Press Conference to Release Surgeon General’s Report on Smoking Cessation

By Paul Henry / in , , , , , , /

Please everyone be seated. So good morning everyone. And thank all of you for joining us both in
person or virtually. Today we are here to discuss the critically
important public health issue of smoking cessation and I would first like to thank all of the
professionals at HHS and throughout the nation who have worked so diligently to help us better
understand and address the single largest cause of preventable death and disease in
the United States and that is smoking. I especially want to express my personal appreciation
and the appreciation of our department and the nation to our nation’s doctor, Surgeon
General Vice Admiral Jerome Adams, who today will issue the first Surgeon’s Report focused
solely on smoking cessation in nearly 30 years and the 34th surgeon general’s report on tobacco
since the original historic report in 1964. I also want to specifically acknowledge many
leaders and subject matter experts from across our department including the CDC, FDA, NIH
and SAMHSA who are all dedicated to reducing and eventually eliminating the devastating
health consequences of tobacco use. And my office whose mission is leading America
to healthier lives can only truly achieve this goal if we eliminate the harms of tobacco
use and prevent our next generation from succumbing to all forms of nicotine addiction. Since the landmark 1964 Surgeon General’s
report on smoking and health, HHS has provided essential support for research and evaluation,
program and policy development, public information and education, regulatory activities, systems
level change and clinical practice. All these efforts have contributed to a nearly
70% decline in cigarette smoking among U.S. adults since 1965. Pretty remarkable achievement. Support from the department has assisted medical
and health care organizations, government agencies at all levels and diverse state and
local partners to create and sustain programs that prevent tobacco initiation, help tobacco
users quit and foster healthy tobacco free environments. This surgeon general’s report is the latest
addition in our legacy of tobacco prevention and control efforts. Reports such as this one provide the latest
evidence-based information on tobacco and health to scientists, health care professionals,
our communities, faith-based groups, educational institutions, families, colleagues and friends. Today’s report complements and informs ongoing
work throughout HHS to prevent and reduce the burden of disease and death from tobacco
use in the United States. Let me highlight some of the important efforts
currently underway. Research leadership and grant funding through
the National Institutes of Health contribute to growing knowledge of effective tobacco
control strategies and smoking cessation tools. The National Tobacco Control Program led by
the Centers for Disease Control and Prevention ensures that these strategies and tools are
readily available to state, local, tribal, and territorial public health programs, as
well as, partners serving a variety of populations that are disproportionately affected by tobacco
use. The U.S. Food and Drug Administration regulates
the manufacturing, marketing and sale of tobacco products. The Centers for Medicare and Medicaid provides
smoking cessation tools to support millions of Americans. Multiple public health information campaigns
such as CDC’s tips from former smokers and the FDA’s Every Try Counts educate Americans
about the significant health risks from smoking and the importance of quitting. Additionally, many HHS agencies provide direct
assistance to smokers including the National Cancer Institute through its
initiative and National Quitline Portal 1-800-QuitNow. But despite these efforts and the tremendous
progress already made today smoking kills nearly half a million Americans each and every
year and an estimated 16 million Americans suffer serious chronic diseases caused by
smoking. We know that comprehensive interventions at
all levels of government and by partners throughout society can be highly effective at preventing
and reducing tobacco use. And I want everyone in the room today and
watching this press conference to know HHS remains committed and I can assure you the
surgeon general and I are personally committed to ending the tobacco use epidemic in the
United States and the needless chronic disease and loss of life that it directly causes. And so now it is my honor and privilege to
introduce our featured speaker, a colleague and friend, a physician and leader who is
truly relentless in his pursuit of building a culture of health and prevention throughout
all sectors in all places and for all people. Ladies and gentlemen, the 20th U.S. Surgeon
General, the nation’s doctor, Vice Admiral Jerome Adams. Jerome Adams: Well, good morning, everyone. Thank you so much, Admiral Giroir for that
kind introduction. Really an honor to have him here opening our
conversation this morning. Many of you don’t know, but Admiral Giroir
was in Puerto Rico with several of our commissioned corps officers and just got back in late last
night after surveying the response to the earthquakes that happened there. So we’re just really pleased to have him here
today. Happy New Year and happy decade to all of
you and thank you for being here. It is both my duty and my honor to release
smoking cessation, a report of the surgeon general.>>Got to show you all the goods here. Jerome Adams: This report right here is why
we’re here today and it is 700 pages of help and hope that are arriving just in time for
those who may need some assistance sticking with their New Year’s and New Decade resolutions. Now, despite substantial progress — and we
have made substantial progress in the area of smoking cessation — 34 million Americans
still smoke. But the good news is that 70% of U.S. adults
who currently smoke cigarettes tell us they say they want to quit and this issue is very,
very personal to me as I lost both of my grandfathers to smoking related illnesses. I often wonder if both of them or at least
one of them would have lived to see my children, their great grandchildren if they’d had more
help quitting. Tobacco dependence is a chronic often relapsing
condition that is driven by an addiction to nicotine. As a result, quitting smoking is often one
of the hardest things a person can do in their life. But while quitting may be hard, we know. We know from people like (Beatrice). (Beatrice), where are you? We’re going to hear from her in a little bit,
but we know from people like (Beatrice) that it is possible. Today’s report includes the latest science
on interventions that have been proven to help people quit smoking. We know a lot about the benefits of keeping
people from starting to smoke preventing initiation, but this report highlights that quitting smoking
is one of the most important things that people can do to improve their health and it doesn’t
matter how old you are or how long you’ve smoked. Right now is the right time to try to quit. So if your loved one or you are a smoker and
you’ve tried to quit or want to quit, there literally has never been a better time to
make a quit attempt. Smoking cessation, a report of the surgeon
general, is the 34th report on tobacco since the first surgeon general’s report was released
way back in 1964 and it’s the first to focus solely on cessation since 1990, 30 years. In the three decades since then the world
has changed dramatically from the advent of smartphones and social media to wider availability
of FDA-approved smoking cessation medications. And with research medical advances and years
of documented experience in tobacco control, we know more about the science of quitting
than ever before. Today’s report documents proven strategies
that help adults quit smoking. It also highlights the broader system of support
and policy interventions that we know encourage, accelerate, and sustain quitting success. The report further addresses the health benefits
derived from quitting smoking and the unique populations who disproportionately face the
burdens of tobacco use. Cigarette smoking has declined considerably
from nearly 43% when the 1964 surgeon general’s report was first published to a historic low
of nearly 14% in 2018. This decline represents one of the greatest
public health achievements of the past century and we have many partners in the room who
helped us get here. So I ask that you give yourselves a round
of applause Thank you for helping us get there, a historic
low, but 34 million U.S. adults, a number you will hear repeatedly today, still smoke
cigarettes and smoking remains the single largest cause of preventable disease, disability,
and death in our country. Cigarette smoking harms nearly every organ
of the body. Nearly half a million Americans as Admiral
Giroir told you die from smoking each year accounting for nearly one in five deaths in
our nation. And cigarettes are to the best of my knowledge
the only legally sold products that when used as directed kill half the people who use them. In addition to the human toll, smoking related
illnesses cost the U.S. more than $300 billion each and every year and I wanted to figure
out how to make that real for people. So this morning I started playing with numbers
and, you know, I realized that we’ve get about 300 million people here in the United States. A billion is a thousand times a million. That means every man, woman and child in the
United States is paying about a thousand dollars due to smoking related costs in this country. So helping more people quit using the tools
detailed in this historic report is the fastest approach to helping improve our nation’s physical
health, as well as, our nation’s fiscal health. This report contains 700 hundred pages of
the latest science around smoking cessation and is the result of an enormous undertaking
with many contributors. The report’s been developed over three years
by a senior scientific editorial team through coordination by CDC using the same scientifically
rigorous peer-reviewed standard that has been the hallmark of U.S. Surgeon General’s reports
on tobacco since their inception. More than 150 individuals worked to compile
and review this report. So thank you to the report’s senior editorial
team who are here with us today including Dr. (Rachel Grana). Where are you? Right there. Dr. (Julian Schauer)? She’s had two babies in the time that she’s
