Tobacco Use and Smoking Cessation
Use of tobacco of any form
- Nicotine sources: cigars, pipes, water pipes, hookahs, cigarettes, and electronic cigarettes (e-cigarettes)
- Electronic nicotine delivery system (ENDS) use is on the rise.
- E-cigarettes are called e-cigs, vapes, ehookahs, vape pens, and electronic nicotine delivery systems.
Smoking causes more deaths each year than alcohol use, motor vehicle accidents, illegal drug use, and firearm-related injuries combined.
- 2.4 million new smokers annually in the United States
- 59% of new smokers are <18 years of age (6% initiation rate for teens).
- Age: highest among those ages 45 to 64 years (16%)
- Gender: male > female (15% vs. 12%)
- Cigarette smoking among adults has declined significantly since the 1960s.
- Cigarette smoking is responsible for >480,000 deaths per year in the United States, including >41,000 deaths from secondhand smoke exposure. This is about 1 in 5 deaths annually or 1,300 deaths every day.
- Each day, about 2,000 people <18 years smoke their first cigarette.
- Each day, about 1,600 youth try their first cigarette.
- In 2018, 21% of high school students reported current use of e-cigarettes.
- In 2019, 14% of all adults (34.1 million people) currently smoked cigarettes: 15.3% in men, 12.7% of women.
- 5% of middle school students report current e-cigarette use.
Etiology and Pathophysiology
- Addiction due to nicotine’s rapid stimulation of the brain’s dopamine system (teenage brain especially susceptible)
- Atherosclerotic risk due to adrenergic stimulation, endothelial damage, carbon monoxide, and adverse effects on lipids
- Direct airway damage from cigarette tar.
- Carcinogens in all tobacco products
- E-cigarettes produce an aerosol by heating liquid nicotine, flavoring, and chemicals.
- Potential adverse effects of e-cigarettes are related to exposure to nicotine as well as to other vapor components produced by the devices.
- If e-cigarette, or vaping product, use is suspected as a possible etiology of a patient’s lung injury, obtain detailed history regarding:
- Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances
- Substance source(s): commercially available liquids, homemade liquids
- Device(s) used: manufacturer; brand name; product name; model
- Vitamin E acetate is strongly linked to the EVALI outbreaks.
- Most product use-associated lung injury (EVALI) associated with products containing THC
- Presence of a smoker in the household
- Easy access to cigarettes
- Comorbid stress and psychiatric disorders
- Low self-esteem/self-worth
- Poor academic performance
- Boys: high levels of aggression and rebelliousness
- Girls: preoccupation with weight and body image
- E-cigarette use has been associated with several cases of idiopathic acute eosinophilic pneumonia.
- Most first-time tobacco use occurs before high school graduation.
- Smoking bans in public areas and workplaces
- Restrict minors’ access to tobacco
- Restrict tobacco advertisements
- Tobacco-free sports initiatives
- The evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnancy is insufficient.
- Current evidence is insufficient to recommend use e-cigarettes for tobacco cessation in adults.
Commonly Associated Conditions
- Coronary artery disease, cerebrovascular disease
- Peripheral vascular disease
- Abdominal aortic aneurysm (AAA)
- Chronic obstructive pulmonary disease (COPD)
- Cancer of the lip, oral cavity, pharynx, larynx, lung, esophagus, stomach, pancreas, kidney, urinary bladder, cervix, and blood
- Pneumonia, osteoporosis
- Alcohol use
- Depression and anxiety, reduced fertility
Smoking during pregnancy can increase the risk of miscarriage, congenital anomalies, stillbirth, fetal growth restriction, preterm birth, placental abruption.
Secondhand smoke increases the risk for:
- Sudden infant death syndrome
- Acute upper and lower respiratory tract infections, exacerbations of asthma, otitis media
- Nicotine passes through breast milk.
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Domino, Frank J., et al., editors. "Tobacco Use and Smoking Cessation." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation.
Tobacco Use and Smoking Cessation. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation. Accessed June 8, 2023.
Tobacco Use and Smoking Cessation. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation
Tobacco Use and Smoking Cessation [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 08]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tobacco Use and Smoking Cessation ID - 116879 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116879/all/Tobacco_Use_and_Smoking_Cessation PB - Wolters Kluwer ET - 27 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -