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• Published: 24 March 2022

Tobacco and nicotine use

• Bernard Le Foll 1 , 2 ,
• Megan E. Piper 3 , 4 ,
• Christie D. Fowler 5 ,
• Serena Tonstad 6 ,
• Laura Bierut 7 ,
• Lin Lu   ORCID: orcid.org/0000-0003-0742-9072 8 , 9 ,
• Prabhat Jha 10 &
• Wayne D. Hall 11 , 12  

Nature Reviews Disease Primers volume  8 , Article number:  19 ( 2022 ) Cite this article

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• Disease genetics
• Experimental models of disease
• Preventive medicine

Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide. More than a billion people smoke, and without major increases in cessation, at least half will die prematurely from tobacco-related complications. In addition, people who smoke have a significant reduction in their quality of life. Neurobiological findings have identified the mechanisms by which nicotine in tobacco affects the brain reward system and causes addiction. These brain changes contribute to the maintenance of nicotine or tobacco use despite knowledge of its negative consequences, a hallmark of addiction. Effective approaches to screen, prevent and treat tobacco use can be widely implemented to limit tobacco’s effect on individuals and society. The effectiveness of psychosocial and pharmacological interventions in helping people quit smoking has been demonstrated. As the majority of people who smoke ultimately relapse, it is important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.

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Introduction.

Tobacco is the second most commonly used psychoactive substance worldwide, with more than one billion smokers globally 1 . Although smoking prevalence has reduced in many high-income countries (HICs), tobacco use is still very prevalent in low-income and middle-income countries (LMICs). The majority of smokers are addicted to nicotine delivered by cigarettes (defined as tobacco dependence in the International Classification of Diseases, Tenth Revision (ICD-10) or tobacco use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)). As a result of the neuro-adaptations and psychological mechanisms caused by repeated exposure to nicotine delivered rapidly by cigarettes, cessation can also lead to a well-characterized withdrawal syndrome, typically manifesting as irritability, anxiety, low mood, difficulty concentrating, increased appetite, insomnia and restlessness, that contributes to the difficulty in quitting tobacco use 2 , 3 , 4 .

Historically, tobacco was used in some cultures as part of traditional ceremonies, but its use was infrequent and not widely disseminated in the population. However, since the early twentieth century, the use of commercial cigarettes has increased dramatically 5 because of automated manufacturing practices that enable large-scale production of inexpensive products that are heavily promoted by media and advertising. Tobacco use became highly prevalent in the past century and was followed by substantial increases in the prevalence of tobacco-induced diseases decades later 5 . It took decades to establish the relationship between tobacco use and associated health effects 6 , 7 and to discover the addictive role of nicotine in maintaining tobacco smoking 8 , 9 , and also to educate people about these effects. It should be noted that the tobacco industry disputed this evidence to allow continuing tobacco sales 10 . The expansion of public health campaigns to reduce smoking has gradually decreased the use of tobacco in HICs, with marked increases in adult cessation, but less progress has been achieved in LMICs 1 .

Nicotine is the addictive compound in tobacco and is responsible for continued use of tobacco despite harms and a desire to quit, but nicotine is not directly responsible for the harmful effects of using tobacco products (Box  1 ). Other components in tobacco may modulate the addictive potential of tobacco (for example, flavours and non-nicotine compounds) 11 . The major harms related to tobacco use, which are well covered elsewhere 5 , are linked to a multitude of compounds present in tobacco smoke (such as carcinogens, toxicants, particulate matter and carbon monoxide). In adults, adverse health outcomes of tobacco use include cancer in virtually all peripheral organs exposed to tobacco smoke and chronic diseases such as eye disease, periodontal disease, cardiovascular diseases, chronic obstructive pulmonary disease, stroke, diabetes mellitus, rheumatoid arthritis and disorders affecting immune function 5 . Moreover, smoking during pregnancy can increase the risk of adverse reproductive effects, such as ectopic pregnancy, low birthweight and preterm birth 5 . Exposure to secondhand cigarette smoke in children has been linked to sudden infant death syndrome, impaired lung function and respiratory illnesses, in addition to cognitive and behavioural impairments 5 . The long-term developmental effects of nicotine are probably due to structural and functional changes in the brain during this early developmental period 12 , 13 .

Nicotine administered alone in various nicotine replacement formulations (such as patches, gum and lozenges) is safe and effective as an evidence-based smoking cessation aid. Novel forms of nicotine delivery systems have also emerged (called electronic nicotine delivery systems (ENDS) or e-cigarettes), which can potentially reduce the harmful effects of tobacco smoking for those who switch completely from combustible to e-cigarettes 14 , 15 .

This Primer focuses on the determinants of nicotine and tobacco use, and reviews the neurobiology of nicotine effects on the brain reward circuitry and the functioning of brain networks in ways that contribute to the difficulty in stopping smoking. This Primer also discusses how to prevent tobacco use, screen for smoking, and offer people who smoke tobacco psychosocial and pharmacological interventions to assist in quitting. Moreover, this Primer presents emerging pharmacological and novel brain interventions that could improve rates of successful smoking cessation, in addition to public health approaches that could be beneficial.

Box 1 Tobacco products

Conventional tobacco products include combustible products that produce inhaled smoke (most commonly cigarettes, bidis (small domestically manufactured cigarettes used in South Asia) or cigars) and those that deliver nicotine without using combustion (chewing or dipping tobacco and snuff). Newer alternative products that do not involve combustion include nicotine-containing e-cigarettes and heat-not-burn tobacco devices. Although non-combustion and alternative products may constitute a lesser risk than burned ones 14 , 15 , 194 , no form of tobacco is entirely risk-free.

Epidemiology

Prevalence and burden of disease.

The Global Burden of Disease Project (GBDP) estimated that around 1.14 billion people smoked in 2019, worldwide, increasing from just under a billion in 1990 (ref. 1 ). Of note, the prevalence of smoking decreased significantly between 1990 and 2019, but increases in the adult population meant that the total number of global smokers increased. One smoking-associated death occurs for approximately every 0.8–1.1 million cigarettes smoked 16 , suggesting that the estimated worldwide consumption of about 7.4 trillion cigarettes in 2019 has led to around 7 million deaths 1 .

In most populations, smoking prevalence is much higher among groups with lower levels of education or income 17 and among those with mental health disorders and other co-addictions 18 , 19 . Smoking is also more frequent among men than women (Figs  1 – 3 ). Sexual and/or gender minority individuals have disproportionately high rates of smoking and other addictions 17 , 20 . In addition, the prevalence of smoking varies substantially between regions and ethnicities; smoking rates are high in some regions of Asia, such as China and India, but are lower in North America and Australia. Of note, the prevalence of mental health disorders and other co-addictions is higher in individuals who smoke compared with non-smokers 18 , 19 , 21 . For example, the odds of smoking in people with any substance use disorder is more than five times higher than the odds in people without a substance use disorder 19 . Similarly, the odds of smoking in people with any psychiatric disorder is more than three times higher than the odds of smoking in those without a psychiatric diagnosis 22 . In a study in the USA, compared with a population of smokers with no psychiatric diagnosis, subjects with anxiety, depression and phobia showed an approximately twofold higher prevalence of smoking, and subjects with agoraphobia, mania or hypomania, psychosis and antisocial personality or conduct disorders showed at least a threefold higher prevalence of smoking 22 . Comorbid disorders are also associated with higher rates of smoking 22 , 23 .

a | Number of current male smokers aged 15 years or older per country expressed in millions. b | Former male smokers aged 45–59 years per country expressed in millions. c | Former male smokers aged 45–59 years per country expressed as the percentage of smokers who stopped. The data shown are for male smokers for the period 2015–2019 from countries with direct smoking surveys. The prevalence of smoking among males is less variable than among females. Data from ref. 1 .

a | Number of current female smokers aged 15 years or older per country expressed in millions. b | Former female smokers aged 45–59 years per country expressed in millions. c | Former female smokers aged 45–59 years per country expressed as the percentage of smokers who stopped. The data shown are for female smokers for the period 2015–2019 from countries with direct smoking surveys. The prevalence of smoking among females is much lower in East and South Asia than in Latin America or Eastern Europe. Data from ref. 1 .

a | Number of current male and female smokers aged 15 years or older per country expressed in millions. b | Former male and female smokers aged 45–59 years per country expressed in millions. c | Former male and female smokers aged 45–59 years per country expressed as the percentage of smokers who stopped. The data shown are for the period 2015–2019 from countries with direct smoking surveys. Cessation rates are higher in high-income countries, but also notably high in Brazil. Cessation is far less common in South and East Asia and Russia and other Eastern European countries, and also low in South Africa. Data from ref. 1 .

Age at onset

Most smokers start smoking during adolescence, with almost 90% of smokers beginning between 15 and 25 years of age 24 . The prevalence of tobacco smoking among youths substantially declined in multiple HICs between 1990 and 2019 (ref. 25 ). More recently, the widespread uptake of ENDS in some regions such as Canada and the USA has raised concerns about the long-term effects of prolonged nicotine use among adolescents, including the possible notion that ENDS will increase the use of combustible smoking products 25 , 26 (although some studies have not found much aggregate effect at the population level) 27 .

Smoking that commences in early adolescence or young adulthood and persists throughout life has a more severe effect on health than smoking that starts later in life and/or that is not persistent 16 , 28 , 29 . Over 640 million adults under 30 years of age smoke in 22 jurisdictions alone (including 27 countries in the European Union where central efforts to reduce tobacco dependence might be possible) 30 . In those younger than 30 years of age, at least 320 million smoking-related deaths will occur unless they quit smoking 31 . The actual number of smoking-related deaths might be greater than one in two, and perhaps as high as two in three, long-term smokers 5 , 16 , 29 , 32 , 33 . At least half of these deaths are likely to occur in middle age (30–69 years) 16 , 29 , leading to a loss of two or more decades of life. People who smoke can expect to lose an average of at least a decade of life versus otherwise similar non-smokers 16 , 28 , 29 .

Direct epidemiological studies in several countries paired with model-based estimates have estimated that smoking tobacco accounted for 7.7 million deaths globally in 2020, of which 80% were in men and 87% were current smokers 1 . In HICs, the major causes of tobacco deaths are lung cancer, emphysema, heart attack, stroke, cancer of the upper aerodigestive areas and bladder cancer 28 , 29 . In some lower income countries, tuberculosis is an additional important cause of tobacco-related death 29 , 34 , which could be related to, for example, increased prevalence of infection, more severe tuberculosis/mortality and higher prevalence of treatment-resistant tuberculosis in smokers than in non-smokers in low-income countries 35 , 36 .

Despite substantial reductions in the prevalence of smoking, there were 34 million smokers in the USA, 7 million in the UK and 5 million in Canada in 2017 (ref. 16 ), and cigarette smoking remains the largest cause of premature death before 70 years of age in much of Europe and North America 1 , 16 , 28 , 29 . Smoking-associated diseases accounted for around 41 million deaths in the USA, UK and Canada from 1960 to 2020 (ref. 16 ). Moreover, as smoking-associated diseases are more prevalent among groups with lower levels of education and income, smoking accounts for at least half of the difference in overall mortality between these social groups 37 . Any reduction in smoking prevalence reduces the absolute mortality gap between these groups 38 .

Smoking cessation has become common in HICs with good tobacco control interventions. For example, in France, the number of ex-smokers is four times the number of current smokers among those aged 50 years or more 30 . By contrast, smoking cessation in LMICs remains uncommon before smokers develop tobacco-related diseases 39 . Smoking cessation greatly reduces the risks of smoking-related diseases. Indeed, smokers who quit smoking before 40 years of age avoid nearly all the increased mortality risks 31 , 33 . Moreover, individuals who quit smoking by 50 years of age reduce the risk of death from lung cancer by about two-thirds 40 . More modest hazards persist for deaths from lung cancer and emphysema 16 , 28 ; however, the risks among former smokers are an order of magnitude lower than among those who continue to smoke 33 .

Mechanisms/pathophysiology

Nicotine is the main psychoactive agent in tobacco and e-cigarettes. Nicotine acts as an agonist at nicotinic acetylcholine receptors (nAChRs), which are localized throughout the brain and peripheral nervous system 41 . nAChRs are pentameric ion channels that consist of varying combinations of α 2 –α 7 and β 2 –β 4 subunits, and for which acetylcholine (ACh) is the endogenous ligand 42 , 43 , 44 . When activated by nicotine binding, nAChR undergoes a conformational change that opens the internal pore, allowing an influx of sodium and calcium ions 45 . At postsynaptic membranes, nAChR activation can lead to action potential firing and downstream modulation of gene expression through calcium-mediated second messenger systems 46 . nAChRs are also localized to presynaptic membranes, where they modulate neurotransmitter release 47 . nAChRs become desensitized after activation, during which ligand binding will not open the channel 45 .

nAChRs with varying combinations of α-subunits and β-subunits have differences in nicotine binding affinity, efficacy and desensitization rate, and have differential expression depending on the brain region and cell type 48 , 49 , 50 . For instance, at nicotine concentrations found in human smokers, β 2 -containing nAChRs desensitize relatively quickly after activation, whereas α 7 -containing nAChRs have a slower desensitization profile 48 . Chronic nicotine exposure in experimental animal models or in humans induces an increase in cortical expression of α 4 β 2 -containing nAChRs 51 , 52 , 53 , 54 , 55 , but also increases the expression of β 3 and β 4 nAChR subunits in the medial habenula (MHb)–interpeduncular nucleus (IPN) pathway 56 , 57 . It is clear that both the brain localization and the type of nAChR are critical elements in mediating the various effects of nicotine, but other factors such as rate of nicotine delivery may also modulate addictive effects of nicotine 58 .

Neurocircuitry of nicotine addiction

Nicotine has both rewarding effects (such as a ‘buzz’ or ‘high’) and aversive effects (such as nausea and dizziness), with the net outcome dependent on dose and others factors such as interindividual sensitivity and presence of tolerance 59 . Thus, the addictive properties of nicotine involve integration of contrasting signals from multiple brain regions that process reward and aversion (Fig.  4 ).

During initial use, nicotine exerts both reinforcing and aversive effects, which together determine the likelihood of continued use. As the individual transitions to more frequent patterns of chronic use, nicotine induces pharmacodynamic changes in brain circuits, which is thought to lead to a reduction in sensitivity to the aversive properties of the drug. Nicotine is also a powerful reinforcer that leads to the conditioning of secondary cues associated with the drug-taking experience (such as cigarette pack, sensory properties of cigarette smoke and feel of the cigarette in the hand or mouth), which serves to enhance the incentive salience of these environmental factors and drive further drug intake. When the individual enters into states of abstinence (such as daily during sleep at night or during quit attempts), withdrawal symptomology is experienced, which may include irritability, restlessness, learning or memory deficits, difficulty concentrating, anxiety and hunger. These negative affective and cognitive symptoms lead to an intensification of the individual’s preoccupation to obtain and use the tobacco/nicotine product, and subsequently such intense craving can lead to relapse.

The rewarding actions of nicotine have largely been attributed to the mesolimbic pathway, which consists of dopaminergic neurons in the ventral tegmental area (VTA) that project to the nucleus accumbens and prefrontal cortex 60 , 61 , 62 (Fig.  5 ). VTA integrating circuits and projection regions express several nAChR subtypes on dopaminergic, GABAergic, and glutamatergic neurons 63 , 64 . Ultimately, administration of nicotine increases dopamine levels through increased dopaminergic neuron firing in striatal and extrastriatal areas (such as the ventral pallidum) 65 (Fig.  6 ). This effect is involved in reward and is believed to be primarily mediated by the action of nicotine on α 4 -containing and β 2 -containing nAChRs in the VTA 66 , 67 .

Multiple lines of research have demonstrated that nicotine reinforcement is mainly controlled by two brain pathways, which relay predominantly reward-related or aversion-related signals. The rewarding properties of nicotine that promote drug intake involve the mesolimbic dopamine projection from the ventral tegmental area (VTA) to the nucleus accumbens (NAc). By contrast, the aversive properties of nicotine that limit drug intake and mitigate withdrawal symptoms involve the fasciculus retroflexus projection from the medial habenula (MHb) to the interpeduncular nucleus (IPN). Additional brain regions have also been implicated in various aspects of nicotine dependence, such as the prefrontal cortex (PFC), ventral pallidum (VP), nucleus tractus solitarius (NTS) and insula (not shown here for clarity). All of these brain regions are directly or indirectly interconnected as integrative circuits to drive drug-seeking and drug-taking behaviours.

Smokers received brain PET scans with [ 11 C]PHNO, a dopamine D 2/3 PET tracer that has high sensitivity in detecting fluctuations of dopamine. PET scans were performed during abstinence or after smoking a cigarette. Reduced binding potential (BP ND ) was observed after smoking, indicating increased dopamine levels in the ventral striatum and in the area that corresponds to the ventral pallidum. The images show clusters with statistically significant decreases of [ 11 C]PHNO BP ND after smoking a cigarette versus abstinence condition. Those clusters have been superimposed on structural T1 MRI images of the brain. Reprinted from ref. 65 , Springer Nature Limited.

The aversive properties of nicotine are mediated by neurons in the MHb, which project to the IPN. Studies in rodents using genetic knockdown and knockout strategies demonstrated that the α 5 -containing, α 3 -containing and β 4 -containing nAChRs in the MHb–IPN pathway mediate the aversive properties of nicotine that limit drug intake, especially when animals are given the opportunity to consume higher nicotine doses 68 , 69 , 70 , 71 , 72 . In addition to nAChRs, other signalling factors acting on the MHb terminals in the IPN also regulate the actions of nicotine. For instance, under conditions of chronic nicotine exposure or with optogenetic activation of IPN neurons, a subtype of IPN neurons co-expressing Chrna5 (encoding the α 5 nAChR subunit) and Amigo1 (encoding adhesion molecule with immunoglobulin-like domain 1) release nitric oxide from the cell body that retrogradely inhibits MHb axon terminals 70 . In addition, nicotine activates α 5 -containing nAChR-expressing neurons that project from the nucleus tractus solitarius to the IPN, leading to release of glucagon-like peptide-1 that binds to GLP receptors on habenular axon terminals, which subsequently increases IPN neuron activation and decreases nicotine self-administration 73 . Taken together, these findings suggest a dynamic signalling process at MHb axonal terminals in the IPN, which regulates the addictive properties of nicotine and determines the amount of nicotine that is self-administered.

Nicotine withdrawal in animal models can be assessed by examining somatic signs (such as shaking, scratching, head nods and chewing) and affective signs (such as increased anxiety-related behaviours and conditioned place aversion). Interestingly, few nicotine withdrawal somatic signs are found in mice with genetic knockout of the α 2 , α 5 or β 4 nAChR subunits 74 , 75 . By contrast, β 2 nAChR-knockout mice have fewer anxiety-related behaviours during nicotine withdrawal, with no differences in somatic symptoms compared with wild-type mice 74 , 76 .

In addition to the VTA (mediating reward) and the MHb–IPN pathway (mediating aversion), other brain areas are involved in nicotine addiction (Fig.  5 ). In animals, the insular cortex controls nicotine taking and nicotine seeking 77 . Moreover, humans with lesions of the insular cortex can quit smoking easily without relapse 78 . This finding led to the development of a novel therapeutic intervention modulating insula function (see Management, below) 79 , 80 . Various brain areas (shell of nucleus accumbens, basolateral amygdala and prelimbic cortex) expressing cannabinoid CB 1 receptors are also critical in controlling rewarding effects and relapse 81 , 82 . The α 1 -adrenergic receptor expressed in the cortex also control these effects, probably through glutamatergic afferents to the nucleus accumbens 83 .

Individual differences in nicotine addiction risk

Vulnerability to nicotine dependence varies between individuals, and the reasons for these differences are multidimensional. Many social factors (such as education level and income) play a role 84 . Broad psychological and social factors also modulate this risk. For example, peer smoking status, knowledge on effect of tobacco, expectation on social acceptance, exposure to passive smoking modulate the risk of initiating tobacco use 85 , 86 .

Genetic factors have a role in smoking initiation, the development of nicotine addiction and the likelihood of smoking cessation. Indeed, heritability has been estimated to contribute to approximatively half of the variability in nicotine dependence 87 , 88 , 89 , 90 . Important advances in our understanding of such genetic contributions have evolved with large-scale genome-wide association studies of smokers and non-smokers. One of the most striking findings has been that allelic variation in the CHRNA5 – CHRNA3 – CHRNB4 gene cluster, which encodes α 5 , α 3 and β 4 nAChR subunits, correlates with an increased vulnerability for nicotine addiction, indicated by a higher likelihood of becoming dependent on nicotine and smoking a greater number of cigarettes per day 91 , 92 , 93 , 94 , 95 . The most significant effect has been found for a single-nucleotide polymorphism in CHRNA5 (rs16969968), which results in an amino acid change and reduced function of α 5 -containing nAChRs 92 .

Allelic variation in CYP2A6 (encoding the CYP2A6 enzyme, which metabolizes nicotine) has also been associated with differential vulnerability to nicotine dependence 96 , 97 , 98 . CYP2A6 is highly polymorphic, resulting in variable enzymatic activity 96 , 99 , 100 . Individuals with allelic variation that results in slow nicotine metabolism consume less nicotine per day, experience less-severe withdrawal symptoms and are more successful at quitting smoking than individuals with normal or fast metabolism 101 , 102 , 103 , 104 . Moreover, individuals with slow nicotine metabolism have lower dopaminergic receptor expression in the dopamine D2 regions of the associative striatum and sensorimotor striatum in PET studies 105 and take fewer puffs of nicotine-containing cigarettes (compared with de-nicotinized cigarettes) in a forced choice task 106 . Slower nicotine metabolism is thought to increase the duration of action of nicotine, allowing nicotine levels to accumulate over time, therefore enabling lower levels of intake to sustain activation of nAChRs 107 .

Large-scale genetic studies have identified hundreds of other genetic loci that influence smoking initiation, age of smoking initiation, cigarettes smoked per day and successful smoking cessation 108 . The strongest genetic contributions to smoking through the nicotinic receptors and nicotine metabolism are among the strongest genetic contributors to lung cancer 109 . Other genetic variations (such as those related to cannabinoid, dopamine receptors or other neurotransmitters) may affect certain phenotypes related to smoking (such as nicotine preference and cue-reactivity) 110 , 111 , 112 , 113 , 114 , 115 .

Diagnosis, screening and prevention

Screening for cigarette smoking.

Screening for cigarette smoking should happen at every doctor’s visit 116 . In this regard, a simple and direct question about a person’s tobacco use can provide an opportunity to offer information about its potential risks and treatments to assist in quitting. All smokers should be offered assistance in quitting because even low levels of smoking present a significant health risk 33 , 117 , 118 . Smoking status can be assessed by self-categorization or self-reported assessment of smoking behaviour (Table  1 ). In people who smoke, smoking frequency can be assessed 119 and a combined quantity frequency measure such as pack-year history (that is, average number of cigarettes smoked per day multiplied by the number of years, divided by 20), can be used to estimate cumulative risk of adverse health outcomes. The Association for the Treatment of Tobacco Use and Dependence recommends that all electronic health records should document smoking status using the self-report categories listed in Table  1 .

Owing to the advent of e-cigarettes and heat-not-burn products, and the popularity of little cigars in the US that mimic combustible cigarettes, people who use tobacco may use multiple products concurrently 120 , 121 . Thus, screening for other nicotine and tobacco product use is important in clinical practice. The self-categorization approach can also be used to describe the use of these other products.

Traditionally tobacco use has been classified according to whether the smoker meets criteria for nicotine dependence in one of the two main diagnostic classifications: the DSM 122 (tobacco use disorder) and the ICD (tobacco dependence) 123 . The diagnosis of tobacco use disorder according to DSM-5 criteria requires the presence of at least 2 of 11 symptoms that have produced marked clinical impairment or distress within a 12-month period (Box  2 ). Of note, these symptoms are similar for all substance use disorder diagnoses and may not all be relevant to tobacco use disorder (such as failure to complete life roles). In the ICD-10, codes allow the identification of specific tobacco products used (cigarettes, chewing tobacco and other tobacco products).

Dependence can also be assessed as a continuous construct associated with higher levels of use, greater withdrawal and reduced likelihood of quitting. The level of dependence can be assessed with the Fagerström Test for Nicotine Dependence, a short questionnaire comprising six questions 124 (Box  2 ). A score of ≥4 indicates moderate to high dependence. As very limited time may be available in clinical consultations, the Heaviness of Smoking Index (HSI) was developed, which comprises two questions on the number of cigarettes smoked per day and how soon after waking the first cigarette is smoked 125 . The HSI can guide dosing for nicotine replacement therapy (NRT).

Other measures of cigarette dependence have been developed but are not used in the clinical setting, such as the Cigarette Dependence Scale 126 , Hooked on Nicotine Checklist 127 , Nicotine Dependence Syndrome Scale 128 , the Wisconsin Inventory of Smoking Dependence Motives (Brief) 129 and the Penn State Cigarette Dependence Index 130 . However, in practice, these are not often used, as the most important aspect is to screen for smoking and encourage all smokers to quit smoking regardless of their dependence status.

Box 2 DSM-5 criteria for tobacco use disorder and items of the Fagerström Test for nicotine dependence

DSM-5 (ref. 122 )

Taxonomic and diagnostic tool for tobacco use disorder published by the American Psychiatric Association.

A problematic pattern of tobacco use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period.

Tobacco often used in larger amounts or over a longer period of time than intended

A persistent desire or unsuccessful efforts to reduce or control tobacco use

A great deal of time spent in activities necessary to obtain or use tobacco

Craving, or a strong desire or urge to use tobacco

Recurrent tobacco use resulting in a failure to fulfil major role obligations at work, school or home

Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (for example, arguments with others about tobacco use)

Important social, occupational or recreational activities given up or reduced because of tobacco use

Recurrent tobacco use in hazardous situations (such as smoking in bed)

Tobacco use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco use

Tolerance, defined by either of the following.

A need for markedly increased amounts of tobacco to achieve the desired effect

A markedly diminished effect with continued use of the same amount of tobacco

Withdrawal, manifesting as either of the following.

Withdrawal syndrome for tobacco

Tobacco (or a closely related substance, such as nicotine) taken to relieve or avoid withdrawal symptoms

Fagerström Test for Nicotine Dependence 124

A standard instrument for assessing the intensity of physical addiction to nicotine.

How soon after you wake up do you smoke your first cigarette?

Within 5 min (scores 3 points)

5 to 30 min (scores 2 points)

31 to 60 min (scores 1 point)

After 60 min (scores 0 points)

Do you find it difficult not to smoke in places where you should not, such as in church or school, in a movie, at the library, on a bus, in court or in a hospital?

Yes (scores 1 point)

No (scores 0 points)

Which cigarette would you most hate to give up; which cigarette do you treasure the most?

The first one in the morning (scores 1 point)

Any other one (scores 0 points)

How many cigarettes do you smoke each day?

10 or fewer (scores 0 points)

11 to 20 (scores 1 point)

21 to 30 (scores 2 points)

31 or more (scores 3 points)

Do you smoke more during the first few hours after waking up than during the rest of the day?

Do you still smoke if you are so sick that you are in bed most of the day or if you have a cold or the flu and have trouble breathing?

A score of 7–10 points is classified as highly dependent; 4–6 points is classified as moderately dependent; <4 points is classified as minimally dependent.

DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Young people who do not start smoking cigarettes between 15 and 25 years of age have a very low risk of ever smoking 24 , 131 , 132 . This age group provides a critical opportunity to prevent cigarette smoking using effective, evidence-based strategies to prevent smoking initiation and reduce escalation from experimentation to regular use 131 , 132 , 133 , 134 , 135 .

Effective prevention of cigarette uptake requires a comprehensive package of cost-effective policies 134 , 136 , 137 to synergistically reduce the population prevalence of cigarette smoking 131 , 135 . These policies include high rates of tobacco taxation 30 , 134 , 137 , 138 , widespread and rigorously enforced smoke-free policies 139 , bans on tobacco advertising and promotions 140 , use of plain packaging and graphic warnings about the health risks of smoking 135 , 141 , mass media and peer-based education programmes to discourage smoking, and enforcement of laws against the sale of cigarettes to young people below the minimum legal purchase age 131 , 135 . These policies make cigarettes less available and affordable to young people. Moreover, these policies make it more difficult for young people to purchase cigarettes and make smoking a much less socially acceptable practice. Of note, these policies are typically mostly enacted in HICs, which may be related to the declining prevalence of smoking in these countries, compared with the prevalence in LMICs.

Pharmacotherapy

Three evidence-based classes of pharmacotherapy are available for smoking cessation: NRT (using nicotine-based patches, gum, lozenges, mini-lozenges, nasal sprays and inhalers), varenicline (a nAChR partial agonist), and bupropion (a noradrenaline/dopamine reuptake inhibitor that also inhibits nAChR function and is also used as an antidepressant). These FDA-approved and EMA-approved pharmacotherapies are cost-effective smoking cessation treatments that double or triple successful abstinence rates compared with no treatment or placebo controls 116 , 142 .

Combinations of pharmacotherapies are also effective for smoking cessation 116 , 142 . For example, combining NRTs (such as the steady-state nicotine patch and as-needed NRT such as gum or mini-lozenge) is more effective than a single form of NRT 116 , 142 , 143 . Combining NRT and varenicline is the most effective smoking cessation pharmacotherapy 116 , 142 , 143 . Combining FDA-approved pharmacotherapy with behavioural counselling further increases the likelihood of successful cessation 142 . Second-line pharmacotherapies (for example, nortriptyline) have some potential for smoking cessation, but their use is limited due to their tolerability profile.

All smokers should receive pharmacotherapy to help them quit smoking, except those in whom pharmacotherapy has insufficient evidence of effectiveness (among adolescents, smokeless tobacco users, pregnant women or light smokers) or those in whom pharmacotherapy is medically contraindicated 144 . Table  2 provides specific information regarding dosing and duration for each FDA-approved pharmacotherapy. Extended use of pharmacotherapy beyond the standard 12-week regimen after cessation is effective and should be considered 116 . Moreover, preloading pharmacotherapy (that is, initiating cessation medication in advance of a quit attempt), especially with the nicotine patch, is a promising treatment, although further studies are required to confirm efficacy.

Cytisine has been used for smoking cessation in Eastern Europe for a long time and is available in some countries (such as Canada) without prescription 145 . Cytisine is a partial agonist of nAChRs and its structure was the precursor for the development of varenicline 145 . Cytisine is at least as effective as some approved pharmacotherapies for smoking cessation, such as NRT 146 , 147 , 148 , and the role of cytisine in smoking cessation is likely to expand in the future, notably owing to its much lower cost than traditional pharmacotherapies. E-cigarettes also have the potential to be useful as smoking cessation devices 149 , 150 . The 2020 US Surgeon General’s Report concluded that there was insufficient evidence to promote cytisine or e-cigarettes as effective smoking cessation treatments, but in the UK its use is recommended for smoking cessation (see ref. 15 for regularly updated review).

Counselling and behavioural treatments

Psychosocial counselling significantly increases the likelihood of successful cessation, especially when combined with pharmacotherapy. Even a counselling session lasting only 3 minutes can help smokers quit 116 , although the 2008 US Public Health Service guidelines and the Preventive Services Task Force 151 each concluded that more intensive counselling (≥20 min per session) is more effective than less intensive counselling (<20 min per session). Higher smoking cessation rates are obtained by using behavioural change techniques that target associative and self-regulatory processes 152 . In addition, behavioural change techniques that will favour commitment, social reward and identity associated with changed behaviour seems associated with higher success rates 152 . Evidence-based counselling focuses on providing social support during treatment, building skills to cope with withdrawal and cessation, and problem-solving in challenging situations 116 , 153 . Effective counselling can be delivered by diverse providers (such as physicians, nurses, pharmacists, social workers, psychologists and certified tobacco treatment specialists) 116 .

Counselling can be delivered in a variety of modalities. In-person individual and group counselling are effective, as is telephone counselling (quit lines) 142 . Internet and text-based intervention seem to be effective in smoking cessation, especially when they are interactive and tailored to a smoker’s specific circumstances 142 . Over the past several years, the number of smoking cessation smartphone apps has increased, but there the evidence that the use of these apps significantly increases smoking cessation rates is not sufficient.

Contingency management (providing financial incentives for abstinence or engagement in treatment) has shown promising results 154 , 155 but its effects are not sustained once the contingencies are removed 155 , 156 . Other treatments such as hypnosis, acupuncture and laser treatment have not been shown to improve smoking cessation rates compared with placebo treatments 116 . Moreover, no solid evidence supports the use of conventional transcranial magnetic stimulation (TMS) for long-term smoking cessation 157 , 158 .

Although a variety of empirically supported smoking cessation interventions are available, more than two-thirds of adult smokers who made quit attempts in the USA during the past year did not use an evidence-based treatment and the rate is likely to be lower in many other countries 142 . This speaks to the need to increase awareness of, and access to, effective cessation aids among all smokers.

Brain stimulation

The insula (part of the frontal cortex) is a critical brain structure involved in cigarette craving and relapse 78 , 79 . The activity of the insula can be modulated using an innovative approach called deep insula/prefrontal cortex TMS (deep TMS), which is effective in helping people quit smoking 80 , 159 . This approach has now been approved by the FDA as an effective smoking cessation intervention 80 . However, although this intervention was developed and is effective for smoking cessation, the number of people with access to it is limited owing to the limited number of sites equipped and with trained personnel, and the cost of this intervention.

Quality of life

Generic instruments (such as the Short-Form (SF-36) Health Survey) can be used to evaluate quality of life (QOL) in smokers. People who smoke rate their QOL lower than people who do not smoke both before and after they become smokers 160 , 161 . QOL improves when smokers quit 162 . Mental health may also improve on quitting smoking 163 . Moreover, QOL is much poorer in smokers with tobacco-related diseases, such as chronic respiratory diseases and cancers, than in individuals without tobacco-related diseases 161 , 164 . The dimensions of QOL that show the largest decrements in people who smoke are those related to physical health, day-to-day activities and mental health such as depression 160 . Smoking also increases the risk of diabetes mellitus 165 , 166 , which is a major determinant of poor QOL for a wide range of conditions.

The high toll of premature death from cigarette smoking can obscure the fact that many of the diseases that cause these deaths also produce substantial disability in the years before death 1 . Indeed, death in smokers is typically preceded by several years of living with the serious disability and impairment of everyday activities caused by chronic respiratory disease, heart disease and cancer 2 . Smokers’ QOL in these years may also be adversely affected by the adverse effects of the medical treatments that they receive for these smoking-related diseases (such as major surgery and radiotherapy).

Expanding cessation worldwide

The major global challenge is to consider individual and population-based strategies that could increase the substantially low rates of adult cessation in most LMICs and indeed strategies to ensure that even in HICs, cessation continues to increase. In general, the most effective tools recommended by WHO to expand cessation are the same tools that can prevent smoking initiation, notably higher tobacco taxes, bans on advertising and promotion, prominent warning labels or plain packaging, bans on public smoking, and mass media and educational efforts 29 , 167 . The effective use of these policies, particularly taxation, lags behind in most LMICs compared with most HICs, with important exceptions such as Brazil 167 . Access to effective pharmacotherapies and counselling as well as support for co-existing mental health conditions would also be required to accelerate cessation in LMICs. This is particularly important as smokers living in LMICs often have no access to the full range of effective treatment options.

Regulating access to e-cigarettes

How e-cigarettes should be used is debated within the tobacco control field. In some countries (for example, the UK), the use of e-cigarettes as a cigarette smoking cessation aid and as a harm reduction strategy is supported, based on the idea that e-cigarette use will lead to much less exposure to toxic compounds than tobacco use, therefore reducing global harm. In other countries (for example, the USA), there is more concern with preventing the increased use of e-cigarettes by youths that may subsequently lead to smoking 25 , 26 . Regulating e-cigarettes in nuanced ways that enable smokers to access those products whilst preventing their uptake among youths is critical.

Regulating nicotine content in tobacco products

Reducing the nicotine content of cigarettes could potentially produce less addictive products that would allow a gradual reduction in the population prevalence of smoking. Some clinical studies have found no compensatory increase in smoking whilst providing access to low nicotine tobacco 168 . Future regulation may be implemented to gradually decrease the nicotine content of combustible tobacco and other nicotine products 169 , 170 , 171 .

Tobacco end games

Some individuals have proposed getting rid of commercial tobacco products this century or using the major economic disruption arising from the COVID-19 pandemic to accelerate the demise of the tobacco industry 172 , 173 . Some tobacco producers have even proposed this strategy as an internal goal, with the idea of switching to nicotine delivery systems that are less harmful ( Philip Morris International ). Some countries are moving towards such an objective; for example, in New Zealand, the goal that fewer than 5% of New Zealanders will be smokers in 2025 has been set (ref. 174 ). The tobacco end-game approach would overall be the best approach to reduce the burden of tobacco use on society, but it would require coordination of multiple countries and strong public and private consensus on the strategy to avoid a major expansion of the existing illicit market in tobacco products in some countries.

Innovative interventions

The COVID-19 pandemic has shown that large-scale investment in research can lead to rapid development of successful therapeutic interventions. By contrast, smoking cessation has been underfunded compared with the contribution that it makes to the global burden of disease. In addition, there is limited coordination between research teams and most studies are small-scale and often underpowered 79 . It is time to fund an ambitious, coordinated programme of research to test the most promising therapies based on an increased understanding of the neurobiological basis of smoking and nicotine addiction (Table  3 ). Many of those ideas have not yet been tested properly and this could be carried out by a coordinated programme of research at the international level.

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Acknowledgements

B.Le F. is supported by a clinician-scientist award from the Department of Family and Community Medicine at the University of Toronto and the Addiction Psychiatry Chair from the University of Toronto. The funding bodies had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The authors thank H. Fu (University of Toronto) for assistance with Figs 1–3.

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Bernard Le Foll

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Department of Medicine, University of Wisconsin, Madison, WI, USA

Megan E. Piper

University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA

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Christie D. Fowler

Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway

Serena Tonstad

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Contributions

Introduction (B.Le F.); Epidemiology (P.J. and W.D.H.); Mechanisms/pathophysiology (C.D.F., L.B., L.L. and B.Le F.); Diagnosis, screening and prevention (P.J., M.E.P., S.T. and B.Le F.); Management (M.E.P., S.T., W.D.H., L.L. and B.Le F.); Quality of life (P.J. and W.D.H.); Outlook (all); Conclusions (all). All authors contributed substantially to the review and editing of the manuscript.

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Correspondence to Bernard Le Foll .

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Competing interests.

B.Le F. has obtained funding from Pfizer (GRAND Awards, including salary support) for investigator-initiated projects. B.Le F. has received some in-kind donations of cannabis product from Aurora and medication donation from Pfizer and Bioprojet and was provided a coil for TMS study from Brainsway. B.Le F. has obtained industry funding from Canopy (through research grants handled by CAMH or the University of Toronto), Bioprojet, ACS, Indivior and Alkermes. B.Le F. has received in-kind donations of nabiximols from GW Pharma for past studies funded by CIHR and NIH. B.Le F. has been an advisor to Shinoghi. S.T. has received honoraria from Pfizer the manufacturer of varenicline for lectures and advice. All other authors declare no competing interests.

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Tobacco, Nicotine, and E-Cigarettes Research Report Introduction

In 2014, the Nation marked the 50th anniversary of the first Surgeon General’s Report on Smoking and Health. In 1964, more than 40 percent of the adult population smoked. Once the link between smoking and its medical consequences—including cancers and heart and lung diseases—became a part of the public consciousness, education efforts and public policy changes were enacted to reduce the number of people who smoke. These efforts resulted in substantial declines in smoking rates in the United States—to half the 1964 level. 1

However, rates of cigarette smoking and other tobacco use are still too high, 2 and some populations are disproportionately affected by tobacco’s health consequences. Most notably, people with mental disorders—including substance use disorders—smoke at higher rates than the general population. 3–6 Additionally, people living below the poverty line and those with low educational attainment are more likely to smoke than those in the general population. As tobacco use is the leading preventable cause of mortality in the United States, 1 differential rates of smoking and use of other tobacco products is a significant contributor to health disparities among some of the most vulnerable people in our society.

The Impact of Active and Passive Smoking Upon Health and Neurocognitive Function.

Loading... Editorial 29 August 2016 Editorial: The Impact of Active and Passive Smoking upon Health and Neurocognitive Function Tom Heffernan 5,566 views 4 citations

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Original Research 02 May 2016 Characteristics of Participants Enrolled in a Brief Motivational Enhancement for Smokers Amy L. Copeland 2,107 views 2 citations

Loading... Original Research 27 April 2016 The Synergistic Impact of Excessive Alcohol Drinking and Cigarette Smoking upon Prospective Memory Anna-Marie Marshall ,  1 more  and  Colin Hamilton 12,502 views 12 citations

Loading... Original Research 06 April 2016 Reversion of AHRR Demethylation Is a Quantitative Biomarker of Smoking Cessation Robert Philibert ,  9 more  and  Kai Wang 3,463 views 59 citations

Opinion 24 March 2016 The Cognitive Deficits Associated with Second-Hand Smoking Jonathan Ling  and  Thomas Heffernan 5,969 views 23 citations

Protocols 22 March 2016 Meditative Movement as a Treatment for Pulmonary Dysfunction in Flight Attendants Exposed to Second-Hand Cigarette Smoke: Study Protocol for a Randomized Trial Peter Payne ,  2 more  and  Mardi Crane-Godreau 4,988 views 4 citations

Original Research 13 January 2016 In vivo Cigarette Smoke Exposure Decreases CCL20, SLPI, and BD-1 Secretion by Human Primary Nasal Epithelial Cells James Jukosky ,  4 more  and  Mardi A. Crane-Godreau 2,830 views 7 citations

Opinion 23 September 2015 Regulatory Issues Surrounding Audit of Electronic Cigarette Charge Composition Mirjana Jovanovic  and  Mihajlo Jakovljevic 2,386 views 6 citations

General Commentary 01 September 2015 The Psychobiological Problems of Continued Nicotine Dependency in E-Cigarette ‘Vapers’. Commentary: “Electronic Cigarettes” Andrew C. Parrott 6,960 views 13 citations

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• Smoking history and all-cause, ischaemic heart disease and lung cancer mortality: follow-up study of 358 551 men and women aged 40–43 years
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• http://orcid.org/0000-0002-2909-5678 Aage Tverdal 1 ,
• http://orcid.org/0000-0002-8331-6363 Randi Selmer 2 ,
• Dag S Thelle 3 , 4
• 1 Centre for Fertility and Health , Norwegian Institute of Public Health , Oslo , Norway
• 2 Department of Mental and Physical Health , Norwegian Institute of Public Health , Oslo , Norway
• 3 Department of Biostatistics , University of Oslo , Oslo , Norway
• 4 Institute of Medicine,School of Public Health and Community Medicien , University of Gothenburg , Goteborg , Sweden
• Correspondence to Dr Aage Tverdal, Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo 0213, Norway; aage.tverdal{at}fhi.no

Aims We studied the health consequences of quitting smoking before age 43 by time since quitting, number of years smoked and cigarettes smoked per day. The outcomes were all-cause, ischaemic heart disease and lung cancer mortality.

Design Prospective study.

Setting Norwegian counties.

Participants Men and women aged 40–43 years who participated in a national cardiovascular screening programme and who were followed from 1985 to 2018.

Measurements Self-reports from questionnaire on time since quitting smoking, years smoked and number of cigarettes per day, and measurements of height, weight and blood pressure, and a blood sample where serum was analysed for total serum cholesterol and triglycerides.

Findings The all-cause mortality rate was 30% higher among quitters less than 1 year ago compared with never smokers (adjusted HR=1.30, 95% CI 1.18–1.43 in men and HR=1.31, 95% CI 1.16 to 1.50 in women). Quitters who had smoked longer than 20 years had 23% higher mortality in men (HR=1.23, 95% CI 1.14 to 1.34) and 32% higher mortality in women (HR=1.32, 95% CI 1.18 to 1.49). Past smoking of more than 20 cigarettes/day was associated with HR=1.14 (1.05–1.23) in men and HR=1.16 (1.01–1.32) in women. The HR for lung cancer was 6.77 (95% CI 4.86 to 9.45) for quitting men who had smoked for more than 20 years compared with never smokers. The corresponding figure for women was 5.75 (95% CI 4.08 to 8.09).

Conclusions The mortality among quitters was close to that of never smokers, except for a higher mortality for lung cancer, which on the other hand was much lower than the lung cancer mortality in current smokers.

• harm reduction
• smoking caused disease

Data availability statement

No data are available.

https://doi.org/10.1136/tc-2023-057977

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Contributors AT is responsible for the overall content and is the guarantor of the paper. AT, RS and DST conceptualised and designed the study and revised the manuscript. AT drafted the initial manuscript. AT, RS and DST critically reviewed the manuscript for intellectual content. AT, RS and DST approved the final revised manuscript and agree to be accountable for all aspects of the work.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Investigators are encouraged to work with tobacco product manufacturers to ensure availability of products to complete planned studies. FDA evaluates the specific uses of investigational tobacco products (ITPs) on a case-by-case basis according to potential human subject protection concerns or other impacts on public health. Generally, submission of protocols by industry and academic researchers for FDA review is a voluntary process; however, FDA will review all protocols submitted. FDA recommends submission of proposed use of ITPs to FDA for review only if the study design is more likely to raise concerns about human subject protection, public health, or both. As discussed by FDA in its February 2019 guidance, Use of Investigational Tobacco Products , factors to consider would be studies that plan to enroll vulnerable populations, particularly those < 21 years old, studies that involve significant increases over the participants’ usual exposure to nicotine, studies that modify the tobacco product in a manner different from that described by the manufacturer or study of a novel product for which there is limited experience and knowledge.  

For all clinical studies involving use of ITPs, we recommend that you notify FDA, all participating clinical investigators, and any committee or group formally designated to oversee the study of any serious or unexpected adverse experience associated with the tobacco product you are investigating within a few weeks after initial notification, and that you supply FDA with a completed case report form for the adverse experience. We encourage the reporting of adverse experiences associated with a clinical investigation of an investigational tobacco product to FDA through the FDACTP Safety Reporting Portal for Researchers.

FDA is committed to furthering scientific research on tobacco products and has a major investment in regulatory science. If you plan to study tobacco products that do not have marketing authorization or that do not comply with an applicable tobacco product standard, you may submit your proposed protocol to FDA for review based on the criteria described above. FDA will review any protocols submitted and intends to evaluate specific uses of investigational tobacco products on a case-by-case basis according to potential human subject protection concerns or other impacts on public health. Generally, FDA does not recommend that investigators correspond with us about the use of investigational tobacco products in nonclinical studies as these are not ordinarily reviewed. You may refer to the draft guidance, Use of Investigational Tobacco Products , for more information regarding how to submit your proposed use of an investigational tobacco product and how FDA intends to make enforcement decisions regarding the use of investigational tobacco products.  

FDA understands that investigators may choose to obtain tobacco products directly from a tobacco product manufacturer with the sole intent to use the products for research investigations without commercializing the products. In such cases, FDA recommends that investigators add language to all product labels to indicate that these products are limited to investigational use, that study participants be instructed that the products may not be further distributed, and that study protocols include a plan to collect and account for all investigational tobacco products after the study has concluded. 

If there are additional questions, investigators should reach out to the FDA CTP at: [email protected]. 

The email should:

• Clearly and uniquely identify the product(s) you wish to study by brand and sub-brand—including the type or category of tobacco product (e.g., cigarette, smokeless tobacco, cigar, electronic nicotine delivery systems [ENDS], waterpipe tobacco) and subcategory (e.g., closed or open e-cigarette, closed or open e-liquid).
• Provide additional available information such as packaging type, package quantity, and/or characterizing flavor that may help answer the specific question(s)

Once the FDA CTP receives the email, they will make every effort to respond via email within 2weeks. 

Note that the FDA CTP intends to respond to investigators within 60 days of receipt of protocols for review. Investigators should receive acknowledgement of the submission with the name and contact information for the assigned Regulatory Health Project Manager (RHPM). If investigators do not receive a response within 60 days, they should contact the RHPM. Investigators may also contact their NIH Program Officer to discuss additional steps/actions.

If the marketed products will be used with investigator-manipulated modification(s), then the investigator should submit an ITP request. In addition to the protocol and other information described in the FDA Draft Guidance, the ITP request should also include: 

• A description of the planned modification(s).
• A rationale for how these modification(s) support the study design and do not increase risk to human participants.

Tobacco Researcher Interviews: Meet some of the people who lead tobacco research

Ongoing Research

• Read about the research goals of the Population Assessment of Tobacco and Health (PATH) Study , a collaboration between FDA and NIH, as well as availability of Restricted Use Files (RUF) and Public Use Files (PUF) for Waves 1 & 2.
• Learn about CTP's research priorities that build the science base behind FDA's authority to regulate tobacco products.
• Find out more about the Tobacco Regulatory Science Program (TRSP), FDA's partnership with NIH to foster tobacco regulatory research, including the  Tobacco Centers of Regulatory Science (TCORS). 
• Learn about FDA's collaboration with CDC on the National Youth Tobacco Survey .
• Review information on Harmful and Potentially Harmful Constituents .
• Understand more about Modified Risk Tobacco Products and the rigorous standards in place to protect the public's health.

Additional Resources

• Products, Ingredients and Components
• FDA's New Regulations for E-Cigarettes, Cigars, and All Other Tobacco Products
• FDA Safety Reporting Portal for Tobacco Products
• Connect with Us
• Tobacco Control Act

Stay current on tobacco regulatory science and research, tobacco scientific publications and study findings, CTP grants, and more in this quarterly newsletter.

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!

• 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.
• 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 […]
• 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.
• 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.
• 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.
• 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.
• 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.
• Smoking: Effects, Reasons and Solutions This presentation provides harmful health effects of smoking, reasons for smoking, and solutions to smoking. Combination therapy that engages the drug Zyban, the concurrent using of NRT and counseling of smokers under smoking cessation program […]
• 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 […]
• 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 […]
• 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.
• Advertisements on the Effect of Smoking Do not Smoke” the campaign was meant to discourage the act of smoking among the youngsters, and to encourage them to think beyond and see the repercussions of smoking.
• 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.
• 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 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 […]
• 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.
• 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 […]
• 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.
• 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.
• 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.
• 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.
• 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 […]
• Hookah Smoking and Its Risks The third component of a hookah is the hose. This is located at the bottom of the hookah and acts as a base.
• Should Smoking Tobacco Be Classified As an Illegal Drug? Although this is the case, the tobacco industry is one of the most profitable industries, a fact that has made it very hard for the government to illegalize the use of tobacco products.
• 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.
• 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 […]
• 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 […]
• 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.
• Tobacco Smoking: Bootleggers and Baptists Legislation or Regulation The issue is based on the fact that tobacco smoking also reduces the quality of life and ruins the body in numerous ways.
• 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 […]
• Marketing a Smoking Cessation Program In the case of the smoking cessation program, the target group is made up of smokers who can be further subdivided into segments such as heavy, medium, and light smokers.
• 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 […]
• 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 […]
• 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.
• Cigar Smoking and Relation to Disease The article “Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease and cancer in Men” by Iribarren et al.is a longitudinal study of cigar smokers and the impact of cigar […]
• 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.
• 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.
• Female Smokers Study: Inferential Statistics Article The article “Differential Effects of a Body Image Exposure Session on Smoking Urge between Physically Active and Sedentary Female Smokers” deepens the behavioral mechanisms that correlate urge to smoke, body image, and physical activity among […]
• 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 Epidemiology Among High School Students In this way, with the help of a cross-sectional study, professionals can minimalize the risk of students being afraid to reveal the fact that they smoke. In this way, the number of students who smoke […]
• Vancouver Coastal Health Smoking Cessation Program The present paper provides an evaluation of the Vancouver Coastal Health smoking cessation program from the viewpoint of the social cognitive theory and the theory of planned behavior.
• 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.
• 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 […]
• Cigarette Smoking and Parkinson’s Disease Risk Therefore, given the knowledge that cigarette smoking protects against the disease, it is necessary to determine the validity of these observations by finding the precise relationship between nicotine and PD.
• 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 […]
• Status of Smoking around the World Economic factors and level of education have contributed a lot to the shift of balance in the status of smoking in the world.
• Redwood Associates Company’s Smoking Ethical Issues Although employees are expected to know what morally they are supposed to undertake at their work place, it is the responsibility of the management and generally the Redwood’s hiring authority to give direction to its […]
• 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.
• Mobile Applications to Quit Smoking A critical insight that can be gleaned from the said report is that one of the major factors linked to failure is the fact that smokers were unable to quit the habit on their own […]
• 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 […]
• Suppressing Smoking Behavior and Its Effects The researchers observed that during the first and the second weeks of the suppressed behavior, the participants successfully managed to reduce their intake of cigarettes.
• 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 […]
• 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.
• “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.
• 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 […]
• The Change of my Smoking Behavior With the above understanding of my social class and peer friends, I was able to create a plan to avoid them in the instances that they were smoking.
• Psychosocial Smoking Rehabilitation According to Getsios and Marton most of the economic models that evaluate the effects of smoke quitting rehabilitation consider the influence of a single quit attempt.
• The Program on Smoking Cessation for Employees Due to the fact that the main purpose of the program on smoking cessation consisted in improving healthy lifestyles of their employees, the focus on cost reduction and insurance seems to be irrelevant.
• Tips From Former Smokers (Campaign) Over the years, the campaigns have led to both the increase and the decrease of smoking all over the world. The second type of anti-smoking campaign employed was the use of celebrities to encourage people […]
• Combating Smoking: Taxation Policies vs. Education Policies This is a considerable provision in the realms of health; hence, the efforts created by the government to curb this trend should be supported fully. In this regard, there is need to reduce the mentioned […]
• The Program to Quit Smoking The second stage of the evaluation proves revealed the benefits of the program for the hospital in terms of discount rates for employees, age categories involved in the program. This process consists in selection of […]
• Smoking Culture in Society Smoking culture refers to the practice of smoking tobacco by people in the society for the sheer satisfaction and delight it offers.
• Possible Smoking Policies in Florida Majority also think that went it comes to workplaces hotels and bars it would be more appropriate to provide specific smoking zones as opposed to total bans The implications of the policy adopted therefore affect […]
• Smoking Ban in the State of Florida
• Core Functions of Public Health in the Context of Smoking and Heart Disease
• Smoking: Pathophysiological Effects
• Putting Out the Fires: Will Higher Taxes Reduce the Onset of Youth Smoking?
• Smoking Bans in US
• Smoking as Activity Enhancer: Schizophrenia and Gender
• Health Care Costs for Smokers
• Medical Coverage for Smoking Related Diseases
• Exposure to mass media proliferate smoking
• The Realm of reality: Smoking
• Ethical Problem of Smoking
• The Rate of Smoking Among HIV Positive Cases.
• Studying the Government’s Anti-Smoking Measures
• Smoking Should Be Banned In the United States
• Effectiveness of Cognitive Behavioral Theory on Smoking Cessation
• Effectiveness of the Cognitive Behavioral Therapy for Smoking Cessation
• Wayco Company’s Non-smoking Policy
• Adverse Aspects of Smoking
• Negative Impacts of Smoking on Individuals and Society
• Dealing With the Increase in the Number of Smokers Between Ages 17 and 45
• Cannabis Smoking in Canada
• Smoking Ban in the United States of America
• Dangers of Smoking Campaign
• Smoking Ban in New York
• Smoking and Adolescents
• Trends in Smoking Prevalence by Race/Ethnicity
• Business Ethics: Smoking Issue
• Where Does the Path to Smoking Addiction Start?
• Public Health Communication: Quit Smoking
• Are Estimated Peer Effects on Smoking Robust?
• Are There Safe Smoking and Tobacco Options?
• What Are the Health Risks of Smoking?
• Does Cigarette Smoking Affect Body Weight?
• Does Cigarette Smuggling Prop Up Smoking Rates?
• What Foods Help You Quit Smoking?
• How Can People Relax Without Smoking?
• Does Education Affect Smoking Behaviors?
• Is Vaping Worse Than Smoking?
• Do Movies Affect Teen Smoking?
• What Is Worse: Drinking or Smoking?
• Does Smoking Affect Breathing Capacity?
• Does Smoking Cause Lung Cancer?
• Does Having More Children Increase the Likelihood of Parental Smoking?
• Does Smoking Cigarettes Relieve Stress?
• Does Time Preference Affect Smoking Behavior?
• How Does Smoking Affect Cardiovascular Endurance?
• How Hypnosis Can Help You Quit Smoking?
• How Does Smoking Affect Brain?
• How Nicotine Affects Your Quit Smoking Victory?
• How Does Secondhand Smoking Affect Us?
• Why Is Smoking Addictive?
• How Smoking Bans Are Bad for Business?
• Why Smoking Should Not Be Permitted in Restaurants?
• Why Public Smoking Should Be Banned?
• Why Has Cigarette Smoking Become So Prominent Within the American Culture?
• What Makes Smoking and Computers Similar?
• Does Smoking Affect Schooling?
• What Effects Can Cigarette Smoking Have on the Respiratory System?
• What Are the Most Prevalent Dangers of Smoking and Drinking?
• Social Security Paper Topics
• Drugs Titles
• Cannabis Essay Titles
• Global Issues Essay Topics
• Cardiovascular Diseases Titles
• Marijuana Ideas
• NHS Research Ideas
• Hypertension Topics
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Health Topics – Tobacco

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Cigarette smoking causes more than 480,000 deaths in the United States every year, including approximately 41,000 nonsmoking adults and 400 infants who die from secondhand smoke exposure. Although cigarette smoking has declined considerably among U.S. adults over the past half century, an estimated 34 million  U.S. adults currently smoked cigarettes in 2019. Moreover, in 2020, 4.5 million U.S. middle and high school students currently used some form of tobacco product. In addition, disparities in tobacco use persist across population groups, including by race/ethnicity, socioeconomic status , and across regions of the country.

Economic Burden

Smoking-related illness in the United States costs  over than $300 billion each year—about $225 billion for direct medical care for adults and more than $156  billion in lost productivity, including $5.6 billion in lost productivity due to secondhand smoke exposure.

Risk Factors

Cigarette smoking remains high among certain groups, including:

Adults with lower educational levels

Adults 25-64 years old

Adults living in the South and Midwest

Adults living below the poverty level

Adults with a disability/ limitations

Adults who are uninsured or have Medicaid

Adults with mental health or substance abuse disorders

American Indian and Alaska Native adults

Lesbian, Gay, and Bisexual adults

Expanding Access to Evidence-Based Tobacco Treatments that Help People Quit

Tobacco use can be reduced by increasing access to evidence-based treatments, such as behavioral counseling and medication that help people quit. The Community Preventive Services Task Force recommends policies and programs to reduce out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit. Additionally, health-system level interventions, such as integrating tobacco use screening and treatment into routine clinical care, can support providers in helping patients quit.

Raising the Price of Tobacco Products

Increasing the price of tobacco products is one of the most effective ways to reduce consumption. A 10% increase in price has been estimated to reduce adult cigarette consumption by 3–5%. Research on cigarette consumption suggests that both youth and young adults are two to three times more likely to respond to increases in price than adults. The Community Preventive Services Task Force recommends interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use.

Implementing Hard Hitting Media Campaigns to Educate the Public about the Harmful Effects of Tobacco Use and the Benefits of Quitting

Mass-reach health communication interventions access large audiences through television and radio broadcasts, print media (e.g., newspaper), out-of-home placements (e.g., billboards, movie theaters, point-of-sale), and digital media to change knowledge, beliefs, attitudes, and behaviors affecting tobacco use. The Community Preventive Services Task Force recommends mass-reach health communication interventions based on strong evidence of effectiveness in decreasing the prevalence of tobacco use and increasing cessation and use of available services, such as quitlines.

For example, CDC’s Tips From Former Smokers ® ( Tips ® ) campaign profiles real people who are living with serious long-term health effects due to smoking cigarettes and secondhand smoke exposure.  The Tips campaign serves as an important counter to the $8.2 billion that was spent on advertising and promotion of cigarettes and smokeless tobacco in 2019—more than $22 million every day, or nearly $1 million every hour. For every $3,800 CDC spends on Tips ads, one death is prevented. From 2012 to 2018, CDC estimates that more than 16.4 million people who smoke have attempted to quit and approximately one million have successfully quit because of the Tips campaign.

Enacting Comprehensive Smoke-Free Policies that Prohibit Smoking in all Indoor Areas of Workplaces and Public Places

Significant disparities exist in secondhand smoke exposure, impacting non-Hispanic Black Americans; people who live below the federal poverty level; those who work in traditionally “blue collar” industries, service occupations, or construction; people who live in multi-unit housing; and children, particularly those aged 3-11 years.  Smoke-free policies include government policies and private-sector rules that prohibit smoking in indoor spaces and public areas. State and local ordinances often establish smoke-free standards for indoor spaces, including workplaces, restaurants and bars. Private-sector policies may include tobacco-free campus policies that prohibit all tobacco use at a company’s buildings and grounds. There is no safe amount of exposure to secondhand smoke. The Community Preventive Services Task Force recommends smoke-free policies to reduce secondhand smoke exposure and tobacco use. In addition to reducing secondhand smoke exposure, smoke-free policies can also promote smoking cessation, prevent smoking initiation, and reinforce smoke-free norms.

Point-of-Sale-Focused Strategies

An estimated 375,000 retailers sell tobacco products across the US. Point-of-sale strategies that focus on the retail environment have potential to further advance tobacco prevention and control efforts. These strategies include: product availability; pricing and promotion; advertising and display; age of sale; and retail licensure.

Featured Resources

Scientific evidence briefs

Scientific evidence briefs provide a summary of the recent science and evidence-based best practices or policy options on select tobacco prevention and control interventions.

CDC’s 6|18 initiative  provides health care partners with rigorous evidence about high-burden health conditions and associated interventions to inform their decisions to have the greatest health and cost impact. This summary provides a look at tobacco use in the United States, evidence of the effectiveness of prevention programs, and current payer coverage for these programs.

Targeted, action-oriented information for stakeholders

Most states have some tobacco control laws or programs but not have taken a comprehensive approach. Comprehensive programs have a greater population health impact and the proven potential to generate savings greater than their implementation costs. To maximize health and economic benefits, CDC recommends investments in comprehensive statewide tobacco control programs and offers technical packages  contain targeted, action-oriented information for stakeholders interested in advancing population health strategies.

An evidence-based guide to help states plan and establish comprehensive tobacco control programs

The Best Practices for Comprehensive Tobacco Control Programs is an evidence-based guidance document which helps states build and maintain effective tobacco control programs to prevent and reduce tobacco use. The document describes an integrated programmatic structure for implementing interventions proven to be effective and provides the recommended level of state investment to reach these goals and to reduce tobacco use in each state.  Other User Guides include: Cessation , Health Communication , Health Equity , Program Infrastructure and Youth Engagement .

Frequently asked questions about implementing system changes in your state’s health care system to reduce tobacco use

As part of the 2014 Best Practices for Comprehensive Tobacco Control Programs, CDC highlights evidence-based strategies states can engage in health systems change  work. This document has frequently asked questions about health systems change that are intended to help state tobacco control programs plan and implement health systems change initiatives.

Surgeon General’s Report on Smoking Cessation

In 2020, the U.S. Surgeon General released a comprehensive report on smoking cessation , the first Surgeon General’s Report on the topic in 30 years. The report makes it clear that one of the most importance actions people can take to improve their health is to quit smoking. This is true regardless of their age or how long they’ve been smoking. This report and its associated fact sheets outline the latest research on clinical treatments and population-level strategies that have been proven to help people successfully quit smoking. It also discusses new ways in which we can promote and support cessation.

Featured Tools

Tobacco-related data in an online, easy to use, interactive application (OSHData)

A comprehensive tobacco prevention and control data in an online, easy to use, interactive data application. You can explore popular datasets, charts, and maps, and you can view/print STATE System fact sheets.

Interactive state-level data in the State Tobacco Activities Tracking and Evaluation (STATE) system

An interactive application that presents current and historical state-level data on tobacco use prevention and control. Build your own reports  by selecting the topics, states, and years of data. Explore the State Highlights report to see a variety of data from across the system for a single selected state. Use Interactive Maps to access key data from across the System in a US map and data table.

For more information on tobacco-related topics, visit www.cdc.gov/tobacco/

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
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• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

192 Smoking Essay Topics

🏆 best essay topics on smoking, ✍️ smoking essay topics for college, 👍 good smoking research topics & essay examples, 🌶️ hot smoking ideas to write about, 🎓 most interesting smoking research titles, 💡 simple smoking essay ideas, 📌 easy smoking essay topics, ❓ research questions about smoking.

• Should Smoking Be Illegal?
• Cigarette Smokers and Their Types
• The Dangers of Smoking and Its Prevent
• Analysis of the Movie “Thank You for Smoking”: The Propaganda
• Smoking in Public Places: Should It Be Banned?
• Smoking in Public Places: Negative Effects
• Discussion: Smoking and Health Risks
• Smoking Dependence Treatment & Statistics The study used a two-group design that involved two samples of 40 participants who had ended treatment for smoking dependence. There were two treatment options.
• Anti-Smoking Poster Visual Analysis in Advertising This discussion presents a visual analysis of an anti-smoking poster that explores usage of words, images, colors, settings, and layout to deliver message to the audience.
• Smoking Ban in Bars and Restaurants The smoking ban in bars and restaurants law took effect in New York in the year 2003. The law stated that there was no one who was supposed to smoke in a café, restaurant or bar.
• Why Should Smoking Be Banned in Public? Cardiovascular diseases, lung cancer, and chronic obstructive pulmonary disease are associated with prolonged exposure to tobacco smoke.
• Impact of Smoking on a Pregnant Woman Smoking has various effects not only on a pregnant woman: it affects both the unborn child and the woman who is expectant.
• Are Anti-smoking Adverts Effective? The loss of individuals due to tobacco use affects the economy of many societies. Many children in the developed world lose their guardians yearly due to smoking.
• Tobacco Smoking Among Adolescents: Signature Assignment The purpose of this paper is to describe the reasons for the prevalence of tobacco use among adolescents of low and middle-income households.
• Smoking in Movies: Tobacco Industry Tactics The American tobacco industry has a long history of collaboration with the film industry to promote smoking and advertise some tobacco brands.
• Smoking and Health Promotion in the UK In the following paper, issues of health promotion and smoking, in particular, will be evaluated and analysed on the basis of facts from the United Kingdom.
• The Pros and Cons of Smoking Ban The question of whether cigarette smoking should be banned as it causes diseases, increases the healthcare system’s burden, and pollutes the environment, is pondered in this paper.
• Motivation Methods to Quit Smoking According to the recommendations for treating tobacco use, the interventions for such patients should be aimed at motivating them to finally quit smoking.
• E-Cigarettes Smoking: Threat or Solution? Nowadays, the new challenge looms on the horizon – the introduction of electronic cigarettes. There are many views on vaping, smoking e-cigarettes, both positive and negative.
• Smoking Ban Ethical Considerations The paper highlights the harmful effects of smoking. The chemicals trigger various adverse health conditions, many of which can cause death.
• Adverse Effects of Smoking Marijuana on Probation The smoking marijuana is associated with many possible negative health effects. Despite the initial euphoric state, panic attacks, confusion and anxiety are common.
• Design and Health Promotion Program for Someone to Quit Smoking The paper will present a smoking intervention program that combines medical and psychological solutions that address all the aspects of smoking addiction.
• Smoking Cessation and Patient Teaching Plan The key purpose of this patient teaching plan is to collaborate with him regarding the improvement of his lifestyle, smoking cessation, awareness related to smoking damages.
• Indoor Smoking Ban: Study Methodology The issue of whether or not the United States should pass a nationwide ban on indoor smoking is one that has managed to elicit a lot of debate.
• Weyco Inc.’s Smoking Ban in Deontological Ethics This paper investigates the case study of the smoking ban used in Weyco Inc. from a deontological (non-consequentialist) perspective.
• Smoking Cessation and Depression Problem The aim of the study is to scrutinize the issues inherent in the process of smoking cessation and align them with the occurrence of depression in an extensive sample of individuals.
• “Thank You for Smoking” by Jason Reitman The movie, ‘Thank You for Not Smoking’ has a theme that mainly revolves within the tobacco industry. The movie Thank You for Smoking is a campaigner for use of tobacco products.
• Why Should Smoking Be Illegal? Cigarettes have been the most harmful invention in human history. Because of this, it is a huge financial and political drain.
• The Problem of Smoking in Young Adults This paper will propose cigarette cessation as a health promotion plan to address smoking in young adults.
• Ban on Smoking in the Workplace The third state after Delaware and California to issue anti-smoking legislature banning the use of tobacco products in public places with effect from April 2008.
• Cigarette Smoking Cessation Methods This essay is about smoking as a bad habit that people should quit and strict laws should be applied against it.
• Smoking Should Be Banned in Public Places Smoking should be banned in public places because it has negative effects on those people who do not smoke and violates their rights to clean air and health safety.
• Smoking Bans in the Nationwide Indoor This paper highlights opinions on indoor smoking bans by the US government and the results show that smoking bans are generally approved by the public.
• Smoking Cessation and Depression It was estimated that nicotine affects the human’s reward system. As a result, smoking cessation might lead to depression and other mental disorder.
• Tobacco Smoking as Substance Abuse Tobacco smoking is the inhalation of smoke from burning tobacco leaves. Tobacco smoking is primarily used for recreational purposes but can also be used for other reasons.
• Smoking and Its Negative Health Outcomes The current research paper focuses on the connection between smoking and the negative impact of this activity on people’s health.
• Smoking and Gender Factors of Lung Cancer The rising prevalence of lung cancer in young females compared to young males is widespread and not entirely explained by gender variations in smoking habits.
• Harmful Effects of Smoking: Why to Quit Smoking? This paper highlights the harmful effects of smoking on the human body and associated health risks and emphasizes the need for smoking cessation.
• Smoking-Related Harmful Health Effects Smoking tobacco continues to be a leading cause of early disability and mortality worldwide. The use of combusted tobacco has health risks that are now beyond dispute.
• Aspects of the Harm of Smoking The paper states that it is a mistake to believe that if you smoke one cigarette for two or three, then the harm to the body will be less.
• Adult Smoking in Hatch, New Mexico Adult smoking is one of the health risk factors with the highest prevalence in Dona Ana County in New Mexico where Hatch is located.
• Impact of UK Smoking Ban on Pub Closures Smoking bans in bars came with serious risks and a dire prognosis; pub owners expected harm in the short term, yet such a ban benefited British society.
• Discussion: Treating Smoking Dependence A controlled study was performed to determine the efficacy of Mindfulness Therapy (MT) in treating smoking dependence among 40 adults.
• Smoking: An Idea for a Statistical Experiment The hypothesis is that people who smoke cigarettes daily tend to earn more than others: this is a personal observation that requires careful experimental testing.
• Passive Smoking and Pancreatic Cancer in Women The association between ETS and pancreatic cancer is weak. The pancreatic cancer risk associated is confounded by environmental tobacco smoke exposures.
• Health Effects of Smoking. Rhinosinusitis Symptoms Smoking has negative impacts on the health of individuals. Many people have developed various complications, whereby some have lost their lives.
• Tobacco Smoking Cessation The Addiction Institute of Mount Sinai’s interventions alleviates the economic and social burdens caused by tobacco use.
• Drinking and Smoking During Pregnancy Smoking and drinking alcohol is a wrong decision for a pregnant woman who wants to heighten the chances of light delivery and good health for her child.
• Smoking Patients. Practice Recommendations There are several ways to handle smoking patients. Brief interventions to screen all clients for all forms of tobacco use and initiate treatment as appropriate are suggested.
• Correlating Smoking to Comorbidities The smoking problem engulfing the world about comorbidities is worrying a lot. Millions of old African Americans suffer through this scourge, whose prevalence increases daily.
• Smoking Cessation and Increase in Quality of Life This paper seeks to establish whether smoking cessation improves the quality of life in African American women beyond 50 years who are smokers with COPD.
• Lung and Bronchus Cancer in Smoking Americans Among the causes of lung and bronchus cancer, smoking is the first to be distinguished, which is the reason for the vast majority of incidence cases.
• The Pharmacists’ Action on Smoking Program The purpose of the research is to analyze and evaluate the results of the Pharmacists’ Action on the Smoking program.
• The US Veterans: The Problem of Tobacco Smoking Although the rate of tobacco use among American veterans has been declining, those returning from Afghanistan and Iraq are smoking at an alarming rate.
• Health-Care Cost of Smoking: Economic Impacts Smoking simply refers to a practice in which a known substance, usually cannabis or tobacco, is burnt and the smoke it produces is inhaled directly.
• Team Collaboration for Smoking Cessation The Centers for Diseases Control and Prevention (2018) show that smoking harms almost every single organ in the human body, causes various diseases and conditions.
• Tobacco Smoking Trend in Australia The following essay investigates the trends of tobacco smoking in Australia and what environmental and health effects it might bear.
• Problems of Smoking in Public Places The below discussion will discuss the arguments for and against banning smoking in public places which will lead to a comparison of the same.
• A Health Problem – Smoking Analysis Smoking has been a health problem worldwide due to its adverse health effects. The paper gives several alternatives that have been advanced to assist addicts in quitting smoking.
• Community-Based Interventions to Promote Non-Smoking The research article’s design is experimental. An experimental design to come up with the cause-effect association among a collection of variables of scientific approaches
• ‘Social Smoking Among Young Adults’ by Song & Ling In the article, Social smoking among young adults: Investigation of Intentions and Attempts to Quit, Song and Ling discuss social smoking among young adults.
• Smoking and Cognitive Dissonance Theory This paper seeks to study smoking from the perspective of the Cognitive Dissonance Theory (CDT) and dissect the issue of dissonance-reducing beliefs in smoking people.
• Motivational Interviewing as a Smoking Cessation Method Motivational Interviewing intervention is one of the primary cessation methods that is used among patients that reluctant to abstain from tobacco use.
• Antismoking Ads and Youth Smoking Prevalence The article “Evidence of a dose-response relationship between “truth” antismoking ads and youth smoking prevalence” elaborates on the influence of antismoking advertisements.
• Smoking Cessation: Causes and Statistics This article focuses on smoking, examining the causes, statistics, and approved medications used to quit smoking.
• Reducing Cigarette Smoking American Youth The number of smokers among juvenility in America is alarming. Instead of going down, this amount just leveled up.
• Health Risks: Smoking and Usage of Substances The purpose of this article is to consider the health risks to which people who smoke and use psychoactive substances are exposed.
• Effects of Smoking on Your Health This paper discusses smoking. Smoking causes severe damage to lungs, increased risk of respiratory infections, etc. Disease caused by smoking.
• Young Mothers-Smokers: The Transtheoretical Model The transtheoretical model by Prochaska and DiClemente involves five consistent stages that are as follows: pre-contemplation, contemplation, action, maintenance, and relapse.
• Smoking: Addiction Treatment Methods The therapists advise those who are daily tobacco users to quit, despite their willingness. However, the intervention for smokers without any desire to stop is a complicated one.
• Smoking and Public Policy in the United States In the USA, a number of public transportation agencies have decided to ban smoking in their transportation facilities, like trains and busses.
• Anti-Smoking Persuasive Campaigns and Factors Determining Outcomes Tobacco has become one of the major health issues, affecting most of the American population and other world citizens.
• The Problem of Smoking Ban The goal of the essay is to provide arguments to defend nonsmokers on the dispute regarding smoking-related restrictions.
• Smoking Bans in Workplaces and Public Spaces The paper researches evidence that secondhand smoke causes the same problems as direct smoking, including lung cancer, cardiovascular disease, and lung ailments.
• Smoking Cessation Plan with mHealth Application The goal of this paper is to develop a smoking cessation plan for a patient at risk of depression, using a mHealth application based on Acceptance and Commitment Therapy.
• Quit Smoking: Therapies and Medications This paper describes how nicotine replacement therapy (NRT), non-nicotine medications, and behavior therapy are valid ways to quit smoking.
• Secondhand Smoking: Environmental Health Promotion Smoking remains a significant environmental problem that affects many people. Secondhand smoking can also be a dangerous issue because of the pernicious impact of tobacco.
• The Changing Public Image of Smoking in the United States Scholars have discovered that 15 of every 100 country residents use tobacco products on a regular basis, which poses the problem as a nationwide issue.
• Smoking Management and Patient Teaching Plan Most smokers need outside prompts to jumpstart their quitting process. This can involve reminding the participant the benefits of quitting.
• Acupuncture for Smoking Cessation: Research Process People want to know if acupuncture may be regarded as an effective method for smokers to quit this harmful habit considering that numerous past attempts were taken in vain.
• Introduction of New Legislation Regarding Smoking in Miami-Dade County Florida Health Department identifies three major risk factors of heart disease: high cholesterol, high blood pressure, and smoking.
• Smoking in Cities: Prohibition Bill The proposed bill presupposes the complete prohibition of smoking in cities except for the places that are specially created for it and equipped with corresponding devices.
• Lowering Drinking and Smoking Age in the U.S. Some scholars indicate that lowering the minimum legal drinking age from 21 to 17 years will help to limit the number of negative consequences faced by young adults.
• Anti-Smoking Persuasion: Rhetorical Situation Analysis This paper narrates a rhetorical moment in which I had an argument with my brother on his smoking behavior while he was in high school.
• Weight Watchers: the Analysis of Smoking The lack of alternatives to the rewards of smoking as a method of controlling weight has created an inelastic demand for the product, which is unlikely to change with the decision to impose high taxes.
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• Can Counselling Assist with Smoking Cessation?
• What Are the Effects and Causes of Smoking in the Human Body?

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A Qualitative Study of Smoking Behaviors among Newly Released Justice-Involved Men and Women in New York City

Long-term effects of cigarette smoking result in an estimated 443,000 deaths each year, including approximately 49,400 deaths due to exposure to secondhand smoke. Tobacco is a major risk factor for a variety of chronic health problems, including certain cancers and heart disease. In this article, authors present qualitative findings derived from individual interviews with men and women who were incarcerated in New York state and New York City. Participants were 60 racially and ethnically diverse men and women ages 21 through 60 ( M  = 46.42, SD  = 6.88). Of the participants interviewed, 91.7 percent released from a smoke-free correctional facility resumed cigarette smoking and 8.3 percent remained abstinent. Daily consumption ranged from smoking four cigarettes to 60 cigarettes. The four themes that emerged from the study were (1) lifetime exposure to cigarette smoking influences smoking behavior; (2) cigarettes help relieve stress and are pleasurable; (3) there is a relationship between access, availability, and relapse; and (4) smoking cessation strategies are available. Negative influences from participants’ families and peers, stressful housing situations, and mandated programs emerged from this study as key challenges to abstaining from smoking cigarettes. Involving family members and partners in smoking cessation interventions could influence newly released justice-involved men and women not to resume cigarette smoking and possibly maintain long-term abstinence.

Cigarette smoke results in an estimated 443,000 deaths each year, including approximately 49,400 deaths from exposure to secondhand smoke ( U.S. Department of Health and Human Services [HHS], n.d. ). Tobacco use is a major risk factor for a variety of chronic health problems, including certain cancers and heart disease ( HHS, n.d. ). An estimated 19.3 percent of the U.S. adult population (45.3 million individuals) were smokers in 2011; however, the smoking prevalence in previously incarcerated populations has consistently been shown to be substantially greater than in the general population, with around 60 percent to 80 percent opting to smoke on release to the community ( Cropsey, Jones-Waley, Jackson, & Hale, 2010 ; King, Dube, Kauffman, Shaw, & Pechacek, 2011 ).

The Federal Bureau of Prisons made all facilities under its control 100 percent smoke free in July 2004. In state prisons and jails, correctional officials have adopted varying degrees of smoke-free resolutions that promote either smoke-free policies or prohibit smoking in their facilities altogether ( American Nonsmokers’ Rights Foundation, 2015 ). Despite the pervasiveness of U.S. correctional smoke-free policies, there are still many questions regarding their effectiveness. For one, enforcement of and compliance with these policies are highly variable and, as a consequence, banning cigarettes does not ensure abstinence from tobacco use on release from a correctional facility ( Foley, Proescholdbell, Herndon Malek, & Johnson, 2010 ). For instance, Cropsey and Kristeller (2005) found that 76 percent of the prisoners who smoked prior to a prison smoking ban still reported some level of smoking one month after being released from the facility. In addition, even if smokers are able to quit while incarcerated, mounting evidence suggests that forced abstinence in prison does not result in sustained nonsmoking behavior on release ( Cropsey & Kristeller, 2005 ; T. Lincoln et al., 2009 ). T. Lincoln et al. (2009) found that 97 percent of prisoners relapsed within six months of release back to their communities.

SMOKING BEHAVIORS AND INTENTIONS TO QUIT IN JUSTICE-INVOLVED POPULATIONS

A better understanding of the smoking behaviors and intentions to quit among individuals involved in the criminal justice system may be critical to reduce tobacco use in this population. Cropsey and Kristeller (2005) found that individuals who continued to smoke after release from a tobacco-free facility were more nicotine-dependent and reported more withdrawal symptoms, even after accounting for baseline nicotine-dependence and baseline withdrawal scores ( Cropsey & Kristeller, 2005 ). In another study, Voglewede and Noel (2004) found that smokers with a strong desire (craving) for tobacco were more likely to intend to smoke on release from jail. Interestingly, they found no relationship between intent to smoke and length of incarceration or level of nicotine dependence ( Voglewede & Noel, 2004 ).

We know very little about how individuals who are supervised in the community (parole or probation) rebuild their lives with respect to their tobacco habits after being released from smoke-free correctional facilities. To learn more about this issue, we asked the participants (a racially and ethnically diverse group of men and women released from New York correctional facilities) to describe their smoking behaviors before, during, and after incarceration and their intentions to quit tobacco use during these same time periods.

In this qualitative study, we explored the following three research questions: (1) What are the smoking behaviors and intentions to quit tobacco in justice-involved populations? (2) What are the social characteristics that support or encourage tobacco resumption? (3) What smoking cessation programs, if any, are provided to, or sought out by, the study participants upon their release from tobacco-free correctional facilities?

Qualitative data presented here were gathered from men and women who were formerly incarcerated in a New York state prison or the Rikers Island jail in New York City (NYC), and who returned to reside in the Bronx, New York. Among the 60 participants were 13 black men and 19 black women, 17 Latino men and eight Latina women, and three white women (but no white men), and they ranged in age from 21 through 60 years ( M  = 46.42, SD  = 6.88). Of the participants interviewed, 58 percent were released within one year; 66 percent served in both prison and jail; 23 percent served jail time only; 10 percent served in prison only; and one participant was involved in an alternative-to-incarceration program. The age of first incarceration ranged from 18 to 52 years ( M  = 29.87, SD  = 14.75).

In terms of the participants’ levels of education, 45 percent of participants (11 women and 16 men) did not complete high school or obtain a GED diploma; 35 percent of participants (11 women and 10 men) graduated from high school or obtained a GED; and the remaining 20 percent (eight women and four men) attained some college education in the form of some college credits, a bachelor’s degree, or a master’s degree. The age when the participants left school ranged from four years old to 24 years old ( M  = 15.95, SD  = 3.34). The participant who indicated that he or she left school at age four did not have any formal schooling. In terms of participants’ marital status, nearly half (48.3 percent; 15 women and 14 men) were single or never married; 25 percent (four women and 11 men) were married; and the remaining were divorced (five women and three men), separated (five women), or widowed (one woman and two men). The number of children among the participants ranged from zero to 10 children ( M  = 2.40, SD  = 1.80). The institutional review boards at Albert Einstein College of Medicine and Columbia University approved the research procedures, and the first author obtained a National Institutes of Health Certificate of Confidentiality.

In New York, approximately 74 percent of individuals in the custody of the Department of Corrections and Community Supervision are black or Latino ( State of New York Department of Corrections and Community Supervision, 2012 ). Of the 13 NYC community districts that have the highest rates of incarceration (greater than 10 inmates per 1,000 residents), six are located in the Bronx. In the district with the highest incarceration rate of 12 per 1,000 residents (containing Morris Heights, University Heights, Fordham, and Mt. Hope), 41 percent of the residents of these district are impoverished, and 58 percent receive public assistance ( Mellow et al., 2008 ). Overall, 31 percent of Bronx residents live below the federal poverty level.

The Bronx has one of the highest rates of current smokers in NYC at 18.0 percent, compared with 15.2 percent in Manhattan ( New York City Department of Health and Mental Hygiene, n.d. ). Because of the borough’s higher-than-average smoking rate and its significant population of formerly incarcerated individuals living in the county, the research team chose the Bronx as a model setting for this study. The borough offers a large population of study participants to draw from; lessons obtained from this study’s focus areas can thus be more broadly applied to other communities of color.

The semistructured interview format was flexible to allow participants to respond to questions naturally, but structured enough to keep the discussion on relevant topics. The interview questions were developed by the first author. The following are examples of the interview questions:

• How many packs of cigarettes do you smoke daily?
• What type of cigarettes do you typically smoke?
• Could you please describe a situation when you need a cigarette?
• How long were you smoking before you were incarcerated?
• How does smoking cigarettes make you feel?
• Why do you smoke now?
• How do you obtain money to buy cigarettes?
• Have you tried to quit? (Probe question: If yes, what have you tried—nicotine patch, therapy, self-help, and medication?)
• When was the last time you tried to quit?
• How has your smoking behavior changed since coming home from prison or jail?
• How much do you spend per week on cigarettes?
• Do you have family members who smoke cigarettes? (Probe for any members dealing with cancer-related to cigarette smoking or tobacco use.)

Participants were recruited through flyers advertising the study placed in criminal court buildings, drug and rehabilitation centers, and social services agencies working with individuals involved in the criminal justice system. Potential participants were asked to contact the research office to determine eligibility. The first author and her research team (master’s-level public health and social work students who were trained in qualitative research methods) recruited study participants and conducted the individual interviews during a six-month period in 2011.

To participate in this study, individuals had to meet the following eligibility criteria: (a) self-identify as a male or female; (b) age 18 years or older; (c) reside in Bronx, New York; (d) under community supervision (parole or probation); (e) report no previous diagnosis of cancer; (f) report substance use history; (g) provide informed consent; and (h) agree to the interview being digitally recorded. We also invited participants to refer friends and peers who met eligibility criteria. The interviews ranged in length from 90 to 120 minutes. All interviews were conducted in a private meeting space, and all participants were compensated in cash for their participation.

Data Analysis

The digital recordings of the interview data were transcribed verbatim by a professional transcriptionist; NVivo 10, a qualitative software package, was used to manage and code the data. The first and second authors analyzed the data using content analysis to develop the smoking behavior codebook. Categories were developed and refined using passages retrieved from the transcripts; the data that were in close associations were grouped together and assigned a tentative code ( Hsieh & Shannon, 2005 ).

We created a table in Microsoft Excel that listed the first-level codes, second-level categories, and potential subheadings as an initial template of the codebook. This stage involved identifying relationships among the codes and developing connections or relationships within the codes that we previously identified. We also created definitions and used the passages to illustrate the inclusion and exclusion criteria for each code. We reread the transcripts related to smoking and the codes selected, followed by the construction of the codebook; we used statements from the participants to support and define the code ( Hsieh & Shannon, 2005 ). The codebook allowed the authors to code passages in which participants described their smoking behaviors and intentions to quit. When discrepancies occurred during coding, we met to discuss the differences until consensus was reached.

We assessed the credibility of our analyses in several ways. First, we reviewed the findings with several participants to ensure that the analyses and interpretations of the data reflected the interviewees’ own experiences and perceptions, thus minimizing researchers’ biases ( Kirk & Miller, 1986 ; Y. S. Lincoln & Guba, 1985 ). Second, we were intensely engaged in the research, conducting multiple reads of the transcripts, met for several months to address discrepancies in the coding process, and ensured that our analyses and interpretations were rooted in the data. Third, we used bracketing to ensure that our assumptions and beliefs did not influence our analysis ( Creswell & Miller, 2000 ). This included writing memos throughout data analyses and reflecting on how we engaged the data.

Of the participants released from a tobacco-free correctional facility, 91.7 percent ( n  = 55) resumed smoking cigarettes after release; only 8.3 percent ( n  = 5) remained abstinent.

Cigarette Smoking Habits

There were many commonalities in the smoking behaviors of the participants. The majority of the interviewees smoked Newport menthol cigarettes (including “loosies” or single Newport Menthol cigarettes and bootleg Newports), followed by rollies and natural cigarettes. The daily smoking behaviors ranged from four cigarettes (light smoker) to 60 cigarettes (heavy smoker), the equivalent of three packs per day ( M  = 17.2, SD  = 12.81).

The majority of the participants spent $11.50 to $16.00 per day on a pack of cigarettes; others spent $0.50 or $0.75 for a single cigarette, or $7.00 on bootleg cigarettes. Bootleg cigarettes are cheaper because they are sold with a counterfeit tax stamp or with no tax stamps at all. On average, participants spent $40 to $50 per week on cigarettes. Some participants borrowed cigarettes from friends.

A little over half (51.6 percent) of the participants claimed they had no knowledge about the health effects of smoking. Despite this, 12 participants reported tobacco-related illnesses, including heart disease, asthma, and advanced emphysema. In addition, six participants reported that lung and bone cancer ( n  = 5) and myocardial infarction ( n  = 1) were the causes of death of a family member.

The four most salient themes that emerged from the data were (1) lifetime exposure to cigarette smoking influences smoking behavior; (2) cigarettes help relieve stress and are pleasurable; (3) there is a relationship between access, availability, and relapse; and (4) smoking cessation strategies are available.

Theme 1: Lifetime Exposure to Cigarette Smoking Influences Smoking Behavior

Participants were exposed to secondhand smoke primarily through caregivers. Many of the participants began smoking cigarettes at a very early age (from five through 15 years old, M  = 12.5). When asked how he acquired his first cigarettes, a Latino male participant, age 43, incarcerated for over 15 years, and released less than six months prior to the interview, said, “I stole my mother’s cigarette. And I just went and I smoked it, and from then on after I puffed a couple of times, there it goes.” A Latina female participant, age 43 years, incarcerated for less than six months in a jail facility, and released less than six months prior to the interview, said, “My mother used to stay with us ... she used to put cigarettes in our mouths because we did not know how to smoke. And I learned how to steal cigarette[s] from my mother.” Unfortunately, the participants did not have family members teaching them about the importance of not smoking; instead of being talked to about the dangers of smoking, it was more common for participants to have family members who smoked. The vast majority of the study participants (70 percent) stated that having smokers as family members influenced their smoking behaviors during the reentry process. Several participants discussed having family members who are currently smokers. For example, “My mother, she smokes a lot. And, I hear her coughing at night. I say, ‘Mommy, you smoke a lot. We gotta stop smoking.’ She gets angry. I say we need to,” noted a black male participant, age 48 years and involved in an alternative-to-incarceration program.

Some participants expressed concern that many people in their family smoked. For example, a black female participant, age 45 years, who experienced both jail and prison time and was released less than three years from the time of the interview, said, “My uncle smokes. My sister smokes, my nephew smokes, and my son smokes. But they don’t smoke like chain smokers. I don’t know how they smoke. I know that they smoke; they indulge in cigarettes every now and then.” Another participant said:

My brother smokes. Well, all my brothers smoke. ... And, one of them has a pacemaker right now. Well, he got to really stop smoking. I think if I was at that level, I’d really stop smoking ... but you know, I been smoking since I was like 14 . (black male participant, age 46, experienced jail and prison, and was released less than six months prior to the interview)

Family members play a very important role in justice-involved men and women’s ability to remain smoke-free after release from a correctional facility.

Theme 2: Cigarettes Help Relieve Stress and Are Pleasurable

Men and women who are newly released from a correctional facility face multiple challenges related to reintegration to society. Some face legal barriers to receiving public benefits; others struggle with mental illness, physical health conditions, substance use problems, or disability; and many are unemployed and often become homeless if there is limited transitional housing or family supports ( La Vigne & Kachnowski, 2003 ). Community reentry is a stressful time for many men and women involved in the criminal justice system. Because of the extreme challenges to meet basic needs (such as stable housing, employment, and food), participants may engage in risky behaviors or old vices to cope with the stressful circumstances ( Luther, Reichert, Holloway, Roth, & Aalsma, 2011 ). Although the participants did not engage in substance use, primarily because the majority of them were under community supervision, most ( n  = 55) reengaged in cigarette smoking on release and while in reentry.

In this study, a little over half of the sample ( n  = 35) denoted psychological pleasure in smoking cigarettes. The most common explanations for smoking cigarettes were “brings pleasure,” “relaxing,” “calms me down,” “reduces anxiety,” “puts me at ease,” and “makes me feel good.”

Study participants discussed the benefits of smoking cigarettes as they navigated the community reentry process. For over half of the participants, cigarettes helped to regulate and ease stressful experiences. A black female participant, age 47 years, who spent 16 months in jail and was released less than six months prior to the interview, was asked by the interviewer what she did when she “started feeling extra stress,” and rather than talk to a counselor, friend, family member, or probation officer about what she was feeling, she smoked more. Another participant, Latino, male, age 50, incarcerated for less than 30 days in jail and released less than six months prior to the interview, reported, “I feel more relaxed. You know, cigarettes relax me. I feel well ... I feel better.” Chain smoking was mentioned by the participants as a method that they used to destress.

Theme 3: Relationship between Access, Availability, and Relapse

Inmates released from prison and under community supervision who need a place to live may be sent to a structured transitional housing facility or a recovery housing facility, and parolees residing in these facilities have access to supportive services. However, some of these housing facilities are not smoke-free properties. In our study, a number of participants said that they reengaged in cigarette smoking immediately because cigarettes were readily available when they were released to transitional housing.

Interviewer: When did you pick up the first cigarette when you got home?

Interviewee: When I got to Facility A. I just went, got a loosie, and smoked it. I was dizzy as hell. I don’t know, I guess it was something to do.

Interviewer: Many people around you?

Interviewee: Yeah, everybody, almost all the girls there smoke. (Latina, female, 39 years old, eight months incarcerated in jail, and released less than six months prior to interview)

Living with other parolees in transitional housing facilities that are not smoke-free properties may be associated with reengaging in cigarette smoking. For instance, a black male participant, age 50 years, who spent less than six months in prison and was released less than six months prior to interview, stated, “Well, right now there are a lot of guys in the house that, you know, a lot of ’em are working, so it’s easy to get a cigarette sometimes. It’s not hard to get a cigarette.” Overall, men and women who are returning from correctional facilities are faced with overwhelming challenges to maintain a smoke-free lifestyle. They are paroled to programs and housing facilities where smoking is hard to resist.

Theme 4: Smoking Cessation Strategies Are Available

The final theme that emerged in the study was a sense of not resigning to a feeling of hopelessness because of one’s circumstances. Despite being exposed to a lifetime of cigarettes, returning to family members who are current smokers, and being mandated to programs and housing facilities that are not smoke-free, some participants felt that they had a choice whether to feel trapped or find approaches to remain smoke free. The last successful attempt for participants was when they were incarcerated and forced to quit. At least half of participants were working toward reducing the number of cigarettes smoked per day, mainly because of cost. Because cigarette smoking is an expensive habit, some participants described using the following strategies to save money and reduce the frequency of smoking cigarettes: “smoking less,” “using the nicotine patch,” “asking a physician for [smoking cessation] medication,” and “substituting candy for a cigarette.” During the interview, these participants felt confident that they would quit one day by using many of these strategies. Participants also cited removing tobacco products, pharmacotherapy, and quitting as a team as critical strategies to smoking cessation for justice-involved populations. Consistent with the latest trends on tobacco regulatory and control, CVS Caremark, a leading drugstore chain, is eliminating cigarettes and tobacco products from their store shelves. In addition, pharmacotherapy such as CHANTIX (varenicline) has been clinically proven to assist ’in smoking cessation ( Hoogendoorn, Welsing, & Rutten-van Mölken, 2008 ). One participant (Latina, female, 53 years old, incarcerated for 1.5 years in jail, and released two years prior to this interview), had used Chantix:

I quit actually with Chantix, when I was in the jail. ’Cause we couldn’t smoke in there. I mean, people used to smoke and sneak, and get in trouble and lose their privileges. So when I saw I was heading down the road, I ... asked the doctor in the facility for Chantix. And it worked. ... I stopped smoking for eight months when I was incarcerated.

Another way to achieve smoking cessation was by encouraging former smokers and family members to “quit as a team.” When the interviewer asked, “Is your husband trying to quit when you quit?,” the black female participant, age 48 years, incarcerated in prison for two years, and released two years prior to interview, responded, “Yeah, we want to do it together. We won’t be in the house smoking together.”

Although only a few participants suggested that “quitting as a team” might be helpful to quit smoking, implementing a family or partner team approach in the community and offering a cessation program may improve motivation to decrease or quit smoking and keep former justice-involved participants from reengaging in the habit.

This qualitative study demonstrates that formerly incarcerated men and women released from correctional facilities lack the support from family, peers, and their environment to maintain abstinence from cigarette smoking following release from prison or jail. In fact, the smoking behaviors of family and friends and stressful housing situations and mandated programs emerged from this study as key challenges to maintaining abstinence. Regardless of lengthy abstinence from smoking cigarettes due to incarceration, study participants returned to smoking cigarettes postrelease. Our findings are consistent with those of Bock and colleagues (2013) , who demonstrated that formerly incarcerated individuals have few social models for not smoking and generally lack strong social support from family and particularly from friends relevant to maintaining smoking abstinence after release.

Social factors, specifically homelessness, mandated court or community supervision programs, and a lifetime of exposure to family and friends who are cigarette smokers influence or shape their susceptibility to return to smoking cigarettes. The lack of available smoking cessation strategies to maintain abstinence on release to the community also contributes to relapse. In this study, our interviewees had the fewest resources to withstand societal changes (due to the stresses of living in transitional housing or securing a job, for example), which means that prolonged years in the confines of correctional institutions may have unintended consequences.

The majority of correctional facilities do not offer smoking cessation treatment ( Kauffman, Ferketich, & Wewers, 2008 ). That being said, the relapse rate for smoking is highest the day after release from incarceration, which suggests that offering cessation services, both in correctional facilities and in the transition back to the community, may be critical to reducing tobacco use in this population ( Clarke et al., 2013 ). Although smoking cessation programs are relatively rare in correctional facilities and even infrequent in the community for justice-involved populations, Cropsey et al. (2010) found that more than half of smokers reported that they would be interested in receiving smoking cessation assistance if free help was available. In particular, pharmacotherapy generated a lot of interest; 60 percent of the individuals interested in smoking cessation assistance desired this option ( Cropsey et al., 2010 ).

This interest in smoking cessation is significant because in a previous study Cropsey and Kristeller (2003) found that the stages of change model was a major factor in motivating individuals to quit tobacco use altogether. The “stage of change” concept comes from a five-stage model of change introduced by two substance abuse researchers, Prochaska and DiClemente (1986) . Of the five stages, Cropsey and Kristeller (2003) focused on two: precontemplation and contemplation. Individuals in the precontemplation stage have not yet begun to think about changing their behavior and may not see their substance use as a problem; individuals in the contemplation stage are willing to consider that their use is problematic and that willingness allows them to see possibility for change. Similarly, Thibodeau, Jorenby, Seal, Kim, and Sosman (2010) found that participants who either desired to remain smoke free after release or were uncertain about whether or not they would resume smoking were more likely (82 percent) to remain abstinent for at least the first month outside of a smoke-free prison environment ( Thibodeau et al., 2010 ).

This study also found that daily cigarette smoking varied among participants, ranging from light (four cigarettes) to heavy (60 cigarettes). Half of interviewees were working toward reducing the number of cigarettes smoked daily; unfortunately, none of the participants were involved in a smoking cessation program to support this effort. Given that our sample returned to the community where cigarette smoking is prevalent, smoking cessation interventions tailored to their unique social, cultural, environmental, psychological, and general post-incarceration characteristics may be helpful to treat heavy cigarette use within the subpopulations of racial and ethnic minorities involved in the criminal justice system. In addition, involving family members, partners, and peers in smoking cessation interventions could influence newly released justice-involved men and women not to resume cigarette smoking and possibly maintain long-term abstinence.

Limitations

Although this study provides critical insight into the smoking behavior and causes for cigarette smoking in justice-involved populations, there are several potential limitations that may have affected our findings. For one, although generalizability is not of highest priority in a qualitative study, limiting our study sample to formerly incarcerated men and women from New York correctional facilities who were released to the Bronx County may have affected our ability to extrapolate our results to formerly incarcerated men and women in general. However, given that relatively little has been studied on this topic, we believe that using a purposive sample was justified as an appropriate means to advance knowledge in this area.

Furthermore, although a substantial portion of the criminal justice population does have issues with substance use, limiting our sample to individuals with histories of substance abuse may have excluded an important perspective within this population. However, it can be argued that focusing on individuals with substance use issues is, in fact, more beneficial to our study because it assists us in gathering ideas for a more comprehensive prevention plan that fits the heavy and the light smoker. Focusing on such individuals helps us develop more aggressive smoking cessation strategies tailored toward the more serious substance user; these strategies can later be tailored to fit the needs of formerly incarcerated individuals who do not have serious substance use issues but, nonetheless, need assistance quitting tobacco. Finally, because we used semistructured interviews and self-reporting for data collection, it is possible that social desirability bias could have affected the validity of our results. However, because very few participants (8.3 percent) reported having remained smoke free, it is unlikely that social desirability significantly altered our findings.

In conclusion, our study provided much needed insight into the smoking behaviors and intentions to quit of justice-involved men and women. It is clear that simply forcing these individuals to stop smoking while incarcerated is not enough. Improving access to smoking cessation products such as pharmacotherapy and family- or partner-assisted smoking cessation programs specifically for newly released justice-involved men and women could be vital in addressing cigarette smoking and improving quality of life among a highly vulnerable population.

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What data does DHS collect about alcohol and tobacco?

Data on consumption of alcohol and use of tobacco among men and women are collected, including frequency of alcohol consumption and frequency and type of tobacco use. Data are also collected on the role of alcohol consumption in domestic violence. Over 40 surveys collected data on alcoholic consumption and over 80 surveys collected data on tobacco use.