been working on this report. True story. Dr. (Jennifer Wronger), where are you? Not – okay. Not here. And Dr. (Ann Mallorshay) and (Ann) is right
there. As well as Dr. (John Samit). (John Samit) couldn’t be here with us today,
but he worked on the surgeon general’s report on cesssation 30 years ago. I think that’s important that folks understand
this isn’t me in some backroom writing down what I. think about what we should be doing. These are experts in the field of tobacco
control who’ve been working on these issues for their entire lives, 150 experts who came
together to help us understand what the science tells us. Thank you also to the carderie of contributing
authors and peer reviewers many of whom are also in this room who worked tirelessly to
ensure the scientific rigor of this report. I also want to personally thank my colleagues
at the Centers for Disease Control and Prevention especially the Office on Smoking and Health
and a special shout out to (Brian King) and (Leslie Norman) – (Leslie), yes, and (Brian)
– whose scientific and technical expertise was instrumental in making the release of
today’s report possible. As well as Dr. (Corinne Graffunder), director
of the Office on Smoking and Health for your leadership in this endeavor. Finally, a sincere thanks to our local, state
and national partners many of whom are here in the room with us today for their commitment
and contributions. Critically important that you all are here. Many of you all know I used to run a State
Department of Health. I also used to work for the city of Berkeley’s
County Health Department. We know that that report right now it’s just
a book. It’s just a doorstop. What helps it come alive are all the people
in this room who are going to take those recommendations and bring them to life. So now I want to turn to the report itself. It’s comprised of 101 chapter conclusions
and 10major conclusions. While previous surgeon general’s reports again
have documented how smoking can increase the risk of numerous diseases, today’s report
is the first to comprehensively document how quitting smoking can reduce the risk of these
diseases. An important distinction. The report also documents an array of effective
clinical and health systems interventions for treating tobacco use independent. One of the things that I worried about in
this report is that people would go back to the stigma that hurts people. The stigma that said it’s all about the individual
and that their clinical health systems and population level interventions that we know
create an environment to help people quit smoking. To provide context on the report itself, I
want to walk through what we know from the major conclusions. We know that smoking can add years of life
and improve health and well-being. Quitting smoking is beneficial at any age. This is true whether you’re 27 or you’re 72. And we’ve got some 27-year-olds in this room
and we’ve got some 72-year-olds in this room. And all of you statistically speaking have
friends who smoke. So tell all your friends it doesn’t matter
how old you or how young you are. Now is the right time to quit. Quitting smoking can also lower a person’s
risk of early death and add as much as a decade to their life expectancy. And I lived and breathed this stuff for year,
but what’s cool about these reports is there are some things that even jump out to us. I didn’t even know until this report came
out that you could add as much as 10 years, a decade to your life expectancy by quitting
smoking. Smoking is costly. I mentioned earlier that 300 billion annually
in smoking related illnesses in terms of the cost to our nation. Findings included in today’s report highlight
that quitting smoking can reduce the financial burden on individual smokers on private and
public health care systems and on society as a whole. I think of a great story that I heard just
a few weeks ago where someone helped a gentleman understand how much money he could save in
a year if he quit smoking and he said, Well, I could buy a truck with that. Well, we could buy a whole lot of trucks with
$300 billion. And it’s important to understand that again
this is not just a toll on our personal and physical health. It’s a toll on our economy and on our nation. And quitting smoking reduces the risk for
serious health conditions including 12 different types of cancer, heart disease, lung disease
and reproductive health problems. We’re highlighting maternal mortality right
now at HHS. There are things that we could be doing to
help more women be healthier when they become pregnant so that they’re more likely to live
to their baby’s first birthday and to see their children grow up. So the science is clear about the benefits
of smoking from both a health and an economic perspective. But more than half of adults who smoke try
to quit in any given year, yet face several challenges, over 40%. This is another one of those numbers that
jumped out at me and I’ve got to own this as the nation’s doctor and our health providers
in this room and in our country need to own this stat. Forty percent of smokers who see a health
provider each year aren’t advised by those health providers to quit. I told you, smoking is the number one preventable
