What is the #1 most common method used by those who successfully quit smoking that the US Centers for Disease Control refuses to name?

In July 2024, a brief report titled Methods US Adults Used to Stop Smoking, 2021–2022 was published on the research portal Medrxiv (pronounced Med Archive) a preprint site where authors publish research which has not yet been peer reviewed. This is typically a procedure designed to get researchers’ data and ideas out there in public much earlier than almost always occurs with the often glacial pace of having papers pass through peer reviewed to publication in journals. Publication often follows as authors move down the research journal food chain till one finally publishes it with a “peer reviewed” pedigree.

The Medrxiv report used “Nationally representative Centers for Disease Control and Prevention (CDC) survey data … to identify which subpopulations of US adults had stopped smoking cigarettes for 6 months or longer in the last year and the methods they used” for the years 2021-22” when the data showed 2.9 million Americans stopped smoking.

The authors reported that “Among those who stopped smoking for 6 months or longer, the most commonly reported methods used were nicotine products (53.9%, 1.5 million US adults), primarily e-cigarettes used alone or in combination with other methods (40.8%, 1.2 million US adults). The least commonly reported methods were non-nicotine, non-prescription drug methods (including a quit line, counseling or clinic, class, or group) (6.3%, 0.2 million US adults). Of the listed methods, the most commonly reported exclusive method selected was e-cigarettes; 26.0% (0.7 million US adults) of adults who stopped smoking from 2021 through 2022 for 6 months or longer selected e-cigarettes as their only listed method.”

So, of 2.9 million who quit, 1.5 million used nicotine products and 200,000 used non-nicotine or non-prescription methods. That leaves a mere 1.2 million (41%) unaccounted for who stopped smoking but were deemed not to have used CDC anointed “surveyed evidence-based methods to stop smoking. Methods containing nicotine, primarily e-cigarettes, were the most commonly-reported methods that were explicitly surveyed.”

A table in the report lists all the methods used by nation’s quitters in descending order. Triumphant in floodlights at the top of the league are those who exclusively used e-cigarettes (40.8%) while skulking right down the end of the list we find the desolate and cryptic “none of the above” with 42.5%, which the numerate among you might have noticed is higher than the quit proportion who exclusively used vapes.

So how on earth did the people who successfully quit smoking for six months or more possibly manage to quit when they weren’t sensible enough to use the “evidence-based methods” explicitly asked about and listed by the CDC and ignored by the report’s authors?  

It’s possible that tiny proportions may have attributed their success to a wide range of weird and wonderful procedures not given as options to respondents by the CDC (a range of placebo complementary medicine and consumer cons like “laser therapy” and even  prayer).  But such options have never been shown to score more than an asterisk (designating homeopathically small numbers) in any study of quit methods I’ve ever seen.

The ignored elephant in the room of this “none of the above” massive army of successful quitters is unassisted, mostly cold turkey quitting: smokers who for a variety of motivations decide to finally stop smoking, and do so without using any pharmaceutical product or vape or being guided or supervised by specialist professionals or clinicians.

Before the availability of nicotine replacement therapy, prescribed drugs or vaping untold millions of smokers stopped permanently around the world. This was seldom documented or researched, but in the US  way back in1979, the then director of the US Office on Smoking and Health noted in a National Institute of Drug Abuse Monograph “In the past 15 years, 30 million smokers have quit the habit, almost all of them on their own.”

The US National Center for Health Statistics routinely included a question on “cold turkey” cessation in its surveys between 1983 and 2000, but this option stopped being even asked in 2005. This was not because quitting unassisted had  somehow become uncommon or irrelevant to the main ways that smokers quit. It was rather a revealing index of the success of efforts by those with vested interests in discrediting unassisted quitting.  Let’s not even ask ex-smokers about it.

The commodification of smoking cessation

In his seminal 1975 paper,  On the structural constraints to state intervention in health Marc Renaud wrote of the fundamental tendency of capitalism to “transform health needs into commodities … When the state intervenes to cope with some health-related problems, it is bound to act so as to further commodify health needs.” (Renaud 1975) The pharmaceutical industry creed is that wherever possible, problems coming before physicians need to be pathologized as biomedical problems that need to be treated with medication. This message is also megaphoned to the public.

My highly-cited 2010 PLoS Med paper  The global research neglect of  unassisted smoking cessation: causes and consequences and my 2022 Sydney University Press open-access book, Quit Smoking Weapons of Mass Distraction document  the on-going 45 year efforts by commercial interests (pharmaceuticals and today’s vaping industry) and professional helping professions to convince smokers wanting quit that they’d need their heads examined if they were foolish enough to try and quit unaided, ironically the very way that most ex-smokers stop.

My 2009 Lancet paper The inverse impact law of smoking cessation  posited  that  “the volume of research and effort devoted to professionally and pharmacologically mediated cessation is in inverse proportion to that examining how most ex-smokers actually quit. Research on cessation is dominated by ever-finely tuned accounts of how smokers can be encouraged to do anything but go it alone when trying to quit—exactly opposite of how a very large majority of ex-smokers succeeded.”

The financial clout of the pharmaceutical, vaping and tobacco industries with their ability to spend billions on PR, across the decades and have legions of researchers “follow the money” continues to see the inverse law being heavily corroborated.

The CDC’s willing or unwitting collusion with these interests by continuing to cold-shoulder unassisted smoking cessation as being even unworthy of mention is truly appalling. An investigation into the politics of and influences on how this happened and continues would make compelling reading.

The continuing  denigration of unassisted cessation as bizarrely not being “evidence-based” when there are oceans of evidence that quitting unaided has contributed more ex-smokers across the decades than all other methods combined is frankly Orwellian.

High 5s for Floe and Ray!

The two authors of the Medrxiv paper both have connections with the vape manufacturers Juul Labs Inc,  First author Floe Foxon works for Pinney Associates  a consultancy company servicing the nicotine industry.  Foxon declared “F.F. provides consulting services through Pinney Associates on tobacco harm reduction on an exclusive basis to Juul Labs Inc, which had no involvement in this article.”  

Most reassuring.

Ray Naiura declared that he “communicated with Juul Labs personnel, for which there was no compensation”. Internal documents from Juul show the company named Niaura in a 2018 list of “current allies” and rated him as one of five “collaborators” with a maximum rank of 10 out of 10 in the same year.

These backgrounds may explain why their paper gave zero emphasis to unassisted quitting, leaving readers to deduce its major impact from a row at the end of a table.   With such a dogs balls obvious omission in the abstract, results and discussion  sections of the paper it is hard to believe that such a report could ever pass peer review in a serious research journal.  The “uninvolved” Juul would surely be just delighted with their research spin here.

Below are five papers on unassisted cessation by a research group I led 2013-2015.

Smith A, Chapman S, Dunlop S. What do we know about unassisted smoking cessation in Australia? A systematic review 2005–2012. Tobacco Control 2013

Smith A, Carter SM, Chapman S, Dunlop S, Freeman B. Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers. BMJ Open 2014

Smith A, Chapman S, Carter SM, Dunlop S, Freeman B. The views and experiences of smokers who quit unassisted. A systematic review of the qualitative evidence. PLoS One May 26, 2015

Smith A, Carter SM, Dunlop S, Freeman B, Chapman S. Revealing the complexity of quitting smoking: a qualitative grounded theory study of the natural history of quitting in Australian ex-smokers. Tobacco Control 2017

Smith A, Carter SM, Dunlop S, Freeman B, Chapman S. Measured, opportunistic, unexpected and naïve quitting: a qualitative grounded theory study of the process of quitting from the ex-smokers’ perspective. BMC Public Health 2017