essay on smoking cessation

Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

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Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking Cessation: A Report of the Surgeon General [Internet]. Washington (DC): US Department of Health and Human Services; 2020.

Smoking Cessation: A Report of the Surgeon General [Internet].

Chapter 1 introduction, conclusions, and the evolving landscape of smoking cessation.

• Introduction

Tobacco smoking is the leading cause of preventable disease, disability, and death in the United States ( U.S. Department of Health and Human Services [USDHHS] 2014 ). Smoking harms nearly every organ in the body and costs the United States billions of dollars in direct medical costs each year ( USDHHS 2014 ). Although considerable progress has been made in reducing cigarette smoking since the first U.S. Surgeon General’s report was released in 1964 ( USDHHS 2014 ), in 2018, 13.7% of U.S. adults (34.2 million people) were still current cigarette smokers ( Creamer et al. 2019 ). One of the main reasons smokers keep smoking is nicotine ( USDHHS 1988 ). Nicotine, a drug found naturally in the tobacco plant, is highly addictive, as with such drugs as cocaine and heroin; activates the brain’s reward circuits; and reinforces repeated nicotine exposure ( USDHHS 1988 , 2010 , 2014 ; National Institute on Drug Abuse [NIDA] 2018 ).

The majority of cigarette smokers (68%) want to quit smoking completely ( Babb et al. 2017 ). The 1990 Surgeon General’s report, The Health Benefits of Smoking Cessation, was the last Surgeon General’s report to focus on current research on smoking cessation and to predominantly review the health benefits of quitting smoking ( USDHHS 1990 ). Because of limited data at that time, the 1990 report did not review the determinants, processes, or outcomes of attempts at smoking cessation. Pharmacotherapy for smoking cessation was not introduced until the 1980s. Additionally, behavioral and other counseling approaches were slow to develop and not widely available at the time of the 1990 report because few were covered under health insurance, and programs such as group counseling sessions were hard for smokers to access, even by those who were motivated to quit ( Fiore et al. 1990 ).

The purpose of this report is to update and expand the 1990 Surgeon General’s report based on new scientific evidence about smoking cessation. Since 1990, the scientific literature has expanded greatly on the determinants and processes of smoking cessation, informing the development of interventions that promote cessation and help smokers quit ( Fiore et al. 2008 ; Schlam and Baker 2013 ). This knowledge and other major developments have transformed the landscape of smoking cessation in the United States. This report summarizes this enhanced knowledge and specifically reviews patterns and trends of smoking cessation; biologic mechanisms; various health benefits; overall morbidity, mortality, and economic benefits; interventions; and strategies that promote smoking cessation.

From 1965 to 2017, the prevalence of current smoking declined from 52.0% to 15.8% (relative percent change: 69.6%) among men and from 34.1% to 12.2% (relative percent change: 64.2%) among women ( Figure 1.1 ). These declines have been attributed, in part, to progress made in smoking cessation since the 1960s, which has continued since the 1990 Surgeon General’s report. Specifically, clinical, scientific, and public health communities have increasingly embraced and acted upon the concept of tobacco use and dependence as a health condition that can benefit from treatment in various forms and levels of intensity. Accordingly, a considerable range of effective pharmacologic and behavioral smoking cessation treatment options are now available. As of October 16, 2019, the U.S. Food and Drug Administration (FDA) has approved five nicotine replacement therapies (NRTs) and two non-nicotine oral medications to help smokers quit, and the use of these treatments has expanded, including stronger integration with counseling support ( Fiore et al. 2008 ).

Trends in prevalence (%) of current and former cigarette smoking among adults 18 years of age and older, by sex; National Health Interview Survey (NHIS) 1965–2017; United States. Source: NHIS, National Center for Health Statistics, public use (more...)

In addition, the reach of smoking cessation interventions has increased substantially since 1990 with the emergence of innovative, population-level interventions and policies that motivate smokers to quit and raise awareness of the health benefits of smoking cessation ( McAfee et al. 2013 ). This includes policies, such as comprehensive smokefree laws, that have been shown to promote cessation at the population level in addition to reducing exposure to secondhand smoke ( USDHHS 2014 ). The development and subsequent expansion of telephone call centers (“quitlines”), mobile phone technologies, Internet-based applications, and other innovations have created novel platforms to provide behavioral and pharmacologic smoking cessation treatments ( Ghorai et al. 2014 ). However, the continued diversification of the tobacco product landscape could have several different potential impacts, ranging from accelerating the rates of complete cessation among adult smokers to erasing progress in reducing all forms of use of tobacco products, especially among youth and young adults. For example, the increasing availability and rapidly increasing use of novel tobacco products, most notably electronic cigarettes (e-cigarettes), raise questions about the potential impact that such products could have on efforts to eliminate disease and death caused by tobacco use at the individual and population levels. Therefore, when considering the impact of e-cigarettes on public health, it is critical to evaluate their effects on both adults and youth.

Collectively, the changes cited in this report provide new opportunities and challenges for understanding and promoting smoking cessation in the United States. However, the evidence-based clinical-, health system-, and population-based tobacco prevention, control, and cessation strategies that are outlined in this report are a necessary but insufficient means to end the tobacco epidemic. Reaching the finish line will require coordination across federal government agencies and other government and non-government stakeholders at the national, state, and local levels. To achieve success, we must work together to maximize resources and coordinate efforts across a wide range of stakeholders.

• Organization of the Report

This chapter summarizes the report, identifies its major conclusions, and presents the conclusions from each chapter. It also offers an overview of the evolving landscape of smoking cessation and key developments since the 1990 Surgeon General’s report. Chapter 2 (“Patterns of Smoking Cessation Among U.S. Adults, Young Adults, and Youth”) documents key patterns and trends in cigarette smoking cessation in the United States among adults overall (persons 18 years of age and older), young adults (18–24 years of age), and youth (12–17 years of age). The chapter also reviews the changing demographic- and smoking-related characteristics of cigarette smokers with a focus on how these changes may influence future trends in cessation. Chapter 3 (“New Biological Insights into Smoking Cessation”) reviews several areas of intensive research since the 2010 Surgeon General’s report on how tobacco smoke causes disease: cellular and molecular biology of nicotine addiction; vaccines and other immunotherapies as treatments for tobacco addiction; neurobiological insights into smoking cessation obtained from noninvasive neuroimaging; and genetics of smoking behaviors and cessation. Chapter 4 (“The Health Benefits of Smoking Cessation”) reviews the more recent findings on disease risks from smoking and benefits after smoking cessation for major types of chronic diseases, including cardiovascular and respiratory systems, cancer, and a wide range of reproductive outcomes. Chapter 5 (“The Benefits of Smoking Cessation on Overall Morbidity, Mortality, and Economic Costs”) discusses general indicators of health that change after smoking cessation, the health benefits of smoking cessation on all-cause mortality, and the economic benefits of smoking cessation. Chapter 6 (“Interventions for Smoking Cessation and Treatments for Nicotine Dependence”) reviews the evidence on current and emerging treatments for smoking cessation, including research that has been conducted since the 2008 U.S. Public Health Service’s Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update ( Fiore et al. 2008 ). Chapter 7 (“Clinical-, System-, and Population-Level Strategies that Promote Smoking Cessation”) focuses on clinical-, system-, and population-level strategies that combine individual components of treatment for smoking cessation with routine clinical care, making cessation interventions available and accessible to individual smokers and creating conditions whereby smokers are informed of these interventions and are motivated to use them. Chapter 8 (“A Vision for the Future”) outlines broad strategies to accelerate the progress that has been made in helping smokers quit.

• Preparation of the Report

This Surgeon General’s report was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), which is part of USDHHS. This report was compiled using a longstanding, peer-reviewed, balanced, and comprehensive process designed to safeguard the scientific rigor and practical relevance from influences that could adversely affect impartiality ( King et al. 2018 ). This process helps to ensure that the report’s conclusions are defined by the evidence, rather than the opinions of the authors and editors. In brief, under the leadership of a senior scientific editorial team, 32 experts wrote the initial drafts of the chapters. The experts were selected for their knowledge of the topics addressed. These contributions, which are summarized in Chapters 1 – 7 , were evaluated by 46 peer reviewers. After this initial stage of peer review, more than 20 senior scientists and other experts examined the scientific integrity of the entire manuscript as part of a second stage of peer review. After each round of peer review, the report’s scientific editors revised each draft based on reviewers’ comments. Chapter 8 , which summarizes and is founded upon the preceding content in the report, was written by the senior scientific editorial team once the content in Chapters 1 – 7 completed peer review. Subsequently, the report was reviewed by various institutes and agencies in the U.S. government, including USDHHS. Throughout the review process, the content of each chapter was revised to include studies and information that were not available when the chapters were first drafted; updates were made until shortly before the report was submitted for publication. These updates reflect the full scope of identified evidence, including new findings that confirm, refute, or refine the initial content. Conclusions are based on the preponderance and quality of scientific evidence.

• Scientific Basis of the Report

The statements and conclusions throughout this report are based on an extensive review of the existing scientific literature. Thus, the report focuses primarily on cessation in the context of adults because this is the population for which the preponderance of scientific literature exists on this topic; however, data on youth and young adults are also presented, when available. The report primarily cites peer-reviewed journal articles, including reviews that integrate findings from numerous studies and books that were published between 2000 and 2018, which reflects a period after the last Surgeon General’s report on the topic of cessation. This report also refers, on occasion, to unpublished research, such as presentations at professional meetings, personal communications from researchers, and information available in various media. These references are used when acknowledged by the editors and reviewers as being scientifically valid and reliable, and a critical addition to the emerging literature on a topic. Throughout the writing and review process, highest priority was given to peer-reviewed, scientific research that is free from tobacco industry interests. As noted in the 2014 Surgeon General’s report, the tobacco industry has a well-documented record of manipulating scientific information about the extent of the harms from cigarette smoking ( USDHHS 2014 ).

• Consistency of the association,
• Strength of the association,
• Specificity of the association,
• Temporal relationship of the association, and
• Coherence of the association ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 , p. 20).
• “Evidence is sufficient to infer a causal relationship.
• Evidence is suggestive but not sufficient to infer a causal relationship.
• Evidence is inadequate to infer the presence or absence of a causal relationship (which encompasses evidence that is sparse, of poor quality, or conflicting).
• Evidence is suggestive of no causal relationship ” ( USDHHS 2004 , p. 18).
• Do multiple high-quality studies show a consistent association between smoking and disease?
• Are the measured effects large enough and statistically strong?
• Does the evidence show that smoking occurs before the disease occurs (a temporal association)?
• Is the relationship between smoking and disease coherent or plausible in terms of known scientific principles, biologic mechanisms, and observed patterns of disease?
• Is there a dose-response relationship between smoking and disease?
• Is the risk of disease reduced after quitting smoking?

The categories acknowledge that evidence can be “suggestive but not sufficient” to infer a causal relationship, and the categories allow for evidence that is “suggestive of no causal relationship.” This framework also separates conclusions about causality from the implications of such conclusions. Inference is sharply and completely separated from policy or research implications of the conclusions, thus adhering to the approach established in the 1964 report. However, consistent with past Surgeon General’s reports on tobacco, conclusions are not limited to just causal determinations and frequently include recommendations for research, policies, or other actions.

• Major Conclusions
• Smoking cessation is beneficial at any age. Smoking cessation improves health status and enhances quality of life.
• Smoking cessation reduces the risk of premature death and can add as much as a decade to life expectancy.
• Smoking places a substantial financial burden on smokers, healthcare systems, and society. Smoking cessation reduces this burden, including smokingattributable healthcare expenditures.
• Smoking cessation reduces risk for many adverse health effects, including reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer. Quitting smoking is also beneficial to those who have been diagnosed with heart disease and chronic obstructive pulmonary disease.
• More than three out of five U.S. adults who have ever smoked cigarettes have quit. Although a majority of cigarette smokers make a quit attempt each year, less than one-third use cessation medications approved by the U.S. Food and Drug Administration or behavioral counseling to support quit attempts.
• Considerable disparities exist in the prevalence of smoking across the U.S. population, with higher prevalence in some subgroups. Similarly, the prevalence of key indicators of smoking cessation—quit attempts, receiving advice to quit from a health professional, and using cessation therapies—also varies across the population, with lower prevalence in some subgroups.
• Smoking cessation medications approved by the U.S. Food and Drug Administration and behavioral counseling are cost-effective cessation strategies. Cessation medications approved by the U.S. Food and Drug Administration and behavioral counseling increase the likelihood of successfully quitting smoking, particularly when used in combination. Using combinations of nicotine replacement therapies can further increase the likelihood of quitting.
• Insurance coverage for smoking cessation treatment that is comprehensive, barrier-free, and widely promoted increases the use of these treatment services, leads to higher rates of successful quitting, and is cost-effective.
• E-cigarettes, a continually changing and heterogeneous group of products, are used in a variety of ways. Consequently, it is difficult to make generalizations about efficacy for cessation based on clinical trials involving a particular e-cigarette, and there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.
• Smoking cessation can be increased by raising the price of cigarettes, adopting comprehensive smokefree policies, implementing mass media campaigns, requiring pictorial health warnings, and maintaining comprehensive statewide tobacco control programs.
• Chapter Conclusions

Chapter 2. Patterns of Smoking Cessation Among U.S. Adults, Young Adults, and Youth

• In the United States, more than three out of every five adults who were ever cigarette smokers have quit smoking.
• Past-year quit attempts and recent and longer term cessation have increased over the past 2 decades among adult cigarette smokers.
• Marked disparities in cessation behaviors, such as making a past-year quit attempt and achieving recent successful cessation, persist across certain population subgroups defined by educational attainment, poverty status, age, health insurance status, race/ethnicity, and geography.
• Advice from health professionals to quit smoking has increased since 2000; however, four out of every nine adult cigarette smokers who saw a health professional during the past year did not receive advice to quit.
• Use of evidence-based cessation counseling and/or medications has increased among adult cigarette smokers since 2000; however, more than two-thirds of adult cigarette smokers who tried to quit during the past year did not use evidence-based treatment.
• A large proportion of adult smokers report using non-evidence-based approaches when trying to quit smoking, such as switching to other tobacco products.

Chapter 3. New Biological Insights into Smoking Cessation

• The evidence is suggestive but not sufficient to infer that increasing glutamate transport can alleviate nicotine withdrawal symptoms and prevent relapse.
• The evidence is suggestive but not sufficient to infer that neuropeptide systems play a role in multiple stages of the nicotine addiction process, and that modulating the function of certain neuropeptides can reduce smoking behavior in humans.
• The evidence is suggestive but not sufficient to infer that targeting the habenulo-interpeduncular pathway with agents that increase the aversive properties of nicotine are a useful therapeutic target for smoking cessation.
• The evidence is suggestive but not sufficient to infer that vaccines generating adequate levels of nicotinespecific antibodies can block the addictive effects of nicotine and aid smoking cessation.
• The evidence is suggestive but not sufficient to infer that dysregulated brain circuits, including prefrontal and cingulate cortical regions and their connections with various striatal and insula loci, can serve as novel therapeutic targets for smoking cessation.
• The evidence is suggestive but not sufficient to infer that the effectiveness of nicotine replacement therapy may vary across specific genotype groups.

Chapter 4. The Health Benefits of Smoking Cessation

• The evidence is sufficient to infer that smoking cessation reduces the risk of lung cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of laryngeal cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of cancers of the oral cavity and pharynx
• The evidence is sufficient to infer that smoking cessation reduces the risk of esophageal cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of pancreatic cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of bladder cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of stomach cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of colorectal cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of liver cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of cervical cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of kidney cancer.
• The evidence is sufficient to infer that smoking cessation reduces the risk of acute myeloid leukemia.
• The evidence is sufficient to infer that the relative risk of lung cancer decreases steadily after smoking cessation compared with the risk for persons continuing to smoke, with risk decreasing to half that of continuing smokers approximately 10–15 years after smoking cessation and decreasing further with continued cessation.

Smoking Cessation After a Cancer Diagnosis

• The evidence is suggestive but not sufficient to infer a causal relationship between smoking cessation and improved all-cause mortality in cancer patients who are current smokers at the time of a cancer diagnosis.

Cardiovascular Disease

• The evidence is sufficient to infer that smoking cessation reduces levels of markers of inflammation and hypercoagulability and leads to rapid improvement in the level of high-density lipoprotein cholesterol.
• The evidence is sufficient to infer that smoking cessation leads to a reduction in the development of subclinical atherosclerosis, and that progression slows as time since cessation lengthens.
• The evidence is sufficient to infer that smoking cessation reduces the risk of cardiovascular morbidity and mortality and the burden of disease from cardiovascular disease.
• The evidence is sufficient to infer that the relative risk of coronary heart disease among former smokers compared with never smokers falls rapidly after cessation and then declines more slowly.
• The evidence is sufficient to infer that smoking cessation reduces the risk of stroke morbidity and mortality.
• The evidence is sufficient to infer that, after smoking cessation, the risk of stroke approaches that of never smokers.
• The evidence is suggestive but not sufficient to infer that smoking cessation reduces the risk of atrial fibrillation.
• The evidence is suggestive but not sufficient to infer that smoking cessation reduces the risk of sudden cardiac death among persons without coronary heart disease.
• The evidence is suggestive but not sufficient to infer that smoking cessation reduces the risk of heart failure among former smokers compared with persons who continue to smoke.
• Among patients with left-ventricular dysfunction, the evidence is suggestive but not sufficient to infer that smoking cessation leads to increased survival and reduced risk of hospitalization for heart failure.
• The evidence is suggestive but not sufficient to infer that smoking cessation reduces the risk of venous thromboembolism.
• The evidence is suggestive but not sufficient to infer that smoking cessation substantially reduces the risk of peripheral arterial disease among former smokers compared with persons who continue to smoke, and that this reduction appears to increase with time since cessation.
• The evidence is suggestive but not sufficient to infer that, among patients with peripheral arterial disease, smoking cessation improves exercise tolerance, reduces the risk of amputation after peripheral artery surgery, and increases overall survival.
• The evidence is sufficient to infer that smoking cessation substantially reduces the risk of abdominal aortic aneurysm in former smokers compared with persons who continue to smoke, and that this reduction increases with time since cessation.
• The evidence is suggestive but not sufficient to infer that smoking cessation slows the expansion rate of abdominal aortic aneurysm.

Smoking Cessation After a Diagnosis of Coronary Heart Disease

• In patients who are current smokers when diagnosed with coronary heart disease, the evidence is sufficient to infer a causal relationship between smoking cessation and a reduction in all-cause mortality.
• In patients who are current smokers when diagnosed with coronary heart disease, the evidence is sufficient to infer a causal relationship between smoking cessation and reductions in deaths due to cardiac causes and sudden death.
• In patients who are current smokers when diagnosed with coronary heart disease, the evidence is sufficient to infer a causal relationship between smoking cessation and reduced risk of new and recurrent cardiac events.

Chronic Respiratory Disease

Chronic obstructive pulmonary disease.

• Smoking cessation remains the only established intervention to reduce loss of lung function over time among persons with chronic obstructive pulmonary disease and to reduce the risk of developing chronic obstructive pulmonary disease in cigarette smokers.
• The evidence is suggestive but not sufficient to infer that airway inflammation in cigarette smokers persists months to years after smoking cessation.
• The evidence is suggestive but not sufficient to infer that changes in gene methylation and profiles of proteins occur after smoking cessation.
• The evidence is inadequate to infer the presence or absence of a relationship between smoking cessation and changes in the lung microbiome.
• The evidence is suggestive but not sufficient to infer that smoking cessation reduces asthma symptoms and improves treatment outcomes and asthma-specific quality-of-life scores among persons with asthma who smoke.
• The evidence is suggestive but not sufficient to infer that smoking cessation improves lung function among persons with asthma who smoke.

Reproductive Health

• The evidence is sufficient to infer that smoking cessation by pregnant women benefits their health and that of their fetuses and newborns.
• The evidence is inadequate to infer that smoking cessation before or during early pregnancy reduces the risk of placental abruption compared with continued smoking.
• The evidence is inadequate to infer that smoking cessation before or during pregnancy reduces the risk of placenta previa compared with continued smoking.
• The evidence is inadequate to infer that smoking cessation before or during pregnancy reduces the risk of premature rupture of the membranes compared with continued smoking.
• The evidence is inadequate to infer that smoking during early or mid-pregnancy alone, and not during late pregnancy, is associated with a reduced risk of preeclampsia.
• The evidence is sufficient to infer that women who quit smoking before or during pregnancy gain more weight during gestation than those who continue to smoke.
• The evidence is suggestive but not sufficient to infer that women who quit smoking before or during pregnancy gain more weight during gestation than nonsmokers.
• The evidence is inadequate to infer that smoking cessation during pregnancy increases the risk of gestational diabetes.
• The evidence is sufficient to infer that smoking cessation during pregnancy reduces the effects of smoking on fetal growth and that quitting smoking early in pregnancy eliminates the adverse effects of smoking on fetal growth.
• The evidence is inadequate to determine the gestational age before which smoking cessation should occur to eliminate the effects of smoking on fetal growth.
• The evidence is sufficient to infer that smoking cessation before or during early pregnancy reduces the risk for a small-for-gestational-age birth compared with continued smoking.
• The evidence is suggestive but not sufficient to infer that women who quit smoking before conception or during early pregnancy have a reduced risk of preterm delivery compared with women who continue to smoke.
• The evidence is suggestive but not sufficient to infer that the risk of preterm delivery in women who quit smoking before or during early pregnancy does not differ from that of nonsmokers.
• The evidence is inadequate to infer that smoking cessation during pregnancy reduces the risk of stillbirth.
• The evidence is inadequate to infer that smoking cessation during pregnancy reduces the risk of perinatal mortality among smokers.
• The evidence is inadequate to infer that women who quit smoking before or during early pregnancy have a reduced risk for infant mortality compared with continued smokers.
• The evidence is inadequate to infer an association between smoking cessation, the timing of cessation, and female fertility or fecundity.
• The evidence is suggestive but not sufficient to infer that smoking cessation reduces the risk of earlier age at menopause compared with continued smoking.
• The evidence is inadequate to infer that smoking cessation reduces the effects of smoking on male fertility and sperm quality.
• The evidence is suggestive but not sufficient to infer that former smokers are at increased risk of erectile dysfunction compared with never smokers.
• The evidence is inadequate to infer that smoking cessation reduces the risk of erectile dysfunction compared with continued smoking.

Chapter 5. The Benefits of Smoking Cessation on Overall Morbidity, Mortality, and Economic Costs

• The evidence is sufficient to infer that smoking cessation improves well-being, including higher quality of life and improved health status.
• The evidence is sufficient to infer that smoking cessation reduces mortality and increases the lifespan.
• The evidence is sufficient to infer that smoking exacts a high cost for smokers, healthcare systems, and society.
• The evidence is sufficient to infer that smoking cessation interventions are cost-effective.

Chapter 6. Interventions for Smoking Cessation and Treatments for Nicotine Dependence

• The evidence is sufficient to infer that behavioral counseling and cessation medication interventions increase smoking cessation compared with self-help materials or no treatment.
• The evidence is sufficient to infer that behavioral counseling and cessation medications are independently effective in increasing smoking cessation, and even more effective when used in combination.
• The evidence is sufficient to infer that proactive quitline counseling, when provided alone or in combination with cessation medications, increases smoking cessation.
• The evidence is sufficient to infer that short text message services about cessation are independently effective in increasing smoking cessation, particularly if they are interactive or tailored to individual text responses.
• The evidence is sufficient to infer that web or Internetbased interventions increase smoking cessation and can be more effective when they contain behavior change techniques and interactive components.
• The evidence is inadequate to infer that smartphone apps for smoking cessation are independently effective in increasing smoking cessation.
• The evidence is sufficient to infer that combining short- and long-acting forms of nicotine replacement therapy increases smoking cessation compared with using single forms of nicotine replacement therapy.
• The evidence is suggestive but not sufficient to infer that pre-loading (e.g., initiating cessation medication in advance of a quit attempt), especially with the nicotine patch, can increase smoking cessation.
• The evidence is suggestive but not sufficient to infer that very-low-nicotine-content cigarettes can reduce smoking and nicotine dependence and increase smoking cessation when full-nicotine cigarettes are readily available; the effects on cessation may be further strengthened in an environment in which conventional cigarettes and other combustible tobacco products are not readily available.
• The evidence is inadequate to infer that e-cigarettes, in general, increase smoking cessation. However, the evidence is suggestive but not sufficient to infer that the use of e-cigarettes containing nicotine is associated with increased smoking cessation compared with the use of e-cigarettes not containing nicotine, and the evidence is suggestive but not sufficient to infer that more frequent use of e-cigarettes is associated with increased smoking cessation compared with less frequent use of e-cigarettes.
• The evidence is sufficient to infer that certain life events—including hospitalization, surgery, and lung cancer screening—can trigger attempts to quit smoking, uptake of smoking cessation treatment, and smoking cessation.
• The evidence is suggestive but not sufficient to infer that fully and consistently integrating standardized, evidence-based smoking cessation interventions into lung cancer screening increases smoking cessation while avoiding potential adverse effects of this screening on cessation outcomes.
• The evidence is suggestive but not sufficient to infer that cytisine increases smoking cessation.

Chapter 7. Clinical-, System-, and Population-Level Strategies that Promote Smoking Cessation

• The evidence is sufficient to infer that the development and dissemination of evidence-based clinical practice guidelines increase the delivery of clinical interventions for smoking cessation.
• The evidence is sufficient to infer that with adequate promotion, comprehensive, barrier-free, evidencebased cessation insurance coverage increases the availability and utilization of treatment services for smoking cessation.
• The evidence is sufficient to infer that strategies that link smoking cessation-related quality measures with payments to clinicians, clinics, or health systems increase the rate of delivery of clinical treatments for smoking cessation.
• The evidence is sufficient to infer that tobacco quitlines are an effective population-based approach to motivate quit attempts and increase smoking cessation.
• The evidence is suggestive but not sufficient to infer that electronic health record technology increases the rate of delivery of smoking cessation treatments.
• The evidence is sufficient to infer that increasing the price of cigarettes reduces smoking prevalence, reduces cigarette consumption, and increases smoking cessation.
• The evidence is sufficient to infer that smokefree policies reduce smoking prevalence, reduce cigarette consumption, and increase smoking cessation.
• The evidence is sufficient to infer that mass media campaigns increase the number of calls to quitlines and increase smoking cessation.
• The evidence is sufficient to infer that comprehensive state tobacco control programs reduce smoking prevalence, increase quit attempts, and increase smoking cessation.
• The evidence is sufficient to infer that large, pictorial health warnings increase smokers’ knowledge about the health harms of smoking, interest in quitting, and quit attempts and decrease smoking prevalence.
• The evidence is suggestive but not sufficient to infer that plain packaging increases smoking cessation.
• The evidence is suggestive but not sufficient to infer that decreasing the retail availability of tobacco products and exposure to point-of-sale tobacco marketing and advertising increases smoking cessation.
• The evidence is suggestive but not sufficient to infer that restricting the sale of certain types of tobacco products, such as menthol and other flavored products, increases smoking cessation, especially among certain populations.
• The Evolving Landscape of Smoking Cessation

This section of the chapter reviews the history of smoking cessation, from its early origins to the modern era, including the changes that have occurred since publication of the 1990 Surgeon General’s report. It also highlights developments that have shaped current initiatives in smoking cessation and will set the stage for the chapters that follow. Finally, this section highlights a broad set of interventions that have been implemented over the past three decades and are proven to be effective at helping people quit successfully. These interventions, which are now being integrated into clinical care and societal policies, include (a) low-intensity interventions, such as telephone quitlines; (b) brief but systematically repeated interventions in primary care settings; (c) over-the-counter medications; and (d) public policy approaches, such as increases in tobacco prices (e.g., through taxation), comprehensive policies to make indoor environments smokefree, and mass media campaigns that increase motivation to quit and may help sustain quit attempts ( CDC 2014a ; USDHHS 2014 ).

Historical Context of Smoking Cessation

Addiction versus habit.

• “Smoking is highly addictive. Nicotine is the addictive drug in tobacco”;
• “Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction”;
• “It’s not easy to quit”; and
• “When you smoke, the nicotine actually changes the brain—that’s why quitting is so hard” ( U.S. Department of Justice 2017a ; Farber et al. 2018 , p. 128).

However, previously secret documents from the tobacco industry reveal that the tobacco industry was aware of the addictive nature of nicotine for decades, long before they publicly acknowledged it or were eventually ordered by the court to publicly acknowledge it ( Elias et al. 2018 ). In fact, the tobacco industry had been engineering cigarettes for decades to improve the rapid delivery of nicotine ( Proctor 2011 ). For years, the tobacco industry coordinated well-financed, systematic efforts to deny the addictiveness of nicotine and the need for users to quit smoking, thereby trivializing the harms of tobacco use while promoting the benefits of nicotine ( Hirschhorn 2009 ; USDHHS 2014 ). The industry did this using welldocumented tactics, including aggressive funding and support for academic, medical, and community organizations that were sympathetic to this perspective ( Proctor 2011 ).

Addiction to any substance often brings on a variety of efforts to overcome or treat it. However, until the late twentieth century, clinical and public health approaches to smoking cessation often treated smoking as a habit rather than as an addiction ( USDHEW 1964 ). The tobacco industry has asserted for many years in public messaging and litigation that smoking is a personal choice ( Friedman et al. 2015 ). Indeed, both smoking and smoking cessation were considered personal choices; the idea was that if persons started smoking cigarettes, they could quit if they truly wanted to, putting the onus on the individual smoker to quit using his or her own motivation and desire to do so. The Surgeon General first concluded in 1988 that “cigarettes and other forms of tobacco are addicting,” and “nicotine is the drug in tobacco that causes addiction” ( USDHHS 1988 , p. 9). Eventually, intensive medical treatments and protocols—such as the use of multiple medications for long periods of time, long-term psychological counseling, and inpatient hospitalization—were developed to address the highly addictive nature of nicotine ( Fiore et al. 2008 ). However, between 2000 and 2015, less than one-third of U.S. adult cigarette smokers reported using evidence-based cessation treatments, such as behavioral counseling and/or medication, when trying to quit smoking ( Babb et al. 2017 ).

The first comprehensive clinical practice guideline for smoking cessation was produced by the federal government in 1996 and emphasized the role of healthcare providers in providing assessment and treatment interventions for smoking with patients who smoke ( Fiore et al. 1996 ). In 2008, an updated federal guideline, Treating Tobacco Use and Dependence: 2008 Update (hereafter referred to as the Clinical Practice Guideline ), was published ( Fiore et al. 2008 ). This guideline uses language similar to that used in helping persons quit other addictive substances and is discussed in more detail in Chapter 7 .

With the shift toward an improved understanding of the nature of nicotine addiction, terminology used to describe tobacco use has also shifted. The Diagnostic and Statistical Manual of Mental Disorders (5th edition) is the primary clinical source of diagnostic criteria for mental health disorders. It provides diagnostic criteria for “tobacco use disorder,” which includes physiologic dependence, impaired control, and social impairment, among others ( American Psychiatric Association 2013 ). These diagnostic criteria align with those for other substance use disorders and acknowledge the physical, psychological, and environmental components of addiction. However, as noted in the Clinical Practice Guideline, although not all tobacco use results in tobacco use disorder, any tobacco use has risks and, therefore, warrants intervention ( Fiore et al. 2008 ). Accordingly, throughout this report, the term “tobacco use and dependence” is used to be inclusive of all patterns of use and to acknowledge the multifactorial and chronic relapsing nature of nicotine addiction. The term “nicotine dependence” is used specifically to refer to physiologic dependence on nicotine. This terminology aligns with that used in the Clinical Practice Guideline, which further details why the term “tobacco use and dependence” is most appropriate when discussing cessation interventions ( Fiore et al. 2008 ).

Coverage of Smoking Cessation, Nicotine, and Addiction in Surgeon General’s Reports

Coverage of cessation, nicotine, and addiction in Surgeon General’s reports has evolved greatly since 1964, reflecting the evolution of scientific understanding of addiction to nicotine and its treatment.

Coverage of Smoking Cessation

Of the 34 Surgeon General’s reports on smoking and health published to date, this is the second to address smoking cessation as the main topic. Even so, beginning with the first report in 1964, evidence reviewed in various reports has supported some conclusions related to the health benefits of smoking cessation. Over time, as the epidemiologic findings from prospective cohort studies became more abundant and covered longer periods of time since quitting smoking, conclusions began to mount on the decline in risks for major smoking-caused diseases after cessation. In fact, declines in risk after cessation figured into the causal inference process presented in the reports, which documented a decrease in health risks after withdrawal of smoking—the presumptive causal agent.

The 1964 Surgeon General’s report reviewed findings from seven prospective cohort studies that had included sufficient numbers of former smokers to provide estimates about cause-specific relative risk for mortality from selected diseases ( USDHEW 1964 ). The data from the cohort studies were complemented by case-control studies for some cancer sites that had also addressed a change in risk after smoking cessation. For all-cause mortality, the 1964 report stated that compared with never smokers, relative mortality was 40% higher among former smokers and 70% higher among current smokers. For lung cancer, quantitative relationships with smoking patterns were described as follows: “The risk of developing lung cancer increases with duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking” (p. 37). In considering the causal nature of the association between smoking and lung cancer, the report stated, “Where discontinuance, time since discontinuance, and amount smoked prior to discontinuance were considered in either retrospective studies or, with more detail, in prospective studies, these all showed lower risks for ex-smokers, still lower risks as the length of time since discontinuance increased, and lower risks among ex-smokers if they had been light smokers” (p. 188). The report did not conclude that smoking caused cardiovascular disease, but it noted a lower risk of death from cardiovascular disease among former smokers compared with continuing smokers and stated, “Although the causative role of cigarette smoking in deaths from coronary disease is not proven, the Committee considers it more prudent from the public health viewpoint to assume that the established association has causative meaning than to suspend judgment until no uncertainty remains” (p. 32).

In ensuing Surgeon General’s reports through the 1970s, the health benefits of smoking cessation did not receive systematic attention, but the results identified a declining risk for some diseases after cessation. The 1979 report offered detailed reviews for major diseases, and it concluded that compared with smokers, risks were lower among former smokers for all-cause mortality, atherosclerosis and coronary heart disease, lung cancer, larynx cancer, lung function, and respiratory symptoms ( USDHEW 1979 ). Three Surgeon General’s reports released in the early 1980s focused on the health consequences of smoking on specific major disease categories: cancer ( USDHHS 1982 ), cardiovascular disease ( USDHHS 1983 ), and chronic lung disease ( USDHHS 1984 ). Each report also examined the impact of smoking cessation on each of those disease categories. In 1988, the report reviewed the evidence to date on nicotine and drew major conclusions that nicotine was addictive ( USDHHS 1988 ).

By 1990, the scope and depth of evidence on smoking cessation was sufficiently abundant to justify a full report, The Health Benefits of Smoking Cessation . The report’s conclusions expanded on those of earlier reports, summarizing descriptions of the temporal course of declining risk for many of the diseases caused by smoking ( USDHHS 1990 ). For example, the report concluded, “The excess risk of [coronary heart disease] caused by smoking is reduced by about half after 1 year of smoking abstinence and then declines gradually. After 15 years of abstinence, the risk of [coronary heart disease] is similar to that of persons who have never smoked” (p. 11).

Importantly, the 1990 report was the first to address smoking cessation and reproduction. That report offered strong conclusions with clinical implications related to reproduction and offered conclusions about the timing of cessation across gestation and implications for birthweight ( USDHHS 1990 ).

The 2004 Surgeon General’s report, The Health Consequences of Smoking, covered active smoking and disease; and the 2014 Surgeon General’s report, The Health Consequences of Smoking—Fifty Years of Progress, again covered the full range of health consequences of smoking, providing conclusions that drew on data from long-running cohort studies that described how risks change in former smokers up to several decades after quitting. For example, the 2004 report concluded, “Even after many years of not smoking, the risk of lung cancer in former smokers remains higher than in persons who have never smoked” ( USDHHS 2004 , p. 25). In contrast, regarding the effect of smoking in accelerating the decline of lung function, the report determined “[t]he evidence is sufficient to infer a causal relationship between sustained cessation from smoking and a return of the rate of decline in pulmonary function to that of persons who had never smoked” (p. 27). The 2014 report updated estimates of relative risks in former smokers, drawing on more contemporary cohorts, and used the estimates to calculate attributable mortality ( USDHHS 2014 ). The extended follow-up of the cohort studies documented the benefits of cessation by early middle age for reducing the risk of death from any cause.

Coverage of Nicotine and Addiction

The 1964 Surgeon General’s report suggested that smoking was a form of habituation, stating that “[e]ven the most energetic and emotional campaigner against smoking and nicotine could find little support for the view that all those who use tobacco, coffee, tea, and cocoa are in need of mental care even though it may at some time in the future be shown that smokers and nonsmokers have different psychologic characteristics” ( USDHEW 1964 , pp. 351–352). The report used such words as “compulsion” and “habit” but did not consider nicotine to be addicting: “Proof of physical dependence requires demonstration of a characteristic and reproducible abstinence syndrome upon withdrawal of a drug or chemical which occurs spontaneously, inevitably, and is not under control of the subject. Neither nicotine nor tobacco comply with any of these requirements” ( USDHEW 1964 , p. 352). Correspondingly, the report emphasized habituation and not addiction: “The habitual use of tobacco is related primarily to psychological and social drives, reinforced and perpetuated by the pharmacologic actions of nicotine on the central nervous system” ( USDHEW 1964 , p. 354). In 1977, the National Institute on Drug Abuse began to support studies of cigarette smoking as a “dependence process,” comparing it to other drug addictions ( Parascandola 2011 ). The monograph, The Behavioral Aspects of Smoking ( Krasnegor 1979 ), reflected an advancing understanding of the power of nicotine as a pharmacologic agent: “Nicotine has been proposed as the primary incentive in smoking [ Jarvik 1973 , as cited in Krasnegor 1979 ] and may be instrumental in the establishment of the smoking habit. Whether or not it is the only reinforcing agent, it is still the most powerful pharmacological agent in cigarette smoke” (p. 12). The 1979 Surgeon General’s report, Smoking and Health, devoted considerable attention to the behavioral aspects of smoking, but it still did not use the term “addiction” ( USDHEW 1979 ). That report also concluded that there was general acceptance of the existence of a tobacco withdrawal syndrome, which was more prominent in heavy smokers.

• “Cigarettes and other forms of tobacco are addicting”;
• “Nicotine is the drug in tobacco that causes addiction”; and
• “The pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine” ( USDHHS 1988 , p. 9).

Later Surgeon General’s reports on tobacco have addressed the subsequent scientific advances in the area of smoking and addiction, particularly the 2010 report on mechanisms by which smoking causes disease ( USDHHS 2010 ).

Perspectives on Smoking Cessation

In 2015, most smokers stated that they wanted to quit smoking (68%), and about 56% of smokers made a serious attempt to quit; however, only about 7% of smokers reported that they had recently quit ( Babb et al. 2017 ). Despite evidence demonstrating that using smoking cessation pharmacotherapy with behavioral support is more effective than quitting without these treatments, most smokers who had recently quit reported that they did not quit with medication or counseling assistance (see Chapter 6 ). Proponents of encouraging smokers to quit without treatment, often called quitting “cold turkey,” point to data indicating that most smokers who quit successfully do so without medications or any type of formal assistance, as well as to population surveys suggesting that cold-turkey quitters do as well or better than those who use over-the-counter NRTs. Proponents of this approach also suggest that medicalization may disempower smokers and create artificial barriers to quitting ( Alpert et al. 2013 ; Polito 2013 ). In contrast, others note that because of a lack of insurance coverage and other barriers, many smokers have little choice but to quit without formal treatment. Selection bias may also play a factor, as the most heavily addicted smokers are those most likely to use NRT, but these smokers also have a lower likelihood of success. In addition, most of those who use NRT do so for short periods of time or at lower-than-recommended doses and do not have adjunctive support available from tobacco cessation quitlines or other interventions ( Amodei and Lamb 2008 ). There are also issues of recall and attribution bias, which may make smokers more likely to report their most proximal experiences with use or nonuse of pharmacologic smoking cessation aids and/or behavioral supports and not to report previous quit attempts during which they used pharmacologic aids and/or behavioral support.

During most of the twentieth century, smokers who wanted to quit had limited resources to do so, especially smokers with mental health or substance use disorders. For example, the investment in research required for behavioral, pharmacologic, and systems-level interventions that increase successful cessation had been relatively limited given the magnitude of tobacco-related disease burden and the size of the population affected ( Dennis 2004 ; Carter et al. 2015 ; Hall et al. 2016 ). Even when interventions developed in the 1980s and 1990s were clearly shown to be effective, most health insurers and health systems showed little interest in providing coverage for or integrating into regular practice any new pharmacologic, behavioral, or systems approaches to cessation (see Chapter 6 ). Additionally, many medical schools provide only a small amount of time, if any, in their academic curriculum or programs for developing clinical skills to train future physicians in addressing tobacco use and dependence in patients ( Ferry et al. 1999 ; Montalto et al. 2004 ; Powers et al. 2004 ; Association of American Medical Colleges 2007 ; Geller et al. 2008 ; Richmond et al. 2009 ; Torabi et al. 2011 ; Griffith et al. 2013 ).

Development and Evolution of a Paradigm for Treating Nicotine Addiction

Clinicians’ views on smoking cessation shifted toward the end of the twentieth century. Given the increasing amount of evidence and awareness of the robust and widespanning beneficial effects of smoking cessation on various chronic diseases ( USDHHS 1990 ), clinicians began to understand that promoting smoking cessation was among the most powerful interventions for increasing health, while merely advising patients to quit was insufficient in promoting smokers to initiate quitting and sustain abstinence without relapsing. Concurrently, researchers began to better understand the powerfully addictive properties of nicotine and the complexities of the nicotine addiction process ( USDHHS 1988 ). This knowledge was disseminated widely to health professionals and the community ( Fiore et al. 1996 ).

Nicotine addiction is now increasingly emphasized as a main driver of both the initiation and continuation of smoking. Thus, the medical community sees the morbidity and mortality associated with smoking as clinical endpoints and nicotine addiction as the cause. Correspondingly, a growing number of intensive behavioral and pharmacologic treatments have become available to promote sustained abstinence.

Epidemiologic Shifts in Smoking Cessation

Chapter 2 provides a detailed discussion of key patterns and trends in cigarette smoking cessation in the United States. It also reviews the changing demographic and smoking-related characteristics of cigarette smokers, with a focus on how these changes may influence future trends in cessation.

Changes in the Patterns of Smoking and Population Characteristics of Smokers

The typical profile of the smoker has evolved over the years. The “hardening hypothesis” suggests that adults who continue to smoke cigarettes in the face of strengthening tobacco control policies and the increasing availability of efficacious cessation interventions will tend to be heavier smokers who are more highly addicted, less interested in quitting, and likely to have more difficulty in quitting ( National Cancer Institute [NCI] 2003 ). Only a limited amount of evidence supports this hypothesis ( Hughes 2011 ). Instead of increases over time in the proportion of smokers with frequent or heavy patterns of smoking, as would be predicted by hardening, the proportion has actually decreased ( Jamal et al. 2016 ). Furthermore, from 2005 to 2015, the percentage of current smokers who were daily smokers declined from 80.8% to 75.7%, and the proportion of current smokers who smoked on only some days (i.e., nondaily smokers) increased from 19.2% to 24.3% ( Jamal et al. 2016 ). Similarly, among daily smokers, the average number of cigarettes smoked per day declined from 16.7 in 2005 to 13.8 in 2014. However, when considering other measures of dependence, some modest and preliminary support exists for hardening among treatment-seeking smokers. For example, in a summary review by Hughes and colleagues (2011) , two of four studies showed increases in dependence and decreases in quit rates, but similar trends were not found among the general population of smokers who had quit.

Reductions in the frequency and heaviness of smoking do not necessarily suggest that a simple continuation of current approaches to increase smoking cessation will increase or even maintain progress in successful quitting. Nondaily or light smokers would be expected to be less addicted to nicotine and, therefore, when motivated to make a cessation attempt, would find it easier to quit than heavier smokers. Still, helping light and nondaily smokers to quit presents challenges. For example, some light and nondaily smokers do not self-identify as smokers, do not believe that they are addicted to nicotine, do not feel that they are at risk of smoking-related health effects, and do not expect quitting to be difficult ( Berg et al. 2013 ; Scott et al. 2015 ; Chaiton et al. 2016 ). The 2008 Clinical Practice Guideline does not recommend cessation medications for use by light smokers, based on insufficient evidence of effectiveness in this population ( Fiore et al. 2008 ). Ten years later, this gap in knowledge about treating light smokers is largely unchanged ( Ebbert et al. 2016 ) (see Chapter 6 ) and presents a barrier for addressing this growing subpopulation of smokers.

The prevalence of smoking is increasingly concentrated in the United States in populations that may face barriers to quitting. These include persons with behavioral health conditions (including mental health conditions or substance use disorders); persons of low socioeconomic status; persons who are lesbian, gay, bisexual, or transgender; American Indians/Alaska Natives; recent immigrants from countries with a high prevalence of smoking; residents of the South and Midwest; and persons with a disability. Such populations have a markedly higher prevalence of cigarette smoking than their respective counterparts, and the decline in the prevalence of smoking in the United States as a whole has been slower among these groups, particularly those with behavioral health conditions and those of lower socioeconomic status ( Grant et al. 2004 ; Schroeder and Morris 2010 ; CDC 2013b , 2016 ; Cook et al. 2014 ; Szatkowski and McNeill 2015 ) (see Chapter 2 ).

Changes in the Products Used by Smokers

The emergence of a wide array of new tobacco products and the increasing use of those products, combined with continued use of other conventional tobacco products, such as menthol cigarettes and smokeless tobacco, could complicate cessation efforts aimed at cigarette smoking ( Trinidad et al. 2010 ; USDHHS 2014 ; Villanti et al. 2016 ; Wang et al. 2016 ). These products include hookahs (water pipes), little cigars and cigarillos, e-cigarettes, and heated tobacco products. Cigarette smokers who also use one or more other tobacco products, generally known as “dual” or “poly” use, have higher dependence on nicotine and greater difficulty quitting ( Wetter et al. 2002 ; Bombard et al. 2007 ; Soule et al. 2015 ).

As of July 26, 2019, 11 states and the District of Columbia have passed laws legalizing nonmedical marijuana use ( National Conference of State Legislatures [NCSL] 2019 ). Although not a tobacco product, marijuana is frequently used in combination with conventional cigarettes or other tobacco products (e.g., cigars, e-cigarettes). For example, approximately 70% of adults who are current users of marijuana are also current users of tobacco ( Schauer et al. 2016 ). Results from populationbased surveys and some clinical studies indicate an association between the use of menthol-flavored cigarettes or marijuana and a lower probability of successful quitting ( Ford et al. 2002 ; Patton et al. 2005 ; Gandhi et al. 2009 ; Schauer et al. 2017 ). The available longitudinal evidence from rigorously conducted studies is limited, so it is too soon to determine whether this association is correlational or causal.

Developments in Approaches to Smoking Cessation at the Individual Level

This section summarizes the landmark developments since the 1990 Surgeon General’s report that have shaped treatment for tobacco dependence and corresponding breakthroughs in smoking cessation interventions at the individual level. Chapter 6 provides detailed evidence for current and emerging smoking cessation treatments, adding to the evidence presented in the Clinical Practice Guideline ( Fiore et al. 2008 ). It also explores approaches to increasing the impact of tobacco cessation treatment through improved efficacy and increased reach.

Pharmacotherapy

The scientific understanding of the neurobiologic impact of chronic exposure to nicotine ( USDHHS 2010 ) has stimulated research and development that focuses on identifying novel medications and improving existing medications. The only FDA-approved smoking cessation medication at the time of the 1990 Surgeon General’s report was the gum form of NRT ( USDHHS 1990 ). Since then, several additional NRT formulations (transdermal patch, lozenge, inhaler, and nasal spray) have been developed, with all but the inhaler and spray now approved for over-the-counter sale. Additionally, FDA has approved two non-NRT medications for smoking cessation: bupropion and varenicline ( GlaxoSmithKline 2017 ; FDA 2017 ; Pfizer 2019 ).

Adding to the progress seen for individual agents, favorable developments in pharmacologic treatment have been seen in a variety of other areas over the past two decades. For example, because of the modest efficacy of monotherapy and the recognition that persons with nicotine addiction benefit from intensive treatments, a variety of combination pharmacotherapies have been studied (see Chapter 6 ).

Behavioral Interventions

Discoveries in the behavioral and social sciences have deepened our understanding of psychosocial influences on the nature and treatment of tobacco dependence, which has propelled new approaches to behavioral treatment. The evidence has clarified that during and long after the dissipation of acute pharmacologic withdrawal from nicotine during cessation, several factors—including vacillation of negative emotional states, repeated urges to smoke, diminished motivation, and having less confidence in the ability to successfully quit—can persist throughout the cessation process and undermine quitting ( Liu et al. 2013 ; Ussher et al. 2013 ). Furthermore, encountering environments and situations previously associated with smoking, such as establishments that serve alcohol or interacting with friends who smoke, has been demonstrated to increase risk of relapse ( Conklin et al. 2013 ). Fortunately, behavioral treatment models for mental health conditions and other substance use disorders have been translated and adapted for nicotine addiction to address these factors and have been shown to improve quit rates ( Hall and Prochaska 2009 ).

In addition to quitlines, which have been a longstanding intervention to deliver population-based behavioral smoking cessation support, technological innovations have opened new service delivery platforms for sophisticated behavioral cessation interventions in other modalities. In the 1990s, computer-tailored, in-depth, personalized mailings based on answers to a lengthy questionnaire were developed and tested on smokers; the tailored or personalized mailings were more effective than mailings with standard text ( Prochaska et al. 1993 ; Strecher et al. 1994 ). Receipt of personalized written feedback and self-help materials was also found to increase cessation rates ( Curry et al. 1991 ). A systematic review by the U.S. Preventive Services Task Force (USPSTF) (2015) found self-help materials that were tailored to the individual patient to be effective cessation interventions. Interactive program modalities have been developed and tested ( USPSTF 2015 ) for desktop and laptop computers, first via programs operated from a CD-ROM or hard drive, later via Internet downloads, and more recently from “the cloud” ( Strecher et al. 2005 ; Haskins et al. 2017 ). The current state of science and technology also allows the leveraging of mobile phone technology and applications to deliver cessation interventions ( Whittaker et al. 2016 ). These include applications involving standardized motivation-enhancing texts or quit-promoting strategies—some of which offer real-time, live-peer, or professional advising or counseling within the application ( Smokefree.gov n.d. ). Preliminary evaluations have suggested that these applications may be beneficial to users ( Cole-Lewis et al. 2016 ; Squiers et al. 2016 , 2017 ; Taber et al. 2016 ) and that the cost of delivery is low.

Treating Tobacco Use and Dependence

The 2000 and 2008 Clinical Practice Guidelines had marked impacts on increasing understanding of and operationalizing the current paradigm of treating tobacco use and dependence ( Fiore et al. 2000 , 2008 ). Until the 1990s, synopses of the state of the evidence on smoking cessation usually relied on a somewhat informal aggregation of clinical and population-based studies, an approach that is prone to author bias in the choice of studies included and in their interpretations. Markedly more formal review processes, such as systematic literature reviews, were applied to smoking cessation and treatment in the 1990s and 2000s, as thousands of cessation-related studies accumulated. These more formal reviews systematized the literature review process by using strict criteria for grading studies and employing meta-analyses where appropriate; they also included a more transparent and elaborate process for synthesizing evidentiary findings into conclusions and recommendations.

In addition, the standards and framing of cessation research have evolved over the past several decades, which is consistent with the increased sophistication of pharmaceutical and population-based trials in general. For example, clinical trials have evolved from examining the success rates of persons completing the trial, often examining only the point prevalence of abstinence, into using intent-to-treat, where all persons starting treatment are considered in the denominator and those lost to follow-up are counted as smokers or subject to data imputation techniques ( Hall et al. 2001 ; Mermelstein et al. 2002 ; SRNT Subcommittee on Biochemical Verification 2002 ; Hughes et al. 2003 ; Shiffman et al. 2004 ). Definitions of successful abstinence often examine smoking status at 1 month, 6 months, and 1 year of abstinence after treatment.

Notably, some definitions of successful abstinence allow for brief lapses in smoking cessation to more accurately reflect the natural course of achieving long-term abstinence ( Zhu et al. 1996 ). Similarly, population-level surveillance and research have evolved to include increasingly more complex questions and techniques to more accurately capture the nature of respondents’ use of tobacco products and cessation behavior. For example, sets of questions have been developed to better categorize respondents’ use of healthcare services and the nature of cessation support they received. In addition, new technologies have been deployed to better understand the patterns of behavior among smokers, such as ecological momentary assessment, which cues smokers to provide data on their smoking urges and other thoughts, emotions, and behaviors in real time ( Shiffman 2009 ). Large clinical trials have also examined the interplay between multiple factors that affect quit success, such as different medications, dual-medication therapy, and different approaches and intensities of behavioral interventions ( Redmond et al. 2010 ).

• Any level of treatment is beneficial, and more intensive and longer behavioral and pharmacologic treatment is generally better.
• Physicians, psychologists, pharmacists, dentists, nurses, and numerous other healthcare professionals can treat nicotine addiction in smokers. Thus, by extension, the various settings in which such professionals work represent appropriate venues for providing these services.
• Behavioral interventions and FDA-approved pharmacotherapies are effective for treating nicotine dependence. A combination of behavioral interventions and pharmacotherapy is the optimal treatment based on overwhelming scientific evidence, with superiority in efficacy over either intervention alone.

Advances in research and technology have shaped how the clinical and scientific communities view and approach treatment for nicotine addiction in smokers, but this progress continues to lag the advances made in treating other chronic diseases. For instance, in cancer, cardiovascular disease, and other illnesses with multifactorial etiologies, major strides have been made toward precision treatment methods, which are based on the premise that clinical outcomes can be enhanced by selecting, adapting, and tailoring treatment on the basis of a patient’s specific clinical profile and disease pathogenesis ( Collins and Varmus 2015 ). Such approaches have been endorsed and promoted as part of the Precision Medicine Initiative ( Genetics Home Reference 2018 ), which reinforces that the future of clinical care lies in basic and clinical research and their translation to optimize health outcomes. Although precision treatment has not advanced for smoking cessation at the same rate as it has for treating certain other illnesses, emerging findings suggest that a personalized, precision approach has the potential to meaningfully improve smoking cessation outcomes ( Allenby et al. 2016 ).

Evolution of Approaches to Smoking Cessation at the Population Level

More intensity versus higher reach of support services.

Through the first decades in which cessation interventions were developed, most of the emphasis was on improved efficacy—specifically, increasing the probability that if smokers engaged and fully used an intervention service, their chances of success would be increased. As interventions, both behavioral or pharmacologic therapies and combination therapies have become increasingly effective, but despite the effectiveness of such therapies, they are not being used as designed by substantial numbers of smokers ( Zhu et al. 2012 ). Several theoretical models suggested that efforts to develop interventions need to consider their population impact, not just their individual efficacy for those taking part in the intervention.

• Almost no health insurers provided any coverage of smoking treatments—either medications, counseling, or physician intervention.
• Most physicians did not systematically address smoking in the course of clinical practice for multiple reasons, including lack of time, perception that patients are unready to quit, limited resources, and inadequate clinical skills related to cessation.
• Although smokers generally understood that smoking had unfavorable health effects, many did not fully understand or accept the magnitude or personal relevance of smoking’s effects on various aspects of health and its dramatic overall effect on longevity ( USDHHS 1989 ; Chapman et al. 1993 ). Even if smokers accept the theoretical possibility of risk, they often do not believe that the hypothetical future risk from smoking applies to them personally—for example, they believe they have “good genes” or other healthy habits, or they smoke in a less dangerous manner ( Oakes et al. 2004 ).
• Smokers and physicians did not realize that effective treatments were available.
• Even when smokers wanted to quit and were potentially interested in getting help, evidence-based treatments were not readily available to them because of financial and practical barriers.

Thus, during the 1980s and 1990s, a series of system and policy innovations were developed and tested to address these barriers. These innovations included the use of organizational system change and quality improvement theory to systematically address opportunities to influence smokers during routine interactions with healthcare systems ( Solberg et al. 1990 ; Manley et al. 1992 ); experiments providing different types of insurance coverage for cessation treatments ( Curry et al. 1998 ); the development of more easily accessible treatments, such as phone-based quitlines ( Orleans et al. 1991 ; Zhu et al. 2012 ); integrated promotion of cessation via mass media campaigns that encouraged the use of cessation services ( McAfee et al. 2013 ); and easily accessible, in-person cessation clinics ( Lee et al. 2016 ).

The lack of accessibility to cessation support was addressed in several ways. One approach attempted to bypass the lack of availability of support within healthcare services by creating easily accessible, low-intensity cessation supports, such as telephone quitlines or in-person clinics, that were generally operated and funded outside the healthcare system. Another approach attempted to integrate very brief but systematic, repeated support for cessation into primary care clinical practices while working to obtain insurance coverage and accessibility to more intense services for those interested in quitting. In some instances, these approaches were combined synergistically ( McAfee et al. 1998 ). A few U.S. states and some other countries, such as the United Kingdom, successfully developed—through funding from tobacco tax dollars or government healthcare—networks of freestanding, in-person cessation clinics that provided basic cessation counseling and medications ( Gibson et al. 2010 ; West et al. 2013 ). However, this model has not been sustained in any geographic region of the United States, primarily because of limited resources to maintain it over time. Still, a higher intensity model, which includes more intensive and comprehensive cessation components, has continued to focus on markedly improving the chances of success by treating nicotine addiction via a tertiary treatment delivery model, akin to how a cancer center approaches patients who are referred for its services. For example, the Mayo Clinic and a handful of similar referral clinics use such strategies as in-depth evaluation by multidisciplinary staff; personalized treatment plans; recurrent follow-up; and, in some cases, admission to a residential facility or hospital ( Hays et al. 2011 ). Although such programs often achieve high rates of smoking cessation, their utility is greatly limited by the high cost of implementation, unclear cost-effectiveness, and limited reach. For example, during a 7-year period, in a study of a large outpatient clinic, 2–3% of smokers used the available nicotine dependence services, even when the services were optimally promoted and delivered ( Burke et al. 2015 ).

Population-Based Interventions

Historically, tobacco control efforts have focused on either helping smokers quit at the individual level, such as through clinical interventions, or on providing population-level interventions to decrease the prevalence of smoking. Potential synergies between these two approaches have become increasingly apparent over the past several decades. This section discusses four examples of attempts to combine individually delivered cessation support and population-based strategies to smoking cessation: quitlines, health systems transformation, mass media campaigns, and health insurance coverage of smoking cessation treatment. Chapter 7 provides a more in-depth review of the current literature on each of these topics and on other population-based interventions that have been shown to promote cessation, such as increasing the prices of tobacco products and the implementation of smokefree policies.

In the late 1980s and throughout the 1990s, researchers interested in helping large numbers of smokers quit smoking began to experiment with the provision of behavioral counseling support via telephone, in the hope of overcoming such barriers to utilization as cost and the reluctance of many smokers to attend face-to-face group or individual sessions. Providing counseling centrally was thought to provide more opportunities for systematically improving the quality of the counseling and the research infrastructures used to answer questions about the cessation process. Protocols were developed and tested in a variety of environments, ranging from academic centers ( Ossip-Klein et al. 1991 ) to health systems ( Orleans et al. 1991 ) to state health departments ( Zhu et al. 1996 ). Multiple large, randomized trials have since established the effectiveness of the telephone modality ( Stead et al. 2013 ). The availability of quitlines grew rapidly during the 1990s and the early 2000s.

The adoption of quitlines by state health departments was initially facilitated by the increased revenue provided to states from the Master Settlement Agreement in 1998 and higher taxes on tobacco products. In 2003, CDC provided supplemental funding to state health departments to establish quitlines in those that did not have them and to enhance quitline services and access in those with existing quitlines ( Zhang et al. 2016 ). In 2004, a national network of state quitlines was created with a single national portal number (1-800-QUIT-NOW), which is serviced by NCI ( Cummins et al. 2007 ; CDC 2014b ). By 2006, residents in all 50 states, the District of Columbia, and U.S. territories had access to quitlines, and the North American Quitline Consortium had been developed to help set evaluation standards and enhance the collection of information, including an agreed-upon minimum dataset to be collected from all callers, with a data warehouse funded by CDC ( North American Quitline Consortium 2007 ; Keller et al. 2010 ). Providers of quitline services grew from modest operations with a few dozen employees to multiple large providers based in a range of organizations, including for-profit and nonprofit national healthcare organizations and academic centers, some employing hundreds of “quit coaches.”

Mass Media Campaigns

Mass media educational campaigns on the hazards of smoking have been used for decades, in part to motivate quit attempts in the general population of current smokers, and a considerable evidence base shows their effectiveness in promoting successful cessation at the population level ( NCI 2008 ; USDHHS 2014 ). These campaigns are generally thought of as being unrelated to efforts to provide direct assistance and support to individual smokers in healthcare settings or through community initiatives. However, since 1990, numerous efforts have been made to create synergies and efficiencies between mass media campaigns and the provision of individual support for quit attempts. For example, CDC’s Tips From Former Smokers (Tips) media campaign features ads with real people (former smokers) who have suffered the health consequences of smoking to increase awareness of suffering caused by smoking. The ads are also tagged with a quitline number ( CDC 2012 , 2013a ). Tagging the ads with an offer of assistance may help smokers absorb the message of the ad by making it actionable rather than simply negative. Chapter 7 discusses the effectiveness of mass media campaigns, including Tips .

Healthcare Systems

Clinic-based integration of health systems.

• Ask: Systematically identify the smoking status of all patients flowing through a practice, usually by an assistant interviewing the patient rather than relying on physician recall of patients’ smoking status at every visit;
• Advise: Provide at every encounter very brief, non-threatening recommendations to quit;
• Assist: Offer practical help for quitting, including tips to make it through the first few weeks and brief supportive counseling; and
• Arrange: Ensure that any smoker planning a quit attempt will receive follow-up (e.g., during future office visits and/or through off-site resources).

Despite being shown to have significant benefits to smokers in clinical practices in the 1980s and 1990s, the adoption, implementation, and subsequent maintenance of this systematic approach was slow and uneven ( Ferketich et al. 2006 ).

Based on an additional review of the evidence ( Fiore et al. 2008 ), a fifth step, “Assess,” was added between the “Advise” and “Assist” components, thereby emphasizing the importance of determining a patient’s level of interest in quitting so that assistance and follow-up could be tailored to that person’s specific circumstances. For example, a brief interaction with a patient not interested in quitting would focus on enhancing motivation rather than providing quit advice.

The 5 A’s model is an example of an intervention designed to maximize the probability of a smoker making a quit attempt and the probability that he or she will be successful during such an attempt. The model seeks to accomplish these two tasks for a population of smokers. Building on the effectiveness of the 5 A’s model, the Ask, Advise, Refer (AAR) model was developed as a shorter alternative to the 5 A’s model in clinical settings where there is less time afforded for the patient encounter ( Schroeder 2005 ). In addition, a different model, termed Ask, Advise, Connect (AAC) ( Vidrine et al. 2013 ) was developed to ameliorate the low rate of participation among persons passively referred to a smoking cessation treatment, usually a quitline, through the AAR model. In the AAC model, smokers who accept the referral are subsequently contacted by the provider of smoking cessation treatment, typically a quitline counselor. The referral or connection services, such as to quitlines, have very strong evidence for effectiveness ( Vidrine et al. 2013 ; Adsit et al. 2014 ) (also see Chapter 7 ). However, fewer studies have assessed the overall population impact of the AAR and AAC models compared with the 4 A’s and 5 A’s models.

• Lack of time;
• Lack of reliable reimbursement for provision of services;
• Lack of acceptance that addressing tobacco dependence is part of a physician’s job;
• Lack of training and/or comfort addressing problems with substance abuse;
• Lack of reliable, accessible referral resources;
• High prevalence of smoking, meaning that even brief interventions significantly affect clinic flow, as the interventions may need to be implemented with a large number of patients ( Vogt et al. 2005 ; Association of American Medical Colleges 2007 ; Blumenthal 2007 ); and
• Privacy concerns, fear of losing patients, the discouraging belief that most patients will not be able to stop, and concern about stigmatizing the smoker ( Schroeder 2005 ).

In recent years, increased attention has also been paid to the importance of building linkages between public health and the healthcare system and between community and clinical healthcare resources. This draws on the recognition that public health and healthcare stakeholders have complementary strengths and perspectives; that ultimately achieving lasting improvements in population health will take the combined efforts of both; and that improved coordination efforts will hasten this outcome. As part of this broader trend, national public health organizations and state tobacco control programs have begun to engage with healthcare systems to encourage and help them integrate treatment for tobacco dependence into their workflows ( CDC 2006 ). Some healthcare systems have broadened the scope of their interventions to address upstream factors that shape health outcomes. For example, some healthcare systems have championed evidence-based interventions that go beyond the clinical sphere, such as smokefree and tobacco-free policies, increases in the price of tobacco products, and policies raising the age of sale for tobacco products to 21 years ( Campaign for Tobacco-Free Kids 2016 ). Predicting the evolution of cessation treatment in the United States and the various roles of different segments of the healthcare system is challenging because of the volatility and uncertain future structure of healthcare, especially the nature of healthcare insurance. Regardless of what type of delivery system emerges, efforts should continue to integrate evidence-based tobacco treatment and cessation supports into healthcare settings and expand those supports. This would require further embedding of smoking processes and outcomes in quality measures, adequate funding, and routinization of training. Such services could be provided in the general healthcare system, as well as through specialized cessation clinics. The ability to deliver services effectively would be aided by having sufficient geographic locations for delivering care, promoting services, and removing barriers to services.

Health Insurance Coverage

Comprehensive insurance coverage for evidencebased cessation treatments plays a key role in helping smokers quit by increasing their access to proven treatments that raise their chances of quitting successfully ( Fiore et al. 2008 ; CDC 2014a ). Research in multiple healthcare settings in the 1990s ( Curry et al. 1998 ) and 2000s ( Joyce et al. 2008 ; Hamlett-Berry et al. 2009 ; Smith et al. 2010 ; Fu et al. 2014 ; Fu et al. 2016 ) has demonstrated that comprehensive cessation coverage increases quit attempts, the use of cessation treatments, and successful quitting ( Fiore et al. 2008 ). Accordingly, implementation of comprehensive cessation coverage is important in both private and public health insurance.

Significant milestones in the recognition that comprehensive insurance coverage for smoking cessation plays a key role in helping smokers quit include (a) the Community Preventive Services Task Force’s finding that reducing tobacco users’ out-of-pocket costs for proven cessation treatments increases the number of tobacco users who quit ( Hopkins et al. 2001 ), and (b) the recommendation in each of the Clinical Practice Guidelines that health insurers cover the FDA-approved cessation treatments and the behavioral treatments that the Guidelines found to be effective ( Fiore et al. 2000 , 2008 ). These recommendations draw on a body of research that has documented the outcomes of insurance coverage for cessation, including its cost-effectiveness. This research has also helped to identify the levels of coverage that influence tobacco cessation. More recently, several studies have examined the utilization of cessation treatments covered by health insurance, especially cessation medications, and how this has changed over time. Initial findings from these analyses suggest that cessation treatments continue to be underused, especially among Medicaid populations, and utilization varies considerably across states ( Babb et al. 2017 ).

Healthcare Insurance Policies

After 2010, several national levers were added to make tobacco use and dependence treatment a part of healthcare. Both Medicare and Medicaid required coverage of certain smoking cessation treatments, and the Affordable Care Act included several provisions that required non-grandfathered commercial health plans to provide in-network smoking cessation medications and counseling without financial barriers because those two treatments had “A” ratings from USPSTF ( McAfee et al. 2015 ). Even with these new regulatory levers, many national plans are not yet providing the required coverage ( Kofman et al. 2012 ). Chapter 7 provides an in-depth discussion of private and public health insurance coverage for the treatment of tobacco use and dependence.

E-Cigarettes: Potential Impact on Smoking Cessation

E-cigarettes (also called electronic nicotine delivery systems [ENDS], vapes, vape pens, tanks, mods, and podmods) are battery-powered devices designed to convert a liquid (often called e-liquid)—which contains a humectant (propylene glycol and vegetable glycerin) and also typically contains nicotine, flavorings, and other compounds— into aerosol for inhalation by the user. First introduced in the United States in 2007 ( USDHHS 2016 ), the advent of e-cigarettes into the tobacco product marketplace was seen by some as a potential harm-reduction tool for current adult smokers if the products were used to transition completely from conventional cigarettes ( Fagerstrom et al. 2015 ; Warner and Mendez 2019 ). E-cigarette aerosol has been shown to contain markedly lower levels of harmful constituents than conventional cigarette smoke ( National Academies of Sciences, Engineering, and Medicine 2018 ). Accordingly, interest remains in policies and approaches that could maximize potential benefits of these devices while minimizing potential pitfalls posed by the devices at the individual and population levels, including concerns about initiation among young people. The 2016 Surgeon General’s report, E-Cigarette Use Among Youth and Young Adults, examined many aspects of e-cigarettes related to young people; however, it did not address the potential impact of e-cigarettes on smoking cessation among adult smokers ( USDHHS 2016 ). It is also important to note that the landscape of available e-cigarette products has rapidly diversified since their introduction in the United States in 2007, including the introduction of “pod mod” e-cigarettes that have dominated the e-cigarette marketplace in recent years ( Barrington-Trimis and Leventhal 2018 ; Office of the U.S. Surgeon General n.d. ). This section highlights salient issues about how e-cigarettes may influence cessation, which is reviewed in more depth in Chapter 6 .

Implications of E-Cigarette Characteristics for Smoking Cessation

Nicotine delivery through inhalation, as is the case with cigarette smoking, results in rapid nicotine absorption and delivery to the brain. The pharmacokinetics of nicotine delivery varies across products and is influenced by user topography, with some, but not all, e-cigarette products providing nicotine delivery comparable to conventional cigarettes ( National Academies of Sciences, Engineering, and Medicine 2018 ). By contrast, the nicotine inhaler, one of several FDA-approved NRTs, delivers nicotine primarily through the buccal mucosa; it is designed to reduce nicotine withdrawal and cravings while minimizing abuse liability ( Schneider et al. 2001 ). For smokers of conventional cigarettes who seek a product with a rapid delivery of nicotine similar to cigarettes, e-cigarettes that deliver nicotine in a similar way to cigarettes may have greater appeal than NRTs. Although rapid boluses of nicotine could increase the appeal, as well as addiction and potential greater abuse liability, of e-cigarettes relative to NRTs, whether this pharmacokinetic profile produces an effective method of cessation is presently inconclusive from the emerging base of empirical evidence ( Shihadeh and Eissenberg 2015 ).

Other features of e-cigarettes that may enhance their appeal to smokers of conventional cigarettes include the ways in which they mirror some of the sensorimotor features of conventional cigarette smoking, including stimulation of the airways, the sensations and taste of e-cigarette aerosol in the mouth and lungs, the hand-to-mouth movements and puffing in which e-cigarette users engage, and the exhalation of aerosol that may visually resemble cigarette smoking. Given the potentially important role of such sensorimotor factors in the reinforcing and addictive qualities of conventional cigarettes ( Chaudhri et al. 2006 ), the presence of these attributes could make e-cigarettes more appealing to smokers as a substitute for cigarettes than NRTs because the NRTs either lack such sensorimotor features (e.g., the transdermal patch, nicotine gum) or offer only partial approximations (e.g., the inhaler).

However, when considering e-cigarettes as a potential cessation aid for adult smokers, it is also important to take into account factors related to both safety and efficacy. NRT has been proven safe and effective, but there is no safe tobacco product. Although e-cigarette aerosol generally contains fewer toxic chemicals than conventional cigarette smoke, all tobacco products, including e-cigarettes, carry risks.

As noted in the 2016 Surgeon General’s report, many of the characteristics that distinguish e-cigarettes from conventional cigarettes increase the appeal of these new products to youth and young adults, particularly nonsmokers ( USDHHS 2016 ). These factors include appealing flavors, high concentrations of nicotine, concealability of use, and widespread marketing through social media promotion and other channels ( Barrington-Trimis and Leventhal 2018 ). Many e-cigarettes differ markedly in shape and feel compared with conventional cigarettes; e-cigarettes come in a variety of shapes, including rectangular tank-style and USB-shaped devices (as discussed in Chapter 6 and shown in Figure 6.1 ). For example, JUUL, the top-selling e-cigarette brand in the United States in 2018 ( Wells Fargo Securities 2018 ), is shaped like a USB flash drive and offers high concentrations of nicotine in the cartridges, which are also known as “pods” ( Huang et al. 2018 ). Notably, the novelty, diversity, and customizability of e-cigarettes appeal to youth ( Chu et al. 2017 ; Office of the U.S. Surgeon General n.d. ). For example, there are numerous scientific reports documenting the appeal of, and dramatic rise in, JUUL use among youth and young adults ( Chen 2017 ; Teitell 2017 ; Beal 2018 ; Bertholdo 2018 ; Coughlin 2018 ; Grigorian 2018 ; Saggio 2018 ; Suiters 2018 ; FDA 2018 ; Willett et al. 2018 ; Radding n.d. ).

Of note, a growing number of e-cigarettes, including JUUL, also use nicotine salts, which have a lower pH than the freebase nicotine used in most other e-cigarettes and traditional tobacco products, and allow particularly high levels of nicotine to be inhaled more easily and with less irritation. Although this type of product may be appealing to adult smokers seeking e-cigarettes with potentially greater nicotine delivery, the potency and appeal of such products can also make it easier for young people to initiate the use of nicotine and become addicted ( Office of the U.S. Surgeon General n.d. ).

The final chapter of the 2014 Surgeon General’s report concluded that the use of e-cigarettes could have both positive and negative impacts at the individual and population levels ( USDHHS 2014 ). One of its conclusions was that “the promotion of noncombustible products is much more likely to provide public health benefits only in an environment where the appeal, accessibility, promotion, and use of cigarettes and other combusted tobacco products are being rapidly reduced” ( USDHHS 2014 , p. 874). Therefore, it is important to continue (a) monitoring the findings of research on the potential of e-cigarettes as a smoking cessation aid and (b) evaluating the positive and negative impacts that these products could have at the individual and population levels, so as to ensure that any potential benefits among adult smokers are not offset at the population level by the already marked increases in the use of these products by youth. It is particularly important to evaluate scientific evidence on the impact of e-cigarettes on adult smoking cessation in the current context of the high level of e-cigarette use by youth, which increased at unprecedented levels in recent years following the introduction of JUUL and other e-cigarettes shaped like USB flash drives ( Cullen et al. 2019 ).

Once erroneously considered a habit that could be broken by simply deciding to stop, nicotine addiction is now recognized as a chronic, relapsing condition. The prevalence of cigarette smoking in the United States has declined steadily since the 1960s; however, as of 2017, there were still more than 34 million adult current cigarette smokers in the United States ( Wang et al. 2018 ).

Proven smoking cessation treatments are widely available today. However, the reach and use of existing smoking cessation interventions remain low, with less than one-third of smokers using any proven cessation treatments (behavioral counseling and/or medication) ( Babb et al. 2017 ). A majority of smokers still attempt to quit without using such treatments, contributing to a failure rate in excess of 90% ( Hughes et al. 2004 ; Fiore et al. 2008 ).

Medications and behavioral interventions with increasing levels of efficacy and sophistication are becoming more widely available, but there is considerable room for improvement. Further, the challenge of getting behavioral and pharmacologic interventions to be used concurrently and disseminated more broadly to the public has only been partially solved.

Full integration of treatment for nicotine dependence into all clinical settings—including primary and specialty clinics, hospitals, and cancer treatment settings—can benefit from increases in barrier-free health insurance coverage. Combining health service systems and electronic media platforms for the delivery of smoking cessation interventions has emerged as one promising method to increase reach of smoking cessation treatment to smokers (e.g., evidence-based cessation interventions using phone lines and mobile phone applications, and use of electronic health records to promote more timely referral to cessation support services). Barrier-free health insurance coverage (e.g., copays, coverage limits, prior authorization) and access to services, coupled with the use of quality improvement metrics and methodologies, have been shown to increase smokers’ use of evidencebased services.

Clinical-, system-, and population-level strategies are increasingly taking a more holistic approach to decreasing the prevalence of smoking, with interventions designed to increase quit attempts and enhance the chances of success. Examples include the national Tips From Former Smokers media campaign, which used ads featuring smokers who had suffered tobacco-related morbidity to increase awareness of individual suffering caused by smoking while simultaneously enhancing the capacity of the national quitline network to respond to upsurges in calls that were generated by tagging the ads with the phone number for the quitline. Millions of smokers made quit attempts as a result of exposure to the ads, and hundreds of thousands have successfully quit smoking. In addition, the development and dissemination of the carefully crafted and research-tested 5 A’s model in healthcare settings, combined with public and private policy changes that encourage coverage of cessation, have systematically encouraged more smokers to try to quit and provided them with evidence-based support. Still, the potential of mass media campaigns, quitlines, and clinical support has been tapped only partially, leaving many opportunities for further adoption, dissemination, and extensions of these approaches.

Use of e-cigarettes could have varied impacts on different segments of the population, including potential benefits to current adult cigarette smokers who transition completely; however, potential efficacy may depend on many factors, such as type of devices and e-liquids used, reason for use, and duration of use. Well-controlled, randomized clinical trials and rigorous, large-scale observational studies with long-term follow-ups will be critical to better understand the impact of e-cigarettes on cessation under various conditions and settings. Nevertheless, the potential benefit of e-cigarettes for cessation among adult smokers cannot come at the expense of escalating rates of use of these products by youth. Accordingly, the current science base supports a number of actions to minimize population risks while continuing to explore the potential utility of e-cigarettes for cessation, including efforts to prevent e-cigarette use among young people, regulate e-cigarette products and marketing, and discourage longterm use of e-cigarettes as a partial substitute for conventional cigarettes rather than completely quitting.

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• Cite this Page United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking Cessation: A Report of the Surgeon General [Internet]. Washington (DC): US Department of Health and Human Services; 2020. Chapter 1, Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation.
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235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

🏆 Best Smoking Essay Examples & Topic Ideas

🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

You should also discuss the various consequences of cigarette use, such as lung cancer, and identify their relationship with the habit. By discussing both sides of the issue, you will be able to write an excellent essay.

Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

• Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
• Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
• Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

Find smoking essay samples and other useful paper samples on IvyPanda, where we have a collection of professionally written materials!

• Should Cigarettes Be Banned? Essay Banning cigarette smoking would be of great benefit to the young people. Banning of cigarette smoking would therefore reduce stress levels in people.
• How Smoking Is Harmful to Your Health The primary purpose of the present speech is to inform the audience about the detrimental effects of smoking. The first system of the human body that suffers from cigarettes is the cardiovascular system.
• Conclusion of Smoking Should Be Banned on College Campuses Essay However, it is hard to impose such a ban in some colleges because of the mixed reactions that are held by different stakeholders about the issue of smoking, and the existing campus policies which give […]
• Should Smoking Be Banned in Public Places? Besides, smoking is an environmental hazard as much of the content in the cigarette contains chemicals and hydrocarbons that are considered to be dangerous to both life and environment.
• Causes and Effects of Smoking Some people continue smoking as a result of the psychological addiction that is associated with nicotine that is present in cigarettes.
• Smoking: Problems and Solutions To solve the problem, I would impose laws that restrict adults from smoking in the presence of children. In recognition of the problems that tobacco causes in the country, The Canadian government has taken steps […]
• Smoking Cigarette Should Be Banned Ban on tobacco smoking has resulted to a decline in the number of smokers as the world is sensitized on the consequences incurred on 31st May.
• On Why One Should Stop Smoking Thesis and preview: today I am privileged to have your audience and I intend to talk to you about the effects of smoking, and also I propose to give a talk on how to solve […]
• Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
• Smoking and Its Effects on Human Body The investigators explain the effects of smoking on the breath as follows: the rapid pulse rate of smokers decreases the stroke volume during rest since the venous return is not affected and the ventricles lose […]
• Smoking and Its Negative Effects on Human Beings Therefore, people need to be made aware of dental and other health problems they are likely to experience as a result of smoking.
• Summary of “Smokers Get a Raw Deal” by Stanley Scott Lafayette explains that people who make laws and influence other people to exercise these laws are obviously at the top of the ladder and should be able to understand the difference between the harm sugar […]
• Quitting Smoking: Strategies and Consequences Thus, for the world to realize a common positive improvement in population health, people must know the consequences of smoking not only for the smoker but also the society. The first step towards quitting smoking […]
• “Thank You For Smoking” by Jason Reitman Film Analysis Despite the fact that by the end of the film the character changes his job, his nature remains the same: he believes himself to be born to talk and convince people.
• Smoking Cessation Programs Through the Wheel of Community Organizing The first step of the wheel is to listen to the community’s members and trying to understand their needs. After the organizer and the person receiving treatment make the connection, they need to understand how […]
• Teenage Smoking and Solution to This Problem Overall, the attempts made by anti-smoking campaigners hardly yield any results, because they mostly focus on harmfulness of tobacco smoking and the publics’ awareness of the problem, itself, but they do not eradicate the underlying […]
• Smoking Qualitative Research: Critical Analysis Qualitative research allows researchers to explore a wide array of dimensions of the social world, including the texture and weave of everyday life, the understandings, experiences and imaginings of our research participants, the way that […]
• Health Promotion for Smokers The purpose of this paper is to show the negative health complications that stem from tobacco use, more specifically coronary heart disease, and how the health belief model can help healthcare professionals emphasize the importance […]
• Gender-Based Assessment of Cigarette Smoking Harm Thus, the following hypothesis is tested: Women are more likely than men to believe that smoking is more harmful to health.
• Hazards of Smoking and Benefits of Cessation Prabhat Jha is the author of the article “The Hazards of Smoking and the Benefits of Cessation,” published in a not-for-profit scientific journal, eLife, in 2020.
• The Impact of Warning Labels on Cigarette Smoking The regulations requiring tobacco companies to include warning labels are founded on the need to reduce nicotine intake, limit cigarette dependence, and mitigate the adverse effects associated with addiction to smoking.
• Psilocybin as a Smoking Addiction Remedy Additionally, the biotech company hopes to seek approval from FDA for psilocybin-based therapy treatment as a cigarette smoking addiction long-term remedy.
• Investing Savings from Quitting Smoking: A Financial Analysis The progression of interest is approximately $50 per year, and if we assume n equal to 45 using the formula of the first n-terms of the arithmetic progression, then it comes out to about 105 […]
• Smoking as a Community Issue: The Influence of Smoking A review of the literature shows the use of tobacco declined between 1980 and 2012, but the number of people using tobacco in the world is increasing because of the rise in the global population.
• Smoking Public Education Campaign Assessment The major influence of the real cost campaign was to prevent the initiation of smoking among the youth and prevent the prevalence of lifelong smokers.
• Quitting Smoking and Related Health Benefits The regeneration of the lungs will begin: the process will touch the cells called acini, from which the mucous membrane is built. Therefore, quitting the habit of smoking a person can radically change his life […]
• Smoking and Stress Among Veterans The topic is significant to explore because of the misconception that smoking can alleviate the emotional burden of stress and anxiety when in reality, it has an exacerbating effect on emotional stress.
• Smoking as a Predictor of Underachievement By comparing two groups smoking and non-smoking adolescents through a parametric t-test, it is possible to examine this assumption and draw conclusions based on the resulting p-value.
• Smoking and the Pandemic in West Virginia In this case, the use of the income variable is an additional facet of the hypothesis described, allowing us to evaluate whether there is any divergence in trends between the rich and the poor.
• Anti-Smoking Policy in Australia and the US The anti-smoking policy is to discourage people from smoking through various means and promotion of a healthy lifestyle, as well as to prevent the spread of the desire to smoke.
• Smoking Prevalence in Bankstown, Australia The secondary objective of the project was to gather and analyze a sufficient amount of auxiliary scholarly sources on smoking cessation initiatives and smoking prevalence in Australia.
• Drug Addiction in Teenagers: Smoking and Other Lifestyles In the first part of this assignment, the health problem of drug addiction was considered among teens and the most vulnerable group was established.
• Aspects of Anti-Smoking Advertising Thus, it is safe to say that the authors’ main and intended audience is the creators of anti-smoking public health advertisements.
• Anti-Smoking Communication Campaign’s Analysis Defining the target audience for an anti-smoking campaign is complicated by the different layers of adherence to the issue of the general audience of young adults.
• Smoking Cessation Project Implementation In addition, the review will include the strengths and weaknesses of the evidence presented in the literature while identifying gaps and limitations.
• Smoking Cessation and Health Promotion Plan Patients addicted to tobacco are one of the major concerns of up-to-date medicine as constant nicotine intake leads to various disorders and worsens the health state and life quality of the users.
• Maternal and Infant Health: Smoking Prevention Strategies It is known that many women know the dangers of smoking when pregnant and they always try to quit smoking to protect the lives of themselves and the child.
• A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.
• Peer Pressure and Smoking Influence on Teenagers The study results indicate that teenagers understand the health and social implications of smoking, but peer pressure contributes to the activity’s uptake.
• Smoking: Benefits or Harms? Hundreds of smokers every day are looking for a way to get rid of the noose, which is a yoke around the neck, a cigarette.
• The Culture of Smoking Changed in Poland In the 1980-90s, Poland faced the challenge of being a country with the highest rates of smoking, associated lung cancer, and premature mortality in the world.
• The Stop Smoking Movement Analysis The paper discusses the ideology, objective, characteristics, context, special techniques, organization culture, target audience, media strategies, audience reaction, counter-propaganda and the effectiveness of the “Stop Smoking” Movement.”The Stop Smoking” campaign is a prevalent example of […]
• Health Promotion Plan: Smokers in Mississippi The main strategies of the training session are to reduce the number of smokers in Mississippi, conduct a training program on the dangers of smoking and work with tobacco producers.
• Smoking Health Problem Assessment The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
• Integration of Smoking Cessation Into Daily Nursing Practice Generally, smoking cessation refers to a process structured to help a person to discontinue inhaling smoked substances. It can also be referred to as quitting smoking.
• E-Cigarettes and Smoking Cessation Many people argue that e-cigarettes do not produce secondhand smoke. They believe that the e-fluids contained in such cigarettes produce vapor and not smoke.
• Introducing Smoking Cessation Program: 5 A’s Intervention Plan The second problem arises in an attempt to solve the issue of the lack of counseling in the unit by referring patients to the outpatient counseling center post-hospital discharge to continue the cessation program.
• Outdoor Smoking Ban in Public Areas of the Community These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their […]
• Nicotine Replacement Therapy for Adult Smokers With a Psychiatric Disorder The qualitative research methodology underlines the issue of the lack of relevant findings in the field of nicotine replacement therapy in people and the necessity of treatment, especially in the early stages of implementation.
• Smoking and Drinking: Age Factor in the US As smoking and drinking behavior were both strongly related to age, it could be the case that the observed relationship is due to the fact that older pupils were more likely to smoke and drink […]
• Smoking Cessation Clinic Analysis The main aim of this project is to establish a smoking cessation clinic that will guide smoker through the process of quitting smoking.
• Cigarette Smoking Among Teenagers in the Baltimore Community, Maryland The paper uses the Baltimore community in Maryland as the area to focus the event of creating awareness of cigarette smoking among the teens of this community.
• Advocating for Smoking Cessation: Health Professional Role Health professionals can contribute significantly to tobacco control in Australia and the health of the community by providing opportunities for smoking patients to quit smoking.
• Lifestyle Management While Quitting Smoking Realistically, not all of the set goals can be achieved; this is due to laxity in implementing them and the associated difficulty in letting go of the past lifestyle.
• Smoking in the Actuality The current use of aggressive marketing and advertising strategies has continued to support the smoking of e-cigarettes. The study has also indicated that “the use of such e-cigarettes may contribute to the normalization of smoking”.
• Analysis of the Family Smoking Prevention and Tobacco Control Act The law ensures that the FDA has the power to tackle issues of interest to the public such as the use of tobacco by minors.
• “50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al. Thun is affiliated with the American Cancer Society, but his research interests cover several areas. Carter is affiliated with the American Cancer Society, Epidemiology Research Program.
• Pulmonology: Emphysema Caused by Smoking The further development of emphysema in CH can lead to such complications caused by described pathological processes as pneumothorax that is associated with the air surrounding the lungs.
• Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
• Health Promotion and Smoking Cessation I will also complete a wide range of activities in an attempt to support the agency’s goals. As well, new studies will be conducted in order to support the proposed programs.
• Maternal Mental Health and Prenatal Smoking It was important to determine the variables that may lead to postpartum relapse or a relapse during the period of pregnancy. It is important to note that the findings are also consistent with the popular […]
• Nursing Interventions for Smoking Cessation For instance, the authors are able to recognize the need to classify the level of intensity in respect to the intervention that is employed by nurses towards smoking cessation.
• Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
• Marketing Plan: Creating a Smoking Cessation Program for Newton Healthcare Center The fourth objective is to integrate a smoking cessation program that covers the diagnosis of smoking, counseling of smokers, and patient care system to help the smokers quit their smoking habits. The comprehensive healthcare needs […]
• Risks of Smoking Cigarettes Among Preteens Despite the good news that the number of preteen smokers has been significantly reducing since the 1990s, there is still much to be done as the effects of smoking are increasingly building an unhealthy population […]
• Public Health Education: Anti-smoking Project The workshop initiative aimed to achieve the following objectives: To assess the issues related to smoking and tobacco use. To enhance the health advantages of clean air spaces.
• Healthy People Program: Smoking Issue in Wisconsin That is why to respond to the program’s effective realization, it is important to discuss the particular features of the target population in the definite community of Wisconsin; to focus on the community-based response to […]
• Health Campaign: Smoking in the USA and How to Reduce It That is why, the government is oriented to complete such objectives associated with the tobacco use within the nation as the reduction of tobacco use by adults and adolescents, reduction of initiation of tobacco use […]
• Smoking Differentials Across Social Classes The author inferred her affirmations from the participant’s words and therefore came to the right conclusion; that low income workers had the least justification for smoking and therefore took on a passive approach to their […]
• Cigarette Smoking Side Effects Nicotine is a highly venomous and addictive substance absorbed through the mucous membrane in the mouth as well as alveoli in the lungs.
• Long-Term Effects of Smoking The difference between passive smoking and active smoking lies in the fact that, the former involves the exposure of people to environmental tobacco smoke while the latter involves people who smoke directly.
• Smoking Cessation Program Evaluation in Dubai The most important program of this campaign is the Quit and Win campaign, which is a unique idea, launched by the DHCC and is in the form of an open contest.
• Preterm Birth and Maternal Smoking in Pregnancy The major finding of the discussed research is that both preterm birth and maternal smoking during pregnancy contribute, although independently, to the aortic narrowing of adolescents.
• Enforcement of Michigan’s Non-Smoking Law This paper is aimed at identifying a plan and strategy for the enforcement of the Michigan non-smoking law that has recently been signed by the governor of this state.
• Smoking Cessation for Patients With Cardio Disorders It highlights the key role of nurses in the success of such programs and the importance of their awareness and initiative in determining prognosis.
• Legalizing Electronic Vaping as the Means of Curbing the Rates of Smoking However, due to significantly less harmful effects that vaping produces on health and physical development, I can be considered a legitimate solution to reducing the levels of smoking, which is why it needs to be […]
• Inequality and Discrimination: Impact on LGBTQ+ High School Students Consequently, the inequality and discrimination against LGBTQ + students in high school harm their mental, emotional, and physical health due to the high level of stress and abuse of various substances that it causes.
• Self-Efficacy and Smoking Urges in Homeless Individuals Pinsker et al.point out that the levels of self-efficacy and the severity of smoking urges change significantly during the smoking cessation treatment.
• “Cigarette Smoking: An Overview” by Ellen Bailey and Nancy Sprague The authors of the article mentioned above have presented a fair argument about the effects of cigarette smoking and debate on banning the production and use of tobacco in America.
• “The Smoking Plant” Project: Artist Statement It is the case when the art is used to pass the important message to the observer. The live cigarette may symbolize the smokers while the plant is used to denote those who do not […]
• Dangers of Smoking While Pregnant In this respect, T-test results show that mean birthweight of baby of the non-smoking mother is 3647 grams, while the birthweight of smoking mother is 3373 grams. Results show that gestation value and smoking habit […]
• The Cultural Differences of the Tobacco Smoking The Middle East culture is connected to the hookah, the Native American cultures use pipes, and the Canadian culture is linked to cigarettes.
• Ban on Smoking in Enclosed Public Places in Scotland The theory of externality explains the benefit or cost incurred by a third party who was not a party to the reasoning behind the benefit or cost. This will also lead to offer of a […]
• How Smoking Cigarettes Effects Your Health Cigarette smoking largely aggravates the condition of the heart and the lung. In addition, the presence of nicotine makes the blood to be sticky and thick leading to damage to the lining of the blood […]
• Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
• Smoking Prohibition: Local Issues, Personal Views This is due to the weakening of blood vessels in the penis. For example, death rate due to smoking is higher in Kentucky than in other parts of the country.
• Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
• Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
• Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
• Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
• Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
• Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
• Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
• Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
• Causes and Effects of Smoking in Public The research has further indicated that the carcinogens are in higher concentrations in the second hand smoke rather than in the mainstream smoke which makes it more harmful for people to smoke publicly.
• Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
• Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
• Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
• Smoking and Youth Culture in Germany The report also assailed the Federal Government for siding the interest of the cigarette industry instead of the health of the citizens.
• New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
• Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
• Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
• Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
• Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
• Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
• Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
• Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
• Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
• Tobacco Debates in “Thank You for Smoking” The advantage of Nick’s strategy is that it offers the consumer a role model to follow: if smoking is considered to be ‘cool’, more people, especially young ones, will try to become ‘cool’ using cigarettes.
• Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
• Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
• Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
• Smoking Among Teenagers as Highlighted in Articles The use of tobacco through smoking is a trend among adolescents and teenagers with the number of young people who involve themselves in smoking is growing each day.
• Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
• South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
• Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
• Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
• Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
• The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
• Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
• Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
• Tobacco Smoking and Its Dangers Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders.
• Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
• Tuberculosis Statistics Among Cigarette Smokers The proposal outlines the statistical applications of one-way ANOVA, the study participants, the variables, study methods, expected results and biases, and the practical significance of the expected results.
• Smoking Habit, Its Causes and Effects Smoking is one of the factors that are considered the leading causes of several health problems in the current society. Smoking is a habit that may be easy to start, but getting out of this […]
• Smoking Ban and UK’s Beer Industry However, there is an intricate type of relationship between the UK beer sector, the smoking ban, and the authorities that one can only understand by going through the study in detail The history of smoking […]
• Smokers’ Campaign: Finding a Home for Ciggy Butts When carrying out the campaign, it is important to know what the situation on the ground is to be able to address the root cause of the problem facing the population.
• Behavior Modification Technique: Smoking Cessation Some of its advantages include: its mode of application is in a way similar to the act of smoking and it has very few side effects.
• Effects of Thought Suppression on Smoking Behavior In the article under analysis called I suppress, Therefore I smoke: Effects of Thought Suppression on Smoking Behavior, the authors dedicate their study to the evaluation of human behavior as well as the influence of […]
• Smoking Cessation Methods These methods are a part of NRT or nicotine replacement therapy, they work according to the principle of providing the smoker with small portions of nicotine to minimize the addiction gradually and at the same […]
• Understanding Advertising: Second-Hand Smoking The image of the boy caught by the smoke is in the center of the picture, and it is in contrast with the deep black background.
• People Should Quit Smoking Other counseling strategies such as telephone calls and social support also serves the ultimate goal of providing a modern approach in which counseling can be tailored to suit the counseling needs of an individual smoker. […]
• Importance of Quitting Smoking As such, quitting smoking is important since it helps relief the worry and the fear associated with possibility of developing cancer among other smoking-related illnesses. It is therefore important to quit smoking if the problems […]
• Cigarette Smoking in Public Places Those who argue against the idea of banning the smoking are of the opinion that some of them opt to smoke due to the stress that they acquire at their work places.
• Ban of Tobacco Smoking in Jamaica The first part of the paper will address effects of tobacco smoking on personal health and the economy. Cognizant of its international obligation and the aforementioned health effects of tobacco smoke, Jamaica enacted a law […]
• Anti-Smoking Campaign in Canada This is not the first attempt that the federal government of Canada intends to make in reducing the prevalence of smoking in the country.
• Electronic Cigarettes: Could They Help University Students Give Smoking Up? Electronic Cigarettes An electronic cigarette is an electronic device that simulates the act of smoking by producing a mist which gives the physical sensation and often the flavor and the nicotine just as the analog […]
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Harms of Cigarette Smoking and Health Benefits of Quitting

What harmful chemicals does tobacco smoke contain.

Tobacco smoke contains many chemicals that are harmful to both smokers and nonsmokers. Breathing even a little tobacco smoke can be harmful ( 1 - 4 ).

Of the more than 7,000 chemicals in tobacco smoke, at least 250 are known to be harmful, including hydrogen cyanide , carbon monoxide , and ammonia ( 1 , 2 , 5 ).

Among the 250 known harmful chemicals in tobacco smoke, at least 69 can cause cancer. These cancer-causing chemicals include the following ( 1 , 2 , 5 ):

• Acetaldehyde
• Aromatic amines
• Beryllium (a toxic metal)
• 1,3–Butadiene (a hazardous gas)
• Cadmium (a toxic metal)
• Chromium (a metallic element)
• Ethylene oxide
• Formaldehyde
• Nickel (a metallic element)
• Polonium-210 (a radioactive chemical element)
• Polycyclic aromatic hydrocarbons (PAHs)
• Tobacco-specific nitrosamines
• Vinyl chloride

What are some of the health problems caused by cigarette smoking?

Smoking is the leading cause of premature, preventable death in this country. Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature deaths each year in the United States ( 1 ). Of those premature deaths, about 36% are from cancer, 39% are from heart disease and stroke , and 24% are from lung disease ( 1 ). Mortality rates among smokers are about three times higher than among people who have never smoked ( 6 , 7 ).

Smoking harms nearly every bodily organ and organ system in the body and diminishes a person’s overall health. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia ( 1 – 3 ).

Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive pulmonary disease (COPD) ( chronic bronchitis and emphysema ), diabetes , osteoporosis , rheumatoid arthritis, age-related macular degeneration , and cataracts , and worsens asthma symptoms in adults. Smokers are at higher risk of developing pneumonia , tuberculosis , and other airway infections ( 1 – 3 ). In addition, smoking causes inflammation and impairs immune function ( 1 ).

Since the 1960s, a smoker’s risk of developing lung cancer or COPD has actually increased compared with nonsmokers, even though the number of cigarettes consumed per smoker has decreased ( 1 ). There have also been changes over time in the type of lung cancer smokers develop – a decline in squamous cell carcinomas but a dramatic increase in adenocarcinomas . Both of these shifts may be due to changes in cigarette design and composition, in how tobacco leaves are cured, and in how deeply smokers inhale cigarette smoke and the toxicants it contains ( 1 , 8 ).

Smoking makes it harder for a woman to get pregnant. A pregnant smoker is at higher risk of miscarriage, having an ectopic pregnancy , having her baby born too early and with an abnormally low birth weight, and having her baby born with a cleft lip and/or cleft palate ( 1 ). A woman who smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS) ( 2 , 3 ). Men who smoke are at greater risk of erectile dysfunction ( 1 , 9 ).

The longer a smoker’s duration of smoking, the greater their likelihood of experiencing harm from smoking, including earlier death ( 7 ). But regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.

What are the risks of tobacco smoke to nonsmokers?

Secondhand smoke (also called environmental tobacco smoke, involuntary smoking, and passive smoking) is the combination of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a smoker) ( 4 , 5 , 10 , 11 ).

The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have classified secondhand smoke as a known human carcinogen (cancer-causing agent) ( 5 , 11 , 12 ). Inhaling secondhand smoke causes lung cancer in nonsmoking adults ( 1 , 2 , 4 ). Approximately 7,300 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke ( 1 ). The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30% ( 4 ).

Secondhand smoke causes disease and premature death in nonsmoking adults and children ( 2 , 4 ). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by an estimated 25 to 30% ( 4 ). In the United States, exposure to secondhand smoke is estimated to cause about 34,000 deaths from heart disease each year ( 1 ). Exposure to secondhand smoke also increases the risk of stroke by 20 to 30% ( 1 ). Pregnant women exposed to secondhand smoke are at increased risk of having a baby with a small reduction in birth weight ( 1 ).        

Children exposed to secondhand smoke are at an increased risk of SIDS, ear infections, colds, pneumonia, and bronchitis. Secondhand smoke exposure can also increase the frequency and severity of asthma symptoms among children who have asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless ( 2 , 4 ).

Is smoking addictive?

Smoking is highly addictive. Nicotine is the drug primarily responsible for a person’s addiction to tobacco products, including cigarettes. The addiction to cigarettes and other tobacco products that nicotine causes is similar to the addiction produced by using drugs such as heroin and cocaine ( 13 ). Nicotine is present naturally in the tobacco plant. But tobacco companies intentionally design cigarettes to have enough nicotine to create and sustain addiction. 

The amount of nicotine that gets into the body is determined by the way a person smokes a tobacco product and by the nicotine content and design of the product. Nicotine is absorbed into the bloodstream through the lining of the mouth and the lungs and travels to the brain in a matter of seconds. Taking more frequent and deeper puffs of tobacco smoke increases the amount of nicotine absorbed by the body.

Are other tobacco products, such as smokeless tobacco or pipe tobacco, harmful and addictive?

Yes. All forms of tobacco are harmful and addictive ( 4 , 11 ). There is no safe tobacco product.

In addition to cigarettes, other forms of tobacco include smokeless tobacco , cigars , pipes , hookahs (waterpipes), bidis , and kreteks . 

• Smokeless tobacco : Smokeless tobacco is a type of tobacco that is not burned. It includes chewing tobacco , oral tobacco, spit or spitting tobacco, dip, chew, snus, dissolvable tobacco, and snuff. Smokeless tobacco causes oral (mouth, tongue, cheek and gum), esophageal, and pancreatic cancers and may also cause gum and heart disease ( 11 , 14 ).
• Cigars : These include premium cigars, little filtered cigars (LFCs), and cigarillos. LFCs resemble cigarettes, but both LFCs and cigarillos may have added flavors to increase appeal to youth and young adults ( 15 , 16 ). Most cigars are composed primarily of a single type of tobacco (air-cured and fermented), and have a tobacco leaf wrapper. Studies have found that cigar smoke contains higher levels of toxic chemicals than cigarette smoke, although unlike cigarette smoke, cigar smoke is often not inhaled ( 11 ). Cigar smoking causes cancer of the oral cavity, larynx, esophagus, and lung. It may also cause cancer of the pancreas. Moreover, daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease.
• Pipes : In pipe smoking, the tobacco is placed in a bowl that is connected to a stem with a mouthpiece at the other end. The smoke is usually not inhaled. Pipe smoking causes lung cancer and increases the risk of cancers of the mouth, throat, larynx, and esophagus ( 11 , 17 , 18 ).
• Hookah or waterpipe (other names include argileh, ghelyoon, hubble bubble, shisha, boory, goza, and narghile): A hookah is a device used to smoke tobacco (often heavily flavored) by passing the smoke through a partially filled water bowl before being inhaled by the smoker. Although some people think hookah smoking is less harmful and addictive than cigarette smoking ( 19 ), research shows that hookah smoke is at least as toxic as cigarette smoke ( 20 – 22 ).
• Bidis : A bidi is a flavored cigarette made by rolling tobacco in a dried leaf from the tendu tree, which is native to India. Bidi use is associated with heart attacks and cancers of the mouth, throat, larynx, esophagus, and lung ( 11 , 23 ).
• Kreteks : A kretek is a cigarette made with a mixture of tobacco and cloves. Smoking kreteks is associated with lung cancer and other lung diseases ( 11 , 23 ).

Is it harmful to smoke just a few cigarettes a day?

There is no safe level of smoking. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers (lung, bladder, and pancreas) and premature death ( 24 , 25 ).

What are the immediate health benefits of quitting smoking?

The immediate health benefits of quitting smoking are substantial:

• Heart rate and blood pressure , which are abnormally high while smoking, begin to return to normal.
• Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s ability to carry oxygen.)
• Within a few weeks, people who quit smoking have improved circulation, produce less phlegm , and don’t cough or wheeze as often.
• Within several months of quitting, people can expect substantial improvements in lung function ( 26 ).
• Within a few years of quitting, people will have lower risks of cancer, heart disease, and other chronic diseases than if they had continued to smoke.

What are the long-term health benefits of quitting smoking?

Quitting smoking reduces the risk of cancer and many other diseases, such as heart disease and COPD , caused by smoking.

Data from the U.S. National Health Interview Survey show that people who quit smoking, regardless of their age, are less likely to die from smoking-related illness than those who continue to smoke. Smokers who quit before age 40 reduce their chance of dying prematurely from smoking-related diseases by about 90%, and those who quit by age 45-54 reduce their chance of dying prematurely by about two-thirds ( 6 ).

Regardless of their age, people who quit smoking have substantial gains in life expectancy, compared with those who continue to smoke. Data from the U.S. National Health Interview Survey also show that those who quit between the ages of 25 and 34 years live about 10 years longer; those who quit between ages 35 and 44 live about 9 years longer; those who quit between ages 45 and 54 live about 6 years longer; and those who quit between ages 55 and 64 live about 4 years longer ( 6 ).

Also, a study that followed a large group of people age 70 and older ( 7 ) found that even smokers who quit smoking in their 60s had a lower risk of mortality during follow-up than smokers who continued smoking.

Does quitting smoking lower the risk of getting and dying from cancer?

Yes. Quitting smoking reduces the risk of developing and dying from cancer and other diseases caused by smoking. Although it is never too late to benefit from quitting, the benefit is greatest among those who quit at a younger age ( 3 ).

The risk of premature death and the chances of developing and dying from a smoking-related cancer depend on many factors, including the number of years a person has smoked, the number of cigarettes smoked per day, and the age at which the person began smoking.

Is it important for someone diagnosed with cancer to quit smoking?

Quitting smoking improves the prognosis of cancer patients. For patients with some cancers, quitting smoking at the time of diagnosis may reduce the risk of dying by 30% to 40% ( 1 ). For those having surgery, chemotherapy, or other treatments, quitting smoking helps improve the body’s ability to heal and respond to therapy ( 1 , 3 , 27 ). It also lowers the risk of pneumonia and respiratory failure ( 1 , 3 , 28 ). In addition, quitting smoking may lower the risk that the cancer will recur, that a second cancer will develop, or that the person will die from the cancer or other causes ( 27 , 29 – 32 ).

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Lots of studies show the benefits of quitting smoking. This includes health and financial benefits that can save lives and money. While it’s best to quit as early in life as possible, quitting at any age can lead to a better lifestyle and health.

Quitting can make you look, feel, and be healthier

• Quitting can help you save money

Quitting can improve your self-confidence and lead to a better lifestyle

• Using tobacco leads to disease and disability and harms nearly every organ of your body.
• Smoking is the leading cause of preventable death.
• Quitting helps stop the damage that tobacco can have on how you look, including, gum disease, tooth loss, and premature wrinkling of your skin.
• Secondhand smoke is dangerous and can harm the health of your friends and family.

 Quitting can help you save money

• Cigarettes and other tobacco products are expensive. At about $8 per pack of cigarettes, smoking a pack a day costs you about $2,900 in a year.
• Quitting lowers your risk of getting colds and other respiratory problems. This means fewer doctor visits, less money spent on medicines, and fewer sick days off work.
• Cleaning and home repairs might cost less since clothes, furniture, curtains, and the car won’t smell like tobacco.
• Not using tobacco products helps keep your family safe.
• Your may have more energy to enjoy quality family and leisure time.
• Quitting can set a good example for others who might need help quitting.
• Family and friends will likely be proud of your progress in quitting and staying quit.

Quitting tobacco (tobacco cessation) is a lot like losing weight. It takes a strong commitment over a long time. 

There’s no one right way to quit tobacco or nicotine products. But there are steps you can take to help make your decision to quit a success. 

Quitting tobacco causes withdrawal symptoms. These can be physical, but also mental and emotional. There are steps you can take to prepare yourself for this.

Developed by the American Cancer Society medical and editorial content team  with medical review and contribution by the American Society of Clinical Oncology (ASCO).

This content has been developed by the American Cancer Society in collaboration with the Smoking Cessation Leadership Center to help people who want to learn about quitting tobacco. 

American Society of Clinical Oncology. Benefits of Quitting Tobacco. Cancer.net. Content is no longer available.

National Cancer Institute. Harms of Cigarette Smoking and Health Benefits of Quitting. Accessed at https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet on October 8, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Smoking Cessation. Version 1.2024. Accessed at https://www.nccn.org/ on October 8, 2024.

US Centers for Disease Control and Prevention. Health Effects of Cigarettes: Cancer. Accessed at https://www.cdc.gov/tobacco/about/cigarettes-and-cancer.html on October 8, 2024. 

Last Revised: October 28, 2024

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy .

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Essay on Stop Smoking

Students are often asked to write an essay on Stop Smoking in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Stop Smoking

Introduction.

Smoking is a dangerous habit that harms our health and environment. It’s crucial to stop smoking for a better life and future.

The Dangers of Smoking

Smoking causes diseases like cancer and heart problems. It also harms others through secondhand smoke.

Ways to Quit

You can stop smoking by seeking help from doctors, using nicotine patches, or joining support groups.

Benefits of Quitting

Quitting smoking improves health, saves money, and protects loved ones from secondhand smoke.

Stopping smoking is challenging but vital. Let’s strive for a smoke-free world for a healthier future.

250 Words Essay on Stop Smoking

The detrimental effects of smoking.

Smoking is a habit that has been ingrained in numerous societies for centuries. Despite its prevalence, the deleterious effects of smoking on health are undeniable. Every puff of smoke inhaled introduces a cocktail of chemicals into the body, many of which are carcinogens. The result is a heightened risk of diseases such as lung cancer, heart disease, and stroke.

Smoking and Its Socioeconomic Impact

Beyond the health implications, smoking also presents significant socioeconomic challenges. The cost of tobacco products and healthcare for smoking-related illnesses can be financially crippling for individuals and families. Moreover, the loss of productivity due to illness and premature death contributes to economic stagnation.

The Power of Prevention

Prevention is the most effective strategy in combating the smoking epidemic. Educational campaigns highlighting the dangers of smoking, combined with regulations limiting tobacco advertising and sales, can significantly reduce smoking rates. Furthermore, support for quitting smoking, like counseling services and nicotine replacement therapies, should be readily accessible.

Personal Responsibility and Collective Action

Ultimately, the decision to stop smoking lies with the individual. However, societal support is crucial in facilitating this decision. Collective action can create an environment that discourages smoking and encourages healthier alternatives.

In conclusion, the negative implications of smoking necessitate immediate action. By understanding the risks, acknowledging the socioeconomic impact, promoting prevention, and encouraging personal responsibility, we can work towards a smoke-free future.

500 Words Essay on Stop Smoking

Smoking is a prevalent habit that has both individual and societal implications. Despite the widespread knowledge of its harmful effects, many individuals continue to smoke, often due to addiction or social pressure. This essay aims to explore the reasons why it is crucial to stop smoking and the benefits that can be derived from it.

The Health Hazards of Smoking

The primary reason to quit smoking revolves around health. Cigarette smoke is a toxic mix of over 7,000 chemicals, many of which are carcinogenic. Smoking is directly linked to lung cancer, heart disease, stroke, and chronic respiratory diseases. Moreover, it weakens the immune system, making smokers more susceptible to diseases. Secondhand smoke also poses severe risks, affecting non-smokers who are exposed to it.

The Economic Impact of Smoking

Smoking also has significant economic implications. The direct cost of smoking, such as the price of cigarettes, is just the tip of the iceberg. The indirect costs, including healthcare expenses and productivity loss due to smoking-related illnesses, are substantial. In the United States alone, the total economic cost of smoking is more than $300 billion a year.

Environmental Consequences

The environmental impact of smoking is often overlooked. Cigarette butts, which are non-biodegradable, are the most littered item worldwide. They contain toxins that can leach into the environment, causing soil, water, and air pollution. The production of tobacco also contributes to deforestation and loss of biodiversity.

The Social Aspect of Smoking

Smoking can also strain relationships. The smell of smoke can be off-putting to non-smokers, and the health risks associated with secondhand smoke can cause tension. Additionally, the time spent on smoking breaks can lead to social exclusion or missed opportunities.

Benefits of Quitting Smoking

Quitting smoking brings immediate and long-term benefits. Within 20 minutes of quitting, heart rate and blood pressure drop. Within a year, the risk of heart disease is halved. Over time, the risk of stroke, lung cancer, and other diseases decrease significantly. Financially, quitting smoking can save individuals thousands of dollars annually. Environmentally, quitting reduces pollution and waste. Socially, it can improve relationships and increase social inclusion.

In conclusion, the reasons to stop smoking are multifaceted, encompassing health, economic, environmental, and social aspects. Each cigarette smoked is a step towards disease, economic loss, environmental degradation, and social isolation. Conversely, each step towards quitting smoking is a step towards better health, financial savings, environmental preservation, and improved social relations. Therefore, it is crucial to promote smoking cessation for a healthier and more sustainable world.

That’s it! I hope the essay helped you.

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