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Kick Butts and the USPSTF 5 A’s Framework

Kick Butts Day is a national day of activism to empower youth to stand up, speak out and seize control against Big Tobacco. Kick Butts Day aims to:

  1. Raise awareness of the problem of tobacco use.
  2. Encourage youth to reject the tobacco industry’s deceptive marketing and stay tobacco-free.
  3. Urge elected officials to take action to protect kids from tobacco.

This Kick Butts Day, Eon decided to examine the prevalence of smoking in the United States, the effect on our communities, and to learn more about smoking cessation. Below is a summary of our findings.

  1. Cigarette smoking is the leading preventable cause of morbidity and mortality worldwide, responsible for over 6 million deaths annually (1).
  2. Smokers who quit smoking reduce their risk of developing and dying from tobacco-related diseases such as cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.
  3. Despite declining smoking rates in the United States, more than 30 million people, or 14.1% of U.S. adults, smoked in 2017 (2).
  4. Annually, one in five U.S. deaths are attributed to cigarette smoking or secondhand smoke exposure (3).
  5. On average, smokers die 10 years earlier than nonsmokers (4).
  6. Economically speaking, smoking costs the United States over $300 billion each year – $170 billion for direct medical care and over $156 billion in lost productivity from premature death and exposure to secondhand smoke (5).
  7. Despite the known risks of smoking, everyday almost 2,000 young adults under the age of 18 smoke their first cigarette (3).

Ironically, big tobacco still spends more than $1 million every hour advertising and promoting cigarettes and smokeless tobacco products (6). Tobacco companies are having to redefine themselves as cigarette smoking has steadily declined and are heavily investing in Modified Risk Tobacco Products (MRTP). In 2016, André Calantzopoulos, CEO of tobacco giant Philip Morris, said he hoped cigarettes would soon be history, a spurious way to say there are no efforts to reduce nicotine addiction and the company is looking to replace cigarette sales with new nicotine alternatives.

Nearly seven in ten (68%) adult smokers want to quit smoking, while more than half of all adult smokers have made some type of quit attempt (7). So why aren’t more smokers successful at quitting? As it turns out, there is much more to it than just quitting.

One of the biggest challenges around smoking cessation is the relatively low rate of sustained success and researchers are just starting to understand the science behind stopping. Tobacco use of any kind can be characterized as a chronic relapsing substance use disorder that is sustained by addiction to nicotine. According to Martin J. Jarvis at the University College of London, “Social, economic, personal, and political influences all play an important part in determining patterns of smoking prevalence and cessation. Although drug effects underpin the behavior, family and wider social influences are often critical in determining who starts smoking, who gives up, and who continues (8).”

Successful interventions begin with identifying nicotine users and appropriate therapies. For providers, the United States Preventive Services Task Force (USPSTF) recommends the “5 A’s Framework”:

  1. Ask every patient about tobacco use
  2. Advise all users to quit
  3. Assess willingness to quit
  4. Assist with attempts to quit
  5. Arrange follow-up

In fact, the Centers for Medicare & Medicaid Services (CMS) now requires all eligible lung cancer screening patients to be offered smoking cessation prior to having a screening exam.

The Centers for Disease Control and Prevention’s Million Hearts offers a Tobacco Cessation Protocol that can be adopted by health systems and providers to use with tobacco dependent patients. The protocol includes a decision tree for intervention and a Quit Plan checklist.  Tobacco Cessation Protocol.

The 5 A’s Framework and identifying nicotine dependent patients has led to an entirely new discipline in healthcare around smoking cessation. As it is, the family doctor who says “you should stop smoking” is not a very successful cessation tool.  What has been found to be successful is a combination of methods and appropriate interventions based upon the user’s willingness to quit. Such methods include:

  • Nicotine replacement therapy (NRT)
  • Medications
  • Counseling and quit plans
  • Quitlines
  • Innovative digital technologies (digital transdermal patch, smart lighters and smart cigarette cases)

Whether you are a physician looking to start a smoking cessation program or a person looking for tools to help a friend stop smoking, this Kick Butts Day join the effort to stand up, speak out, and seize control against big tobacco.


  1. https://www.sciencedirect.com/science/article/pii/S014067361730819X
  2. https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease201803_08.pdf
  3. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
  4. https://www.nejm.org/doi/full/10.1056/NEJMsa1211128
  5. https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html
  6. https://www.tobaccofreekids.org/what-we-do/us/statereport/
  7. https://www.cdc.gov/mmwr/volumes/67/wr/mm6744a2.htm
  8. https://www.bmj.com/content/328/7434/277

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