Chest
Volume 116, Supplement 3, December 1999, Pages 490S-492S
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Smoking Cessation and Tobacco Control: An Overview

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Cigarette smoking is an intractable public health problem and thesingle largest risk factor for a variety of malignancies, includinglung cancer. Worldwide, about 3 million people die each year ofsmoking-related disease, and this is expected to increase to > 10million deaths per year. The Agency for Health Care Policy and Researchhas published a clinical practice guideline detailing available outcomedata for various smoking cessation strategies. In particular, it hasbeen recommended that all patients be screened for smoking status onevery health-care visit, and that all patients who smoke be stronglyadvised to quit and offered assistance to do so. Health-care providersplay a vital role in the effort to reduce the prevalence of smoking bydelivering smoking cessation advice, supporting community-based effortsto control tobacco, and becoming involved in the tobacco controldebate.

Section snippets

Tobacco Control: A Historical Perspective

In 1906, the first federal food and drug law was passed. A drug was defined as any medicine listed in the U.S. Pharmacopoeia at the time of the law's passage. Tobacco was included in the U.S. Pharmacopoeia until 1905, and thus it escaped regulation and set a precedent related to the protection of tobacco from regulation. For example, in 1938, the U.S. Food and Drug Administration (FDA) was given jurisdiction over food, drugs, medicinal devices, and cosmetics. This provided the FDA with

Smoking Prevalence

In 1965, approximately 60% of men and 30% of women in the United States smoked; in 1996, 24% of the U.S. population were smokers.3 Although the gender gap in smoking prevalence has narrowed considerably, men still smoke at a slightly but significantly higher rate than women. Smoking prevalence is highest among individuals categorized as American Indian or Alaskan Native; overall, smoking prevalence is virtually equivalent among whites and African Americans. However, sex and race interactions

Health Consequences of Smoking

Smoking is a major contributor to preventable morbidity and mortality. Worldwide, about 3 million people die each year of smoking-related diseases.6 By 2025, this figure is expected to increase to > 10 million deaths per year. In 1990, > 430,000 smokers in the United States alone died of smoking-related diseases, accounting for 26% of all deaths among men and 17% of deaths among women.6 Lung cancer has now replaced breast cancer as the leading cancer killer of women. In 1993, the estimated

Factors Influencing Smoking

It is clear that smoking results from multiple determinants, including physiologic, psychological, social, and community factors (Fig 1).8, 910, 11 Social factors have typically been considered of most importance in the initiation of smoking. However, recent evidence focusing on smoking among lower income populations, where smoking prevalence remains the highest, suggests that social factors are also very important in the maintenance of smoking behavior. Community factors include access to

Smoking Cessation Counseling by Health-Care Providers

The Agency for Health Care Policy and Research (AHCPR) has published a clinical practice guideline on smoking that details available outcome data for various smoking cessation strategies.16 The smoking cessation guideline makes several recommendations that are relevant to all types of health-care providers (Table 1). In particular, it has been recommended that all patients be screened for smoking status on every health-care visit, and that all patients who smoke be strongly advised to quit and

Summary

We are at a historic crossroads in tobacco control. Never before has there been as much attention focused on this very important public health issue, particularly from forces that span legislative, regulatory, federal, local, and state interests. In this climate, there is an unprecedented opportunity to reduce the prevalence of smoking in this country to historic lows. Health-care providers play a vital role in this effort by delivering smoking cessation advice and counseling to their patients,

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Supported in part by grants from the National Cancer Institute(1RO1CA77780, 1RO1CA73242 and 1RO1HL50017), the National Heart, Lung, and Blood Institute (5RO1HL54351), the Robert Wood Johnson Foundation Smoke-Free Families Initiative, NYNEX, Liberty Mutual Insurance Company, Aetna, and the Boston Company.

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