cause of death, disease and disability in the United States. So why are 40% of our health providers out
there not advising smokers to quit when they come in? Two-thirds of smokers who try to quit don’t
use FDA-approved medications and counseling which have been proven to increase the probability
of quitting. Another challenge is the disparities in smoking
and cessation behaviors persist in our nation and I was talking with someone about this
just yesterday. It’s easy for me who lives in the suburbs
to think that no one smokes anymore. We look around. I don’t see anyone smoking. We’re at historic low numbers. But the fact is many groups have been left
behind by the progress we’ve made over the last several decades. Cigarette smoking remains highest among LGBTQ
adults, people with disabilities or limitations, American Indians and Alaska Natives and people
with mental health conditions or substance use disorders. Do you know that 40%of the cigarettes consumed
in this country are consumed by people with a mental illness or a substance use disorders
diagnosis? And so I encourage you to go to SAMHSA’s Web
site and view their advisory that they put out on just this issue because one of the
problems if we think that people in these populations don’t want to quit or that they
can’t quit, but this report tells us that’s just not true. They want to quit. They can quit. They need our help. And there’s still so much more work to be
done and this report helps us understand where and how we need to target our future efforts. While quitting smoking may be hard, it’s possible
especially when people who want to quit are connected to proven treatments that are safe
and effective. Behavioral counseling and FDA-approved medications
according to the science compiled in this report actually double the chance that someone
can successfully quit when used in concert. Behavioral counseling and the seven FDA-approved
medications are effective alone, but again when we use them together we significantly
increase the chance that someone can quit. And counseling is available now in a variety
of forms. This wasn’t the case 30 years ago when the
last report came out. There’s individual. There’s group. There’s one-on-one counseling over quit lines. The times are evolving and so must we. This report tells us text message-based interventions
are effective in increasing the likelihood of successfully quitting smoking as our web
or internet-based interventions. So we need to get with the times, people. We need to help connect with folks where they
are to ensure people who want to quit can have meaningful access to counseling and medications. The report tells us that the health system
and payer levels have a responsibility in providing comprehensive barrier-free insurance
coverage for cessation services. Too many plans in my opinion have co-pays
or prior authorization policies that are penny wise and pound foolish. According to the report, comprehensive barrier-free
coverage and promotion can increase the use of proven treatments, lead to higher rates
of successful quitting and has been shown that science over the past three decades shows
us these are cost-effective interventions. Again, penny wise and pound foolish to not
give someone access to what we know works. Having highlighted the report’s findings about
strategy that the individual in systems levels, I want to finish on population level strategies. This report details a number of interventions
proven to decrease smoking on a population level. So maybe you’re not an individual who smokes
and knows someone who smokes. Maybe you don’t work within a health care
system. There are still things that you can do and
you can advocate for it to help those 34 million Americans who are still smoking. And these include raising the price of cigarettes,
adopting comprehensive smoke-free policies, implementing mass media campaigns CDC tips
from former smokers campaign and requiring pictorial health warnings on cigarette packing. That report tells us all of those are proven
interventions that save money and save lives. And again, I would be remiss if I didn’t mention
that a former state health officer that it is important to fully fund comprehensive statewide
tobacco control programs which provide a foundation for advancing population level interventions. Now when discussing interventions and innovations
that can help people quit smoking the question inevitably is raised about the potential role
of e-Cigarettes. So I want to address this issue starting with
the language of the major conclusion related to e-Cigarettes that’s included in this report. E-Cigarettes are a continually changing and
diverse group of products that are used in a variety of ways. Therefore, it is difficult to make generalizations
about their effectiveness for cessation based on studies of a particular e-Cigarette and
there is presently inadequate evidence to conclude that e-Cigarettes in general increase
smoking cessation. Now, that said, it is very important that
you all understand. I’ve heard powerful accounts from individuals
who have used e-Cigarettes to quit smoking traditional combustible cigarettes. And there are some studies that are actually
reviewed in this report documenting that certain types of e-Cigarettes may be associated with
quitting in some adult smokers. But it’s also important that we use the entire
body of available science to guide our current recommendations. And this report is based on over 150 expert
contributors reviewing the totality of scientific data about what works on a population level
to help people quit. And these experts, not the surgeon general
in a back room, 150 national and international tobacco control experts concluded that right
now more research is needed on whether e-Cigarettes in general are an effective quit aide at the
population level and more research is needed to better understand the health effects of
e-Cigarettes. It’s also important to note that irrespective
of ongoing research related to e-Cigarettes there’s a potential cessation tool for adult
smokers this absolutely cannot come at the expense of escalating rates of use of these
products. So I want to be absolutely crystal clear. I want to be crystal clear. Use of any tobacco products including e-Cigarettes
is unsafe. I know that was a lot of information share. It wasn’t nearly as much as in those 700 pages,
but hopefully it provides a snapshot of the richness of the scientific data and findings
included in this historic report. Findings like those contained in this report
are crucial to inform ongoing efforts around smoking cessation. And we know that the science will continue
to evolve and help to improve our understanding of what works to help people quit. One of the most important things about this
report is helping us understand what works. Another one of the most important things about
this report is to help us understand where the gaps exist. And so we need you all to go out and fill
in those gap so that the next time we put this report together we can move the ball
down the field even further. In releasing today’s report I want America
to know that smoking cessation, a report of the surgeon general, is a blueprint, the gold
standard right now for continued coordinated and collective action among each of us as
stakeholders who want to help those 34 million Americans right now who are still dependent
on nicotine. The intent behind the development and release
of surgeon general’s reports again is not only to report on the current science, but
to encourage application of the science because otherwise it’s just a nice red book. So in addition to the release of the report,
today we’re also releasing a suite of materials that translate and highlight some of the key
takeaways and findings from the report to enhance their uptake and implementation. So I want to give you just one of these examples
because the CDC has done a great job preparing these materials. We don’t expect someone who comes into a doctor’s
office to pick up that 700-page report and read it while they’re waiting to see their
health care provider. But this has been translated into what we
know to be effective at a population level, at a community level, at an individual level. Smoking – quitting smoking save lives and
money, health benefits of quitting smoking. Again, we want to see these in every doctor’s
office. We want to see these in every pharmacy. We want to see these in every clinic. We want to give people the tools that we know
are effective and the language to be able to ask for what works so that they can quit
smoking. Most of the 34 million Americans who smoke
want to quit. That’s a key takeaway. That’s what I want you all to tweet out. I want you to help people understand 70% of
current smokers say they want to quit. We need to connect them with the effective
treatments that can help them do so. We know coordinated efforts providing treatment
and support across multiple sectors can help people quit smoking, but not enough of those
34 million Americans are getting access to those treatments and supports. Equipped with both science and resolve, we
have the ability to end the tobacco epidemic in America. Working together we can take the completely
preventable tragedy of tobacco-related disease, disability and death, the preventable tragedy
that took both of my grandfathers from this earth, and we can make it a thing of the past
so that future surgeons general don’t have to stand in front of a podium and talk about
how they lost their loved ones to unfortunately preventable tobacco-related illnesses. Now, it’s one thing to talk about the data
and scientific findings that demonstrate health benefits and improvements and quality of life,
but we wanted you to hear firsthand from someone who can share in her own words what smoking
cessation means to her. Thanks to the CDC since 2012 the tips from
former smokers national tobacco education campaign has featured more than 30 brave individuals
and their personal stories to help motivate others who want to quit smoking. And I encourage you to go to their Web site,
hear their stories. They’re powerful. But I didn’t want to just rely on you going
to the Web site. I actually brought (Beatrice) here today. She’s one of those heroes. (Beatrice), come on up. (Beatrice) is a mother and a former smoker
and she’s got a powerful story that I hope she’s going to share with you right now. Thank you, (Beatrice). (Beatrice): Yes. Thank you, Dr. Adams, and thank you to the
Office of the Surgeon General for having me here today. My grandmother was a smoker and when I was
7 years old my brother and I took one from her pack because we wanted to try. By the time I was 13, I was smoking regularly. I had friends that smoked. And like many kids in junior high, we thought
we were cool because we smoked. More than 25 years late I was a married mom
of two boys and still a smoker. I had tried many times to quit, but finally
in 2010 I made the decisions to quit for good. I received a letter from my 11-year-old son
encouraging me to quit and stick with it which was the motivation I needed to stay smoke-
free. I still carry that letter with me. Each time I had a craving I would reach for
that letter to remind myself why I had to quit and that I was strong enough to stay
smoke-free for myself and my family. I have been smoke-free for nearly a decade
and I still carry that letter around with me. Thank you. It’s a true honor to share my story with the
CDC’s tips for – from former smokers campaign and to help others who are struggling to find
their motivation to quit smoking. The good news for people who smoke and want
to quit is that they don’t have to do it alone. For example, I use nicotine replacement therapy
and sought support from my family and friends to help me quit smoking for good. My tip to smokers who are struggling to quit
is to just keep trying. Each day is a new opportunity to be smoke-free. I am proud to stand before you today to put
a face to the millions of people nationally who have quit smoking for good. Quitting smoking is possible and whatever
your reasons are for taking that initial decision to quit there are science-based tools to increase
your chances of success along with your quitting journey. You don’t have to do it alone. Thank you again for the opportunity to be
here today Jerome Adams: Wow. Thank you so much, (Beatrice). That’s what we’re here today for. That’s really what we’re here today for. We’re not here today really because of that
big book. We’re here because of people like (Beatrice). And we want more people to understand that
quitting is possible. And I just I know how hard it is to stand
up here and to share a bit of yourself and especially when it’s personal. And I just want to say thank you again, (Beatrice). Thank you so much. And with that, I would like to invite our
senior editor, Dr. (Brian King) up to the stage and we’ll be happy to take questions
starting with reporters in the room who may have questions. Female 1: So while we’re getting set up for
questions and answers in the room, operator, can you please queue up individual reporters
on the phone for questions as well? Coordinator: We will now begin our question
and answer session. If you’d like to ask a question, please press
Star 1 from your phone, unmute your line and record your name clearly when prompted. If you like to withdraw your question, please
press Star 2. One moment as we wait for our first question. Female 1: Yes. Okay. (Joyce Freedan): Hi. (Joyce Freedan) from
MedPage Today. I just wanted to ask about public health policies
that might help more people quit smoking. I saw something in here about raising tobacco
taxes for instance and wanted you to address it. Jerome Adams: Well, thank you so much for
that question and I appreciate you being here. When I think of the interventions contained
in this report, I really think of three different buckets. I think of individual level interventions
that we know work. Again, seven FDA-approved quit medications. But I didn’t share this shocking stat with
you. Two-thirds of people who make a quit attempt
actually make a quit attempt without the assistance of FDA-approved quit medications. And so interventional -interventions on an
individual level we know behavioral counseling combined with FDA-approved quit medication
significantly increases your chances of quitting. We know there are health care systems interventions. We know that our health care systems could
be better utilize EHRs to help empower and enable providers to advise people to quit. We know that we need to give people the education
and the confidence to be able to have that conversation because too many of them look
at someone and say no, too hard, too much effort. No, that’s not what they’re here for today. But simply asking, advising and referring
can be enough to get someone on the pathway to quitting. But then to your point, there are population
level interventions that have been shown over and over and over again to be effective. CDC’s tips from former smokers campaign is
the gold standard for mass media campaigns that we know help encourage people to quit. Raising the price of cigarettes we know not
only prevents people from starting, but helps people quit. We know that smoke- free policies – and this
can happen on a large population level in a community, but employers out there and businesses
can actually create smoke-free environments within their institutions. Those types of things can help people quit. And can’t hammer this home enough, fully funded
state tobacco control programs have been shown the science is clear that fully funding them
