A SUMMARY OF SMOKING CESSATION: A REPORT OF THE SURGEON GENERAL – 2020

Smoking Cessation – 

The Role of Payers

Smoking in the U.S.

Since the first Surgeon General’s report on smoking and health was 

released in 1964, cigarette smoking among U.S. adults has declined 

from nearly 43% to a low of nearly 14% in 2018. Despite this progress, 

smoking remains the leading cause of preventable disease and death 

in the U.S. Additionally, smoking-related illnesses continue to cost 

the nation more than $300 billion every year. 

Smoking Cessation Can Improve 

Health and Well-Being

Tobacco dependence is a chronic, relapsing condition driven by 

addiction to nicotine. But cessation treatment can help people quit. 

The 2020 Surgeon General’s Report highlights the latest evidence on 

the benefits of smoking cessation. The evidence is clear – one of the 

most important actions people can take to improve their health 

is to quit smoking, no matter how old they are or how long they’ve 

been smoking. 

Smoking cessation:

` Reduces the risk of premature death, improves health, and 

enhances quality of life. Quitting can add as much as a decade to 

life expectancy.

` Reduces the risk for many adverse health effects including poor 

reproductive health outcomes, cardiovascular diseases, chronic 

obstructive pulmonary disease (COPD), and 12 types of cancer. 

` Benefits people who have already been diagnosed with coronary 

heart disease or COPD.

` Benefits the health of pregnant women and that of their fetuses 

and babies.

` Reduces the financial burden that smoking places on people who 

smoke, healthcare systems, and society.

Key Findings from the 2020 

Surgeon General’s Report

` Smoking cessation reduces risk for many adverse 

health effects, including poor reproductive 

health outcomes, cardiovascular diseases, chronic 

obstructive pulmonary disease (COPD), and cancer. 

Quitting smoking is also beneficial to those who 

have been diagnosed with heart disease or COPD.

` More than three out of five U.S. adults who have 

ever smoked cigarettes have quit. Although a 

majority of cigarette smokers make a quit attempt 

each year, less than one-third use cessation 

medications approved by the U.S. Food and Drug 

Administration (FDA) or behavioral counseling to 

support quit attempts.

` Considerable disparities exist in the prevalence of 

smoking across the U.S. population, with higher 

prevalence in some subgroups. Similarly, the 

prevalence of key indicators of smoking cessation—

quit attempts, receiving advice to quit from a health 

professional, and using cessation therapies—also 

varies across the population, with lower prevalence 

in some subgroups.

` Smoking cessation medications approved by the 

FDA and behavioral counseling are cost-effective 

cessation strategies. Cessation medications approved 

by the FDA and behavioral counseling increase 

the likelihood of successfully quitting smoking, 

particularly when used in combination. Using 

combinations of nicotine replacement therapies can 

further increase the likelihood of quitting.

` Insurance coverage for smoking cessation treatment 

that is comprehensive, barrier-free, and widely 

promoted increases the use of these treatment 

services, leads to higher rates of successful quitting, 

and is cost-effective.

For information about:

` quitting smoking, visit www.CDC.gov/quit

` the Surgeon General’s report, visit

www.CDC.gov/CessationSGR
Evidence-Based Cessation 

Treatments Work

Tobacco use and dependence often requires repeated intervention 

and long-term support to help patients quit. The Surgeon General’s 

Report outlines an array of effective treatments and resources for 

tobacco use and dependence, including:

Counseling, which is available in a variety of formats, including 

individual, group, and by telephone. 

` Proactive counseling from quitlines can increase the 

chances of quitting when used alone or in combination with 

cessation medication. 

` Text messaging and web-based cessation interventions can also 

help people successfully quit smoking. 

Medications that have been approved by the FDA to improve 

chances of quitting. 

` Medications include five nicotine replacement therapies (NRTs) 

and two non-nicotine prescription medications. 

` Compared to using a single form of NRT, combining a long-acting 

NRT (e.g., patch) with a short-acting NRT (e.g., lozenge) increases 

the chances of quitting.

Combination of counseling and medication. Each is effective 

when used alone and combining them can more than double 

chances of successfully quitting.

Payers Can Contribute to a 

Future with Fewer Costly 

Tobacco-Driven Conditions

Each year, over half of adults who smoke try to quit. Yet fewer 

than one in 10 adults who smoke successfully quit in a given year. 

Opportunities exist to better connect individuals who smoke to 

proven strategies that can help them quit. 

As outlined in the Surgeon General’s Report:

` There is evidence that insurance coverage for smoking cessation 

treatment that is comprehensive, barrier-free, and widely 

promoted increases the use of these treatment services, leads to 

higher rates of successful quitting, and is cost-effective. 

` Certain life events – including hospitalization, surgery, and lung 

cancer screening – can trigger attempts to quit smoking, 

increase uptake of smoking cessation treatment, and lead to 

successful cessation. These events are often scheduled by 

payers in advance and can create an opportunity to encourage 

smoking cessation.

` Strategies that link smoking cessation-related quality measures 

with payments to clinicians, clinics, or health systems increase the 

rate of delivery of clinical treatments for smoking cessation.

` Proactive quitline counseling, when provided alone or in 

combination with cessation medications, is an effective approach 

to increase smoking cessation.

In working toward enhancements in coverage and healthcare 

delivery that are rooted in these findings, payers can play an 

important role in helping their members achieve smoking cessation.

Smoking Cessation 

Resources for Payers

` Cessation Materials for State Tobacco Control 

Programs – www.CDC.gov/tobacco/quit_smoking/

cessation/index.htm

` U.S. Preventive Services Task Force (USPSTF), 

Tobacco Smoking Cessation in Adults, 

Including Pregnant Women: Behavioral and 

Pharmacotherapy Interventions – 

www.uspreventiveservicestaskforce.org/Page/

Document/UpdateSummaryFinal/tobacco-usein-adults-and-pregnant-women-counseling-andinterventions1