referring to data collected in a 2015 national health survey that was included in the 700-page report released on Thursday. “Four out of every nine adult cigarette smokers who saw a health professional during the past year did not receive advice to quit,” the report noted.
Vulnerable populations in particular are not getting the help they need to stop smoking, it said, and recommended that doctors and public health officials devote more attention to offering smoking cessation assistance to gay and transgender people, Native Americans, people with mental illness diagnoses and several other groups with high smoking rates.
“The biggest take-home from this report is that far too many people who want to quit aren’t getting access to the cessation treatments that we know work,” Dr. Adams added.
Antismoking groups welcomed the new report. Chris Bostic, deputy director for policy at the Action on Smoking & Health, said, “I believe society has withheld or restricted access to cessation because smokers ‘did it to themselves,’ but nearly all smokers became addicted as children, when they could not have consented to the risk.”
More than 55 years after the first surgeon general’s report warned that smoking causes cancer, it remains the leading cause of preventable death and disease in the United States. According to the Centers for Disease Control and Prevention, the rate of smoking in the United States has declined to an all-time low of 14 percent. More than 3 of every 5 adult Americans who have smoked have quit, the report said. Still, 34 million Americans currently smoke, and an estimated 480,000 die from smoking-related illnesses each year, the agency said.
About 16 million people in the United States now suffer from cancer, heart disease and smoking-related disorders, according to the C.D.C. The financial toll is enormous too, with annual health care spending attributed to smoking exceeding $170 billion, the agency said.
The report said that quitting smoking is beneficial at any age, and can add as much as 10 years to life expectancy. It noted that the Food and Drug Administration has approved numerous medications for smoking cessation, including the nicotine patch, and other nicotine replacement therapy, and that these can be most successful when used in combination, especially with behavioral counseling.
It also said that e-cigarettes, which are a diverse and constantly changing group of products, haven’t yet been proven to be effective for quitting. In a news conference on Thursday, Dr. Adams said more research was needed on the effects of e-cigarettes.
The report was released as e-cigarettes, which deliver nicotine without the toxins of burning tobacco, remain a thorny issue for both the public health community and the Trump administration.
Millions of high school students now use e-cigarettes and many of them are struggling with nicotine addiction. At the same time, however, some longtime smokers have found the products helpful in quitting traditional cigarettes.
Even as Dr. Adams cautioned that there is no scientific evidence of the effectiveness of e-cigarettes as smoking cessation tools, he said: “We’ve heard powerful accounts from adults out there who tell us that they’ve used e-cigarettes to successfully transition from combustible cigarettes.”
In the fall, President Trump agreed to ban most flavored e-cigarettes to keep them away from minors. But after opposition from the vaping and tobacco industries and from voters who vaped, he wavered, and the administration eventually announced a new policy that bans most flavored e-cigarette cartridges but exempts menthol products as well as flavored liquid nicotine sold in open tank systems at vape shops. It also doesn’t cover disposable e-cigarettes, which are becoming more widely available and are sold in a wide range of flavors.
Erika Sward, a spokeswoman for the American Lung Association, said the new report underscored how important it is to quit smoking at any stage of life.
“The surgeon general has made some major conclusions about the ways our nation must do more to help smokers quit,” said Ms. Sward, “and that includes many of the things that the American Lung Association speaks of, preventing kids from starting, raising tobacco taxes and making sure everyone has access to quit-smoking medications and counseling without barriers.”
Jan Hoffman contributed reporting.
