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Argumentative Essay on Smoking Cigarettes

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Words: 507 |

Published: Mar 13, 2024

Words: 507 | Page: 1 | 3 min read

Health effects of smoking, economic implications, impact on non-smokers, the case for regulation, references:.

Centers for Disease Control and Prevention. (2020). Smoking & Tobacco Use. Retrieved from https://www.cdc.gov/tobacco/data_statistics/index.htm

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Essay on Smoking

500 words essay on smoking.

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

Ill-Effects of Smoking

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

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

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

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

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

How to Quit Smoking?

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

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

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

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

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

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

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

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

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

Question 2: Why should we avoid smoking?

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

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Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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Keep reading

Essay on Smoking Cigarettes

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

Let’s take a look…

100 Words Essay on Smoking Cigarettes

Harmful habit.

Smoking cigarettes is a dangerous habit that can lead to many health issues. The chemicals in cigarettes damage the lungs and heart, and they can also cause cancer.

Effects on the Lungs

Smoking cigarettes paralyzes the tiny hairs in the lungs that help to keep them clean. This makes it easier for tar and other harmful substances to build up in the lungs, which can lead to lung disease and cancer.

Effects on the Heart

Smoking cigarettes increases the risk of heart disease and stroke. The chemicals in cigarettes damage the blood vessels and make them more likely to form clots. Smoking also raises blood pressure and cholesterol levels, which are both risk factors for heart disease.

Effects on Cancer

Smoking cigarettes is the leading cause of preventable cancer deaths. The chemicals in cigarettes can damage DNA and cause cells to grow out of control. Smoking cigarettes increases the risk of cancer of the lungs, mouth, throat, esophagus, stomach, pancreas, kidney, and bladder.

250 Words Essay on Smoking Cigarettes

Smoking cigarettes: a harmful habit.

Smoking cigarettes is a habit that can have serious consequences for your health. Cigarettes contain harmful chemicals that can cause cancer, heart disease, and other health problems.

Smoking cigarettes is the leading cause of preventable cancer deaths. Cigarettes contain chemicals that can damage the DNA in your cells, which can lead to cancer. The chemicals in cigarettes can also cause inflammation, which is a risk factor for cancer.

Heart Disease

Smoking cigarettes increases your risk of heart disease. The chemicals in cigarettes can damage the blood vessels in your heart, which can lead to a heart attack or stroke. Smoking cigarettes can also raise your blood pressure and cholesterol levels, which are also risk factors for heart disease.

Quitting Smoking

If you smoke cigarettes, quitting is the best thing you can do for your health. Quitting smoking can reduce your risk of cancer, heart disease, and other health problems. It can also improve your appearance, energy levels, and overall quality of life.

There are many resources available to help you quit smoking. Talk to your doctor, pharmacist, or other healthcare provider. You can also find support and information online or through quit-smoking programs.

Smoking cigarettes is a harmful habit that can have serious consequences for your health. If you smoke, quitting is the best thing you can do for your health. There are many resources available to help you quit smoking.

500 Words Essay on Smoking Cigarettes

What are cigarettes.

Cigarettes are small, cylindrical objects made of tobacco leaves that are rolled in paper. They are lit at one end and smoked, with the smoke being inhaled into the lungs.

Why Do People Smoke?

There are many reasons why people start smoking cigarettes. Some people think it looks cool, while others believe it helps them to relax or concentrate. Still others may smoke because they are addicted to nicotine, a chemical found in tobacco that can make people feel good.

The Dangers of Smoking

Smoking cigarettes is a very dangerous habit. It can cause a number of health problems, including lung cancer, heart disease, and stroke. Smoking can also increase the risk of developing other diseases, such as COPD, emphysema, and bronchitis.

The Effects of Smoking on the Body

When you smoke a cigarette, the nicotine in the tobacco quickly enters your bloodstream. This can cause your heart rate and blood pressure to increase, and it can also make you feel lightheaded or dizzy. Smoking can also damage your lungs and other organs, and it can lead to a number of health problems.

If you smoke cigarettes, the best thing you can do for your health is to quit. Quitting smoking can be difficult, but it is possible. There are many resources available to help you quit, such as support groups, counseling, and medication.

Smoking cigarettes is a harmful habit that can lead to a number of health problems. If you smoke, the best thing you can do for your health is to quit. There are many resources available to help you quit, so there is no reason to continue smoking.

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

If you’re looking for more, here are essays on other interesting topics:

Essay on Smoking Ban In Public Places
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Happy studying!

Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

Introduction

Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation’s public and economic health in the future ( Perry et al. 1994 ; Kessler 1995 ). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending on health care ( Anderson 2010 ), is well-documented and undeniable. Although progress has been made since the first Surgeon General’s report on smoking and health in 1964 ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 ), nearly one in four high school seniors is a current smoker. Most young smokers become adult smokers. One-half of adult smokers die prematurely from tobacco-related diseases ( Fagerström 2002 ; Doll et al. 2004 ). Despite thousands of programs to reduce youth smoking and hundreds of thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products, and family after family continues to suffer the devastating consequences. Yet a robust science base exists on social, biological, and environmental factors that influence young people to use tobacco, the physiology of progression from experimentation to addiction, other health effects of tobacco use, the epidemiology of youth and young adult tobacco use, and evidence-based interventions that have proven effective at reducing both initiation and prevalence of tobacco use among young people. Those are precisely the issues examined in this report, which aims to support the application of this robust science base.

Nearly all tobacco use begins in childhood and adolescence ( U.S. Department of Health and Human Services [USDHHS] 1994 ). In all, 88% of adult smokers who smoke daily report that they started smoking by the age of 18 years (see Chapter 3 , “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”). This is a time in life of great vulnerability to social influences ( Steinberg 2004 ), such as those offered through the marketing of tobacco products and the modeling of smoking by attractive role models, as in movies ( Dalton et al. 2009 ), which have especially strong effects on the young. This is also a time in life of heightened sensitivity to normative influences: as tobacco use is less tolerated in public areas and there are fewer social or regular users of tobacco, use decreases among youth ( Alesci et al. 2003 ). And so, as we adults quit, we help protect our children.

Cigarettes are the only legal consumer products in the world that cause one-half of their long-term users to die prematurely ( Fagerström 2002 ; Doll et al. 2004 ). As this epidemic continues to take its toll in the United States, it is also increasing in low- and middle-income countries that are least able to afford the resulting health and economic consequences ( Peto and Lopez 2001 ; Reddy et al. 2006 ). It is past time to end this epidemic. To do so, primary prevention is required, for which our focus must be on youth and young adults. As noted in this report, we now have a set of proven tools and policies that can drastically lower youth initiation and use of tobacco products. Fully committing to using these tools and executing these policies consistently and aggressively is the most straight forward and effective to making future generations tobacco-free.

The 1994 Surgeon General’s Report

This Surgeon General’s report on tobacco is the second to focus solely on young people since these reports began in 1964. Its main purpose is to update the science of smoking among youth since the first comprehensive Surgeon General’s report on tobacco use by youth, Preventing Tobacco Use Among Young People , was published in 1994 ( USDHHS 1994 ). That report concluded that if young people can remain free of tobacco until 18 years of age, most will never start to smoke. The report documented the addiction process for young people and how the symptoms of addiction in youth are similar to those in adults. Tobacco was also presented as a gateway drug among young people, because its use generally precedes and increases the risk of using illicit drugs. Cigarette advertising and promotional activities were seen as a potent way to increase the risk of cigarette smoking among young people, while community-wide efforts were shown to have been successful in reducing tobacco use among youth. All of these conclusions remain important, relevant, and accurate, as documented in the current report, but there has been considerable research since 1994 that greatly expands our knowledge about tobacco use among youth, its prevention, and the dynamics of cessation among young people. Thus, there is a compelling need for the current report.

Tobacco Control Developments

Since 1994, multiple legal and scientific developments have altered the tobacco control environment and thus have affected smoking among youth. The states and the U.S. Department of Justice brought lawsuits against cigarette companies, with the result that many internal documents of the tobacco industry have been made public and have been analyzed and introduced into the science of tobacco control. Also, the 1998 Master Settlement Agreement with the tobacco companies resulted in the elimination of billboard and transit advertising as well as print advertising that directly targeted underage youth and limitations on the use of brand sponsorships ( National Association of Attorneys General [NAAG] 1998 ). This settlement also created the American Legacy Foundation, which implemented a nationwide antismoking campaign targeting youth. In 2009, the U.S. Congress passed a law that gave the U.S. Food and Drug Administration authority to regulate tobacco products in order to promote the public’s health ( Family Smoking Prevention and Tobacco Control Act 2009 ). Certain tobacco companies are now subject to regulations limiting their ability to market to young people. In addition, they have had to reimburse state governments (through agreements made with some states and the Master Settlement Agreement) for some health care costs. Due in part to these changes, there was a decrease in tobacco use among adults and among youth following the Master Settlement Agreement, which is documented in this current report.

Recent Surgeon General Reports Addressing Youth Issues

Other reports of the Surgeon General since 1994 have also included major conclusions that relate to tobacco use among youth ( Office of the Surgeon General 2010 ). In 1998, the report focused on tobacco use among U.S. racial/ethnic minority groups ( USDHHS 1998 ) and noted that cigarette smoking among Black and Hispanic youth increased in the 1990s following declines among all racial/ethnic groups in the 1980s; this was particularly notable among Black youth, and culturally appropriate interventions were suggested. In 2000, the report focused on reducing tobacco use ( USDHHS 2000b ). A major conclusion of that report was that school-based interventions, when implemented with community- and media-based activities, could reduce or postpone the onset of smoking among adolescents by 20–40%. That report also noted that effective regulation of tobacco advertising and promotional activities directed at young people would very likely reduce the prevalence and onset of smoking. In 2001, the Surgeon General’s report focused on women and smoking ( USDHHS 2001 ). Besides reinforcing much of what was discussed in earlier reports, this report documented that girls were more affected than boys by the desire to smoke for the purpose of weight control. Given the ongoing obesity epidemic ( Bonnie et al. 2007 ), the current report includes a more extensive review of research in this area.

The 2004 Surgeon General’s report on the health consequences of smoking ( USDHHS 2004 ) concluded that there is sufficient evidence to infer that a causal relationship exists between active smoking and (a) impaired lung growth during childhood and adolescence; (b) early onset of decline in lung function during late adolescence and early adulthood; (c) respiratory signs and symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea; and (d) asthma-related symptoms (e.g., wheezing) in childhood and adolescence. The 2004 Surgeon General’s report further provided evidence that cigarette smoking in young people is associated with the development of atherosclerosis.

The 2010 Surgeon General’s report on the biology of tobacco focused on the understanding of biological and behavioral mechanisms that might underlie the pathogenicity of tobacco smoke ( USDHHS 2010 ). Although there are no specific conclusions in that report regarding adolescent addiction, it does describe evidence indicating that adolescents can become dependent at even low levels of consumption. Two studies ( Adriani et al. 2003 ; Schochet et al. 2005 ) referenced in that report suggest that because the adolescent brain is still developing, it may be more susceptible and receptive to nicotine than the adult brain.

Scientific Reviews

Since 1994, several scientific reviews related to one or more aspects of tobacco use among youth have been undertaken that also serve as a foundation for the current report. The Institute of Medicine (IOM) ( Lynch and Bonnie 1994 ) released Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, a report that provided policy recommendations based on research to that date. In 1998, IOM provided a white paper, Taking Action to Reduce Tobacco Use, on strategies to reduce the increasing prevalence (at that time) of smoking among young people and adults. More recently, IOM ( Bonnie et al. 2007 ) released a comprehensive report entitled Ending the Tobacco Problem: A Blueprint for the Nation . Although that report covered multiple potential approaches to tobacco control, not just those focused on youth, it characterized the overarching goal of reducing smoking as involving three distinct steps: “reducing the rate of initiation of smoking among youth (IOM [ Lynch and Bonnie] 1994 ), reducing involuntary tobacco smoke exposure ( National Research Council 1986 ), and helping people quit smoking” (p. 3). Thus, reducing onset was seen as one of the primary goals of tobacco control.

As part of USDHHS continuing efforts to assess the health of the nation, prevent disease, and promote health, the department released, in 2000, Healthy People 2010 and, in 2010, Healthy People 2020 ( USDHHS 2000a , 2011 ). Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Each iteration of Healthy People serves as the nation’s disease prevention and health promotion roadmap for the decade. Both Healthy People 2010 and Healthy People 2020 highlight “Tobacco Use” as one of the nation’s “Leading Health Indicators,” feature “Tobacco Use” as one of its topic areas, and identify specific measurable tobacco-related objectives and targets for the nation to strive for. Healthy People 2010 and Healthy People 2020 provide tobacco objectives based on the most current science and detailed population-based data to drive action, assess tobacco use among young people, and identify racial and ethnic disparities. Additionally, many of the Healthy People 2010 and 2020 tobacco objectives address reductions of tobacco use among youth and target decreases in tobacco advertising in venues most often influencing young people. A complete list of the healthy people 2020 objectives can be found on their Web site ( USDHHS 2011 ).

In addition, the National Cancer Institute (NCI) of the National Institutes of Health has published monographs pertinent to the topic of tobacco use among youth. In 2001, NCI published Monograph 14, Changing Adolescent Smoking Prevalence , which reviewed data on smoking among youth in the 1990s, highlighted important statewide intervention programs, presented data on the influence of marketing by the tobacco industry and the pricing of cigarettes, and examined differences in smoking by racial/ethnic subgroup ( NCI 2001 ). In 2008, NCI published Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use ( NCI 2008 ). Although young people were not the sole focus of this Monograph, the causal relationship between tobacco advertising and promotion and increased tobacco use, the impact on youth of depictions of smoking in movies, and the success of media campaigns in reducing youth tobacco use were highlighted as major conclusions of the report.

The Community Preventive Services Task Force (2011) provides evidence-based recommendations about community preventive services, programs, and policies on a range of topics including tobacco use prevention and cessation ( Task Force on Community Preventive Services 2001 , 2005 ). Evidence reviews addressing interventions to reduce tobacco use initiation and restricting minors’ access to tobacco products were cited and used to inform the reviews in the current report. The Cochrane Collaboration (2010) has also substantially contributed to the review literature on youth and tobacco use by producing relevant systematic assessments of health-related programs and interventions. Relevant to this Surgeon General’s report are Cochrane reviews on interventions using mass media ( Sowden 1998 ), community interventions to prevent smoking ( Sowden and Stead 2003 ), the effects of advertising and promotional activities on smoking among youth ( Lovato et al. 2003 , 2011 ), preventing tobacco sales to minors ( Stead and Lancaster 2005 ), school-based programs ( Thomas and Perara 2006 ), programs for young people to quit using tobacco ( Grimshaw and Stanton 2006 ), and family programs for preventing smoking by youth ( Thomas et al. 2007 ). These reviews have been cited throughout the current report when appropriate.

In summary, substantial new research has added to our knowledge and understanding of tobacco use and control as it relates to youth since the 1994 Surgeon General’s report, including updates and new data in subsequent Surgeon General’s reports, in IOM reports, in NCI Monographs, and in Cochrane Collaboration reviews, in addition to hundreds of peer-reviewed publications, book chapters, policy reports, and systematic reviews. Although this report is a follow-up to the 1994 report, other important reviews have been undertaken in the past 18 years and have served to fill the gap during an especially active and important time in research on tobacco control among youth.

Focus of the Report

Young People

This report focuses on “young people.” In general, work was reviewed on the health consequences, epidemiology, etiology, reduction, and prevention of tobacco use for those in the young adolescent (11–14 years of age), adolescent (15–17 years of age), and young adult (18–25 years of age) age groups. When possible, an effort was made to be specific about the age group to which a particular analysis, study, or conclusion applies. Because hundreds of articles, books, and reports were reviewed, however, there are, unavoidably, inconsistencies in the terminology used. “Adolescents,” “children,” and “youth” are used mostly interchangeably throughout this report. In general, this group encompasses those 11–17 years of age, although “children” is a more general term that will include those younger than 11 years of age. Generally, those who are 18–25 years old are considered young adults (even though, developmentally, the period between 18–20 years of age is often labeled late adolescence), and those 26 years of age or older are considered adults.

In addition, it is important to note that the report is concerned with active smoking or use of smokeless tobacco on the part of the young person. The report does not consider young people’s exposure to secondhand smoke, also referred to as involuntary or passive smoking, which was discussed in the 2006 report of the Surgeon General ( USDHHS 2006 ). Additionally, the report does not discuss research on children younger than 11 years old; there is very little evidence of tobacco use in the United States by children younger than 11 years of age, and although there may be some predictors of later tobacco use in those younger years, the research on active tobacco use among youth has been focused on those 11 years of age and older.

Tobacco Use

Although cigarette smoking is the most common form of tobacco use in the United States, this report focuses on other forms as well, such as using smokeless tobacco (including chew and snuff) and smoking a product other than a cigarette, such as a pipe, cigar, or bidi (tobacco wrapped in tendu leaves). Because for young people the use of one form of tobacco has been associated with use of other tobacco products, it is particularly important to monitor all forms of tobacco use in this age group. The term “tobacco use” in this report indicates use of any tobacco product. When the word “smoking” is used alone, it refers to cigarette smoking.

Organization of the Report

This chapter begins by providing a short synopsis of other reports that have addressed smoking among youth and, after listing the major conclusions of this report, will end by presenting conclusions specific to each chapter. Chapter 2 of this report (“The Health Consequences of Tobacco Use Among Young People”) focuses on the diseases caused by early tobacco use, the addiction process, the relation of body weight to smoking, respiratory and pulmonary problems associated with tobacco use, and cardiovascular effects. Chapter 3 (“The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”) provides recent and long-term cross-sectional and longitudinal data on cigarette smoking, use of smokeless tobacco, and the use of other tobacco products by young people, by racial/ethnic group and gender, primarily in the United States, but including some worldwide data as well. Chapter 4 (“Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth”) identifies the primary risk factors associated with tobacco use among youth at four levels, including the larger social and physical environments, smaller social groups, cognitive factors, and genetics and neurobiology. Chapter 5 (“The Tobacco Industry’s Influences on the Use of Tobacco Among Youth”) includes data on marketing expenditures for the tobacco industry over time and by category, the effects of cigarette advertising and promotional activities on young people’s smoking, the effects of price and packaging on use, the use of the Internet and movies to market tobacco products, and an evaluation of efforts by the tobacco industry to prevent tobacco use among young people. Chapter 6 (“Efforts to Prevent and Reduce Tobacco Use Among Young People”) provides evidence on the effectiveness of family-based, clinic-based, and school-based programs, mass media campaigns, regulatory and legislative approaches, increased cigarette prices, and community and statewide efforts in the fight against tobacco use among youth. Chapter 7 (“A Vision for Ending the Tobacco Epidemic”) points to next steps in preventing and reducing tobacco use among young people.

Preparation of the Report

This report of the Surgeon General was prepared by the Office on Smoking and Health (OSH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), USDHHS. In 2008, 18 external independent scientists reviewed the 1994 report and suggested areas to be added and updated. These scientists also suggested chapter editors and a senior scientific editor, who were contacted by OSH. Each chapter editor named external scientists who could contribute, and 33 content experts prepared draft sections. The draft sections were consolidated into chapters by the chapter editors and then reviewed by the senior scientific editor, with technical editing performed by CDC. The chapters were sent individually to 34 peer reviewers who are experts in the areas covered and who reviewed the chapters for scientific accuracy and comprehensiveness. The entire manuscript was then sent to more than 25 external senior scientists who reviewed the science of the entire document. After each review cycle, the drafts were revised by the chapter and senior scientific editor on the basis of the experts’ comments. Subsequently, the report was reviewed by various agencies within USDHHS. Publication lags prevent up-to-the-minute inclusion of all recently published articles and data, and so some more recent publications may not be cited in this report.

Evaluation of the Evidence

Since the first Surgeon General’s report in 1964 on smoking and health ( USDHEW 1964 ), major conclusions concerning the conditions and diseases caused by cigarette smoking and the use of smokeless tobacco have been based on explicit criteria for causal inference ( USDHHS 2004 ). Although a number of different criteria have been proposed for causal inference since the 1960s, this report focuses on the five commonly accepted criteria that were used in the original 1964 report and that are discussed in greater detail in the 2004 report on the health consequences of smoking ( USDHHS 2004 ). The five criteria refer to the examination of the association between two variables, such as a risk factor (e.g., smoking) and an outcome (e.g., lung cancer). Causal inference between these variables is based on (1) the consistency of the association across multiple studies; this is the persistent finding of an association in different persons, places, circumstances, and times; (2) the degree of the strength of association, that is, the magnitude and statistical significance of the association in multiple studies; (3) the specificity of the association to clearly demonstrate that tobacco use is robustly associated with the condition, even if tobacco use has multiple effects and multiple causes exist for the condition; (4) the temporal relationship of the association so that tobacco use precedes disease onset; and (5) the coherence of the association, that is, the argument that the association makes scientific sense, given data from other sources and understanding of biological and psychosocial mechanisms ( USDHHS 2004 ). Since the 2004 Surgeon General’s report, The Health Consequences of Smoking , a four-level hierarchy ( Table 1.1 ) has been used to assess the research data on associations discussed in these reports ( USDHHS 2004 ). In general, this assessment was done by the chapter editors and then reviewed as appropriate by peer reviewers, senior scientists, and the scientific editors. For a relationship to be considered sufficient to be characterized as causal, multiple studies over time provided evidence in support of each criteria.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

When a causal association is presented in the chapter conclusions in this report, these four levels are used to describe the strength of the evidence of the association, from causal (1) to not causal (4). Within the report, other terms are used to discuss the evidence to date (i.e., mixed, limited, and equivocal evidence), which generally represent an inadequacy of data to inform a conclusion.

However, an assessment of a casual relationship is not utilized in presenting all of the report’s conclusions. The major conclusions are written to be important summary statements that are easily understood by those reading the report. Some conclusions, particularly those found in Chapter 3 (epidemiology), provide observations and data related to tobacco use among young people, and are generally not examinations of causal relationships. For those conclusions that are written using the hierarchy above, a careful and extensive review of the literature has been undertaken for this report, based on the accepted causal criteria ( USDHHS 2004 ). Evidence that was characterized as Level 1 or Level 2 was prioritized for inclusion as chapter conclusions.

In additional to causal inferences, statistical estimation and hypothesis testing of associations are presented. For example, confidence intervals have been added to the tables in the chapter on the epidemiology of youth tobacco use (see Chapter 3 ), and statistical testing has been conducted for that chapter when appropriate. The chapter on efforts to prevent tobacco use discusses the relative improvement in tobacco use rates when implementing one type of program (or policy) versus a control program. Statistical methods, including meta-analytic methods and longitudinal trajectory analyses, are also presented to ensure that the methods of evaluating data are up to date with the current cutting-edge research that has been reviewed. Regardless of the methods used to assess significance, the five causal criteria discussed above were applied in developing the conclusions of each chapter and the report.

Major Conclusions
Cigarette smoking by youth and young adults has immediate adverse health consequences, including addiction, and accelerates the development of chronic diseases across the full life course.
Prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults.
After years of steady progress, declines in the use of tobacco by youth and young adults have slowed for cigarette smoking and stalled for smokeless tobacco use.
Coordinated, multicomponent interventions that combine mass media campaigns, price increases including those that result from tax increases, school-based policies and programs, and statewide or community-wide changes in smoke-free policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults.
Chapter Conclusions

The following are the conclusions presented in the substantive chapters of this report.

