Tobacco Use and Smoking Cessation
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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 vaporized, sniffed, sucked, or chewed.
- Nicotine sources: cigars, pipes, water pipes, hookahs, and cigarettes and electronic cigarettes
- Electronic nicotine delivery system (ENDS) use is on the rise.
- 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 (37.8 million people): 17.5% of males, 13.5% of females are current cigarette smokers.
- Age: highest among those aged 25 to 44 years (17%)
- Race: highest among Native Americans (32%) and is lower among Hispanics (11%) and Asians (9%)
- Gender: male > female (22% vs. 17%)
- Education: inversely proportional to education level
- Psychological association: nearly 36% of adults with a serious psychological distress compared to 14% without this distress
- 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
- 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, urinary 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.