Treatment of Tobacco Smoking

Abstract

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...

Perceived Disease Risk of Smoking, Barriers to Quitting, and Cessation Intervention Preferences by Sex Amongst Homeless Adult Concurrent Tobacco Product Users and Conventional Cigarette-Only Users

“…Finally, the field is clear about evidence-based interventions for tobacco use cessation. For example, research on smoking cessation indicates that medications, and particularly medications used in combination with one another, when combined with brief counseling, especially as delivered in every health care encounter, are effective in assisting a quit attempt [ 40 ]. This suggests that quitting “cold turkey” is less likely to lead to cessation success.…”

Comparative Effectiveness of Postdischarge Smoking Cessation Interventions for Hospital Patients

“…Both TTCM and QL models assumed that the typical 3-month tobacco cessation treatment duration would suffice to sustain a quit attempt that had been prompted by hospitalization. However, abstinence rates declined more in the TTCM group than the QL group after proactive support ended at 3 months, underscoring the chronic relapsing nature of tobacco dependence. A longer treatment duration may have extended the 3-month abstinence rates in both groups.…”

How to Effectively Help Patients Stop Smoking: A Primer for Cardiologists

“…Overall, combination therapy of pharmacotherapy plus behavioural therapy with regular follow-ups and prolonged use should be the preferable approach to smoking cessation. 1 An expanded overview on smoking cessation with complete citations are provided in the Supplementary Material.…”

“…Tobacco smoking is a chronic disorder based on nicotine dependence and is the single most reversible risk factor of cardiovascular diseases. 1 This primer provides an overview of evidence-based smoking cessation interventions, pharmacological and nonpharmacological. Interventions with limited or conflicting data are also discussed.…”