how to quit smoking process essay

Best Essay Writing Services

Process Essay: How to Quit Smoking

All those anti-smoking campaigns seem to be working since the prevalence of smoking has been declining for a while now. But, the actual number of smokers is not declining whatsoever. On the opposite, people seem to be smoking less, but the number of smokers continues to increase.

According to the Institute for Health Metrics and Evaluation at the University of Washington, smoking prevalence decreased by 25% for men and 42% for women by 2012. However, the actual number of smokers increased by 41% in the period between 1980 and 2012.

Smoking is a terrible habit indeed, and everyone will tell you the same. Even those who once got rid of this scourge succumb to the temptation and return to smoking again. Because of this, many smokers wonder if it is possible to quick smoking forever and not return to it a short while afterward.

Those anti-smoking campaigns won’t really help you quit. All the scary pictures on the packs and lessons can do is inform people of the harm cigarettes can do to their bodies and health. If you want to quit smoking, you need to do it with your personal will and intent.

The first thing you need to do to stop smoking is to decide to stop smoking. People who keep persuading you to quit smoking cannot convince you unless you want it to, and attempting to do so for the exhortations of others will probably not be long-lasting or successful. I have found that the most important factor in quitting this habit is your will. If those ugly pictures on the billboards and the cigarette packs haven’t convinced you yet, get more informed about the harms of smoking.

Secondly, you need to start talking to people who managed to do this. Reading and listening to such stories will give you an idea as to what expects you and help you create a plan. When you calculate how much this terrible habit costs you in a year, you will surely be more inclined to stop smoking. Cigarettes get more and more expensive almost every year. When you find a reason why you need to quit smoking, you can start working on the strategy. Whether it is to preserve your health and avoid problems like heart attacks or to save some money, every reason is a reason good enough. Being certain that you want to quit will give you the motivation you need and you can start throwing away the cigarettes.

Of course, if you are smoking for a long time or smoke too many cigarettes a day, you shouldn’t quit right away. Quitting over a certain period of time is much easier for your body and your mind, especially if you are smoking when you are bored or stressed. A single cigarette with the morning cup of coffee does not mean that you are not quitting. Just calculate the steps and set a deadline. Reduce the number of cigarettes you are smoking throughout this period.

Assign the last day and the last cigarette. This is the day when you will stop being a smoker, but until that day, you will be working toward it. Some people say that quitting with someone else is much easier because you and the other person can motivate each other and not let ourselves slip. When that day comes, smoke the last cigarette. Make sure this cigarette is the very last you will ever smoke.

This all sounds so simple, but it is not. Smoking is much more of a psychological than a physical addiction, making it harder to get rid of. In order to quit smoking, you don’t only have to decide and buy nicotine patches. You need to find out what makes you smoke and do things to distract you from it. Even when you quit smoking, your job does not end here. For a very long time, you will have moments when you will feel the urge to smoke ‘just one cigarette’. If you allow yourself to do this, you will become a smoker again. Avoid things that make you want to smoke and if you cannot, find a hobby or make a habit that will distract you from these things when the time comes. When you feel like you really need a smoke, go running, go to a concert, ride your bike, take a walk with your dog, or do anything else that will keep you distracted. You may think that one more cigarette is all that you need, but this will rapidly turn into a renewed smoking habit.

A physical, healthy routine can go a long way. If you start exercising regularly, you will literally turn the pages in your life. Not only will this distract you from smoking, but it will also come with a variety of health benefits and may just be what keeps you healthy after all those years of smoking. Don’t let your willpower be tested. It is easier to say ‘I will quit’ than actually quit, but once you do it, be strong enough not to get back to it. A bit of faith in yourself and some good distraction tricks is what keeps non-smokers from going back to this terrible habit.

Smoking is an unhealthy behavior that accounts for almost 40% of all deaths in the US. It is also very expensive and very dangerous to your health, so quitting smoking is simply the natural and logical thing to do. It isn’t easy, but many have done it. If they can, you can do it too.

References:

[1] http://www.healthdata.org/news-release/despite-declines-smoking-rates-number-smokers-and-cigarettes-rises

[2] A.H. Mokdad, J.S. Marks, J.S. Stroup, J.L. GeberdingActual causes of death on the United States, 2000 JAMA, 291 (2004), pp. 1238-1245

Privacy Overview

Alcoholism and Alcohol Abuse

Relaxation techniques for stress relief.

• Emotional Eating and How to Stop It

Choosing an Alcohol Rehab Treatment Program

Staying social when you quit drinking.

• Vaping: The Health Risks and How to Quit

Women and Alcohol

• Binge Drinking: Effects, Causes, and Help
• Online Therapy: Is it Right for You?
• Mental Health
• Health & Wellness
• Children & Family
• Relationships

Are you or someone you know in crisis?

• Bipolar Disorder
• Eating Disorders
• Grief & Loss
• Personality Disorders
• PTSD & Trauma
• Schizophrenia
• Therapy & Medication
• Exercise & Fitness
• Healthy Eating
• Well-being & Happiness
• Weight Loss
• Work & Career
• Illness & Disability
• Heart Health
• Childhood Issues
• Learning Disabilities
• Family Caregiving
• Teen Issues
• Communication
• Emotional Intelligence
• Love & Friendship
• Domestic Abuse
• Healthy Aging
• Aging Issues
• Alzheimer’s Disease & Dementia
• Senior Housing
• End of Life
• Meet Our Team

Why is quitting so hard?

Your personal stop smoking plan, identify your smoking triggers, coping with nicotine withdrawal symptoms, manage cigarette cravings, preventing weight gain after you stop smoking, medication and therapy to help you quit, what to do if you slip or relapse, helping a loved one to stop smoking, how to quit smoking.

Ready to stop smoking? These tips will help you kick the cigarette habit for good.

We all know the health risks of smoking, but that doesn’t make it any easier to kick the habit. Whether you’re an occasional teen smoker or a lifetime pack-a-day smoker, quitting can be really tough.

Smoking tobacco is both a physical addiction and a psychological habit. The nicotine from cigarettes provides a temporary—and addictive—high. Eliminating that regular fix of nicotine causes your body to experience physical withdrawal symptoms and cravings. Because of nicotine’s “feel good” effect on the brain, you may turn to cigarettes as a quick and reliable way to boost your outlook, relieve stress, and unwind. Smoking can also be a way of coping with depression, anxiety, or even boredom. Quitting means finding different, healthier ways to cope with those feelings.

Smoking is also ingrained as a daily ritual. It may be an automatic response for you to smoke a cigarette with your morning coffee, while taking a break at work or school, or on your commute home at the end of a hectic day. Or maybe your friends, family, or colleagues smoke, and it’s become part of the way you relate with them.

To successfully stop smoking, you’ll need to address both the addiction and the habits and routines that go along with it. But it can be done. With the right support and quit plan, any smoker can kick the addiction—even if you’ve tried and failed multiple times before.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

While some smokers successfully quit by going cold turkey, most people do better with a tailored plan to keep themselves on track. A good quit plan addresses both the short-term challenge of stopping smoking and the long-term challenge of preventing relapse. It should also be tailored to your specific needs and smoking habits.

Questions to ask yourself

Take the time to think of what kind of smoker you are, which moments of your life call for a cigarette, and why. This will help you to identify which tips, techniques, or therapies may be most beneficial for you.

Are you a very heavy smoker (more than a pack a day)? Or are you more of a social smoker? Would a simple nicotine patch do the job?

Are there certain activities, places, or people you associate with smoking? Do you feel the need to smoke after every meal or whenever you break for coffee?

Do you reach for cigarettes when you’re feeling stressed or down? Or is your cigarette smoking linked to other addictions, such as alcohol or gambling ?

Start your stop smoking plan with START

S = Set a quit date.

Choose a date within the next two weeks, so you have enough time to prepare without losing your motivation to quit. If you mainly smoke at work, quit on the weekend, so you have a few days to adjust to the change.

T = Tell family, friends, and co-workers that you plan to quit.

Let your friends and family in on your plan to quit smoking and tell them you need their support and encouragement to stop. Look for a quit buddy who wants to stop smoking as well. You can help each other get through the rough times.

A = Anticipate and plan for the challenges you’ll face while quitting.

Most people who begin smoking again do so within the first three months. You can help yourself make it through by preparing ahead for common challenges, such as nicotine withdrawal and cigarette cravings.

R = Remove cigarettes and other tobacco products from your home, car, and work.

Throw away all of your cigarettes, lighters, ashtrays, and matches. Wash your clothes and freshen up anything that smells like smoke. Shampoo your car, clean your drapes and carpet, and steam your furniture.

T = Talk to your doctor about getting help to quit.

Your doctor can prescribe medication to help with withdrawal symptoms. If you can’t see a doctor, you can get many products over the counter at your local pharmacy, including nicotine patches, lozenges, and gum.

One of the best things you can do to help yourself quit is to identify the things that make you want to smoke, including specific situations, activities, feelings, and people.

Keep a craving journal

A craving journal can help you zero in on your patterns and triggers. For a week or so leading up to your quit date, keep a log of your smoking. Note the moments in each day when you crave a cigarette:

• What time was it?
• How intense was the craving (on a scale of 1-10)?
• What were you doing?
• Who were you with?
• How were you feeling?
• How did you feel after smoking?

Do you smoke to relieve unpleasant feelings?

Many of us smoke to manage unpleasant feelings such as stress, depression, loneliness, and anxiety. When you have a bad day, it can seem like cigarettes are your only friend. As much comfort as cigarettes provide, though, it’s important to remember that there are healthier and more effective ways to keep unpleasant feelings in check. These may include exercising, meditating, relaxation strategies , or simple breathing exercises.

For many people, an important aspect of giving up smoking is to find alternate ways to handle these difficult feelings without turning to cigarettes. Even when cigarettes are no longer a part of your life, the painful and unpleasant feelings that may have prompted you to smoke in the past will still remain. So it’s worth spending some time thinking about the different ways you intend to deal with stressful situations and the daily irritations that would normally have you lighting up.

Tips for avoiding common triggers

Alcohol. Many people smoke when they drink . Try switching to non-alcoholic drinks or drink only in places where smoking inside is prohibited. Alternatively, try snacking on nuts, chewing on a cocktail stick or sucking on a straw.

Other smokers. When friends, family, and co-workers smoke around you, it can be doubly difficult to give up or avoid relapse. Talk about your decision to quit so people know they won’t be able to smoke when you’re in the car with them or taking a coffee break together. In your workplace, find non-smokers to have your breaks with or find other things to do, such as taking a walk.

End of a meal. For some smokers, ending a meal means lighting up, and the prospect of giving that up may appear daunting. However, you can try replacing that moment after a meal with something else, such as a piece of fruit, a healthy dessert, a square of chocolate, or a stick of gum.

Once you stop smoking, you’ll likely experience a number of physical symptoms as your body withdraws from nicotine. Nicotine withdrawal begins quickly, usually starting within an hour of the last cigarette and peaking two to three days later. Withdrawal symptoms can last for a few days to several weeks and differ from person to person.

Common nicotine withdrawal symptoms include:

• Cigarette cravings
• Irritability, frustration, or anger
• Anxiety or nervousness
• Difficulty concentrating Restlessness
• Increased appetite
• Increased coughing
• Constipation or upset stomach
• Decreased heart rate

As unpleasant as these withdrawal symptoms may be, it’s important to remember that they are only temporary. They will get better in a few weeks as the toxins are flushed from your body. In the meantime, let your friends and family know that you won’t be your usual self and ask for their understanding.

While avoiding smoking triggers will help reduce your urge to smoke, you probably can’t avoid cigarette cravings entirely. Fortunately, cravings don’t last long—typically, about 5 or 10 minutes. If you’re tempted to light up, remind yourself that the craving will soon pass and try to wait it out. It helps to be prepared in advance by having strategies to cope with cravings.

Distract yourself. Do the dishes, turn on the TV, take a shower, or call a friend. The activity doesn’t matter as long as it gets your mind off smoking.

Remind yourself why you quit. Focus on your reasons for quitting, including the health benefits (lowering your risk for heart disease and lung cancer, for example), improved appearance, money you’re saving, and enhanced self-esteem.

Get out of a tempting situation. Where you are or what you’re doing may be triggering the craving. If so, a change of scenery can make all the difference.

Reward yourself. Reinforce your victories. Whenever you triumph over a craving, give yourself a reward to keep yourself motivated.

Coping with cigarette cravings in the moment

Find an oral substitute – Keep other things around to pop in your mouth when cravings hit. Try mints, carrot or celery sticks, gum, or sunflower seeds. Or suck on a drinking straw.

Keep your mind busy – Read a book or magazine, listen to some music you love, do a crossword or Sudoku puzzle, or play an online game.

Keep your hands busy – Squeeze balls, pencils, or paper clips are good substitutes to satisfy that need for tactile stimulation.

Brush your teeth – The just-brushed, clean feeling can help banish cigarette cravings.

Drink water – Slowly drink a large glass of water. Not only will it help the craving pass, but staying hydrated helps minimize the symptoms of nicotine withdrawal.

Light something else – Instead of lighting a cigarette, light a candle or some incense.

Get active – Go for a walk, do some jumping jacks or pushups, try some yoga stretches, or run around the block.

Try to relax – Do something that calms you down, such as taking a warm bath, meditating, reading a book, or practicing deep breathing exercises.

Go somewhere smoking is not permitted – Step into a public building, store, mall, coffee shop, or movie theatre, for example.

Smoking acts as an appetite suppressant, so gaining weight is a common concern for many of us when we decide to give up cigarettes. You may even be using it as a reason not to quit. While it’s true that many smokers put on weight within six months of stopping smoking, the gain is usually small—about five pounds on average—and that initial gain decreases over time. It’s also important to remember that carrying a few extra pounds for a few months won’t hurt your heart as much as smoking does. However, gaining weight is NOT inevitable when you stop smoking.

Smoking dampens your sense of smell and taste, so after you quit food will often seem more appealing. You may also gain weight if you replace the oral gratification of smoking with eating unhealthy comfort foods. Therefore, it’s important to find other, healthy ways to deal with unpleasant feelings such as stress, anxiety, or boredom rather than  mindless, emotional eating .

Nurture yourself. Instead of turning to cigarettes or food when you feel stressed, anxious, or depressed, learn new ways to quickly soothe yourself . Listen to uplifting music, play with a pet, or sip a cup of hot tea, for example.

Eat healthy, varied meals. Eat plenty of fruit, vegetables, and healthy fats . Avoid sugary food , sodas, fried, and convenience food.

Learn to eat mindfully. Emotional eating tends to be automatic and virtually mindless. It’s easy to polish off a tub of ice cream while zoning out in front of the TV or staring at your phone. But by removing distractions when you eat, it’s easier to focus on how much you’re eating and tune into your body and how you’re really feeling. Are you really still hungry or eating for another reason?

Drink lots of water. Drinking at least six to eight 8 oz. glasses will help you feel full and keep you from eating when you’re not hungry. Water will also help flush toxins from your body.

Take a walk. Not only will it help you burn calories and keep the weight off , but it will also help alleviate feelings of stress and frustration that accompany smoking withdrawal.

Snack on guilt-free foods. Good choices include sugar-free gum, carrot and celery sticks, or sliced bell peppers or jicama.

There are many different methods that have successfully helped people to kick the smoking habit. While you may be successful with the first method you try, more likely you’ll have to try a number of different methods or a combination of treatments to find the ones that work best for you.

Medications

Smoking cessation medications can ease withdrawal symptoms and reduce cravings. They are most effective when used as part of a comprehensive stop smoking program monitored by your physician. Talk to your doctor about your options and whether an anti-smoking medication is right for you. The U.S. Food and Drug Administration (FDA) approved options are:

Nicotine replacement therapy. Nicotine replacement therapy involves “replacing” cigarettes with other nicotine substitutes, such as nicotine gum, patch, lozenge, inhaler, or nasal spray. It relieves some of the withdrawal symptoms by delivering small and steady doses of nicotine into your body without the tars and poisonous gases found in cigarettes. This type of treatment helps you focus on breaking your psychological addiction and makes it easier to concentrate on learning new behaviors and coping skills.

Non-nicotine medication. These medications help you stop smoking by reducing cravings and withdrawal symptoms without the use of nicotine. Medications such as bupropion (Zyban) and varenicline (Chantix, Champix) are intended for short-term use only.

What you need to know about e-cigarettes (vaping)

While some people find that vaping can help them to stop smoking, the FDA has not approved vaping as a method of smoking cessation. And recent news reports have even linked vaping to severe lung disease, prompting many questions about the safety of vaping. Here’s what you need to know:

• In the United States, the FDA does not regulate e-cigarette products.
• The FDA warns that vaping is “not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.”
• It’s hard to always know exactly what’s in e-cigarettes.
• The liquid used in some e-cigarettes contains nicotine, which has many negative health effects. It can lead to high blood pressure and diabetes and can be especially dangerous to the developing brains of children and teens.
• There is no information available about the long-term effects vaping can have on your health.
• Until more is known, federal and state authorities recommend avoiding all vaping.

To learn more, read: Vaping: The Health Risks and How to Quit

Alternative therapies

There are several things you can do to stop smoking that don’t involve nicotine replacement therapy, vaping, or prescription medications. These include:

Hypnosis – This is a popular option that has produced good results for many smokers struggling to quit. Forget anything you may have seen from stage hypnotists, hypnosis works by getting you into a deeply relaxed state where you are open to suggestions that strengthen your resolve to stop smoking and increase your negative feelings toward cigarettes.

Acupuncture – One of the oldest known medical techniques, acupuncture is believed to work by triggering the release of endorphins (natural pain relievers) that allow the body to relax. As a smoking cessation aid, acupuncture can be helpful in managing smoking withdrawal symptoms.

Behavioral Therapy – Nicotine addiction is related to the habitual behaviors or rituals involved in smoking. Behavior therapy focuses on learning new coping skills and breaking those habits.

Motivational Therapies – Self-help books and websites can provide a number of ways to motivate yourself to give up smoking. One well known example is calculating the monetary savings. Some people have been able to find the motivation to quit just by calculating how much money they will save. It may be enough to pay for a summer vacation.

Smokeless or spit tobacco is NOT a healthy alternative to smoking

Smokeless tobacco, otherwise known as spit or chewing tobacco, is not a safe alternative to smoking cigarettes. It contains the same addictive chemical, nicotine, contained in cigarettes. In fact, the amount of nicotine absorbed from smokeless tobacco can be 3 to 4 times the amount delivered by a cigarette.

Most people try to stop smoking several times before they kick the habit for good, so don’t beat yourself up if you slip up and smoke a cigarette. Instead, turn the relapse into a rebound by learning from your mistake. Analyze what happened right before you started smoking again, identify the triggers or trouble spots you ran into, and make a new stop-smoking plan that eliminates them.

It’s also important to emphasize the difference between a slip and a relapse. If you start smoking again, it doesn’t mean that you can’t get back on the wagon. You can choose to learn from the slip and let it motivate you to try harder or you can use it as an excuse to go back to your smoking habit. But the choice is yours. A slip doesn’t have to turn into a full-blown relapse.

You’re not a failure if you slip up. It doesn’t mean you can’t quit for good.

Don’t let a slip become a mudslide. Throw out the rest of the pack. It’s important to get back on the non-smoking track as soon as possible.

Look back at your quit log and feel good about the time you went without smoking.

Find the trigger. Exactly what was it that made you smoke again? Decide how you will cope with that issue the next time it comes up.

Learn from your experience. What has been most helpful? What didn’t work?

Are you using a medicine to help you quit? Call your doctor if you start smoking again. Some medicines cannot be used if you’re smoking at the same time.

It’s important to remember that you cannot make a friend or loved one give up cigarettes; the decision has to be theirs. But if they do make the decision to stop smoking, you can offer support and encouragement and try to ease the stress of quitting. Investigate the different treatment options available and talk them through with the smoker; just be careful never to preach or judge. You can also help a smoker overcome cravings by pursuing other activities with them, and by keeping smoking substitutes, such as gum, on hand.

If a loved one slips or relapses, don’t make them feel guilty. Congratulate them on the time they went without cigarettes and encourage them to try again. Your support can make all the difference in helping your loved one eventually kick the habit for good.

Helping a teen to quit

Most smokers try their first cigarette around the age of 11, and many are addicted by the time they turn 14. The use of e-cigarettes (vaping) has also soared dramatically in recent years. While the health implications of vaping aren’t yet fully known, the FDA warns that it’s not safe for teens and we do know that teens who vape are more likely to begin smoking cigarettes.

[Read: Vaping: The Health Risks and How to Quit]

This can be worrying for parents, but it’s important to appreciate the unique challenges and peer pressure teens face when it comes to quitting smoking (or vaping). While the decision to give up has to come from the teen smoker him- or herself, there are still plenty of ways for you to help.

Tips for parents of teens who smoke or vape

• Find out why your teen is smoking or vaping; they may want to be accepted by their peers or be seeking attention from you. Rather than making threats or ultimatums, talk about what changes can be made in their life to help them stop smoking.
• If your child agrees to quit, be patient and supportive as they go through the process.
• Set a good example by not smoking yourself. Parents who smoke are more likely to have kids who smoke.
• Know if your kids have friends that smoke or vape. Talk with them about how to refuse a cigarette or e-cigarette.
• Explain the health dangers and the unpleasant side effects smoking can have on their appearance (such as bad breath, discolored teeth and nails).
• Establish a smoke-free policy in your home. Don’t allow anyone to smoke or vape indoors at any time.

Hotlines and support

Visit  Smokefree.gov  or call the quitline at 1-800-784-8669.

Take steps NOW to stop smoking  or call the helpline at 0300 123 1044.

Visit  Health Canada  or call the helpline at 1-866-366-3667.

QuitNow  or call 13 7848.

Nicotine Anonymous  offers a 12-Step program modeled after Alcoholics Anonymous with meetings in many different countries.

More Information

• Join Freedom From Smoking - Smoking cessation program. (American Lung Association)
• How to Quit Using Tobacco - Dealing with both the mental and physical addiction. (American Cancer Society)
• How to Help Someone Quit Smoking - General hints for friends and family supporting someone who is quitting. (American Cancer Society)
• Substance-Related and Addictive Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link
• Lopez-Quintero, C., Pérez de los Cobos, J., Hasin, D. S., Okuda, M., Wang, S., Grant, B. F., & Blanco, C. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence, 115(1–2), 120–130. Link
• Quit Smoking | Smokefree. (n.d.). Retrieved August 2, 2021, from Link
• US Preventive Services Task Force. (2021). Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA, 325(3), 265–279. Link
• Leone, F. T., Zhang, Y., Evers-Casey, S., Evins, A. E., Eakin, M. N., Fathi, J., Fennig, K., Folan, P., Galiatsatos, P., Gogineni, H., Kantrow, S., Kathuria, H., Lamphere, T., Neptune, E., Pacheco, M. C., Pakhale, S., Prezant, D., Sachs, D. P. L., Toll, B., … Farber, H. J. (2020). Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine, 202(2), e5–e31. Link
• Complementary Health Approaches for Smoking Cessation: What the Science Says. (n.d.). NCCIH. Retrieved August 2, 2021, from Link
• Miller, Jacqueline W., Timothy S. Naimi, Robert D. Brewer, and Sherry Everett Jones. Binge Drinking and Associated Health Risk Behaviors among High School Students. Pediatrics 119, no. 1 (January 2007): 76–85. Link
• O’Brien, Charles P. Evidence-Based Treatments of Addiction. FOCUS 9, no. 1 (January 1, 2011): 107–17. Link

More in Addiction

Recognizing the signs and symptoms of a drinking problem

The power of the relaxation response to reduce stress and boost mood

Emotional Eating

How to recognize and stop emotional and stress eating

A guide to alcohol addiction treatment services

Cutting down on alcohol doesn’t have to mean losing your social life

The health risks in young people and how to quit

The hidden risks of drinking

Binge Drinking

Help if you have trouble stopping drinking once you start

Professional therapy, done online

BetterHelp makes starting therapy easy. Take the assessment and get matched with a professional, licensed therapist.

Most Popular

English and social studies teachers pioneer ai usage in schools, study finds.

12 days ago

TeachMeforFree Review

Best summarising strategies for students, how to cite page numbers in apa.

13 days ago

Reddit Users Advise Against Using ChatGPT for Technical Reports, But Why?

7 easy steps to quit smoking essay sample, example.

Scary pictures printed on cigarette packs, PSAs, and suasion will not help you quit. Due to them, instead of smoking with pleasure, you smoke being irritated, or scared, with all that informational ado. The same refers to weird recipes, such as soaking cigarettes in milk. All you need in order to quit is your intent to do it and your personal will.

1. At first, make a final decision to quit. Do not just fall for others’ exhortations; do not persuade yourself that you have to quit smoking as soon as possible. You do not have to do anything. Give your decision some time to ripen and make it when you understand that you actually want to quit. This part of the process is the most important.

2. To help yourself, develop motivation. Start reading stories of people who managed to quit for keeps; count how much money smoking costs you per month, or per year; study statistics of deaths caused by smoking; find some information about its impact on the human body. For example, you can think that quitting your habit will help you live longer, look better, spend less money, get rid of the fear of cancer, emphysema, heart attacks, etc.

3. When you are done with steps 1 and 2, do not rush to throw away your cigarettes. Instead, observe situations when you usually smoke. You think about cigarettes in a number of typical situations: in the morning, after taking food, when stressed or bored, while waiting, before going to bed, and so on. If you are warned about “risky” situations, it will be easier for you to control your habit.

4. When you are finally ready, assign a day when you are going to smoke your last cigarette. Do not wait for this date with despair or fear of terrible trials coming; do not delay. Instead, think of this day as the date of your release. Also, it is useful to make preparations. Find someone who also wants to quit smoking; tell your friends and relatives about your intentions and ask for help. You will need them if hard times come. Then smoke your last cigarette.

5. Smoking is much more about psychological addiction than physical addiction, so make a list of activities that would help distract you from thoughts about cigarettes when they appear. For instance, you can delve deeper into your job or hobbies, go jogging, ride a bike, go to a concert, or perform any other healthy activity. Do not think you are “trying to quit”—this will make the process never ending. Instead, persuade yourself you have already done that. It is also important to remember that searching for substitutes is not a sound idea—why quit one bad habit if you change it to another? Among the most popular substitutes are food, alcohol, and nicotine chewing gum.

6. Start a physical exercise routine. This will help you feel you have moved on to a new life. Besides, this will prevent, or at least minimize, the jump in weight that often follows quitting. One of the easiest alternatives is to buy a gym membership because free activities, such as jogging, will require additional willpower.

7. It is likely you will experience a temptation to check if you have quit, to test your willpower. Usually, a person decides to see if everything worked out, smokes a cigarette, thinking that the habit is broken and that there is nothing to worry about—and returns to it again. Remember, that there is no such thing as “one last cigarette just to make sure.”

It is easier to say than to do. Still, quitting is an act worth doing. It will have a significant, positive impact not only on your health, but also on your self-respect, faith in yourself, and your ability to succeed in many more facets of life.

Follow us on Reddit for more insights and updates.

Comments (0)

Welcome to A*Help comments!

We’re all about debate and discussion at A*Help.

We value the diverse opinions of users, so you may find points of view that you don’t agree with. And that’s cool. However, there are certain things we’re not OK with: attempts to manipulate our data in any way, for example, or the posting of discriminative, offensive, hateful, or disparaging material.

Comments are closed.

More from Essay on Process Analysis Examples and Samples

Apr 11 2019

How to Cook Rice Essay Sample, Example

Apr 09 2019

How to Start a Business Essay Sample, Example

Apr 08 2019

How to Save Money Essay Sample, Example

Remember Me

What is your profession ? Student Teacher Writer Other

Forgotten Password?

Username or Email

Importance of Quitting Smoking Essay

Smoking is a practice which involves the burning of a substance, for instance tobacco or cannabis, and later the smoke that emanates from it is inhaled. When referring to smoking, many people refer to tobacco smoking or cigarette smoking. The most widely used substance for smoking is tobacco, which is manufactured as cigarettes or hand-rolled tobacco. Smoking is an addictive habit and most smokers would attest that they wish they were able to stop the habit.

As much as it may seem to be a comfortable habit, smoking is in its actual sense not pleasurable and in any case it does not bring any relief. It is therefore the desire of many smokers to quit smoking. The knowledge that smoking can lead to serious health problems is one that is conscious in every smoker. This may make the smoker stay worried yet overcoming the addiction is a problem.

As such, quitting smoking is important since it helps relief the worry and the fear associated with possibility of developing cancer among other smoking-related illnesses. The smell that comes with smoking is very embarrassing and most people hate it.

Quitting smoking is therefore an important way of regaining self confidence by doing away with the embarrassing smell of cigarette smoke. Quitting smoking is an important way of shedding off the worry of the constant coughs and short breath brought about by smoking (Quit Smoking Review para 2-3).

Quitting smoking comes with a myriad of benefits which place more weight on the importance of quitting this addictive habit. If one quits smoking, it is no doubt that someone else is also saved from the problem of chain smoking. It is important that smokers reconsider their actions and identify that they spread the negative effects of smoking to persons who would not like to smoke.

It is therefore important to quit smoking if the problems associated with chain smoking are to be solved. The unborn are also beneficiaries of quitting smoking, especially among pregnant mothers. The elimination of very dangerous chemicals from the body motivates many people to avoid the practice. Most smokers thus find the health benefits as an encouraging gesture to quit smoking.

Quitting smoking is important since it leads to saving of monies that would have been used to buy cigarettes. These daily savings resulting from quitting smoking can be put into wiser and productive ways such as helping the family to settle bills as well as saving the money for investing. The fact that every individual’s lifestyle seems to influence another person’s life is an important reason why it is advisable to quit smoking. For instance, parents can act as good role models to their children by choosing to quit smoking.

In such a case, children are able to appreciate that smoking is a harmful habit and they will view the parent as a proactive parent as far as achieving good health is concerned. Additionally, quitting smoking gives the individual whiter and good looking teeth coupled with a fresh breath (Quit Smoking Review para 4-5). Most smokers are prone to gum diseases among other mouth diseases in comparison to non-smokers.

The individual’s health is also greatly improved as the breathing system that was once clogged with tobacco particles becomes clear and the lung capacity improves generally by about 10% (Gilman & Xun 45). Young smokers may not experience the negative effects of smoking until their later years but lung capacity generally weakens and diminishes with age.

Further, quitting smoking increases the individual’s life span, as Gilman and Xun (51) notes that half of all long-term smokers die from smoking related diseases such as heart attacks, lung cancer and others such as chronic bronchitis.

Those who quit smoking at age 30 are at an advantage as they add almost 10 years of their life span. As earlier mentioned stress levels are lower after one quits smoking since one has overcome the annoying habit. Most smokers suffer from withdrawal effects especially from nicotine, and the pleasant feeling of satisfying a craving is very temporary. Thus, non-smokers can concentrate better than smokers.

The body senses are also improved to a great extent as the system gets rid of many toxic chemicals found in the body as a result of cigarette smoke. Additionally, the individual experiences more energy as two weeks after quitting smoking, the circulation improves making many physical activities much easier. Additionally, the immune system is improved as mild diseases such as flu, colds and headaches can be easily fought.

In general, quitting smoking is an important step towards realizing an overall improvement in quality of life. Quitting smoking is also an important measure of ensuring cleanliness in one’s environment (American Academy of Family Physicians para 6).

Once one has quit smoking, the cigarette butts and ashes that are common in houses or cars of the smoker are no longer seen. This leads to greater happiness to the individual as well as those who live with the smoker. In addition, there is no need to worry much over the possible fire outbreaks brought about by careless disposal of burning cigarette butts.

Works Cited

American Academy of Family Physicians. Do I want to quit smoking ? 2000. Web.

Gilman, Sander and Xun, Zhou. Smoke: A global history of smoking . London, UK: Reaktion Books. 2004. Print.

Quit Smoking Review. The importance of quitting smoking . Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2020, April 27). Importance of Quitting Smoking. https://ivypanda.com/essays/importance-of-quitting-smoking/

"Importance of Quitting Smoking." IvyPanda , 27 Apr. 2020, ivypanda.com/essays/importance-of-quitting-smoking/.

IvyPanda . (2020) 'Importance of Quitting Smoking'. 27 April.

IvyPanda . 2020. "Importance of Quitting Smoking." April 27, 2020. https://ivypanda.com/essays/importance-of-quitting-smoking/.

1. IvyPanda . "Importance of Quitting Smoking." April 27, 2020. https://ivypanda.com/essays/importance-of-quitting-smoking/.

Bibliography

IvyPanda . "Importance of Quitting Smoking." April 27, 2020. https://ivypanda.com/essays/importance-of-quitting-smoking/.

• Smokers' Campaign: Finding a Home for Ciggy Butts
• "Introduction: Problem-Solving Courts" by Jeffery Butts
• People Should Quit Smoking
• Quitting Smoking: Strategies and Consequences
• Quitting Smoking: Motivation and Brain
• Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia
• Lifestyle Management While Quitting Smoking
• Quitting Smoking and Related Health Benefits
• Psychosocial Smoking Rehabilitation
• Process of Quitting a Bad Habit
• The Social Contract Aspects
• Women in the Contemporary Society
• Sexuality and Masculinity in Adolescents
• Masculinity Concept Analysis
• The Challenges and Advantages of Facebook

How to Quit

Quitting smoking is one of the most important steps you can take to improve your health. This is true no matter how old you are or how long you have smoked.

Many people who smoke become addicted to nicotine, a drug that is found naturally in tobacco. This can make it hard to quit smoking. But the good news is there are proven treatments that can help you quit.

Medications

Get help quitting today.

Can help you make a plan to quit smoking. Can help you prepare to cope with stress, urges to smoke, and other issues you may face when trying to quit.

Can help you manage withdrawal symptoms and cravings, which helps you stay confident and motivated to quit.