Chapter 2. The Health Consequences of Tobacco Use Among Young People

The evidence is sufficient to conclude that there is a causal relationship between smoking and addiction to nicotine, beginning in adolescence and young adulthood.
The evidence is suggestive but not sufficient to conclude that smoking contributes to future use of marijuana and other illicit drugs.
The evidence is suggestive but not sufficient to conclude that smoking by adolescents and young adults is not associated with significant weight loss, contrary to young people’s beliefs.
The evidence is sufficient to conclude that there is a causal relationship between active smoking and both reduced lung function and impaired lung growth during childhood and adolescence.
The evidence is sufficient to conclude that there is a causal relationship between active smoking and wheezing severe enough to be diagnosed as asthma in susceptible child and adolescent populations.
The evidence is sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and early abdominal aortic atherosclerosis in young adults.
The evidence is suggestive but not sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and coronary artery atherosclerosis in adulthood.

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
Almost one in four high school seniors is a current (in the past 30 days) cigarette smoker, compared with one in three young adults and one in five adults. About 1 in 10 high school senior males is a current smokeless tobacco user, and about 1 in 5 high school senior males is a current cigar smoker.
Among adolescents and young adults, cigarette smoking declined from the late 1990s, particularly after the Master Settlement Agreement in 1998. This decline has slowed in recent years, however.
Significant disparities in tobacco use remain among young people nationwide. The prevalence of cigarette smoking is highest among American Indians and Alaska Natives, followed by Whites and Hispanics, and then Asians and Blacks. The prevalence of cigarette smoking is also highest among lower socioeconomic status youth.
Use of smokeless tobacco and cigars declined in the late 1990s, but the declines appear to have stalled in the last 5 years. The latest data show the use of smokeless tobacco is increasing among White high school males, and cigar smoking may be increasing among Black high school females.
Concurrent use of multiple tobacco products is prevalent among youth. Among those who use tobacco, nearly one-third of high school females and more than one-half of high school males report using more than one tobacco product in the last 30 days.
Rates of tobacco use remain low among girls relative to boys in many developing countries, however, the gender gap between adolescent females and males is narrow in many countries around the globe.

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

Given their developmental stage, adolescents and young adults are uniquely susceptible to social and environmental influences to use tobacco.
Socioeconomic factors and educational attainment influence the development of youth smoking behavior. The adolescents most likely to begin to use tobacco and progress to regular use are those who have lower academic achievement.
The evidence is sufficient to conclude that there is a causal relationship between peer group social influences and the initiation and maintenance of smoking behaviors during adolescence.
Affective processes play an important role in youth smoking behavior, with a strong association between youth smoking and negative affect.
The evidence is suggestive that tobacco use is a heritable trait, more so for regular use than for onset. The expression of genetic risk for smoking among young people may be moderated by small-group and larger social-environmental factors.

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

In 2008, tobacco companies spent $9.94 billion on the marketing of cigarettes and $547 million on the marketing of smokeless tobacco. Spending on cigarette marketing is 48% higher than in 1998, the year of the Master Settlement Agreement. Expenditures for marketing smokeless tobacco are 277% higher than in 1998.
Tobacco company expenditures have become increasingly concentrated on marketing efforts that reduce the prices of targeted tobacco products. Such expenditures accounted for approximately 84% of cigarette marketing and more than 77% of the marketing of smokeless tobacco products in 2008.
The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people.
The evidence is suggestive but not sufficient to conclude that tobacco companies have changed the packaging and design of their products in ways that have increased these products’ appeal to adolescents and young adults.
The tobacco companies’ activities and programs for the prevention of youth smoking have not demonstrated an impact on the initiation or prevalence of smoking among young people.
The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

The evidence is sufficient to conclude that mass media campaigns, comprehensive community programs, and comprehensive statewide tobacco control programs can prevent the initiation of tobacco use and reduce its prevalence among youth.
The evidence is sufficient to conclude that increases in cigarette prices reduce the initiation, prevalence, and intensity of smoking among youth and young adults.
The evidence is sufficient to conclude that school-based programs with evidence of effectiveness, containing specific components, can produce at least short-term effects and reduce the prevalence of tobacco use among school-aged youth.
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Cite this Page National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012. 1, Introduction, Summary, and Conclusions.
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Smoking and Its Effect on the Brain Essay

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Introduction

Effects on the brain, neuroscience, motivation to engage in quitting smoking behavior.

Global use of tobacco is growing rapidly and consequently contributing to the global burden of disease. Currently, 50% of men and 9% of women in developing countries smoke, as compared with 35% of men and 22% of women in developed countries. According to WHO report, tobacco was ranked fourth among the ten leading risk factors in terms of avoidable disease burden and remains high on the list in the 2010 projections (Lloyd, 1998). Many cases of illness have been reported to be caused by tobacco and nicotine smoking. In the year 2000, tobacco alone contributed 5% of lung illness. In addition, males have been more prone to smoking illness especially in the United States and United Kingdom.

The main reason why smoking is widely used is the immediate effects that result after smoking. People smoke for the pleasure associated with it while others smoke for social reasons. In the recent decade, vast research on smoking has widely improved our understanding of human physiology and behavior (Goodwin & Hamilton, 2002). The research has further reported that addition is a biological brain disease which can be chronic or relapsing in nature. The main reason why most individuals engage in the habit of smoking psychoactive substances is the ‘benefit’ associated with them after they enter the body. An effect such as relaxation of mind and pleasure prompts most people to take drugs. However smoking may result in either short-term or long term harmful effects in your body. Long term effects include chronic diseases such as lung cancer as well as emphysema. Other categories such as acute social problems and chronic social problems may arise due to smoking.

Substance addiction or dependence is a disorder of altered brain function caused by prolonged use of psychoactive substances. In addition smoking affects the emotional and motivational process occurring in the brain. Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The brain is affected by smoking and may result to traumas, illness such as stroke and brain injuries. Tobacco or nicotine affects the brain cell by linking at various receptors at the neural pathway. The effect is coordinated to affect and stabilize the pain or pleasure pathway. Recent developments in substance abuse and addiction have cited the root causes of such behaviors. To date, researchers have identified several factors that lead to these conditions such as poverty, racism, weak families, peer pressure, lack of education, social dysfunction and many others. In addition, genetics and environment have played a critical role in smoking (Lloyd, 1998).

After the initial use of the dependence substance, the victim’s mood, perception and emotional state are instantly modified. There are four common routes of administering psychoactive substances in the body. This include; oral consumption, intranasal consumption, smoking (inhalation into the lungs) and intravenous injection. Once the psychoactive substance enters the brain system they immediately exert their effect. The brain is highly organized into a number of different regions with specialized functions (Cardinal, 2002). The hindbrain is the part of the brain that functions as a life maintaining region as well as controlling other useful activities such as breathing and alertness. The part of the brain referred to as the midbrain is important when substances like nicotine or tobacco enter the brain.

The midbrain is involved with motivation and learning about the external environment and controls various body behaviors such as smoking, drinking and eating. The forebrain is highly developed and more complex compared to the midbrain. Its main function is to help a person to think and be perceptive in receiving information and organizing thoughts. Recent research on brain-imaging has demonstrated that smoke is responsible for activating the forebrain region. In addition, the activation results in craving to smoke and thereby the person becoming addicted. However, the forebrain has also been seen to function abnormally in most long term smokers. The work of neurons is to transmit information and coordinate messengers in the brain and the rest of the body. The brain structure has neurons that bind to different and specific receptor. However, when psychoactive substances get into the brain region they actually mimic the neurotransmitters and convey a message. This affects the brain’s normal function of coordinating information.

They do this by blocking the neurotransmitter immediately when it is activated at the presynaptic terminal (Cardinal, 2002). Psychoactive substances are divided into two groups. Those that interact and increase the function of the receptors are precisely referred to as agonists, and those that interact to stop or block (the antagonists) the normal function of the brain. The several different psychoactive substances affect the brain in different ways with each subjecting the brain to different illness. This is because tobacco bind to a specific receptor from nicotine and therefore the brain react differently. The resulting emotional effects are therefore different since the brain tolerates them in different ways.

A successive survey indicates that over 60% of the smokers want to quit the habit. Very few have succeeded while others attempt more than five times before dropping the habit successfully. Since most of the psychoactive substances are addictive, quitting becomes a difficult task to overcome. The main key factor to quit smoking is motivation. An addict should be motivated through rehabilitation centers, engaging in activities sports or other activities that will help his or her mind forget the craving of smoking. The smoker is therefore required to overcome those factors that make the processes of quitting difficult. Another factor that the smoker has to fight with is the intensity of the withdrawal symptoms which has been suggested to be the basic contributing factors that hinders quitting.

The first days of quitting are associated with discomfort, anxiety, sleepiness, irritability and many more. Such symptoms may continue for the first 30 days or months (Robinson & Berridge, 2000). People with nicotine-dependence faces great obstacles during the process of quitting. They usually have low confidence and perceive quitting as a difficult process. The heavy smokers often express verbal desire to quit the habit though this is not translated to real life since they are not fully motivated to take the path. Another hallmark obstacle is the weight factor associated with smoking. Recent epidemiological studies reports indicate that nonsmokers weigh more than smokers. However, other studies have shown alterations of weight gain or loss during the life of nicotine smokers. During weight gain periods, the smoker experiences depression, irritability, aggression as well as abstention. Theories behind weight changes include, increased rate in metabolism and loss of appetite

The health data have clearly suggested the main cause of mental illness to be associated with smoking. This is because most people with mental illness are smokers. This indicates a close connection between smoking and the brain. However those individuals with a clear record of past history of depression are likely to quit smoking compared to their counterparts. Treatment of the habit requires a combination of medical and behavioral therapies though controversial debates have accompanied these kinds of treatments. For instance, public announcements through the media for the dangers of nicotine have successfully motivated people not to smoke.

Goodwin, R & Hamilton, S. (2002). Cigarette smoking and panic: the role of neuroticism. American Journal of Psychiatry , 159(7), 1208-13.

Cardinal, N. (2002). Emotion and motivation: the role of the amygdala, ventral striatum, and prefrontal cortex. Neuroscience and Biobehavioral Reviews , 26(2), 321–352.

Lloyd, C. (1998). Risk factors for problem drug use: identifying vulnerable groups. Drugs: Education Prevention and Policy , 5(1), 217–232.

Robinson, T. E. & Berridge, K. C. 2000. The psychology and neurobiology of addiction: an incentive-sensitization view. Addiction , 95(2), S91–S117.

Psychoactive Drug Testing on Animals
Importance of Quitting Smoking
Quitting Smoking: Strategies and Consequences
Working With Working Memory
Learning and Making the Connection: The Neuron, Synaptic Transmission
Relationship Between the Brain and the Nervous System
Spinal Cord Injuries and New Treatments
Dopamine as a Neurotransmitter
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Peer-reviewed

Research Article

Moderation of the real-world effectiveness of smoking cessation aids by mental health conditions: A population study

Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft

* E-mail: [email protected]

Affiliations Department of Behavioural Science and Health, University College London, London, United Kingdom, SPECTRUM Consortium, London, United Kingdom

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Writing – review & editing

Affiliations SPECTRUM Consortium, London, United Kingdom, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom

Roles Conceptualization, Data curation, Investigation, Methodology, Writing – review & editing

Roles Conceptualization, Investigation, Methodology, Writing – review & editing

Roles Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Supervision, Writing – review & editing

Sarah E. Jackson,
Leonie Brose,
Vera Buss,
Lion Shahab,
Deborah Robson,
Jamie Brown

Published: June 4, 2024
https://doi.org/10.1371/journal.pmen.0000007
Peer Review
Reader Comments

To examine whether the real-world effectiveness of popular smoking cessation aids differs between users with and without a history of mental health conditions.

Nationally-representative cross-sectional survey conducted monthly between 2016–17 and 2020–23.

Participants

5,593 adults (2,524 with a history of ≥1 mental health conditions and 3,069 without) who had smoked regularly within the past year and had attempted to quit at least once in the past year.

Main outcome measures

The outcome was self-reported abstinence from quit date up to the survey. Independent variables were use of the following cessation aids during the most recent quit attempt: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, vaping products, face-to-face behavioural support, telephone support, written self-help materials, websites, hypnotherapy, Allen Carr’s Easyway, heated tobacco products, and nicotine pouches. The moderator was history of diagnosed mental health conditions (yes/no). Covariates included sociodemographic characteristics, level of cigarette addiction, and characteristics of the quit attempt.

Relative to those without, participants with a history of mental health conditions were significantly more likely to report using vaping products (38.8% [95%CI 36.7–40.8] vs. 30.7% [28.9–32.5]), prescription NRT (4.8% [3.9–5.7] vs. 2.7% [2.1–3.3]), and websites (4.0% [3.2–4.8] vs. 2.2% [1.6–2.7]). Groups did not differ significantly in their use of other aids. After adjusting for covariates and use of other cessation aids, those who used vaping products (OR = 1.92, 95%CI 1.61–2.30), varenicline (OR = 1.88, 95%CI 1.19–2.98), or heated tobacco products (OR = 2.33, 95%CI 1.01–5.35) had significantly higher odds of quitting successfully than those who did not report using these aids. There was little evidence that using other cessation aids increased the odds of successful cessation, or that the user’s history of mental health conditions moderated the effectiveness of any aid.

Conclusions

Use of vaping products, varenicline, or heated tobacco products in a quit attempt was associated with significantly greater odds of successful cessation, after adjustment for use of other cessation aids and potential confounders. There was no evidence to suggest the effectiveness of any popular cessation aid differed according to the user’s history of mental health conditions.

Citation: Jackson SE, Brose L, Buss V, Shahab L, Robson D, Brown J (2024) Moderation of the real-world effectiveness of smoking cessation aids by mental health conditions: A population study. PLOS Ment Health 1(1): e0000007. https://doi.org/10.1371/journal.pmen.0000007

Editor: Sasidhar Gunturu, BronxCare Health System, UNITED STATES

Received: December 4, 2023; Accepted: March 6, 2024; Published: June 4, 2024

Copyright: © 2024 Jackson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data used in these analyses are available on Open Science Framework ( https://osf.io/5xubc/ ).

Funding: This work was supported by CRUK (PRCRPG-Nov21\100002 to JB) and UK Prevention Research Partnership (MR/S037519/1 to LB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: JB has received unrestricted research funding from Pfizer and J&J, who manufacture smoking cessation medications. LS has received honoraria for talks, an unrestricted research grant and travel expenses to attend meetings and workshops from Pfizer, and has acted as paid reviewer for grant awarding bodies and as a paid consultant for health care companies. All authors declare no financial links with tobacco companies, e-cigarette manufacturers, or their representatives. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Introduction

Tobacco smoking remains a leading cause of preventable illness and premature mortality in England [ 1 ]. Relative to the general population, people with mental health conditions are more likely to smoke, smoke more heavily, and show greater signs of dependence [ 2 – 5 ]. They are also at increased risk of tobacco-related morbidities, including cardiovascular disease [ 6 , 7 ], which causes them to have substantially lower life expectancy [ 8 , 9 ]. Quitting smoking can reduce these risks [ 10 ]. A range of smoking cessation aids have been found to increase successful smoking cessation in randomised controlled trials (RCTs) [ 11 – 14 ] and in real-world settings [ 15 – 24 ]. Understanding whether and, if so, how far their effectiveness differs between people with and without mental health conditions can help health professionals and patients to make informed choices around the use of aids for smoking cessation.

In England, a comprehensive range of smoking cessation medications and behavioural support are available [ 25 ]. Pharmacological aids include nicotine replacement therapy (NRT), which is available free of charge on prescription or can be bought over-the-counter (OTC), and varenicline (Champix) and bupropion (Zyban) which are only available on prescription. The supply of Champix, the most effective of these [ 14 , 23 , 24 ], was disrupted in 2021 due to nitrosamine impurities found by its supplier, Pfizer [ 26 ]. The supply of Zyban was disrupted in late 2022 due to similar concerns about nitrosamine impurities found by its supplier, GSK [ 27 ]. Both medications remain unavailable as of March 2024. Generic versions of varenicline are available in other countries and cytisine, a drug with similar properties to varenicline, is licensed [ 28 ] and has begun to be supplied in England since January 2024.

Vaping products (often referred to as e-cigarettes) and nicotine pouches are available from specialist ‘vape shops’, supermarkets, smaller convenience stores, and online [ 29 ]. Heated tobacco products have been available in the UK since 2016 but their efficacy for smoking cessation is uncertain [ 30 ]. Smokers also have access to free dedicated stop smoking services, which offer behavioural support, pharmacotherapy, and in some cases, vaping products [ 31 ]. Telephone support is available via a free Smokefree National Helpline, and websites offer information on quitting, other forms of support available, and how to access them. Other behavioural treatments, including hypnotherapy and Allen Carr’s Easyway method (a single-session pharmacotherapy-free behavioural programme) [ 32 , 33 ], are provided by private companies.

Around one in two attempts to stop smoking in England involves the use of at least one of these cessation aids [ 34 ]. Vaping products are most commonly used (~30% of quit attempts), followed by NRT available OTC (~10%) and medications obtained on prescription (NRT, varenicline, or bupropion; ~5%) [ 34 ].

It is possible that the effectiveness of these smoking cessation aids may differ between people with and without mental health conditions [ 35 ]. People with mental health conditions may experience stronger reinforcing effects of nicotine, more severe withdrawal symptoms when they try to quit, and greater cessation fatigue (being tired of trying to stop smoking) [ 36 ]. As such, it is possible that they may benefit more from cessation aids that mimic the effect of nicotine (e.g., varenicline) or provide an alternative source of nicotine (e.g., NRT, vaping products, nicotine pouches) and less from other cessation aids (e.g., forms of behavioural support). On the other hand, people with mental health conditions may be less likely to adhere to treatments [ 37 ], causing effectiveness to be lower.

To our knowledge, just two large experimental studies have investigated whether the effectiveness of smoking cessation treatments is moderated by a person’s mental health status. These have focused on varenicline, bupropion, and NRT. One large RCT (‘EAGLES’) compared varenicline and bupropion with nicotine patch and placebo and showed similar efficacy of these medications for smokers with and without psychiatric disorders [ 38 ]. However, a recent secondary analysis of another RCT that compared the effectiveness of bupropion and varenicline reported a slightly different pattern of results [ 39 ]. While varenicline was associated with similar quitting outcomes for smokers with depressive symptoms than those without, bupropion appeared to be less effective as a smoking cessation aid for those with depressive symptoms [ 39 ]. Further research is required on these and other cessation aids. Observational data can shed light on any differences in treatment effectiveness in real-world settings [ 40 ].

Using data from the Smoking Toolkit Study, a large, nationally-representative survey of adults in England, this study aimed to comprehensively examine whether the real-world effectiveness of popular smoking cessation aids differs between users with and without mental health conditions. Data on smoking status in relation to history of mental health conditions have been published elsewhere [ 2 ], so this paper focused specifically on the use and effectiveness of different cessation aids among those attempting to quit smoking. Specifically, we aimed to address the following research questions:

To what extent does a history of one or more diagnosed mental health conditions moderate associations between use (vs. non-use) of various cessation aids in a quit attempt and chances of success?
Are any moderating effects similar for those with a single mental health condition and those with multiple mental health conditions?

Materials and methods

Pre-registration.

The study protocol and analysis plan were pre-registered on Open Science Framework (osf.io/5xubc). We made one amendment. We had planned to calculate Bayes factors for non-significant interactions based on an expected effect size of OR = 1.5 in the observed direction (i.e., OR = 1.5 for observed ORs >1 and OR = 0.67 for observed ORs <1). Instead, we calculated Bayes factors in both directions, to offer more insight into whether the data suggested a given aid was more or less effective for people with a history of mental health conditions than those without.

This was an observational study using data from the Smoking Toolkit Study; a nationally-representative monthly cross-sectional survey of adults (≥16 years) in England [ 41 ]. The study uses a hybrid of random probability and simple quota sampling to select a new sample of approximately 1,700 adults aged ≥16 years each month. Comparisons with other national surveys and sales data indicate that the survey obtains nationally-representative estimates for key variables including sociodemographic characteristics, smoking prevalence, and cigarette consumption [ 41 , 42 ]. The Smoking Toolkit Study is coordinated by this study’s authors at University College London (PI Jamie Brown).

Data collection for the Smoking Toolkit Study began in November 2006 and the study continues to collect data from a new sample each month. Up to February 2020, the survey was conducted via face-to-face computer-assisted interviews. However, social distancing restrictions introduced during the Covid-19 pandemic meant that no data were collected in March 2020, and data from April 2020 onwards have been collected via telephone interviews. The telephone interviews use a similar sampling and weighting approach as the face-to-face interviews and data collected via the two modalities show good comparability [ 43 – 45 ]. Data were not collected from 16 and 17 year olds between April 2020 and December 2021.

While a core set of questions is included in each monthly survey, other variables are only assessed in certain waves, depending on availability of competitive research funding. Questions on mental health have been collected in two periods: January 2016-December 2017 and October 2020-June 2023. We used data from participants surveyed in these periods. We selected participants aged ≥18 years who:

smoked cigarettes (including hand-rolled) or any other tobacco product (e.g., pipe or cigar) daily or occasionally at the time of the survey or during the past year; and
reported having made at least one serious quit attempt in the past year.

Ethics statement

Ethical approval was provided by the UCL Research Ethics Committee (0498/001). Participants provided informed verbal consent to take part in the study, and all methods are carried out in accordance with relevant regulations. The data are not collected by UCL and are anonymised when received by UCL.

Outcome: Successful smoking cessation.

The outcome variable was self-reported continuous abstinence from the start of the most recent quit attempt up to the time of survey. Respondents were asked ‘How long did your most recent quit attempt last before you went back to smoking?’ Responses were coded 1 for those who responded that they were still not smoking and 0 otherwise.

Exposures: Use of cessation aids.

Independent variables were self-reported use or not (dummy coded) of the following smoking cessation aids in the most recent quit attempt: prescription NRT (available in England from prescribing health professionals, including advisors at specialist stop smoking services); NRT available OTC; varenicline; bupropion; vaping products; face-to-face behavioural support; telephone support; written self-help materials; websites; hypnotherapy; Allen Carr’s Easyway; heated tobacco products; and nicotine pouches.

Respondents were asked to indicate all that apply, and data for each were coded 1 if chosen and 0 if not. Heated tobacco products were included in the list of response options from April 2016 and nicotine pouches from June 2021; given the low prevalence of use of these products [ 46 , 47 ], we imputed missing values as 0 for participants surveyed before the response options were introduced.

Moderator: History of mental health conditions.

Diagnosed mental health conditions were assessed with the question: ‘Since the age of 16, which of the following, if any, has a doctor or health professional ever told you that you had?’ followed by a list of ICD-10 recognised conditions: depression; anxiety; obsessive compulsive disorder; panic disorder or a phobia; post-traumatic stress disorder; psychosis; personality disorder; attention deficit hyperactivity disorder; an eating disorder; alcohol misuse or dependence; drug use or dependence; and problem gambling. Between 2020 and 2023, this list also included: autism or autism spectrum disorder; and bipolar disorder.

For our primary analysis (RQ1), those who reported any of these diagnoses were coded 1, else they were coded 0 (including those who did not respond, responded ‘don’t know’, or ‘prefer not to say’).

For our secondary analysis (RQ2), we subdivided the group reporting mental health diagnoses to create a three-level variable: no history of mental health conditions (coded 0), single mental health condition (1 diagnosis; coded 1), and multiple mental health conditions (≥2 diagnoses; coded 2), given previous evidence showing stronger associations with smoking outcomes among those with multiple conditions [ 2 ].

Covariates.

Covariates included a range of sociodemographic characteristics, level of cigarette addiction, and variables relating to the most recent quit attempt.

Sociodemographic covariates included age, gender, and occupational social grade (ABC1, which includes managerial, professional and intermediate occupations, vs. C2DE, which includes lower supervisory and technical occupations, semi‐routine and routine occupations, never worked and long‐term unemployed).

Level of cigarette addiction was assessed by asking participants to self-report ratings of the strength of urges to smoke over the last 24 hours (not at all (coded 0), slight (1), moderate (2), strong (3), very strong (4), extremely strong (5)). This question was also coded ‘0’ for smokers who respond ‘not at all’ to the (separate) question ‘How much of the time have you spent with the urge to smoke?’ [ 48 ]. This validated measure has similar predictive value as the Fagerström Test of Cigarette Dependence and the Heaviness of Smoking Index in for cessation [ 49 ].

The characteristics of the most recent quit attempt included time since the quit attempt started (<1 month, 1–6 months, >6 months), the number of prior quit attempts in the past year (1, 2, 3 or ≥4), whether the quit attempt was planned, and whether the respondent cut down first or stopped abruptly.

The month and year of survey were also included to account for seasonal variation in quit attempts (e.g., in January or ‘Stoptober’ [ 50 , 51 ]) and changes in the availability and regulation of different smoking cessation aids over the study period. We also adjusted for the mode of data collection with a variable coded 0 up to February 2020 (when data were collected face to face) and 1 from April 2020 onwards (when data were collected via telephone).

Statistical analysis

The Smoking Toolkit Study uses survey weights to adjust data so that the sample matches the demographic profile of England on age, social grade, region, housing tenure, ethnicity and working status within sex [ 41 ]. The following analyses used weighted data. Missing values were excluded on a per-analysis basis.

We calculated the proportion and 95% confidence interval (CI) of smokers with and without mental health conditions reporting using each cessation aid in the most recent quit attempt, and the quit success rate among users of each aid. We also provided descriptive data on the proportion reporting using each cessation aid and the overall quit success rate separately for each individual mental health condition.

We used logistic regression to analyse associations between self-reported abstinence (abstinent yes vs. no) and use of different smoking cessation aids (use of a specific aid vs. no use of that specific aid), adjusting for mental health status, covariates, and use of other cessation aids (baseline model). We repeated the baseline model with the addition of the two-way interaction between mental health diagnoses (0 vs ≥1 mental health conditions) and each cessation aid in turn.

To explore any differences between those with single and multiple mental health diagnoses, we reran the interactions using a 3-level mental health variable (0, 1, ≥2 mental health conditions).

We calculated Bayes factors using an online calculator (bayesfactor.info) to aid in the interpretation of non-significant interactions with mental health diagnoses. These enabled us to examine whether these associations could best be characterised as evidence of no effect, evidence of an effect, or whether data were insensitive to detect an effect [ 52 , 53 ]. Alternative hypotheses were represented by half-normal distributions and the expected effect size set to OR = 1.5 in the observed direction (OR = 1.5 where the observed OR was >1 and OR = 0.67 when the observed OR was <1) [ 23 ].

Of 95,952 participants surveyed in eligible waves, 17,394 (18.1%) reported smoking in the past year, of whom 5,741 (33.0%) attempted to stop smoking in the past year. We excluded 148 participants with missing data on mental health conditions (there were no missing data on use of cessation aids), leaving a final sample for analysis of 5,593 participants.

Just under half (45.1% weighted) of participants reported having ever been diagnosed with a mental health condition; 16.8% reported a single mental health condition and 28.3% multiple conditions. Table 1 summarises the characteristics of participants with and without a history of mental health conditions. S1 Table presents corresponding data for those reporting single and multiple mental health conditions. Relative to those without, participants reporting a history of mental health conditions were more likely to be younger, identify as women or non-binary, and come from less advantaged social grades. They also reported a higher level of cigarette addiction, on average, but there were no notable differences in the characteristics of their most recent quit attempt.

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https://doi.org/10.1371/journal.pmen.0000007.t001

Table 2 summarises use of cessation aids by participants’ history of mental health conditions. Participants with a history of mental health conditions were significantly more likely to report using one or more cessation aids (58.9%) than those without (52.9%) and to report using multiple aids (12.0% vs. 7.3%). Among those with and without a history of mental health conditions, vaping products were the most commonly used aid (38.8% and 30.7%, respectively), followed by NRT available over-the-counter (16.7% and 17.8%). All other aids were used by <5% of participants. Relative to those without, participants with a history of mental health conditions were more likely to report using vaping products, prescription NRT, and websites. Use of other aids did not differ significantly between groups. There was no significant difference in the prevalence of use of any cessation aid between those with single versus multiple mental health conditions ( S2 Table ).

https://doi.org/10.1371/journal.pmen.0000007.t002

Table 2 also shows unadjusted quit success rates for those using each cessation aid. Although absolute differences appeared large for some aids (e.g., written self-help materials and nicotine pouches), wide confidence intervals meant there was no statistically significant difference in quit rates between users of aids with and without a history of mental health conditions, before adjustment for potential confounding variables and use of other aids.

Table 3 shows the results of the logistic regression analyses. The baseline model, which included use (vs. non-use) of each cessation aid, history of mental health conditions, and covariates, indicated participants who used vaping products (OR = 1.92, 95%CI 1.61–2.30), varenicline (OR = 1.88, 95%CI 1.19–2.98), or heated tobacco products (OR = 2.33, 95%CI 1.01–5.35) in their quit attempt had significantly higher odds of quitting successfully than those who did not. Those who used Allen Carr’s Easyway method (either via face-to-face session [19.8%], book [66.9%], or both [13.3%]) had significantly lower odds of quitting successfully than those who did not (OR = 0.41, 95%CI 0.18–0.94). Use of other aids was not significantly associated with odds of quit success, after adjustment.

https://doi.org/10.1371/journal.pmen.0000007.t003

Tests of interactions showed no statistically significant moderating effect of history of mental health conditions on the effectiveness of any cessation aid ( Table 3 ). Bayes factors indicated the data were largely insensitive to distinguish between evidence of moderation and no evidence of moderation, meaning we were unable to rule out potential differences in effectiveness by history of mental health conditions. The only exception was for vaping products, where the data favoured the null (Bayes factor = 0.20), indicating that the effectiveness of vaping products for smoking cessation did not differ significantly between those with and without a history of mental health conditions.

There was no notable difference in the pattern of results when history of mental health conditions was analysed as a 3-level variable (distinguishing between those with none, a single mental health condition, and multiple conditions; S4 Table ).

Nine in every 20 people who attempted to quit smoking had a history of one or more mental health conditions. Those with a history of mental health conditions were more likely to support their quit attempt with the use of cessation aids. Specifically, they were more likely than those without a history of mental health conditions to report using vaping products, prescription NRT, or websites, with no significant differences between groups in the use of other aids. After we adjusted for covariates and participants’ use of other cessation aids, those who used vaping products, varenicline, or heated tobacco products had significantly higher odds of quitting successfully than those who did not report using these aids. There was little evidence of benefits of using other cessation aids, or that the user’s history of mental health conditions moderated the effectiveness of any aid.

Our results echo the findings of the EAGLES trial [ 38 ], which found varenicline, bupropion, and nicotine patch were similarly effective for smokers with and without psychiatric disorders, under trial conditions. They also extend existing evidence by covering the whole range of cessation aids used by people who smoke in England and using observational data from people using these aids in the real world, where people do not necessarily receive continued monitoring and support from healthcare professionals.

The real-world effectiveness of varenicline and vaping products are established, having been reported in a number of previous studies [ 15 – 24 ]. In 2019, we used data from the Smoking Toolkit Study to examine the effectiveness of different cessation aids when used in real-world settings [ 23 ]. Our results suggested using varenicline or vaping products was associated with the highest odds of success in a quit attempt. When we controlled for use of other aids and other potential confounding variables (e.g., level of dependence), we found that people who used varenicline or vaping products in a quit attempt had 1.82- and 1.95-times higher odds, respectively, of remaining abstinent than those who did not. Our present results, which use data from the same survey but over a different time frame and with additional adjustment for history of mental health conditions, are consistent with these estimates.

