ore than an estimated 8 million smoking-attributed deaths occur globally each year, and approximately 34 million people in the US (14% of adults) currently smoke cigarettes. 1,2 One-third to one-half of people who regularly smoke cigarettes die of a tobacco-related disease, typically approximately 10 years earlier than people who do not smoke cigarettes. 3 Most smoking-attributed deaths are due to cancer (34%), cardiovascular diseases (32%), or respiratory disease (21%). 3 Smoking is associated with cancers of the lung, oropharynx, larynx, esophagus, stomach, liver, pancreas, kidney, bladder, uterine cervix, and colon or rectum, as well as acute myeloid leukemia. 3 Nearly 90% of lung cancers are attributed to cigarette smoking. 3 Smoking is responsible for approximately 80% of chronic obstructive pulmonary disease deaths. 3 The health risk from cigarette smoking is primarily due to chemicals produced by the burning of tobacco and not to nicotine. 3 More than 80% of tobacco users in the US use combustible products, primarily cigarettes but also cigars, pipes, and waterpipes (hookah). 2 In 2019, 19% of US tobacco users reported using multiple tobacco products. 2 Disproportionately high rates of smoking occur among adults with lower education, lower incomes, nontobacco substance use disorders, psychiatric conditions, people living with HIV, American Indian or Alaska Native individuals, and members of the lesbian, gay, bisexual, transgender (LGBT+) community. 2,4 Black individuals experience higher rates of tobacco-related disease and death than any other race. Black men have the highest lung cancer death rate of any racial or ethnic group at 60.4 per 100 000, despite having similar smoking rates as White individuals. 2,5 Worldwide, an estimated 1.3 billion individuals use tobacco products, and more than 80% of them live in low-and middle-income countries. 1 In the US, nearly 90% of adult daily smokers started IMPORTANCE More deaths in the US are attributed to cigarette smoking each year than to any other preventable cause. Approximately 34 million people and an estimated 14% of adults in the US smoke cigarettes. If they stopped smoking, they could reduce their risk of tobacco-related morbidity and mortality and potentially gain up to 10 years of life.OBSERVATIONS Tobacco smoking is a chronic disorder maintained by physical nicotine dependence and learned behaviors. Approximately 70% of people who smoke cigarettes want to quit smoking. However, individuals who attempt to quit smoking make an average of approximately 6 quit attempts before achieving long-term abstinence. Both behavioral counseling and pharmacotherapy while using nicotine replacement therapy (NRT) products, varenicline, or bupropion are effective treatments when used individually, but they are most effective when combined. In a meta-analysis including 19 488 people who smoked cigarettes, the combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or u...