Use Nicotine Replacement Therapy (NRT) over-the-counter forms: patch , gum , lozenge prescription forms: inhaler , nasal spray

Talk to your Healthcare Provider About Using a Pill Prescription Medication varenicline bupropion

Combine Medications Use a long-acting form of NRT (nicotine patch) together with a short-acting form (such as nicotine gum or lozenge) . Compared to using one form of NRT, this combination can further increase your chances of quitting.

Using counseling and medication together gives you the best chance of quitting for good.

Many of these treatments and resources may be available to you free of charge or may be covered by your insurance .

Call a quitline coach ( 1-800-QUIT-NOW ) or Talk to a healthcare professional.

They can help you decide what treatment is best for you and can connect you to quit smoking programs and resources .

Remember, even if you’ve tried before, the key to success is to keep trying and not give up. After all, more than half of U.S. adults who smoked have quit.

For information about quitting smoking, visit CDC.gov/quit .

To receive email updates about Smoking & Tobacco Use, enter your email address:

• Tips From Former Smokers ®
• Division of Cancer Prevention and Control
• Lung Cancer
• National Comprehensive Cancer Control Program
• Division of Reproductive Health

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Essay on Stop Smoking

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

Let’s take a look…

100 Words Essay on Stop Smoking

Introduction.

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

The Dangers of Smoking

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

Ways to Quit

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

Benefits of Quitting

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

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

250 Words Essay on Stop Smoking

The detrimental effects of smoking.

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

Smoking and Its Socioeconomic Impact

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

The Power of Prevention

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

Personal Responsibility and Collective Action

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

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

500 Words Essay on Stop Smoking

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

The Health Hazards of Smoking

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

The Economic Impact of Smoking

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

Environmental Consequences

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

The Social Aspect of Smoking

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

Benefits of Quitting Smoking

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

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

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

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

• Essay on Stop Pollution
• Essay on Stop Littering
• Essay on Stop Hunting Animals

Apart from these, you can look at all the essays by clicking here .

Happy studying!

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

People also read

A Comprehensive Guide to Writing an Effective Persuasive Essay

200+ Persuasive Essay Topics to Help You Out

Learn How to Create a Persuasive Essay Outline

30+ Free Persuasive Essay Examples To Get You Started

Read Excellent Examples of Persuasive Essay About Gun Control

How to Write a Persuasive Essay About Covid19 | Examples & Tips

Crafting a Convincing Persuasive Essay About Abortion

Learn to Write Persuasive Essay About Business With Examples and Tips

Check Out 12 Persuasive Essay About Online Education Examples

Are you wondering how to write your next persuasive essay about smoking?

Smoking has been one of the most controversial topics in our society for years. It is associated with many health risks and can be seen as a danger to both individuals and communities.

Writing an effective persuasive essay about smoking can help sway public opinion. It can also encourage people to make healthier choices and stop smoking. 

But where do you begin?

In this blog, we’ll provide some examples to get you started. So read on to get inspired!

• 1. What You Need To Know About Persuasive Essay
• 2. Persuasive Essay Examples About Smoking
• 3. Argumentative Essay About Smoking Examples
• 4. Tips for Writing a Persuasive Essay About Smoking

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

Tough Essay Due? Hire Tough Writers!

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.

Paper Due? Why Suffer? That's our Job!

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.

However, don't stress if you need expert help to write your essay! We're the best essay writing service for you!

Our persuasive essay writing service is fast, affordable, and trustworthy. 

Try it out today!

Write Essay Within 60 Seconds!

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

Paper Due? Why Suffer? That’s our Job!

Keep reading

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

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

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

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

• Introduction

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

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

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

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

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

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

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

• Organization of the Report

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

• Preparation of the Report

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

• Scientific Basis of the Report

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

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

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

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

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

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

Chapter 3. New Biological Insights into Smoking Cessation

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

Chapter 4. The Health Benefits of Smoking Cessation

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

Smoking Cessation After a Cancer Diagnosis

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

Cardiovascular Disease

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

Smoking Cessation After a Diagnosis of Coronary Heart Disease

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

Chronic Respiratory Disease

Chronic obstructive pulmonary disease.

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

Reproductive Health

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

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

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

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

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

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

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

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

Historical Context of Smoking Cessation

Addiction versus habit.

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

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

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

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

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

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

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

Coverage of Smoking Cessation

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

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

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

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

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

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

Coverage of Nicotine and Addiction

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

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

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

Perspectives on Smoking Cessation

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

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

Development and Evolution of a Paradigm for Treating Nicotine Addiction

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

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

Epidemiologic Shifts in Smoking Cessation

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

Changes in the Patterns of Smoking and Population Characteristics of Smokers

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

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

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

Changes in the Products Used by Smokers

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

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

Developments in Approaches to Smoking Cessation at the Individual Level

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

Pharmacotherapy

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

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

Behavioral Interventions

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

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

Treating Tobacco Use and Dependence

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

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

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

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

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

Evolution of Approaches to Smoking Cessation at the Population Level

More intensity versus higher reach of support services.

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

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

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

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

Population-Based Interventions

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

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

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

Mass Media Campaigns

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

Healthcare Systems

Clinic-based integration of health systems.

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

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

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

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

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

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

Health Insurance Coverage

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

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

Healthcare Insurance Policies

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

E-Cigarettes: Potential Impact on Smoking Cessation

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

Implications of E-Cigarette Characteristics for Smoking Cessation

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

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

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

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

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

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

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

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

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

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

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

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

References 1

• Adsit RT, Fox BM, Tsiolis T, Ogland C, Simerson M, Vind LM, Bell SM, Skora AD, Baker TB, Fiore MC. Using the electronic health record to connect primary care patients to evidence-based telephonic tobacco quitline services: a closed-loop demonstration project. Translational Behavioral Medicine 2014;4(3):324–32. [ PMC free article : PMC4167898 ] [ PubMed : 25264471 ]
• Allenby CE, Boylan KA, Lerman C, Falcone M. Precision medicine for tobacco dependence: development and validation of the nicotine metabolite ratio. Journal of Neuroimmune Pharmacology 2016;11(3):471–83. [ PMC free article : PMC5479354 ] [ PubMed : 26872457 ]
• Alpert HR, Connolly GN, Biener L. A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation. Tobacco Control 2013;22(1):32–7. [ PubMed : 22234781 ]
• American Psychiatric Association. Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders . 5th ed. Arlington (VA): American Psychiatric Association Publishing, 2013.
• Amodei N, Lamb RJ. Over-the-counter nicotine replacement therapy: can its impact on smoking cessation be enhanced? Psychology of Addictive Behaviors 2008;22(4):472–85. [ PMC free article : PMC3577424 ] [ PubMed : 19071972 ]
• Association of American Medical Colleges. Physician Behavior and Practice Patterns Related to Smoking Cessation . Washington (DC): Association of American Medical Colleges, 2007.
• Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults—United States, 2000–2015. Morbidity and Mortality Weekly Report 2017;65(52):1457–64. [ PubMed : 28056007 ]
• Barrington-Trimis JL, Leventhal AM. Adolescents’ use of “pod mod” e-cigarettes—urgent concerns. New England Journal of Medicine 2018;379(12):1099–102. [ PMC free article : PMC7489756 ] [ PubMed : 30134127 ]
• Bartsch AL, Harter M, Niedrich J, Brutt AL, Buchholz A. A systematic literature review of self-reported smoking cessation counseling by primary care physicians. PLoS One 2016;11(12):e0168482. [ PMC free article : PMC5176294 ] [ PubMed : 28002498 ]
• Beal K. JUUL e-cigarettes make their way into local schools, February 8, 2018; < http://wset ​.com/news ​/local/juul-e-cigarettes-make-their-way-into-local-schools >; accessed: August 9, 2018.
• Berg CJ, Schauer GL, Buchanan TS, Sterling K, DeSisto C, Pinsker EA, Ahluwalia JS. Perceptions of addiction, attempts to quit, and successful quitting in nondaily and daily smokers. Psychology of Addictive Behaviors 2013;27(4):1059–67. [ PMC free article : PMC4030671 ] [ PubMed : 24364689 ]
• Bertholdo S. Vaping goes mainstream: high tech devices especially popular on local campuses. The Acorn, February 1, 2018; < https://www ​.theacorn ​.com/articles/vaping-goes-mainstream/ >; accessed: August 9, 2018.
• Blumenthal DS. Barriers to the provision of smoking cessation services reported by clinicians in underserved communities. Journal of the American Board of Family Medicine 2007;20(3):272–9. [ PubMed : 17478660 ]
• Bombard JM, Pederson LL, Nelson DE, Malarcher AM. Are smokers only using cigarettes? exploring current polytobacco use among an adult population. Addictive Behaviors 2007;32(10):2411–9. [ PubMed : 17490825 ]
• Burke MV, Ebbert JO, Schroeder DR, McFadden DD, Hays JT. Treatment outcomes from a specialist model for treating tobacco use disorder in a medical center. Medicine 2015;94(44):e1903. [ PMC free article : PMC4915890 ] [ PubMed : 26554789 ]
• Campaign for Tobacco-Free Kids. Trinity Health and Campaign for Tobacco-Free Kids partner to reduce tobacco use with focus on raising tobacco age to 21 [press release], April 28 2016; < https://www ​.tobaccofreekids ​.org/press_releases ​/post/2016_04_28_trinity >; accessed: September 14, 2017.
• Carter AJ, Delarosa B, Hur H. An analysis of discrepancies between United Kingdom cancer research funding and societal burden and a comparison to previous and United States values. Health Research Policy and Systems 2015;13:62. [ PMC free article : PMC4629288 ] [ PubMed : 26526609 ]
• Centers for Disease Control and Prevention. A Practical Guide to Working with Health-Care Systems on Tobacco-Use Treatment . Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
• Centers for Disease Control and Prevention. Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign—March 19–June 10, 2012. Morbidity and Mortality Weekly Report 2012;61(34):667–70. [ PubMed : 22932300 ]
• Centers for Disease Control and Prevention. Impact of a national tobacco education campaign on weekly numbers of quitline calls and website visitors—United States, March 4–June 23, 2013. Morbidity and Mortality Weekly Report 2013a;62(37):763–7. [ PMC free article : PMC4585359 ] [ PubMed : 24048152 ]
• Centers for Disease Control and Prevention. Vital signs: current cigarette smoking among adults aged ≥18 years with mental illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013b;62:81–7. [ PMC free article : PMC4604817 ] [ PubMed : 23388551 ]
• Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014 . Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014a; < https://www ​.cdc.gov/tobacco ​/stateandcommunity ​/best_practices ​/pdfs/2014/comprehensive.pdf >; accessed: July 26, 2017.
• Centers for Disease Control and Prevention. Frequently asked questions (FAQ) about 1-800-QUIT-NOW and the National Network of Tobacco Cessation Quitlines, May 2014b; < https://www ​.cdc.gov/tobacco ​/quit_smoking ​/cessation/pdfs/1800quitnow_faq.pdf >; accessed: April 4, 2018.
• Centers for Disease Control and Prevention. Current cigarette smoking among adults in the United States, December 1, 2016; < https://www ​.cdc.gov/tobacco ​/data_statistics ​/fact_sheets/adult_data ​/cig_smoking/index.htm >; accessed: September 7, 2017.
• Chaiton M, Cohen JE, Bondy SJ, Selby P, Brown KS, Ferrence R, Garcia JM. Perceived addiction as a predictor of smoking cessation among occasional smokers. Journal of Smoking Cessation 2016:1–8.
• Chapman S, Wong WL, Smith W. Self-exempting beliefs about smoking and health: differences between smokers and ex-smokers. American Journal of Public Health 1993;83(2):215–9. [ PMC free article : PMC1694573 ] [ PubMed : 8427326 ]
• Chaudhri N, Caggiula AR, Donny EC, Palmatier MI, Liu X, Sved AF. Complex interactions between nicotine and nonpharmacological stimuli reveal multiple roles for nicotine in reinforcement. Psychopharmacology 2006;184(3-4):353–66. [ PubMed : 16240165 ]
• Chen A. Teenagers embrace JUUL, saying it’s discreet enough to vape in class, December 4, 2017; < https://www ​.npr.org/sections ​/health-shots ​/2017/12/04/568273801 ​/teenagers-embrace-juul-saying-its-discreet-enough-to-vape-in-class >; accessed: August 9, 2018.
• Chu K, Allem J, Cruz TB, Unger JB. Vaping on Instagram: cloud chasing, hand checks and product placement. Tobacco Control 2017;26:575–8. [ PMC free article : PMC5362347 ] [ PubMed : 27660111 ]
• Cole-Lewis H, Augustson E, Sanders A, Schwarz M, Geng Y, Coa K, Hunt Y. Analysing user-reported data for enhancement of SmokefreeTXT: a national text message smoking cessation intervention. Tobacco Control 2016. [ PubMed : 27852892 ]
• Collins FS, Varmus H. A new initiative on precision medicine. New England Journal of Medicine 2015;372(9):793–5. [ PMC free article : PMC5101938 ] [ PubMed : 25635347 ]
• Conklin CA, Salkeld RP, Perkins KA, Robin N. Do people serve as cues to smoke? Nicotine and Tobacco Research 2013;15(12):2081–7. [ PMC free article : PMC3819981 ] [ PubMed : 23873978 ]
• Cook BL, Wayne GF, Kafali EN, Liu Z, Shu C, Flores M. Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation. JAMA: the Journal of the American Medical Association 2014;311(2):172–82. [ PMC free article : PMC5555156 ] [ PubMed : 24399556 ]
• Corey CG, Chang JT, Rostron BL. Electronic nicotine delivery system (ENDS) battery-related burns presenting to US emergency departments, 2016. Injury Epidemiology 2018;5(1):4. [ PMC free article : PMC5835487 ] [ PubMed : 29504085 ]
• Coughlin S. We asked teens to explain Juuling to us & wow, August 9, 2018; < http://www ​.refinery29 ​.com/2018/02/190089 ​/what-is-juul-e-cigarette-vaping-teenagers >.
• Creamer MR, Wang TW, Babb S, Cullen KA, Day H, Willis G. Tobacco product use and cessation indicators among adults—United States, 2018. Morbidity and Mortality Weekly Report 2019;68(45):1013–9. [ PMC free article : PMC6855510 ] [ PubMed : 31725711 ]
• Cullen KA, Gentzke AS, Sawdey MD, Chang JT, Anic GM, Wang TW, Creamer MR, Jamal A, Ambrose BK, King BA. E-cigarette use among youth in the United States, 2019. JAMA: the Journal of the American Medical Association 2019. [ PMC free article : PMC6865299 ] [ PubMed : 31688912 ]
• Cummins SE, Bailey L, Campbell S, Koon-Kirby C, Zhu SH. Tobacco cessation quitlines in North America: a descriptive study. Tobacco Control 2007;16:(Suppl 1):i9–i15. [ PMC free article : PMC2598516 ] [ PubMed : 18048639 ]
• Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. New England Journal of Medicine 1998;339(10):673–9. [ PubMed : 9725926 ]
• Curry SJ, Wagner EH, Grothaus LC. Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. Journal of Consulting and Clinical Psychology 1991;59(2):318–24. [ PubMed : 2030194 ]
• Dennis PA. Disparities in cancer funding. Science 2004;305(5689):1401–2. [ PubMed : 15353780 ]
• Ebbert JO, Croghan IT, Hurt RT, Schroeder DR, Hays JT. Varenicline for smoking cessation in light smokers. Nicotine and Tobacco Research 2016;18(10):2031–5. [ PMC free article : PMC6280997 ] [ PubMed : 27117285 ]
• Elias J, Hendlin YH, Ling PM. Public versus internal conceptions of addiction: an analysis of internal Philip Morris documents. PLoS Medicine 2018;15(5):e1002562. [ PMC free article : PMC5929514 ] [ PubMed : 29715300 ]
• Fagerstrom K, Etter JF, Unger JB. E-cigarettes: a disruptive technology that revolutionizes our field? Nicotine and Tobacco Research 2015;17(2):125–6. [ PMC free article : PMC4892710 ] [ PubMed : 25609846 ]
• Farber HJ, Neptune ER, Ewart GW. Corrective statements from the tobacco industry: more evidence for why we need effective tobacco control. Annals of the American Thoracic Society 2018;15(2):127–30. [ PubMed : 29140104 ]
• Ferketich AK, Khan Y, Wewers ME. Are physicians asking about tobacco use and assisting with cessation? Results from the 2001–2004 national ambulatory medical care survey (NAMCS). Preventive Medicine 2006;43(6):472–6. [ PubMed : 16920185 ]
• Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in U.S. undergraduate medical education. JAMA: the Journal of the American Medical Association 1999;282(9):825–9. [ PubMed : 10478687 ]
• Fiore MC, Bailey WC, Cohen SJ. Treating Tobacco Use and Dependence: Clinical Practice Guideline . Rockville (MD): U.S. Department of Health and Human Services, U.S. Public Health Service, 2000.
• Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, Heyman RB, Holbrook J, Jaen CR, Kottke TE, et al. Smoking Cessation: Clinical Practice Guideline No. 18 . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1996. AHCPR Publication No. 96-0692.
• Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update. U.S. Public Health Service Clinical Practice Guideline . Rockville (MD): U.S. Department of Health and Human Services, 2008.
• Fiore MC, Novotny TE, Pierce JP, Giovino GA, Hatziandreu EJ, Newcomb PA, Surawicz TS, Davis RM. Methods used to quit smoking in the United States. Do cessation programs help? JAMA: the Journal of the American Medical Association 1990;263(20):2760–5. [ PubMed : 2271019 ]
• Ford DE, Vu HT, Anthony JC. Marijuana use and cessation of tobacco smoking in adults from a community sample. Drug and Alcohol Dependence 2002;67(3):243–8. [ PubMed : 12127195 ]
• Friedman LC, Cheyne A, Givelber D, Gottlieb MA, Daynard RA. Tobacco industry use of personal responsibility rhetoric in public relations and litigation: disguising freedom to blame as freedom of choice. American Journal of Public Health 2015;105(2):250–60. [ PMC free article : PMC4318333 ] [ PubMed : 25521876 ]
