CHAPTER 1 Smoking Cessation

Overview
Tobacco use is a public health issue of enormous
importance, and smoking is the primary risk factor
for the development of lung cancer. Considerable
knowledge has been gained with respect to biobe-
havioral factors leading to smoking initiation and
development of nicotine dependence. Smoking ces-
sation provides extensive health benefits for every-
one. State-of-the-art treatment for smoking cessa-
tion includes behavioral counseling in conjunction
with one or more FDA-approved pharmaceutical
aids for cessation. The US Public Health Service Clin-
ical Practice Guideline for Treating Tobacco Use and De-
pendence advocates a five-step approach to smoking
cessation (Ask about tobacco use, Advise patients to
quit, Assess readiness to quit, Assist with quitting,
and Arrange follow-up). Health care providers are
encouraged to provide at least brief interventions at
each encounter with a patient who uses tobacco.
Introduction
More than two decades ago, the former US Surgeon
General C. Everett Koop stated that cigarette smok-
ing is the “chief, single, avoidable cause of death in
our society and the most important public health
issue of our time” [1]. This statement remains true
today. In the United States, cigarette smoking is the
primary known cause of preventable deaths [2],
resulting in nearly 440,000 deaths each year [3].
The economic implications are enormous: more
than $75 billion in medical expenses and over $81
billion in loss of productivity as a result of pre-
mature death are attributed to smoking each year
[4–8].While the public often associates tobacco use
with elevated cancer risk, the negative health con-
sequences are much broader. The 2004 Surgeon
General’s Report on the health consequences of
smoking [9] provides compelling evidence of the ad-
verse impact of smoking and concluded that smok-
ing harms nearly every organ in the body (Table
1.1). In 2000, 8.6 million persons in the United
States were living with an estimated 12.7 mil-
lion smoking-attributable medical conditions [10].
There is convincing evidence that stopping smok-
ing is associated with immediate as well as long-
term health benefits, including reduced cumulative
risk for cancer. This is true even in older individu-
als, and in patients who have been diagnosed with
cancer [11].
Smoking and lung cancer
In the United States, approximately 85% of all
lung cancers are in people who smoke or who
have smoked [3]. Lung cancer is fatal for most
patients. The estimated number of deaths of lung
cancer will exceed 1.3 million annually early in the
third millennium [12]. Lung cancer is the leading
cause of cancer-related deaths among Americans
of both genders, with 174,470 estimated newly
diagnosed cases and 162,460 deaths [13,14]. The
number of deaths due to lung cancer exceeds the
Table 1.1 Health consequences of smoking.
Cancer Acute myeloid leukemia
Bladder
Cervical
Esophageal
Gastric
Kidney
Laryngeal
Lung
Oral cavity and pharyngeal
Pancreatic
Cardiovascular
diseases
Abdominal aortic aneurysm
Coronary heart disease (angina pectoris,
ischemic heart disease, myocardial
infarction, sudden death)
Cerebrovascular disease (transient
ischemic attacks, stroke)
Peripheral arterial disease
Pulmonary Acute respiratory illnesses
diseases Pneumonia
Chronic respiratory illnesses
Chronic obstructive pulmonary
disease
Respiratory symptoms (cough,
phlegm, wheezing, dyspnea)
Poor asthma control
Reduced lung function in infants
exposed (in utero) to maternal
smoking
Reproductive
effects
Reduced fertility in women
Pregnancy and pregnancy outcomes
Premature rupture of membranes
Placenta previa
Placental abruption
Preterm delivery
Low infant birth weight
Infant mortality (sudden infant death
syndrome)
Other
effects
Cataract
Osteoporosis (reduced bone density in
postmenopausal women, increased risk
of hip fracture)
Periodontitis
Peptic ulcer disease (in patients who are
infected with Helicobacter pylori)
Surgical outcomes
Poor wound healing
Respiratory complications