Tobacco Use and Smoking Cessation
Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:
-- The first section of this topic is shown below --
- Use of tobacco of any form
- The second leading actual cause of death in the United States
- Smokeless tobacco refers to tobacco products that are sniffed, sucked, or chewed.
- Nicotine sources: cigars, pipes, water pipes, hookahs, and cigarettes
- 2.4 million new smokers annually in the United States (2.6% initiation rate)
- 59% of new smokers are <18 years of age (5.8% initiation rate for teens).
- 9.7 million people age >18 years smoke 20 or more cigarettes daily.
- 15% of all adults (36.5 million people): 17% of males, 14% of females are current cigarette smokers.
- Highest among those aged 18 to 25 years (41%)
- Adults aged >25 years (28%)
- Race: highest among whites (22%) and African Americans (21%) and is lower among Hispanics (15%) and Asians (12%)
- Gender: male > female (22% vs. 17%)
- Inversely proportional to education level
- Cigarette smoking is responsible for >480,000 deaths per year in the United States, including >41,000 deaths from secondhand smoke exposure. This is about 1 in 5 deaths annually or 1,300 deaths every day.
Etiology and Pathophysiology
- Addiction due to nicotine’s rapid stimulation of the brain’s dopamine system (teenage brain especially susceptible)
- Atherosclerotic risk due to adrenergic stimulation, endothelial damage, carbon monoxide, and adverse effects on lipids
- Direct airway damage from cigarette tar
- Carcinogens in all tobacco products
- Presence of a smoker in the household
- Easy access to cigarettes
- Comorbid stress and psychiatric disorders
- Low self-esteem/self-worth
- Poor academic performance
- Boys: high levels of aggression and rebelliousness
- Girls: preoccupation with weight and body image
- International Journal of Environmental Research and Public Health defined heavy smoking as 20 or more cigarettes per day, or 20 or more pack-years. A pack-year is determined by multiplying the number of cigarettes smoked per day by the number of years of smoking. Twenty pack-years is equivalent to a pack a day for 20 years or 2 packs a day for 10 years. Other common cut-points for heavy smoking include 15 and 25 cigarettes per day.
- Most first-time tobacco use occurs before high school graduation.
- The Tar Wars program of the American Academy of Family Physicians has successfully targeted tobacco use prevention in 4th and 5th graders.
- Smoking bans in public areas and workplaces
- Restriction of minors’ access to tobacco
- Restrictions on tobacco advertisements
- Raising prices through taxation
- Media literacy education
- Tobacco-free sports initiatives
Commonly Associated Conditions
- Coronary artery disease
- Cerebrovascular disease
- Peripheral vascular disease
- Abdominal aortic aneurysm (AAA)
- Cancer of the lip, oral cavity, pharynx, larynx, lung, esophagus, stomach, pancreas, kidney, bladder, cervix, and blood
- Pneumonia, osteoporosis
- Alcohol use
- Depression and anxiety
- Reduced fertility
Women who smoke or are exposed to secondhand smoke during pregnancy have increased risks of miscarriage, placenta previa, placental abruption, premature rupture of membranes, preterm delivery, low-birth-weight infants, and stillbirth.
- Secondhand smoke increases the risk for:
- Sudden infant death syndrome
- Acute upper and lower respiratory tract infections
- More severe exacerbations of asthma
- Otitis media and need for tympanostomies
- Nicotine passes through breast milk. Effects on growth and development of nursing infants are unknown.