U.S. Surgeon General Jerome M. Adams has a complicated relationship with tobacco.
He grew up working on his grandfather’s tobacco farm in St. Mary’s County, where he made money to buy sneakers and a prom suit. But his grandfather was also a life-long smoker who died from complications of lung cancer surgery when Adams was in high school. And Adams suffered from asthma so severe as a child he once had to be airlifted to a children’s hospital in Washington, D.C.
The tobacco industry “paid for the clothes on my back as a youth and also prematurely ended my grandfather’s life,” Adams told a crowd at the annual convention of the Society for Research on Nicotine and Tobacco at the Baltimore Hilton.
These days Adams’ asthma is controlled and he runs half-marathons. In his role as surgeon general, he wants to promote ways to end tobacco use.
“It is within our power to stop tobacco use in this country,” he said.
There were 53 million adult smokers in the United States in 1965, said Adams, citing numbers from the Centers for Disease Control. He noted that great strides have been made since then; there are now 20 million fewer smokers. But disparities have grown, he said. Minorities, low-income people and those with mental illness smoke at disproportionately higher rates.
He also cited the country’s opioid epidemic as a contributor to smoking. Too often, he said, people turn to cigarettes when they stop using drugs. He hopes to use addiction treatment as a pathway for preventing people from smoking or getting them to stop by encouraging the use of other natural and nonaddictive ways to cope, such as exercise.
“This larger conversation must emphasize tobacco cessation as part of comprehensive addiction treatment,” Adams said. “We don’t want to say, ‘Okay we saved you from opioids and we’ll see you in a couple of years when you’re back with your problem related to tobacco use.’ ”
The head of the U.S. Food and Drug Administration, Dr. Scott Gottlieb has a bold proposal to get people to quit smoking that Adams also supports. Gottlieb wants to reduce the amount of nicotine, a highly addictive drug, in cigarettes to nonaddictive levels. Nicotine not only makes people become addicted to cigarettes but also other products that contain it. Nicotine products kill 480,000 people a year.
Adams also said menthol is contributing to health disparities in cigarette addiction and should be eliminated from cigarettes. Menthol cigarettes have been found to be harder to quit. Cigarettes with the additive also can be enticing to young people because of the minty taste and are smoked more by African-Americans. More than half of young people who smoke use menthol cigarettes, Adams said.
“I think we really need to focus on disparities that exist and make sure we are equitable and that is one of the greatest places of inequity,” he said.
The medical community needs to do a better job at helping people quit smoking, Adams said. Seventy percent of people want to quit and 50 percent make an attempt to quit for more than one day, but just 7.4 percent are successful.
He said new approaches are needed for the most vulnerable communities. “We have to figure out what is going to make them quit,” he said.
Rather than just tell people to stop smoking, he said, doctors should ask smokers what is important to them. If it is watching their kids play baseball, tell them that won’t be possible if they die from lung cancer.
“We have to take it from the people in this room to the people on the streets,” Adams said.
Prior to becoming surgeon general, Adams was health commissioner in Indiana, where he was credited with convincing then-Gov. Mike Pence to create needle exchange programs after an HIV outbreak in rural Scott County. Pence was against the idea at first on moral grounds but eventually authorized a short-term emergency needle exchange and later supported legislation legalizing it throughout the state.
Adams said he can bring that experience to his new job, where he could face people resistant to his different approaches on improving public health.
Adams said he found common ground with people in Indiana. They wanted to reduce crime; he convinced them that needle exchange would help.
“If you sit down with people and talk to them, you will be surprised at how often you find areas of alignment,” he said. “That is what we did in Indiana.”