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Cigarette smoking, which is responsible for >400,000 deaths annually, represents the single most avoidable cause of premature death in the United States today. While the prevalence of smoking in the United States has declined since the early 1960s, >40 million adults are current smokers (20% prevalence among adults), ensuring that this behavior will continue to influence rates of premature morbidity and ­mortality rates for decades to come. Most people begin smoking during their teenage years and struggle to quit as adults. Clinicians need to view nicotine dependence as a chronic health condition with exacerbations and remissions.

There are benefits to quitting even among those who have already experienced health problems caused by smoking. Some of the benefits of smoking cessation occur shortly after quitting, while other smoking-related risks are not moderated for months or years. An individual’s disease risk depends on previous duration and intensity of smoking, the presence of preexisting illnesses, and individual susceptibility. On a population-wide basis, it is now clear that progress achieved in extending life expectancy has been due in part to successful tobacco control, especially efforts to persuade and assist smokers to quit.

Cummings  KM, Mahoney  MC. Strategies for smoking cessation: what is new and what works? Expert Rev Respir Med. 2008; 2:201–213.
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IARC. Tobacco Control: Reversal of Risk After Quitting Smoking. International Agency for Research on Cancer (IARC) Handbooks of Cancer Prevention, vol 11; 2007.
US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.  [PubMed: NBK44695]   [PubMed: 2225238]


Most smokers report that they want to quit, and approximately 40–50% attempt to stop smoking annually. However, most quit attempts are unplanned, usually last only a few days or weeks, and are unsupported by the provision of pharmacotherapy and counseling support. Difficulty quitting is best predicted by how much one smokes on a daily basis and smoking within 30 minutes of waking up each day, both of which are measures of nicotine dependence.

Also, many smokers turn to methods with no proven efficacy to support sustained abstinence such as switching to so-called low-yield cigarettes, hypnotherapy, acupuncture, and various pharmacological therapies [eg, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), anxiolytics, benzodiazepines, β-blockers, silver acetate, mecamylamine, appetite suppressants, caffeine, ephedrine, dextrose tablets, lobeline, moclobemide) further lowering quit success and contributing to a cycle of failed quit efforts, making the prospect of stopping smoking appear hopeless to many smokers.

The vast majority (ie, 80–90% of current smokers) are addicted to nicotine, which makes it difficult or impossible for some ...

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