How are alcohol and tobacco use relevant to health and DHS?

Consumption of alcohol and use of tobacco are lifestyle measures that may cause direct or indirect health risks. Smoking has been shown to have significant adverse health effects, both for the individual smoker and for other people exposed to second-hand or "environmental" tobacco smoke. Smoking is a known risk factor for cardiovascular disease; it causes lung cancer and other forms of cancer and contributes to the severity of pneumonia, emphysema, and chronic bronchitis. Tobacco use by pregnant women can cause low birth weight and small size at birth. It can also interfere with pregnancy and breastfeeding. Environmental tobacco smoke can cause acute respiratory infections and interfere with the growth of children.      The harmful use of alcohol is a global problem that negatively affects both individual and social development. Alcohol consumption causes harm far beyond the physical and psychological health of the drinker. It also causes harm to the well-being and health of others. Alcohol is associated with violence, child neglect and abuse, and absenteeism in the workplace. Harmful drinking is a major determinant for alcohol use disorders, injury, epilepsy and other noncommunicable diseases such as cardiovascular diseases, cirrhosis of the liver and various cancers. The harmful use of alcohol is also associated with several infectious diseases like HIV/AIDS, tuberculosis and sexually transmitted infections (STIs). This is because alcohol consumption can lead to risky behavior, and because it weakens the immune system thus allowing infection by pathogens. In addition, alcohol consumption has a negative effect on patients' adherence to antiretroviral treatment. Because the health impact from alcohol use strikes relatively early in life, it is the leading risk factor for mortality and the overall burden of disease in the 15–59 age group.

Photo credit: Mukunda Bogati, Courtesy of Photoshare. 

• WHO - alcohol portal
• Global Status Report on Alcohol & Health 2011 - country profiles
• Global Information System on Alcohol and Health (GISAH)
• WHO - alcohol publications
• The Lancet - special series on alcohol & global health
• WHO - tobacco portal
• Tobacco Control at a Glance
• Report on the Global Tobacco Epidemic, 2011
• Tobacco Atlas
• Tobacco Questions for Surveys

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Researchers find that gratitude is a useful emotional tool in reducing desire to smoke

by Harvard University

Smoking continues to rank as the foremost preventable cause of premature death. In a paper published this week in the Proceedings of the National Academy of Science , Harvard researchers report findings that evoking feelings of gratitude in people who smoke helps reduce their urge to smoke, and increases their likelihood of enrollment in a smoking cessation program. They note that these findings could inform newer approaches to public health messaging campaigns that aim to reduce so-called "appetitive" risk behaviors like smoking, drinking, and drug use.

The research team built on the Appraisal Tendency Framework , a theoretical model of emotional and decision making, and earlier experimental studies on the connection between emotions and risk behaviors to hypothesize that sparking the specific positive emotion of gratitude could drive reductions in smoking . Previous meta-analyses had concluded that positive emotion has no effect on these types of behaviors .

"The conventional wisdom in the field was to induce negative emotions in anti-smoking campaigns," said lead researcher Ke Wang, Harvard Kennedy School Ph.D. 2024. "Our work suggests that such campaigns should consider inducing gratitude, a positive emotion that triggers cascading positive effects."

Through a series of multi-method studies, the researchers found consistent evidence that inducing feelings of gratitude was associated with lower rates of smoking behavior . Nationally representative surveys in the U.S. and a global sample found that higher levels of gratitude correlated with a lower likelihood of smoking, even after accounting for other known drivers of smoking.

Experimental studies further demonstrated causality. Inducing feelings of gratitude in adults who smoke significantly reduced their self-reported craving to smoke, whereas inducing compassion or sadness did not have these beneficial effects. Critically, inducing gratitude also increased participants' enrollment in an online smoking cessation program, showing effects on actual quit-smoking behaviors.

These findings create opportunities to re-think the scientific foundations of anti-smoking campaigns. The investigators examined the largest federally funded anti-smoking public service campaign, Tips from Former Smokers, by the Centers for Disease Control and Prevention. Unfortunately, this landmark campaign has seldom induced gratitude.

Instead, it has most often induced emotions of sympathy, sadness, and compassion—three emotions that may not produce intended effects on smoking cessation behaviors. In the case of sadness, earlier research by the research team found that evoking sadness actually increased desire to smoke, as well as the intensity with which smokers inhale immediately after the emotion is triggered.

"Compared to how much money tobacco companies spend on advertising, public health campaigns have paltry budgets; they need to make the most of every dollar," said Professor Jennifer Lerner.

"The theoretically-grounded and empirically-tested framework presented here will hopefully help public health officials design more effective public media campaigns across a broad spectrum of appetitive risk behaviors that have underlying emotional components."

Unlike other positive emotions (e.g., happiness, compassion, and hope), gratitude has the unique quality of making people less inclined toward immediate gratification and more focused on long-term relationships and health. The research team posits that this unique effect is related to the emotion's influence on smoking behaviors and desires to quit.

The researchers believe designing public health messaging campaigns to more effectively induce gratitude could help them have greater impact on reducing smoking rates and other risky health behaviors.

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Quit Smoking for Better Health: The Top 10 Reasons to Quit

• September 12, 2022

After witnessing his father’s slow death from emphysema caused by smoking, Patrick Reynolds made it his life’s mission to fight against Big Tobacco, the industry his family helped build. Patrick is the grandson of R.J. Reynolds, who founded the R.J. Reynolds Tobacco Company in 1875. Today, he runs the anti-smoking organization Tobacco Free Earth, and he wants to help you quit smoking.

Smoking is the leading preventable cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), smoking kills more than 480,000 Americans yearly — more than AIDS, alcohol abuse, car accidents, murders, and suicides combined.

Most smokers have tried to quit smoking in the past. Many have failed several times. Every time they fail, many become more convinced they can’t quit.

The truth is, failing is part of the normal journey toward becoming a non-smoker.

Most do it without a program, and 95% go back to smoking within a year. Even with the best programs available, the failure rate is still high. Even so, the numbers provide a compelling reason to get into a program.

About a third of smokers will die from the disease, and studies show the other two-thirds will likely suffer from other diseases and have significantly shorter lifespans. If that’s not enough, below are ten more reasons to stop smoking.

1. Secondhand Smoke Can Kill Those You Love

Secondhand smoke exposure can cause lung cancer, heart disease, and other respiratory problems in nonsmokers. The CDC estimates that secondhand smoke exposure causes approximately 34,000 deaths from heart disease and lung cancer each year in nonsmokers. It’s also a known risk factor for sudden infant death syndrome (SIDS).

Smoking is also a leading cause of fire deaths in the United States. According to the National Fire Protection Association, smoking is the leading cause of home fire deaths, accounting for 20% of all fire deaths each year.

So if you’re a smoker, you are putting your own health at risk and endangering the lives of the people around you. Quitting smoking is the best way to protect yourself and your loved ones from the dangers of tobacco smoke.

2. Smoking Hurts The Environment

Cigarette butts are the most common form of litter. They’re made of cellulose acetate, a type of plastic that can take up to 12 years to degrade. Each year, billions of cigarette butts end up in landfills, parks, and beaches.

Tobacco production is also a leading cause of deforestation. In 2012, tobacco companies cleared more than 400,000 hectares of forestland. This deforestation contributes to climate change, as trees play a vital role in absorbing carbon dioxide from the atmosphere.

Smoking also pollutes the air and water. Cigarette smoke contains more than 7000 chemicals, including lead, mercury, and arsenic. These toxic chemicals are released into the environment when cigarettes are burned.

So, not only does smoking hurt your health, but it also hurts the planet.

3. Smoking Is Expensive

Tobacco taxes I have skyrocketed in recent years, making tobacco products prohibitively expensive. Taxing tobacco is popular with lawmakers of both parties because the data shows it prices many teens out of the market, it brings in the needed revenue for state governments, and gives smokers a strong financial incentive to quit, saving millions on Medicare and Medicaid costs.

Smoking cigarettes is costly not only to your wallet but also to the economy. Every year smoking costs the United States more than $240 billion in healthcare spending, nearly $185 billion in lost productivity from smoking-related illnesses and health conditions, nearly $180 billion in lost productivity from smoking-related premature death, and $7 billion in lost productivity from premature death from secondhand smoke exposure.

So, not only will quitting smoking save you money, but it will also help reduce the burden on our healthcare system.

4. Smoking Causes Wrinkles and Premature Aging

Smoking cigarettes causes wrinkles and premature aging. The chemicals in tobacco smoke damage the collagen and elastin in your skin, which leads to wrinkles, sagging skin, and a dull complexion.

Smoking also decreases the blood flow to your skin, which results in a loss of nutrients and oxygen. This can make your skin dry, thin, and more susceptible to wrinkling.

Not only does smoking damage your appearance, but it also increases your risk of developing skin cancer.

If you’re looking for a reason to quit smoking, your appearance should be enough motivation!

5. Smoking Can Damage Your Senses

Tobacco smoke damages the delicate lining of your nose and mouth, which can cause a decrease in your ability to smell and taste.

Tobacco smoke also irritates your eyes, leading to redness, watering, and blurred vision.

6. Smoking Causes Gum Disease and Tooth Loss

Tobacco smoke contains harmful chemicals that damage the gums and teeth, which can cause gum disease and tooth loss.

Gum disease can lead to tooth loss, receding gums, and bone loss. Gum disease is also linked to an increased risk of heart disease, stroke, and diabetes.

7. Smoking Increases your Risk of Cancer

Cigarette smoking is responsible for more than 30% of all cancer deaths in the United States. In 2020 cancer was the second leading cause of death after heart disease in the United States. Smoking is the leading cause of premature, preventable death in the U.S. and is the leading cause of cancer worldwide, causing almost six million deaths each year.

The prognosis for lung cancer is poor. The five-year survival rate for lung cancer is only 18%. This means that only 18% of people diagnosed with lung cancer will be alive five years after diagnosis.

Smoking also increases your risk of developing other types of cancer, such as bladder cancer, cervical cancer, throat cancer, mouth cancer, pancreatic cancer, and kidney cancer.

8. Smoking Increases your Risk of Heart Disease

Above all, smoking increases the risk of developing heart disease. Tobacco smoke damages the lining of the arteries, which can lead to a build-up of plaque. This can cause a narrowing of the arteries (atherosclerosis) and an increased risk of heart attack and stroke.

Smoking Can Also Cause:

• Peripheral Artery Disease – Peripheral artery disease (PAD) is a condition in which the arteries outside your heart and brain become narrowed or blocked. This can lead to reduced blood flow to your limbs, causing pain, numbness, or weakness. PAD can also lead to ulcers or gangrene (dead tissue) in your legs or feet.
• Aortic Aneurysm – An aortic aneurysm is a bulge or ballooning in the aorta, the large artery that carries blood from your heart to your body. An aortic aneurysm can rupture and cause life-threatening internal bleeding.
• Sudden Cardiac Death – Sudden cardiac death is a sudden, unexpected death caused by a change in heart rhythm (cardiac arrest).
• Respiratory Disease – Smoking also increases your risk of other respiratory diseases, such as emphysema, bronchitis, and chronic obstructive pulmonary disease (COPD). Cigarette smoking is responsible for more than 85% of COPD deaths.

Smoking is also linked to an increased risk of sudden cardiac death. Sudden cardiac death is a sudden, unexpected death caused by a change in heart rhythm (cardiac arrest).

Smoking is harmful to your health, and there are many ways that it can damage your body. If you’re looking for a reason to quit, consider your health. The benefits of quitting smoking are numerous, and your health is worth the effort.

9. Smoking Can Kill Your Unborn Child

Smoking during pregnancy can harm your baby. Smoking during pregnancy increases your risk of having a low-birth-weight baby, premature birth, placental abruption, and stillbirth.

Smoking is also linked to an increased risk of sudden infant death syndrome (SIDS). SIDS is the sudden, unexpected death of a baby under the age of one.

If you’re pregnant, quit smoking to give your baby a better chance at a healthy start in life.

10. Cigarettes Contain Many Harmful Chemicals

Cigarettes contain more than 7000 chemicals, including arsenic, carbon monoxide, lead, and formaldehyde. These chemicals are known to cause cancer.

When you inhale tobacco smoke, these harmful chemicals enter your bloodstream and are distributed throughout your body. They can damage your heart, lungs, blood vessels, and reproductive system.

Quitting smoking is the best way to reduce your exposure to these harmful chemicals.

There Are Many Resources Available To Help You Quit Smoking

If you’re ready to quit smoking, many resources are available to help you. Nicotine replacement therapy, prescription medications, and counseling can all be effective quitting aids. There are many anti-smoking organizations that can provide support and motivation.

Quit Smoking Resources

• Centers for Disease Control and Prevention: 800-CDC-INFO
• Quitting tips at www.tobaccofree.org/quitting /
• CDC’s quit-smoking website, www.Smokefree.gov

Anti-Smoking Organizations

• Tobacco Free Earth: Tobaccofree.org 310-577-9828
• Action on Smoking and Health: 202-296-5469
• American Cancer Society: 800-227-2345
• American Lung Association: 800-586-4872
• American Heart Association: 800-424-4301

If you’re not ready to quit smoking, try cutting down the number of cigarettes you smoke each day. Whatever you do, don’t give up on quitting smoking. You can stop tobacco use!

There are plenty of resources available to help you stop smoking.

Have a family member who died from cigarettes?

Help change the world by supporting an anti-smoking organization like Tobacco Free Earth, an international anti-vaping and anti-smoking group with a global outreach and mission.

Tobacco Free Earth prevents kids from starting tobacco, and empowers those addicted to stop smoking. They work with schools, youth groups, and community organizations. Their outreach is global, thanks to their website and a major grant from Google Ads. This raises public awareness about the dangers of smoking and tobacco use around the world.

The group also advocates for stronger local, state, and federal tobacco control laws.

You can help change the world by supporting an anti-smoking organization like Tobacco Free Earth, by sharing your story and raising awareness about the dangers of smoking. If you have a loved one who died from smoking, you donate in their memory at the group’s website.

Tobacco Free Earth is a tax-exempt, public foundation. If you’d like to support this worthy group, please donate now . Your gift will save lives.

Related Posts

Anti-Smoking Organizations Aim to Protect Teens and Save Lives

Anti-smoking organizations are on a mission to protect teenagers from the dangers of smoking and vaping. By raising awareness and providing resources, these anti-smoking organizations hope to save lives by stopping teenage smoking and vaping before they start. Smoking is the leading cause of preventable death in the United States, and teenage smokers are at significantly higher risk for health problems later in life. If you’re looking for ways to help stop teen smoking and vaping, keep reading!

Tobaccofree Earth is an international anti-vaping and anti-smoking group with a global outreach and mission. Please  donate now  to support the vital work we are doing.

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