However, to our knowledge, this is the first observational study to examine the effectiveness of heated tobacco products, because use of these products until recently has been rare in England [ 47 ]. We documented an association between use of heated tobacco products and increased odds of quit success [ 30 ]. Our data indicate use of these products in quit attempts remains relatively rare (consistent with low overall prevalence of use among adults in England [ 47 ]). As a result, the 95% CI around the estimate was wide and included the possibility of no meaningful difference (lower CI = 1.01), so conclusions may change with more data. It will be important to continue to monitor the effectiveness of heated tobacco products as the number of people using them to quit smoking grows.

The lack of evidence for differential effectiveness of any cessation aid by the user’s history of mental health conditions should provide reassurance to people with mental health conditions who want to stop smoking that their condition need not affect their choice of cessation aid. Of note, vaping products were both the most popular aid used by people with and without a history of mental health conditions and one of the most effective. Vaping products were also the only aid for which the data provided clear evidence that effectiveness was not lower for users with a history of mental health conditions (data for the other aids were insensitive).

Our results also suggest that healthcare professionals can base their recommendations for, and prescription of, smoking cessation treatments to people with mental health conditions on evidence of their effectiveness in the general population. Previous research has shown that people with mental health conditions have lower odds of being prescribed varenicline than NRT, despite having greater odds of quitting successfully with varenicline than NRT [ 54 ]. Consistent with this, our data show higher prevalence of use of prescription NRT among people with a history of mental health conditions than those without, and significantly higher odds of quit success among users of varenicline, but not NRT. Healthcare professionals may opt to prescribe NRT over varenicline for patients with mental health conditions due to concerns that varenicline may increase the risk of neuropsychiatric adverse events [ 55 ]. However, much evidence of this risk is based on information contained in case reports [ 55 ], and a large RCT of the relative neuropsychiatry safety of varenicline compared with nicotine patch and placebo among people with and without psychiatric disorders observed no significant increase in adverse events among those randomised to use varenicline [ 38 ]. If the risk of adverse events are similar, offering the more effective treatment (varenicline, once available again) is likely to be the better option.

This study had several limitations. First, questions on mental health conditions relied on self-reports, which may be less accurate than if linked health record data were used. Second, the items assessed ever (as opposed to current) diagnoses. As such, the results cannot tell us whether treatment effectiveness differs according to the user’s current mental health status. In addition, those with a history of multiple mental health conditions may also have been diagnosed with these conditions at different points in time, so a history of multiple mental health conditions may not reflect current comorbidity. Third, to boost statistical power for analyses, we grouped together participants reporting any of the mental health conditions we assessed. As the list of conditions was heterogeneous, covering a broad range of conditions from common mental health disorders (e.g., anxiety and depression) to severe mental illness (psychosis), we cannot rule out the possibility that certain conditions may moderate the effectiveness of cessation aids while others do not. Given the low prevalence of most of these conditions within the general population, much larger samples would be required to explore this. Fourth, despite combining all mental health conditions, Bayes factors indicated our data were insensitive to distinguish between evidence of absence of an interaction between aid use and mental health conditions (i.e., mental health conditions moderate treatment effectiveness) and absence of evidence for the majority of aids (all except vaping products). This means we are unable to conclusively rule out there being small to moderate differences in effectiveness by people’s history of mental health conditions. Fifth, although we adjusted for a range of potential confounders, there may be residual confounding by other variables not included in our models. Finally, it is possible that smoking cessation treatments offered to people with mental health conditions may differ from the general population, introducing potential selection bias from the treatment provider in addition to the user. Although clinical trials suggest varenicline and bupropion are effective for people with severe mental illness [ 38 , 56 ], in the real world, people with these conditions are rarely offered these medications by clinicians [ 54 ]. Interactions with other medications is an important consideration in deciding on a treatment approach: bupropion is known to interact with other medications (including those indicated for treatment of mental health conditions), which may reduce the effectiveness of one or both treatments [ 57 ]. Nonetheless, our data provide useful insights into potential differences in the effectiveness of popular smoking cessation treatments in a real-world setting.

In conclusion, use of vaping products, varenicline, or heated tobacco products in a quit attempt was associated with significantly greater odds of successful cessation, after adjustment for use of other cessation aids and potential confounders. There was no evidence to suggest the effectiveness of any popular cessation aid differed according to the user’s history of mental health conditions.

Supporting information

S1 table. weighted sample characteristics– 3-level mental health variable..

https://doi.org/10.1371/journal.pmen.0000007.s001

S2 Table. Use of cessation aids in the most recent quit attempt by history of mental health conditions– 3-level mental health variable.

https://doi.org/10.1371/journal.pmen.0000007.s002

S3 Table. Use of cessation aids in the most recent quit attempt by history of mental health conditions–by individual mental health condition.

https://doi.org/10.1371/journal.pmen.0000007.s003

S4 Table. Real-world effectiveness of cessation aids for success in stopping smoking and interactions with the user’s history of mental health conditions– 3-level mental health variable.

https://doi.org/10.1371/journal.pmen.0000007.s004

S1 Questionnaire. Smoking Toolkit Study questionnaire.

https://doi.org/10.1371/journal.pmen.0000007.s005

View Article
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The good news is that the beneficial effects of smoking bans appear to be fairly immediate, with declines in reported heart attack cases within 3 months. The impact of bans was strengthened if compliance was good, if baseline smoking prevalence was low and if air quality was good.
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A cigarettes is made from tobacco, chemical additives, a filter, and paper wrapping. The chemical additives include an extensive list of about 7000 different compounds, 250 of which are known to be very harmful to the human body. To demonstrate, here are several examples. Ammonia found in cigarettes is also used in traditional many cleaning ...
Smoking and its Effect on the Brain
The brain is affected by smoking and may result to traumas, illness such as stroke and brain injuries. Tobacco or nicotine affects the brain cell by linking at various receptors at the neural pathway. The effect is coordinated to affect and stabilize the pain or pleasure pathway.
Write an essay on harms of chewing and smoking tobacco.
The Effects of Using Tobacco In America alone, 16 million people have some type of disease from smoking or other tobacco related uses (CDC). Tobacco has been around for hundreds of years has been and is used in many different ways like smokeless tobacco, smoking cigarettes, hookah, and cigars.
Moderation of the real-world effectiveness of smoking cessation aids by
Introduction. Tobacco smoking remains a leading cause of preventable illness and premature mortality in England [].Relative to the general population, people with mental health conditions are more likely to smoke, smoke more heavily, and show greater signs of dependence [2-5].They are also at increased risk of tobacco-related morbidities, including cardiovascular disease [6, 7], which causes ...

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Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

The 1994 Surgeon General’s Report

Tobacco Control Developments

Recent Surgeon General Reports Addressing Youth Issues

Scientific Reviews

Young People

Tobacco Use

Chapter 2. The Health Consequences of Tobacco Use Among Young People

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

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Smoking and Its Effect on the Brain Essay

Introduction

Moderation of the real-world effectiveness of smoking cessation aids by mental health conditions: A population study

Participants

Main outcome measures

Conclusions

Introduction

Materials and methods

Ethics statement

Outcome: Successful smoking cessation.

Exposures: Use of cessation aids.

Moderator: History of mental health conditions.

Covariates.

Statistical analysis

Supporting information

S2 Table. Use of cessation aids in the most recent quit attempt by history of mental health conditions– 3-level mental health variable.

S3 Table. Use of cessation aids in the most recent quit attempt by history of mental health conditions–by individual mental health condition.

S4 Table. Real-world effectiveness of cessation aids for success in stopping smoking and interactions with the user’s history of mental health conditions– 3-level mental health variable.

S1 Questionnaire. Smoking Toolkit Study questionnaire.

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