will significantly decrease the number of people who are smoking and help prevent disease,
death, disability and skyrocketing health care costs. Anything you’d add to that? (Brian King): Yes, the only thing I’d add
is that we know from the available science that a comprehensive approach is warranted
and there’s not going to be any single solution that’s ultimately going to reduce, you know,
cigarette smoking down to levels where we’d like to see them. And we know from decades of tobacco control
experience at the national, state and local levels that comprehensive approaches are warranted
in terms of addressing all the various levers that cannot only influence initiation, but
can also promote cessation. And that includes those tried and true interventions
like increasing price, smoke-free policies, as well as, some of these more novel strategies
that are outlined in this report for which there is suggestive evidence that we need
more research including very low nicotine containing cigarettes as well as strategies
to address flavored tobacco products and the impact
on cessation. (Jackie Lee): Hi. (Jackie Lee) with Bloomberg Law. When you mentioned the e-Cigarettes and smoking
cessation I believe you mentioned that there were certain – like, it’s difficult to make
a general statement about how effective e-Cigarettes are with smoking cessation. But you mentioned that there are certain products
that are linked to adult smokers helping them stop smoking. What are those products? Like, specifically what brands are they and
when and where was the research done on those products? Jerome Adams: I’ll let – I’ll give you some
broader context and then I’ll let Dr. (King) drill down. It’s important to understand that this landscape
has been rapidly evolving. There are literally thousands of different
products in the e-Cigarette and vaping categories. Thousands. And so we simply need more research to determine
which devices for which people under which circumstances have the potential to help people
quit. One thing is clear. One in four of our young people is initiating
tobacco product use with e-Cigarettes. And so we are concerned about that and that’s
why I put up my 2018 surgeon general’s advisory. Another thing we’re clear about in this report
is that we have evidence-based strategies that we know work. FDA-approved, quit medications, behavioral
counseling, all the things I named, that are being underutilized – severely underutilized. They’re not being recommended by providers. When they are being recommended by providers
they’re not being paid for by payers. When they are being paid for by payers, people
aren’t using them in the field. And so we want to lean on where the science
tells us to go. And right now the e-Cigarette market is so
varied that it’s just – it’s hard. The science isn’t there yet to say that on
a population level that they actually help people quit smoking. And that’s not to discount anyone’s individual
story. I’ve heard – again I’ve heard powerful accounts
of people using these products to quit, but we need more research. Dr. (King)? (Brian King): Yes. So in terms of sequeing into the actual research,
we did a very nuanced review of the available science on this issue all the way from self-reported
surveys all the way to randomized clinical trials. And as was noted, there’s a variety of different
products on the market and the landscape has trained – changed drastically since these
products were introduced into the marketplace in 2007 from products that resembled the same
size and shape as conventional cigarettes all the way to newer pot- based symptoms. And so a lot of the products that are currently
on the market are not the same one for which the research has been done. But this report does acknowledge that given
the wide diversity of the different products on the landscape the evidence is currently
inadequate to demonstrate a causal association between e-Cigarettes and general cessation. But it also does note that there is suggestive
but not sufficient evidence in terms of certain types of e-Cigarettes including those that
contain nicotine compared to those that don’t as well as higher frequency of use compared
to less frequency. But it’s important to note that that’s suggestive
evidence. It’s not the highest standard of sufficient
evidence. And as was noted, we have proven interventions
that meet that standard including nicotine replacement therapy as well as other non-nicotine
containing medications approved by the FDA in addition to counseling. And so it’s important that we continue to
do research on the issue of e-Cigarettes but we base our recommendations based on the available
science as we continue to monitor the available science on e-Cigarettes and cessation and
also importantly prevent initiation among youth for which we’ve seen skyrocketing rates
within the past couple of years. Jerome Adams: And I just want to hop back
in because one of the things that I really want people to take away from this isn’t the
inadequate conclusion on e-Cigarettes. There’s a lot in here that we know we need
more research on and that we will continue to follow the evidence on. What I want people to take away is we know
what works. People want to quit. We know what works. Not enough of them are getting it. And there are terrible disparities in who
