Smoking Behavior and Disease Risk
Cigarette smoking, which is responsible for over 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 over the past half century, about 40 million adults are current smokers ensuring that this behavior will continue to influence rates of premature morbidity and mortality rates for years to come. Most people begin smoking during their teenage years and struggle to quit as adults; smoking prevalence among adults is about 20%. Clinician needs to view nicotine dependence as a chronic health condition with exacerbations and remissions.
The best evidence on the benefits of smoking cessation comes from a 2007 systematic review by the International Agency for Research on Cancer which found that 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. There are benefits to quitting even among those who have already experienced health problems caused by smoking.
Cummings KM, Mahoney MC: Strategies for smoking cessation: what is new and what works? Expert Rev Respir Med 2008;2:201-213.
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. U.S. 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.
Tobacco Dependence and Implications for Treatment
Most smokers report that they want to quit and approximately 40% attempt to stop smoking annually. Difficulty quitting is best predicted by how much one smokes on a daily basis and within 30 minutes of waking up each day, both of which are measures of nicotine dependence. However, most quit attempts are unplanned and usually only last a few days or weeks and are unsupported by the provision of pharmacotherapy and counseling support. Also, many smokers turn to methods with no proven efficacy (eg, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [other than nortriptyline], anxiolytics, benzodiazepines, β-blockers, silver acetate, mecamylamine, appetite suppressants, caffeine, ephedrine, St. John's wort, dextrose tablets, lobeline, moclobemide [a monoamine oxidase inhibitor], acupuncture, hypnotherapy, or use of low tar cigarettes) further lowering quit success and contributing to a cycle of failed quit efforts that make the prospect of stopping smoking appear hopeless to many smokers. The reality is ...