Obama on front lines in battle to stop smoking

Physicians and other smoking-cessation advocates have found a high-profile illustration of the challenges of quitting tobacco: President-elect Barack Obama.

"His honesty should help a lot of people, because it's just not that easy to quit smoking," said Anthony Atkins, MD, a family physician and director of minority health and community outreach for the Lima Community Health Center in Lima, Ohio.

Obama has smoked intermittently for years, tried to quit several times and chewed nicotine gum, according to a report on his health compiled by his primary care physician, David L. Scheiner, MD, and released in May 2008 by his presidential campaign. According to more recent news reports, he still lights up occasionally but has pledged to respect the ban on smoking in the White House. To those who work on smoking issues, his situation is a very public example of how difficult quitting can be and how much effort it can require.

"He has not given up, and people should not give up or feel that they are failures if they do not quit smoking on the first or second or third attempt. They should just continue to try until they get it," said Carolyn Barley Britton, MD, president of the National Medical Assn.

Many physicians also hope he will be a role model for African-American men in particular. This demographic group tends to smoke more than do white males, although the numbers for white and black women are comparable. African-Americans experience a disproportionate rate of disease associated with tobacco use. The reason for this is unclear, but data from the National Cancer Institute's Surveillance Epidemiology and End Results indicate that African-Americans are 17% more likely than Caucasians to develop lung cancer.

Many experts praised Obama for taking all the right steps, even if it appears he has not yet been successful.

"This is an incredible opportunity to help educate the majority of smokers in America who want to quit, and those who have tried to quit and have failed, that this is a chronic medical condition and there are evidence-based treatments available," said Michael C. Fiore, MD, MPH, director of the Center for Tobacco Research and Intervention at the University of Wisconsin in Madison.

The American Medical Association encourages physicians to use practice guidelines to help patients with smoking cessation, such as Treating Tobacco Use and Dependence: 2008 Update.

Dr. Fiore chaired the panel that authored the document, which was released in May 2008 by the U.S. Public Health Service. It recognized tobacco dependence as a chronic disease that often requires more than one intervention and several attempts to quit.

The Update also advocates using existing treatments to improve the chance of success.

In addition, anti-smoking advocates are optimistic that Obama's personal experience with attempting to give up tobacco will trigger more interest in legislation amenable to reducing the number of smokers.

"My hope is that his firsthand knowledge of the power of tobacco will influence his administration in confronting tobacco dependence in our society," Dr. Fiore said.

According to the report on Obama's health, he exercises regularly and eats a balanced diet. His blood pressure is 90/60 and his pulse 60 beats per minute. His triglycerides are 44, total cholesterol 173, HDL cholesterol 68 and LDL cholesterol 96. Dr. Scheiner rated his health as excellent.