is and is not getting access to effective and evidence-based treatments. That’s the story here. That’s the headline here. That’s what’s important for people to know. That’s what’s going to save people’s lives. Female 1: Now, let’s go to the phone with
questions. Coordinator: Our first question comes from
(Sarah Ormal). Your line is now open. Jerome Adams: We scared (Sarah) away. Coordinator: (Sarah), are you on the line? (Sarah Ormal): I’m sorry. Can you hear me now? Female 1: Yes. (Sarah Ormal): Okay. Sorry about that. Hi, Dr. Adams. This is (Sarah Ormal) with Politico. Along those same lines as the last question,
you talked about, you know, the potential for (unintelligible) of there being inadequate
evidence and then of course the potential that (unintelligible) could be using them. So what it from your perspective as a doctor
needs to be done with the flavor bands that are currently in the works of the Trump Administration? Do you think that’s the right approach to
take? And then along the same lines of there not
being evidence for them (unintelligible) smoking cessation devices e-Cigarette manufacturers
have been clear that they don’t want to be marketed that way anyway. So what – where are you going to get this
data in the future to determine whether they are effective that way? Jerome Adams: Well, (Sarah), thanks for calling. I really appreciate that. Again, I want to help people understand because
this is a – it seems like an obvious point, but it’s important that we understand the
difference between initiation and the science behind initiation and the data behind initiation
infestation and what helps people quit. As Surgeon General I put up my advisory because
I’m terribly concerned about the clear data that showed the user initiating tobacco products
use with e-Cigarettes. And now to your question about my feelings
on our current policy, our current policy reflects the science. It reflects a balance between a desire to
really make sure people aren’t initiating with these products, but also a desire to
again try to maintain a pathway for adults who have – want to use these products to quit
to be able to use them. Today, we’re here to talk about smoking cessation
and again the science according to 150 tobacco-control experts is that there’s currently inadequate
evidence to conclude that e-Cigarettes lead to smoking cessation in general. There’s lots of evidence, 700 pages of evidence
to suggest that – or to tell us – not suggest, you tell us definitively that FDA-approved
quit medications and behavioral counseling are effective in helping people quit. And we need more people to know about that
and we need to continue to push for the research. Now, that said, the FDA laid out a pathway
for people to submit their research and their findings and we have to let that process play
out. But I hope that the researchers in this room,
I hope that the people who are advocates for an array of other options to help people quit
will continue to push for the research, do the research so that the next time we put
together a report we’ll have more to pull from and we can come up with more definitive
conclusions. (Brian King): (Unintelligible) nicely said. Female 1: Okay. We have time for one last question from the
phone. Operator? Coordinator: Our next question comes from
(Alisha Alt). Your line is now open. (Alisha Alt): Yes, thank you for taking my
call. My question has to do with FDA and where we
stand with the requirement that cigarette makers are going to have to put those pictorial
warnings you mentioned on the packaging. Can you give us an update on where we are
with that? Jerome Adams: I’m going to have – Dr. (King)
lives and breathes this stuff and I’m going to have him give you a more specific update. But what I will say in general is that there
is good evidence detailed in this report that pictorial warnings are an effective way of
helping people quit. And so the question then becomes how do we
get from the science to a place where we can help more people quit and there’s the regulatory
process, there are legal processes that have to play out, but right now the science says
the pictorial warnings help people quit smoking. (Brian King): Yes. And I wouldn’t add much further beyond just
deferring to FDA. As noted, there’s a very specific and nuanced
process for developing the science to inform regulation. And the findings in this report really reinforce
what FDA has proposed to do. We know that pictorial health warnings are
effective in terms of promoting cessation particularly having them on the pack at the
point where an individual user sees them very prominently. And so the available science was sufficient
to conclude that those are effective. And we’ve also seen the experience of multiple
countries across the world who have already implemented these types of strategies again
as part of a comprehensive approach to help promote cessation and to create an environment
where these products are less appealing to individuals (Alisha Alt): Well, thank you very much. Female 1: That was our last question and this
concludes the press conference. Thank
you everyone for joining.

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