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Tobacco Use and Smoking Cessation

Tobacco Use and Smoking Cessation is a topic covered in the 5-Minute Clinical Consult.

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  • 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

Risk Factors

  • 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.

General Prevention

  • 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)
  • COPD
  • Cancer of the lip, oral cavity, pharynx, larynx, lung, esophagus, stomach, pancreas, kidney, bladder, cervix, and blood
  • Pneumonia, osteoporosis
  • Periodontitis
  • Alcohol use
  • Depression and anxiety
  • Reduced fertility

Pregnancy Considerations
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.

Pediatric Considerations
  • 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.

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Stephens, Mark B., et al., editors. "Tobacco Use and Smoking Cessation." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation.
Tobacco Use and Smoking Cessation. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation. Accessed March 26, 2019.
Tobacco Use and Smoking Cessation. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation
Tobacco Use and Smoking Cessation [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tobacco Use and Smoking Cessation ID - 116879 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -