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Cigarette smoking is the leading preventable cause of death in the United States, responsible for an estimated 443,000 deaths per year, or one in every five deaths. Physicians often care for the health consequences of their patients’ tobacco use, and it is equally important for them to prevent smoking-related disease. There is no safe level of tobacco use. Smoking as few as one to four cigarettes per day increases the risk of myocardial infarction and cardiovascular mortality. Smoking cigarettes with reduced tar and nicotine content does not protect against the health hazards of smoking. Smoking cessation treatment is one of the most cost-effective actions available to clinicians.

The prevalence of cigarette smoking in the United States rose rapidly in the first half of the twentieth century and peaked in 1965, when 40% of adult Americans smoked cigarettes. Since then, smoking prevalence has been cut in half, reaching 19% of adults in 2011. This dramatic decline reflects growing public awareness of the health risks of tobacco and decades of public health efforts to discourage tobacco use. More recently, smoking prevalence has stabilized but the pattern of tobacco use has changed. Twenty percent of current smokers do not smoke every day, and the average smoker smokes only 15 cigarettes daily. Combining cigarette smoking with other tobacco products, especially smokeless tobacco, is increasingly reflecting the impact of expanding restrictions on places where smoking is allowed. The rising cost of cigarettes has led increasing number of smokers to use small cigars that have lower tobacco excise taxes and to buy tobacco in bulk and roll their own cigarettes.

Tobacco smoking starts during childhood and adolescence. Nearly 90% of smokers begin to smoke before the age of 18 years and 99% start by the age of 26 years. The rates of tobacco use in men and women, once very different, are now similar, with 16.5% of adult women and 21.6% of adult men smoking cigarettes in 2011. In the United States, smoking is more closely linked to education than it is to age, race, occupation, or any other sociodemographic factors. Educational attainment is a marker for socioeconomic status, and these data indicate that smoking is a problem that is concentrated in lower socioeconomic groups. Smoking is also more prevalent among individuals with comorbid psychiatric disorders and substance abuse disorders.


Cigarette smoking increases overall mortality and morbidity rates and is a cause of cardiovascular disease (including myocardial infarction and sudden death), cerebrovascular disease; peripheral vascular disease; chronic obstructive pulmonary disease; and cancers at many sites, including the lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix. Approximately 30% of tobacco-related deaths are due to cardiovascular disease. Lung cancer, once a rare disease, increased dramatically during the twentieth century, becoming the leading cause of deaths due to cancer among men in 1955 and among women in 1986. ...

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