No Other Health Intervention Could Yield Such Improvements to the Health of the American Public

A New Partnership with The American Cancer Society

The new year marks the launch of a new partnership between the Smoking Cessation Leadership Center (SCLC) and the American Cancer Society (ACS) that will focus on smoking cessation among persons with behavioral health conditions. This partnership derives from a confluence of circumstances: the century-long efforts of the ACS to combat cancer in the United States and worldwide; the stark fact that about a third of all cancers are caused by smoking tobacco products; the reality that smoking is now concentrated among persons with behavioral health conditions (mental illnesses as well as substance use disorders), and the 14-year history of the SCLC’s efforts to promote smoking cessation activities.

The rationale for this partnership stems from today’s tobacco control landscape. Despite great strides in lowering the rate of tobacco use and its devastating health consequences, certain groups received scant benefit from this progress. Chief among them are those with behavioral health conditions. This population consumes about 40% of all cigarettes sold in the United States and accounts for an estimated 240,000 of the approximately 540,000 annual deaths from smoking; a significant proportion of those premature deaths are caused by lung cancer, as well as other tobacco-induced cancers. Yet, until recently, health professionals, relevant governmental agencies such as the huge federal Substance Abuse and Mental Health Services Administration, and advocacy groups such as the National Alliance on Mental Illness, have not identified this group as constituting a health disparity or priority population meriting special emphasis on tobacco use. Yet the behavioral health smoking prevalence is two-to-three times the national average and this population dies 10-to-25 years earlier than the general population, mainly from smoking-related illnesses such as lung cancer, heart disease, stroke, and chronic obstructive pulmonary disease. It is clearly time to pay attention to this hidden epidemic.

The ACS/SCLC partnership launched in October 2016 at ACS headquarters in Atlanta. In attendance were 16 senior representatives of major organizations concerned about tobacco use and behavioral health. The group reviewed existing data on smoking prevalence and health consequences among persons with behavioral health conditions. It agreed upon a goal of reducing smoking prevalence in the United States among those with behavioral health problems from the current 34% (more than double the current national average of 15%--a figure that includes the entire population and thus overestimates prevalence for those without behavioral health conditions) to 30% by the year 2020.

This proposed goal of a 4% reduction may at first glance seem modest. But a closer look shows just how much improvement it could yield. There are approximately 57.7 million Americans with chronic mental illness, plus 23.5 million with substance use disorders. Since some persons suffer with both conditions, the total number is less than the 81.2 million persons derived by summing the two categories. If we assume that 65 million people have one or more of these two conditions, and that their smoking prevalence is 34%, that translates to about 22 million smokers. Those 22 million smokers amount to more than half the population of smokers in the United States. Reducing the prevalence to 30%--or 19.5 million smokers --would result in 2.5 million fewer smokers. If we assume that one half of all smokers die prematurely from smoking-induced illnesses, that would translate to more than a million premature deaths averted, as well as avoiding needless suffering and expense. In addition, it would prevent many millions more from struggling with chronic tobacco-induced diseases, especially cancer, heart disease and lung disease. No other health intervention could yield such improvements to the health of the American public.

We recognize that this ambitious project is just underway, and that its execution is not guaranteed. At this stage many questions remain. I will pose and then try to answer some of them:

  • What is the goal of this partnership? We hope to catalyze a national movement that will result in a multi-faceted effort to reduce smoking among those with behavioral health conditions and thereby save lives and improve the health of the public.
  • How will this be accomplished? Like with tobacco control in general, it will require employing a variety of strategies and enlisting a broad set of partners with the capacity to make a difference.
  • Does the effort have a name? It has a provisional name: The National Roundtable on Behavioral Health and Tobacco Use: Healthier, Smoke-Free Lives for People with Mental Illnesses and Substance Use Disorders.
  • What would be its governance? The effort would be housed at the American Cancer Society. Establishing Roundtable status is contingent on securing resources. SCLC staff would serve as the secretariat. Given the enormity of the problem, this is envisioned as a long-term activity.
  • What is its membership and how will it grow? The 16 organizations that attended the October, 2016 Atlanta meeting will serve as the base membership. It is anticipated that other organizations will be invited to join, based on their capacity to share in the goals and contribute to the strategies.

Creating and sustaining such a movement will require resources, energy, creativity, and stamina. We invite your suggestions as to how to make this movement a reality. Please feel free to contact me at: