ACSM’s Health & Fitness Journal

HISTORY OF SMOKING-CESSATION EFFORTS

King-size cigarettes; free gifts to “light up;” physicians and health care professionals smoking! This was the culture of the 1950s and 1960s. Creative advertising encouraged people to “walk a mile for a Camel.” Cigarette smoking was a part of daily life. Men and women smoked, and even young children started. In the haze of the smoke, there was a vague awareness of associated health risks, but few people kicked the habit.

And then Surgeon General of the U.S. Public Health Service Luther L. Terry, M.D., released the report of the Surgeon General’s Advisory Committee on Smoking and Health. The report, published more than 50 years ago on January 11, 1964, was the first of a series of steps to diminish the impact of tobacco use on the health of the American people (¹). After extensive review of articles available at that time relating to smoking and disease, the Advisory Committee concluded that cigarette smoking was:

• A cause of lung cancer and laryngeal cancer in men.
• A probable cause of lung cancer in women.
• The most important cause of chronic bronchitis.

In the years following the initial Surgeon General’s report, the U.S. Congress adopted the Federal Cigarette Labeling and Advertising Act of 1965 and the Public Health Cigarette Smoking Act of 1969. These acts included:

• Requiring a health warning on cigarette packages.
• Banning cigarette advertising in the broadcasting media.
• Calling for an annual report on the health consequences of smoking.

Adding to initiatives in 1965, the Public Health Service established the National Clearinghouse for Smoking and Health. The Clearinghouse and its successor organization, the U.S. Centers for Disease Control and Prevention’s Office on Smoking and Health, have been responsible across the years for reports on the health consequences of smoking. Working with voluntary health organizations, the Public Health Service has supported state and community programs to reduce tobacco use, has disseminated research findings related to tobacco use, and has worked to ensure the public visibility of antismoking messages.

FIFTY YEARS LATER

Tobacco use is an addiction, and nicotine is the primary drug in tobacco that causes addiction (⁹). Most smokers are dependent on nicotine. Despite years of successful smoking cessation efforts since the first Surgeon General’s report 50 years ago, tobacco and nicotine use still remain the leading cause of disease, disability, and death in the United States (⁸). Smoking can lead to a number of illnesses, including cancer, heart disease, diabetes, and various lung diseases. More than 42 million American adults still smoke and, on average, compared with people who have never smoked, smokers suffer more health problems and disability, losing more than a decade of life. Secondhand smoke has significant consequences also. Most of the 20 million smoking-related deaths since 1964 have been adults with a history of smoking; however, 2.5 million of those deaths have been among nonsmokers who died from diseases caused by exposure to secondhand smoke (⁸). For every person who dies because of smoking, nearly 30 more people suffer from at least one serious smoking-related illness. An estimated 14 million major medical conditions can be attributed to smoking each year (¹). Tobacco use costs the United States more than $289 billion annually ($133 billion in medical care and $156 billion in lost productivity). Tobacco control and smoking cessation efforts are an important health triumph of the past 50 years but, as current statistics indicate, there is still much more to do. The number of smokers worldwide is now just short of one billion people (⁶). Efforts to implement proven interventions must be continued and expanded. According to Melissa Parton Baumgartner, founder of Wellness Speaks and a certified health and wellness coach and personal trainer who provides smoking-cessation workshops, the positive news is that companies and organizations are directing more attention to employees and nicotine use. This focus on nicotine use has a “domino effect” because other risk factors for disease will decrease when a person ends his/her use of nicotine. Workplaces are going nicotine-free and are administering tests to determine an employee’s use of tobacco substances. Companies with a wellness focus often include nicotine testing in their biometric screening process and, in a growing number of organizations, an employee is faced with an increase in insurance premiums or deductible rates for nicotine (tobacco) use. As Baumgartner notes, addiction is physical (biological), habitual (social), and emotional with many “closet smokers.” The comment she hears over and over again during smoking-cessation workshops: “I’m not a tobacco user. I just smoke cigars or an occasional cigarette.” Baumgartner’s private thought: “I hear you, but in the insurance world, this means you are a tobacco user and will read positive when tested.” She notes that one cigar may contain as much tobacco as an entire pack of cigarettes.

THE FITNESS PROFESSIONAL AND SMOKING-CESSATION

The estimate is that more than 68% of adult cigarette smokers want to quit and more than 40% try to quit each year (²). However, even people who are highly motivated to make a change find doing so extremely difficult, whether it is adopting a new habit such as exercise or breaking an old habit such as smoking (³). Two thirds of adult smokers who wish they could quit say they find it too difficult (²).

Imagine the results if health care and fitness professionals helped smokers quit and kept others from starting? Proven strategies and treatments to reduce smoking rates are successful according to the Surgeon General, and the tools and resources are readily available (⁹). Implementing effective treatment strategies involves a number of areas. These include:

• Brief clinical interventions, such as a physician taking 10 minutes or less to deliver advice and assistance about quitting.
• Individual, group, or telephone counseling.
• Behavioral therapies, such as training in problem solving.
• Treatments with counseling sessions and greater intensity.

Certifications and Specialty Training

For a fitness professional, becoming a certified health coach is one of the steps available to grow and develop expertise in the health and fitness field. To encourage this effort, applying health coaching techniques seems to be an effective tobacco-cessation intervention (⁵). Using your coaching skills, you can provide programs and services in smoking cessation and tobacco use for health clubs and for companies focusing on reducing health care costs and promoting wellness. And, to increase your knowledge beyond the core learning objectives in many health coach certifications, you can obtain a specialty certification in the treatment of tobacco use and dependence. Competency in this area is important in the treatment and counseling of clients.

The Council for Tobacco Treatment Training Programs is the primary accrediting body for Tobacco Treatment Specialist Training Programs (⁷). Certified Tobacco Treatment Specialists are professionals specially trained to provide treatment for individuals seeking to address their tobacco use and begin smoking and nicotine cessation efforts. Training as a Certified Tobacco Treatment Specialist includes:

• Understanding the science behind tobacco addiction, nicotine withdrawal symptoms, and effective treatments for tobacco use.
• Learning to provide clear and accurate information about the causes and consequences of tobacco use.
• Developing individualized treatment plans.
• Learning to work with a variety of populations including individuals with specific health issues.
• Serving as an educational resource for organizations, health care providers, and the general public regarding tobacco use treatment issues.

Accredited programs include, but are not limited to, Healthways, Inc., the Mayo Clinic Nicotine Dependence Center, the University of Mississippi Medical Center, and the University of Massachusetts Medical School. For a complete list and details, visit the Association for the Treatment of Tobacco Use and Dependence Web site (⁷).

THE NEXT 50 YEARS

Smoking cessation, similar to adding regular physical activity, requires lifestyle changes that create and maintain a daily circle of health (⁴). With the appropriate knowledge, tools, and support, lifestyle changes can be planned and implemented successfully. The fitness professional and health coach are in key positions to assist a person with lifestyle changes and make an impact on smoking-cessation efforts. Let’s change the course of the next 50 years. Think beyond your current role and job duties. Expand your horizons and make a difference.

AcknowledgmentThe author thanks Melissa Parton Baumgartner, Wellness Speaks, for providing insight and guidance on smoking cessation and nicotine use and the role of the health coach.

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