• Fu SS, van RynM, Nelson D, Burgess DJ, Thomas JL, Saul J, Clothier B, Nyman JA, Hammett P, Joseph AM. Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. Thorax 2016;71(5):446–53. [ PMC free article : PMC4862067 ] [ PubMed : 26931362 ]
• Fu SS, van Ryn M, Sherman SE, Burgess DJ, Noorbaloochi S, Clothier B, Taylor BC, Schlede CM, Burke RS, Joseph AM. Proactive tobacco treatment and population-level cessation: a pragmatic randomized clinical trial. JAMA Internal Medicine 2014;174(5):671–7. [ PubMed : 24615217 ]
• Gandhi KK, Foulds J, Steinberg MB, Lu SE, Williams JM. Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic. International Journal of Clinical Practice 2009;63(3):360–7. [ PubMed : 19222622 ]
• Geller AC, Brooks DR, Powers CA, Brooks KR, Rigotti NA, Bognar B, McIntosh S, Zapka J. Tobacco cessation and prevention practices reported by second and fourth year students at U.S. medical schools. Journal of General Internal Medicine 2008;23(7):1071–6. [ PMC free article : PMC2517923 ] [ PubMed : 18612747 ]
• Genetics Home Reference. What is the Precision Medicine Initiative, June 12, 2018; < https://ghr ​.nlm.nih.gov ​/primer/precisionmedicine/initiative >; accessed: June 13, 2018.
• Ghorai K, Akter S, Khatun F, Ray P. mHealth for smoking cessation programs: a systematic review. Journal of Personalized Medicine 2014;4(3):412–23. [ PMC free article : PMC4263966 ] [ PubMed : 25563359 ]
• Gibson JE, Murray RL, Borland R, Cummings KM, Fong GT, Hammond D, McNeill A. The impact of the United Kingdom’s national smoking cessation strategy on quit attempts and use of cessation services: findings from the International Tobacco Control Four Country Survey. Nicotine and Tobacco Research 2010;12(Suppl):S64–S71. [ PMC free article : PMC2948139 ] [ PubMed : 20889483 ]
• GlaxoSmithKline. Medication guide: Wellbutrin (bupropion hydrochloride) tablets, May 2017; < https://www ​.gsksource ​.com/pharma/content ​/dam/GlaxoSmithKline ​/US/en/Prescribing_Information ​/Wellbutrin_Tablets ​/pdf/WELLBUTRIN-TABLETS-PI-MG ​.PDF >; accessed: July 16, 2019.
• Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 2004;61(11):1107–15. [ PubMed : 15520358 ]
• Griffith BN, Montalto NJ, Ridpath L, Sullivan K. Tobacco dependence curricula in U.S. osteopathic medical schools: a follow-up study. Journal of the American Osteopathic Association 2013;113(11):838–48. [ PubMed : 24174505 ]
• Grigorian G. Juuling at Dartmouth: addiction renewed and reimagined. The Dartmouth , February 9, 2018; < http://www ​.thedartmouth ​.com/article/2018 ​/02/juuling-at-dartmouth-addiction-renewed-and-reimagined >; accessed: August 9, 2018.
• Hajek P, Stead LF, West R, Jarvis M, Hartmann-Boyce J, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub4. [ PubMed : 23963584 ] [ CrossRef ]
• Hall M, Bogdanovica I, Britton J. Research funding for addressing tobacco-related disease: an analysis of UK investment between 2008 and 2012. BMJ Open 2016;6(7):e011609. [ PMC free article : PMC4947797 ] [ PubMed : 27377637 ]
• Hall SM, Delucchi KL, Velicer WF, Kahler CW, RangerMoore J, Hedeker D, Tsoh JY, Niaura R. Statistical analysis of randomized trials in tobacco treatment: longitudinal designs with dichotomous outcome. Nicotine and Tobacco Research 2001;3(3):193–202. [ PubMed : 11506764 ]
• Hall SM, Prochaska JJ. Treatment of smokers with cooccurring disorders: emphasis on integration in mental health and addiction treatment settings. Annual Review of Clinical Psychology 2009;5:409–31. [ PMC free article : PMC2718730 ] [ PubMed : 19327035 ]
• Hamlett-Berry K, Davison J, Kivlahan DR, Matthews MH, Hendrickson JE, Almenoff PL. Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration. Military Medicine 2009;174(1):29–34. [ PubMed : 19216295 ]
• Haskins BL, Lesperance D, Gibbons P, Boudreaux ED. A systematic review of smartphone applications for smoking cessation. Translational Behavioral Medicine 2017;7(2):292–9. [ PMC free article : PMC5526818 ] [ PubMed : 28527027 ]
• Hays JT, Croghan IT, Schroeder DR, Burke MV, Ebbert JO, McFadden DD, Hurt RD. Residential treatment compared with outpatient treatment for tobacco use and dependence. Mayo Clinic Proceedings 2011;86(3):203–9. [ PMC free article : PMC3046940 ] [ PubMed : 21307389 ]
• Hirschhorn N. Evolution of the Tobacco Industry Positions on Addiction to Nicotine: A Report Prepared for the Tobacco Free Initiative, World Health Organization . Geneva (Switzerland): World Health Organization, 2009; < http://www ​.who.int/iris ​/handle/10665/43988 >; accessed: September 14, 2017.
• Hopkins DP, Husten CG, Fielding JE, Rosenquist JN, Westphal LL. Evidence reviews and recommendations on interventions to reduce tobacco use and exposure to environmental tobacco smoke: a summary of selected guidelines. American Journal of Preventive Medicine 2001;20:(2 Suppl):67–87. [ PubMed : 11173216 ]
• Huang J, Duan Z, Kwok J, Binns S, Vera LE, Kim Y, Szczypka G, Emery SL. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the U.S. retail e-cigarette market. Tobacco Control 2018. [ PMC free article : PMC6274629 ] [ PubMed : 29853561 ]
• Hughes JR. The hardening hypothesis: is the ability to quit decreasing due to increasing nicotine dependence? A review and commentary. Drug and Alcohol Dependence 2011;117(2-3):111–7. [ PMC free article : PMC3133840 ] [ PubMed : 21411244 ]
• Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99(1):29–38. [ PubMed : 14678060 ]
• Hughes JR, Keely JP, Niaura RS, Ossip-Klein DJ, Richmond RL, Swan GE. Measures of abstinence in clinical trials: issues and recommendations. Nicotine and Tobacco Research 2003;5(1):13–25. [ PubMed : 12745503 ]
• Jamal A, Gentzke A, Hu SS, Cullen KA, Apelberg BJ, Homa DM, King BA. Tobacco use among middle and high school students—United States, 2011–2016. Morbidity and Mortality Weekly Report 2017;66(23):597–603. [ PMC free article : PMC5657845 ] [ PubMed : 28617771 ]
• Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults—United States, 2005–2015. Morbidity and Mortality Weekly Report 2016;65(44):1205–11. [ PubMed : 27832052 ]
• Jarvik ME. Further observations on nicotine as the reinforcing agent in smoking. In: Dunn WL Jr, editor. Smoking Behavior: Motives and Incentives . Washington (DC): V. H. Winston and Sons, 1973:33–49.
• Joyce GF, Niaura R, Maglione M, Mongoven J, LarsonRotter C, Coan J, Lapin P, Morton S. The effectiveness of covering smoking cessation services for Medicare beneficiaries. Health Services Research 2008;43(6):2106–23. [ PMC free article : PMC2614005 ] [ PubMed : 18783459 ]
• Kasza KA, Ambrose BK, Conway KP, Borek N, Taylor K, Goniewicz ML, Cummings KM, Sharma E, Pearson JL, Green VR, et al. Tobacco-product use by adults and youths in the United States in 2013 and 2014. New England Journal of Medicine 2017;376(4):342–53. [ PMC free article : PMC5317035 ] [ PubMed : 28121512 ]
• Keller PA, Feltracco A, Bailey LA, Li Z, Niederdeppe J, Baker TB, Fiore MC. Changes in tobacco quitlines in the United States, 2005–2006. Preventing Chronic Disease 2010;7(2):A36. [ PMC free article : PMC2831790 ] [ PubMed : 20158964 ]
• King BA, Creamer MR, Harrell M, Kelder S, Norman L, Perry CL. Surgeon General’s reports on tobacco: a continued legacy of unbiased and rigorous synthesis of the scientific evidence. Nicotine and Tobacco Research 2018;20(8):1033–6. [ PMC free article : PMC6023778 ] [ PubMed : 29300946 ]
• King BA, Dube SR, Babb SD, McAfee TA. Patient-reported recall of smoking cessation interventions from a health professional. Preventive Medicine 2013;57(5):715–7. [ PMC free article : PMC4572889 ] [ PubMed : 23872172 ]
• Kofman M, Dunton K, Senkewicz MB. Implementation of Tobacco Cessation Coverage Under the Affordable Care Act: Understanding How Private Health Insurance Policies Cover Tobacco Cessation Treatments . Washington (DC): Health Policy Institute, Georgetown University, 2012.
• Krasnegor NA, editor. The Behavioral Aspects of Smoking. NIDA Research Monograph 26. Rockville (MD): U.S. Department of Health, Education, and Welfare; Public Health Service; Alcohol, Drug Abuse, and Mental Health Administration; National Institute on Drug Abuse; Division of Research, August 1979.
• Lee JE, Park EC, Chun SY, Park HK, Kim TH. Sociodemographic and clinical factors contributing to smoking cessation among men: a four-year follow up study of the Korean Health Panel Survey. BMC Public Health 2016;16:908. [ PMC free article : PMC5006525 ] [ PubMed : 27581873 ]
• Lindson-Hawley N, Thompson TP, Begh R. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub3. [ PubMed : 25726920 ] [ CrossRef ]
• Liu X, Li R, Lanza ST, Vasilenko SA, Piper M. Understanding the role of cessation fatigue in the smoking cessation process. Drug and Alcohol Dependence 2013;133(2):548–55. [ PMC free article : PMC4057045 ] [ PubMed : 23954071 ]
• Manley MW, Epps RP, Glynn TJ. The clinician’s role in promoting smoking cessation among clinic patients. Medical Clinics of North America 1992;76(2):477–94. [ PubMed : 1548972 ]
• McAfee T, Babb S, McNabb S, Fiore MC. Helping smokers quit—opportunities created by the Affordable Care Act. New England Journal of Medicine 2015;372(1):5–7. [ PMC free article : PMC4465216 ] [ PubMed : 25409263 ]
• McAfee T, Davis KC, Alexander RL Jr, Pechacek TF, Bunnell R. Effect of the first federally funded U.S. antismoking national media campaign. Lancet 2013;382(9909):2003–11. [ PubMed : 24029166 ]
• McAfee T, Sofian NS, Wilson J, Hindmarsh M. The role of tobacco intervention in population-based health care: a case study. American Journal of Preventive Medicine 1998;14:(3 Suppl):46–52. [ PubMed : 9566937 ]
• Mermelstein R, Colby SM, Patten C, Prokhorov A, Brown R, Myers M, Adelman W, Hudmon K, McDonald P. Methodological issues in measuring treatment outcome in adolescent smoking cessation studies. Nicotine and Tobacco Research 2002;4(4):395–403. [ PubMed : 12521399 ]
• Montalto NJ, Ferry LH, Stanhiser T. Tobacco dependence curricula in undergraduate osteopathic medical education. Journal of the American Osteopathic Association 2004;104(8):317–23. [ PubMed : 15345701 ]
• National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes . Washington (DC): The National Academies Press, 2018. [ PubMed : 29894118 ]
• National Cancer Institute. Those Who Continue to Smoke: Is Achieving Abstinence Harder and Do We Need to Change Our Interventions? Smoking and Tobacco Control Monograph No. 15. Bethesda (MD): U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2003.
• National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use . Smoking and Tobacco Control Monograph No. 19. Bethesda (MD): U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008. NIH Publication No. 07-6242.
• National Conference of State Legislatures. Marijuana Overview: Legalization, 2016; < http://www ​.ncsl.org/research ​/civil-and-criminal-justice ​/marijuana-over-view.aspx >; accessed: November 5, 2019.
• National Institute on Drug Abuse. Research Reports: Tobacco, Nicotine, and E-Cigarettes . Bethesda (MD): National Institutes of Health, National Institute on Drug Abuse, 2018.
• North American Quitline Consortium. North American quitlines: a profile of reach and services in 2005 across the U.S. and Canada, 2007; < http://c ​.ymcdn.com/sites/www ​.naquitline.org ​/resource/resmgr/docs ​/factsheet-survey2007.pdf >; accessed: September 14, 2017.
• Oakes W, Chapman S, Borland R, Balmford J, Trotter L. “Bulletproof skeptics in life’s jungle”: which self-exempting beliefs about smoking most predict lack of progression towards quitting? Preventive Medicine 2004;39(4):776–82. [ PubMed : 15351545 ]
• Office of the U.S. Surgeon General. Surgeon General’s Advisory on E-Cigarette Use Among Youth , n.d.; < https: ​//e-cigarettes ​.surgeongeneral.gov/documents ​/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf >; accessed: January 9, 2019.
• Orleans CT, Schoenbach VJ, Wagner EH, Quade D, Salmon MA, Pearson DC, Fiedler J, Porter CQ, Kaplan BH. Self-help quit smoking interventions: effects of selfhelp materials, social support instructions, and telephone counseling. Journal of Consulting and Clinical Psychology 1991;59(3):439–48. [ PubMed : 2071729 ]
• Ossip-Klein DJ, Giovino GA, Megahed N, Black PM, Emont SL, Stiggins J, Shulman E, Moore L. Effects of a smoker’s hotline: results of a 10-county self-help trial. Journal of Consulting and Clinical Psychology 1991;59(2):325–32. [ PubMed : 2030195 ]
• Parascandola M. Tobacco harm reduction and the evolution of nicotine dependence. American Journal of Public Health 2011;101(4):632–41. [ PMC free article : PMC3052352 ] [ PubMed : 21330596 ]
• Patton GC, Coffey C, Carlin JB, Sawyer SM, Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 2005;100(10):1518–25. [ PubMed : 16185213 ]
• Pfizer. Medication guide: Chantix (varenicline) tablets, February 2019; < http://labeling ​.pfizer ​.com/ShowLabeling.aspx?id ​=557&section=MedGuide >; accessed: July 16, 2019.
• Polito JR. Freedom from Nicotine: The Journey Home , 2013; < http://whyquit ​.com/ffn/index.html >; accessed: September 14, 2017.
• Powers CA, Zapka JG, Bognar B, Dube C, Hyder Ferry L, Ferguson KJ, O’Donnell J F, Rigotti N, Conley Thomson C, White M, et al. Evaluation of current tobacco curriculum at 12 U.S. medical schools. Journal of Cancer Education 2004;19(4):212–9. [ PubMed : 15725638 ]
• Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychology 1993;12(5):399–405. [ PubMed : 8223364 ]
• Proctor RN. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition . Berkeley (CA): University of California Press, 2011.
• Radding B. Pax Juul: the iPhone of e-cigs?, n.d.; < https://www ​.mensfitness ​.com/life/gearandtech ​/pax-juul-iphone-e-cigs >; accessed: August 9, 2018.
• Redmond LA, Adsit R, Kobinsky KH, Theobald W, Fiore MC. A decade of experience promoting the clinical treatment of tobacco dependence in Wisconsin. Wisconsin Medical Journal 2010;109(2):71–8. [ PubMed : 20443325 ]
• Richmond R, Zwar N, Taylor R, Hunnisett J, Hyslop F. Teaching about tobacco in medical schools: a worldwide study. Drug and Alcohol Review 2009;28(5):484–97. [ PubMed : 19737207 ]
• Rothman KJ, Greenland S. Modern Epidemiology . 2nd ed. Philadelphia (PA): Lippincott-Raven, 1998.
• Saggio J. What is a Juul? It’s a trend parents need to know about. Florida Today , 2018; < https://www ​.floridatoday ​.com/story/news/2018 ​/02/02/what-juul-its-trend-parents-need-know/1070088001 >; accessed: August 9, 2018.
• Schauer GL, Berg CJ, Kegler MC, Donovan DM, Windle M. Differences in tobacco product use among past month adult marijuana users and nonusers: findings from the 2003–2012 National Survey on Drug Use and Health. Nicotine and Tobacco Research 2016;18(3):281–8. [ PubMed : 26009578 ]
• Schauer GL, King BA, McAfee TA. Prevalence, correlates, and trends in tobacco use and cessation among current, former, and never adult marijuana users with a history of tobacco use, 2005–2014. Addictive Behaviors 2017;73:165–71. [ PubMed : 28525833 ]
• Schlam TR, Baker TB. Interventions for tobacco smoking. Annual Review of Clinical Psychology 2013;9:675–702. [ PMC free article : PMC5844577 ] [ PubMed : 23297788 ]
• Schneider NG, Olmstead RE, Franzon MA, Lunell E. The nicotine inhaler: clinical pharmacokinetics and comparison with other nicotine treatments. Clinical Pharmacokinetics 2001;40(9):661–84. [ PubMed : 11605715 ]
• Schroeder SA. What to do with a patient who smokes. JAMA: the Journal of the American Medical Association 2005;294(4):482–7. [ PubMed : 16046655 ]
• Schroeder SA, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health 2010;31:297–314. [ PubMed : 20001818 ]
• Scott KA, Mason MJ, Mason JD. I’m not a smoker: constructing protected prototypes for risk behavior. Journal of Business Research 2015;68(10):2198–206.
• Shiffman S. Ecological momentary assessment (EMA) in studies of substance use. Psychological Assessment 2009;21(4):486–97. [ PMC free article : PMC2846437 ] [ PubMed : 19947783 ]
• Shiffman S, West R, Gilbert D. Recommendation for the assessment of tobacco craving and withdrawal in smoking cessation trials. Nicotine and Tobacco Research 2004;6(4):599–614. [ PubMed : 15370156 ]
• Shihadeh A, Eissenberg T. Electronic cigarette effectiveness and abuse liability: predicting and regulating nicotine flux. Nicotine and Tobacco Research 2015;17(2):158–62. [ PMC free article : PMC4837999 ] [ PubMed : 25180079 ]
• Siu AL. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2015;163(8):622–34. [ PubMed : 26389730 ]
• Smith MW, Chen S, Siroka AM, Hamlett-Berry K. Using policy to increase prescribing of smoking cessation medications in the VA healthcare system. Tobacco Control 2010;19(6):507–11. [ PubMed : 20870742 ]
• Smokefree ​.gov . Sign up for SmokefreeTXT, n.d.; < https://smokefree ​.gov/smokefreetxt >; accessed: August 17, 2017.
• Solberg LI, Maxwell PL, Kottke TE, Gepner GJ, Brekke ML. A systematic primary care office-based smoking cessation program. Journal of Family Practice 1990;30(6):647–54. [ PubMed : 2345333 ]
• Soule EK, Pomeranz JL, Moorhouse MD, Barnett TE. Multiple tobacco use and increased nicotine dependence among people with disabilities. Disability and Health Journal 2015;8(2):258–63. [ PubMed : 25445017 ]
• Squiers L, Brown D, Parvanta S, Dolina S, Kelly B, Dever J, Southwell BG, Sanders A, Augustson E. The SmokefreeTXT (SFTXT) study: web and mobile data collection to evaluate smoking cessation for young adults. JMIR Research Protocols 2016;5(2):e134. [ PMC free article : PMC4940604 ] [ PubMed : 27349898 ]
• Squiers LB, Augustson E, Brown D, Kelly B, Southwell B, Dever J, Dolina S, Tzeng J, Parvanta S, Holt S, et al. An experimental comparison of mobile texting programs to help young adults quit smoking. Health Systems 2017;6(1):1–14.
• SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine and Tobacco Research 2002;4(2):149–59. [ PubMed : 12028847 ]
• Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3. [ PubMed : 23934971 ] [ CrossRef ]
• Strecher VJ, Kreuter M, Den Boer DJ, Kobrin S, Hospers HJ, Skinner CS. The effects of computer-tailored smoking cessation messages in family practice settings. Journal of Family Practice 1994;39(3):262–70. [ PubMed : 8077905 ]
• Strecher VJ, Shiffman S, West R. Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction 2005;100(5):682–8. [ PubMed : 15847626 ]
• Suiters K. Are your kids JUULing at school? 7 on your side investigates, January 31, 2018; < http://wjla ​.com/features ​/7-on-your-side/are-your-kids-juuling-at-school-7-on-your-side-investigates >; accessed: August 9, 2018.
• Szatkowski L, McNeill A. Diverging trends in smoking behaviors according to mental health status. Nicotine and Tobacco Research 2015;17(3):356–60. [ PMC free article : PMC5479511 ] [ PubMed : 25180078 ]
• Taber JM, Klein WM, Ferrer RA, Augustson E, Patrick H. A pilot test of self-affirmations to promote smoking cessation in a national smoking cessation text messaging program. JMIR mHealth uHealth 2016;4(2):e71. [ PMC free article : PMC4917724 ] [ PubMed : 27278108 ]
• Teitell B. “Juuling”: The most widespread phenomenon you’ve never heard of. The Boston Globe , November 16, 2017; < https://www ​.bostonglobe ​.com/metro/2017/11 ​/15/where-teenagers-are-high-school-bathrooms-vaping ​/IJ6xYWWlOTKqsUGTTlw4UO ​/story.html >; accessed: August 9, 2018.
• Torabi MR, Tao R, Jay SJ, Olcott C. A cross-sectional survey on the inclusion of tobacco prevention/cessation, nutrition/diet, and exercise physiology/fitness education in medical school curricula. JAMA: the Journal of the American Medical Association 2011;103(5):400–6. [ PubMed : 21809789 ]
• Trinidad DR, Perez-Stable EJ, Messer K, White MM, Pierce JP. Menthol cigarettes and smoking cessation among racial/ethnic groups in the United States. Addiction 2010;105:(Suppl 1):84–94. [ PMC free article : PMC4214376 ] [ PubMed : 21059139 ]
• U.S. Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service . Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, 1964. PHS Publication No. 1103.
• U.S. Department of Health, Education, and Welfare. Smoking and Health. A Report of the Surgeon General . Washington: U.S. Department of Health, Education, and Welfare, Office of the Assistant Secretary for Health, Office on Smoking and Health, 1979. DHEW Publication No. (PHS) 79-50066.
• U.S. Department of Health and Human Services. The Health Consequences of Smoking: Cancer. A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1982. DHHS Publication No. (PHS) 82-50179.
• U.S. Department of Health and Human Services. The Health Consequences of Smoking: Cardiovascular Disease. A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1983. DHHS Publication No. (PHS) 84-50204.
• U.S. Department of Health and Human Services. The Health Consequences of Smoking: Chronic Obstructive Lung Disease. A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1984. DHHS Publication No. (PHS) 84-50205.
• U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General . Atlanta (GA): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988. DHHS Publication No. (CDC) 88-8406.
• U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989. DHHS Publication No. (CDC) 89-8411.
• U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General . Rockville (MD): U.S. Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. DHHS Publication No. (CDC) 90-8416. [ PubMed : 32255575 ]
• U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General . Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
• U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease—The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General . Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. [ PubMed : 21452462 ]
• U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General . Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. [ PubMed : 24455788 ]
• U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General . Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2016. [ PubMed : 30869850 ]
• U.S. Department of Justice. Print corrective statements— exhibit 3: newspaper exemplars, October 2, 2017a; < https://www ​.justice.gov ​/opa/press-release ​/file/1013581/download >; accessed: April 11, 2019.
• U.S. Department of Justice. Tobacco companies to begin issuing court-ordered statements in tobacco racketeering suit [press release], November 22, 2017b; < https://www ​.justice.gov ​/opa/pr/tobacco-companies-begin-issuing-court-ordered-statements-tobacco-racketeering-suit >; accessed: April 11, 2019.
• U.S. Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, M.D., on new enforcement actions and a Youth Tobacco Prevention Plan to stop youth use of, and access to, JUUL and other e-cigarettes [press release], April 24, 2018; < https://www ​.fda.gov/NewsEvents ​/Newsroom/PressAnnouncements ​/ucm605432.htm >; accessed: August 9, 2018.
• U.S. Food and Drug Administration (FDA). Want to Quit Smoking? FDA-Approved Products Can Help [consumer update], 2017; < https://www ​.fda.gov/ForConsumers ​/ConsumerUpdates/ucm198176 ​.htm >; accessed: August 1, 2018.
• U.S. Preventive Services Task Force. Final Update Summary: Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions, September 2015; < https://www ​.uspreventiveservicestaskforce ​.org/Page/Document/UpdateSummaryFinal ​/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions1 >; accessed: May 24, 2017.
• Ussher M, Beard E, Abikoye G, Hajek P, West R. Urge to smoke over 52 weeks of abstinence. Psychopharmacology 2013;226(1):83–9. [ PubMed : 23052572 ]
• Vidrine JI, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, Miles L, Zbikowski SM, Wetter DW. Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings. JAMA Internal Medicine 2013;173(6):458–64. [ PMC free article : PMC3858085 ] [ PubMed : 23440173 ]
• Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014. Tobacco Control 2016;25:(Suppl 2):ii14–ii20. [ PubMed : 27729565 ]
• Vogt F, Hall S, Marteau TM. General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction 2005;100(10):1423–31. [ PubMed : 16185204 ]
• Wang TW, Asman K, Gentzke AS, Cullen KA, Holder-Hayes E, Reyes-Guzman C, Jamal A, Neff L, King BA. Tobacco product use among adults—United States, 2017. Morbidity and Mortality Weekly Report 2018;67(44):1225–32. [ PMC free article : PMC6223953 ] [ PubMed : 30408019 ]
• Wang TW, Kenemer B, Tynan MA, Singh T, King B. Consumption of combustible and smokeless tobacco— United States, 2000–2015. Morbidity and Mortality Weekly Report 2016;65(48):1357–63. [ PMC free article : PMC5584068 ] [ PubMed : 27932780 ]
• Warner KE, Mendez D. E-cigarettes: comparing the possible risks of increasing smoking initiation with the potential benefits of increasing smoking cessation. Nicotine and Tobacco Research 2019;21(1):41–7. [ PubMed : 29617887 ]
• Wells Fargo Securities. Nielsen: Tobacco “All Channel” Data: Marlboro Vol Weak But Share Pressures Ease . Equity Research. San Francisco (CA): Wells Fargo Securities, 2018.
• West R, May S, West M, Croghan E, McEwen A. Performance of English stop smoking services in first 10 years: analysis of service monitoring data. BMJ 2013;347:f4921. [ PubMed : 23963106 ]
• Wetter DW, McClure JB, de Moor C, Cofta-Gunn L, Cummings S, Cinciripini PM, Gritz ER. Concomitant use of cigarettes and smokeless tobacco: prevalence, correlates, and predictors of tobacco cessation. Preventive Medicine 2002;34(6):638–48. [ PubMed : 12052025 ]
• Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub4. [ PMC free article : PMC6485940 ] [ PubMed : 27060875 ] [ CrossRef ]
• Willett JG, Bennett M, Hair EC, Xiao H, Greenberg MS, Harvey E, Cantrell J, Vallone D. Recognition, use and perceptions of JUUL among youth and young adults. Tobacco Control 2018. [ PubMed : 29669749 ]
• Zhang L, Malarcher A, Mann N, Campbell K, Davis K, Anderson C, Alexander R, Rodes R. The influence of state-specific quitline numbers on call volume during a national tobacco education campaign promoting 1-800-QUIT-NOW. Nicotine and Tobacco Research 2016;18(8):1780–5. [ PubMed : 27073208 ]
• Zhu SH, Lee M, Zhuang YL, Gamst A, Wolfson T. Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades? Tobacco Control 2012;21(2):110–8. [ PMC free article : PMC3446870 ] [ PubMed : 22345233 ]
• Zhu SH, Stretch V, Balabanis M, Rosbrook B, Sadler G, Pierce JP. Telephone counseling for smoking cessation: effects of single-session and multiple-session interventions. Journal of Consulting and Clinical Psychology 1996;64(1):202–11. [ PubMed : 8907100 ]

For reference entries that contain URLs, those URLs were active on the access date presented in the respective reference entry.

Unless otherwise noted in the text, all material appearing in this work is in the public domain and may be reproduced without permission. Citation of the source is appreciated.

• Cite this Page United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking Cessation: A Report of the Surgeon General [Internet]. Washington (DC): US Department of Health and Human Services; 2020. Chapter 1, Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation.
• PDF version of this title (9.8M)
• Disable Glossary Links

In this Page

Other titles in this collection.

• Publications and Reports of the Surgeon General

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Recent Activity

• Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation - Smo... Introduction, Conclusions, and the Evolving Landscape of Smoking Cessation - Smoking Cessation

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

• Houston Community College
• Eagle Online

• Debra Sandstrom
• Integrated Reading and Writing, Spring 2017 (INRW 0420)

Process Essay Sample, 7 Easy Steps to Quit Smoking

To print or download this file, click the link below:

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.

Customize your course in 30 seconds

Which class are you in.

• Travelling Essay
• Picnic Essay
• Our Country Essay
• My Parents Essay
• Essay on Favourite Personality
• Essay on Memorable Day of My Life
• Essay on Knowledge is Power
• Essay on Gurpurab
• Essay on My Favourite Season
• Essay on Types of Sports

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Download the App

We use cookies to enhance our website for you. Proceed if you agree to this policy or learn more about it.

• Essay Database >
• Essay Examples >
• Essays Topics >
• Essay on Psychology

Free How to Quit Smoking Essay

Type of paper: Essay

Topic: Psychology , Smoking , Experience , Motivation , Friendship , Life , Management , Sociology

Published: 12/06/2019

ORDER PAPER LIKE THIS

Introduction

Smoking is one of the habits that one can be badly addicted to. Smoking is a habit that is too difficult to quit. In a smoker’s life for instance, it can be a very big step for one to quit smoking, unfortunately this step is not easy to take. This does not recognize whether you are a teen smoker or whether you have smoked all your life. It is basically difficult to quit smoking ones you are an addict. So, improvements are needed to quit smoking which foundationally need some motivation. This motivation should come from the social aspect, and the persons well calculated moves. Through motivation therefore, it is possible to learn the new ways and finally quit and manage the vehement desires of smoking. (Greaves, 36) As a smoker, I have really found it hard to accept the fact that there are people who once smoked and are now free from this habit. I find it very wise to quit smoking but the initiative has been an uphill to me. This is what prompted me to carry out some research on this habit.

This research relies on people’s experience which I do put in prose form.

Why it is hard to quit smoking.

There are several reasons which I found that have kept me smoking. One, smoking comes out to be a physical addiction and psychological habit. Smoking is like a daily ritual which needs to be repeated on daily basis. In addition to this we find that the content of cigarette, nicotine, does provide temporary and addictive state. So if one is to refrain from smoking, then there must be some physical signs that automatically will call for only the determined to stand against and move on. Basically when one has to quit smoking he has to quit both the addiction and the habit. Only through this will one count himself to be out of the addiction of nicotine. (Hilton, 13) Secondly, it is not easy to quit smoking especially for people who were used to it in managing overwhelming and unpleasant feelings such as anxiety, stress, and loneliness. Basically, smoking act as the only companion when one is lonely or is stressed. You find that the comfort that people seem to find through smoking is not an easy thing to abandon and start doing something else. But because one will pretend that he is quitting smoking, he or she will continue smoking and may continue till the end of his or her life. This is because it is not easy due to its addictive nature. The comfort that cigarettes do provide is also addictive. In addition to the addiction, there are some side benefits that do come with smoking thus making it very difficult to quit. These side benefits can include the stimulation that smokers do get when the smoke, the pleasure, the relaxation that these smokers get is very overwhelming that stopping smoking is not easy. These are some of the reasons why I find it not easy to stop smoking. Though it is difficult to stop smoking, I have come to understand that people have been able to stop smoking. They have graduated from that class and have joined the class of non smokers. On inquiring, I came out with some possible solutions to why they managed to quit smoking. The foremost step is that one has to take the initiate to stop smoking. He or she should come out with an effective plan to help him or she quit the craving desire for cigarettes, to manage his or her unpleasant and overwhelming feelings. On top of these, one needs support from the social aspect of life. Those who are close to this smoker do play a very big role in ensuring that they either continue smoking or quit. Through the support of people like the family, the peers and friends from whichever dimension, quitting smoking will not be difficult to undertake.

Personally, I have found it very difficult to stop smoking but now I know that people can work their ways out of the habit. I just want to try my best to quit this habit just like my friends have done it. I want to acknowledge the role that psychology play in such calls for actions. The role that the mind plays stands out to be very significant and this proves that the major step in quitting smoking is having a determined mind to quit smoking. The experience I have had while smoking is pathetic and it is my wish you don’t fall into this trap that I fell in. kindly don not smoke.

Works cited:

Hilton, M. The Smoking Culture: Perfect Pleasures. Manchester University Press, 2000 Gilman, S. L. . Smoke: History of Smoking. Reaktion Books, 2003 Greaves, L. Reflections on Addiction and Modernity State University of New York Press, 2002 Robicsek, F. The Smoking Gods . Eve publishers. Michigan, 1978 West, R. and Shiffman, S. Fast Facts: Smoking Cessation. Health Press Ltd, 2007.

Cite this page

Share with friends using:

Removal Request

Finished papers: 2432

This paper is created by writer with

ID 274594201

If you want your paper to be:

Well-researched, fact-checked, and accurate

Original, fresh, based on current data

Eloquently written and immaculately formatted

275 words = 1 page double-spaced

Get your papers done by pros!

Other Pages

Teaching personal statements, fable book reviews, archives book reviews, cabinet book reviews, kiss book reviews, gaelic book reviews, blackness book reviews, nest book reviews, seed book reviews, vitality book reviews, relay book reviews, missile book reviews, nets essays, amylin essays, circum essays, centration essays, bosniak essays, electrocuted essays, chondrocytes essays, bial essays, demeester essays, cinerea essays, circumferential essays, example of terrorist motivation course work, example of finance report 3, example of creative writing on rhetorical choices as writing technique, exercise of speech by a citizen essay examples, christian mysticism essay samples, sample critical thinking on mark twain, example of combat stress ptsd research paper, same sex marriage essays example, free us transportation policy statement on bicycle and pedestrian accommodation regulations and recommendations course work sample, business ethics essay samples, free health care administration essay sample, free introduction to translational medicine course work example, human will in oedipus the king essay examples, good clara barton research paper example, free essay on grateful dead concert review, free authoritarian essay example, good essay about the impact of advertising, free how feminist movement found expression in the 18th century essay sample.

Password recovery email has been sent to [email protected]

Use your new password to log in

You are not register!

By clicking Register, you agree to our Terms of Service and that you have read our Privacy Policy .

Now you can download documents directly to your device!

Check your email! An email with your password has already been sent to you! Now you can download documents directly to your device.

or Use the QR code to Save this Paper to Your Phone

The sample is NOT original!

Short on a deadline?

Don't waste time. Get help with 11% off using code - GETWOWED

No, thanks! I'm fine with missing my deadline

Home — Essay Samples — Nursing & Health — Smoking — The Challenges of Quitting Smoking

The Challenges of Quitting Smoking

• Categories: Smoking Tobacco

About this sample

Words: 509 |

Published: Mar 1, 2019

Words: 509 | Page: 1 | 3 min read

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Dr Jacklynne

Verified writer

• Expert in: Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

3 pages / 1585 words

1 pages / 611 words

2 pages / 783 words

2 pages / 1162 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Smoking

Initial impressions of a person smoking Association of smoking with wealth and maturity Irony of anti-smoking education Relaxation and stress reduction Taking breaks and social interactions Life skills [...]

Smoking is a prevalent practice in many societies, with approximately 1 billion people engaging in this habit. The act of smoking involves burning substances, such as tobacco or cannabis, and inhaling the resulting smoke into [...]

Understanding the Effects of Smoking Smoking is a habit that has been linked to a myriad of health risks, including lung cancer, heart disease, and respiratory illnesses. In addition to the physical health risks, smoking also [...]

Good afternoon, ladies and gentlemen. Today, I would like to talk to you about the dangers of smoking and the impact it has on individuals and society as a whole. Smoking is a prevalent habit that has been around for centuries, [...]

Vaping is not a traditional smoking. Many of us don’t even consider it as a substitute of smoking. That’s why a large chunk of non-smokers get attracted towards vaping because it’s harmless, flavored, aromatic and obviously [...]

Stop smoking it can cost you your life! What is smoking? How can something small cause so much harm to the world? Smoking is an addictive drug that can cause death or cancer it has caused, More than 10 times as many U.S. [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

How to Write the Essay on “Ways to Quit Smoking”?

In the process of your research on essay or persuasive speech on smoking , you will most likely find out that there is a certain study, which says this way works better than the other. Then you just turn the next page and see that there is another way to quit smoking and it’s better than all what you knew before. As you see, it’s a never-ending story. As an alternative, you may dedicate your paper to putting together a special quit smoking program, which can be applied by the others.

“Ways to Quit Smoking” Essay: Write a Hooking Introduction!

There are more than 4000 (!) health-damaging elements in tobacco. The element that makes a human being addicted to smoking is nicotine. Just a drop of information for you to include into the assignment! The thing is that the first two or three lines are the most crucial for they will either attract your readers or make them put the project aside for good. Make sure to start your paper with a hooking open theme to make sure your audience will be longing for more once they’re done with the intro.

Writing an Essay or a Speech About Smoking: Successful Quit-Smoking Plan

Once you decide to work out a booming quit smoking program, make sure to include the following elements in your essay:

• Pharmacological products appropriate use . Those, who are severely addicted to the cigarettes, could consider using nicotine-replacement elements so that the body could gradually get rid of nicotine-addiction. Make sure to recommend your audience to consult their doctors before using the drugs.
• One-to-one counseling. It is highly important to point out that qualified support helps smokers to identify their aims. Moreover, in the moments of weakness, a professional counselor will help to prevent relapse. Consider telephone counseling, one-to-one counseling, group support, internet programs for smokers, etc.
• Measure & Record. Suggest your readers an idea to take a black-and-white look at how much they actually smoke, how much $ they pay each months (day, week, etc.) for their addiction and how much money they could actually save.
• Improve Your Knowledge. Tell your readers to read the science, converse with the experienced experts in order to make 100% sure how smoking ruins their health and the health of the people around. Being aware of how the others have tackled life-saving challenge will give courage to those, who are still fighting the addiction!

Our statistics

• Free Samples
• Premium Essays
• Editing Services Editing Proofreading Rewriting
• Extra Tools Essay Topic Generator Thesis Generator Citation Generator GPA Calculator Study Guides Donate Paper
• Essay Writing Help
• About Us About Us Testimonials FAQ
• Studentshare
• Social science
• How to Quit Smoking

How to Quit Smoking - Essay Example

• Subject: Social science
• Type: Essay
• Level: Ph.D.
• Pages: 2 (500 words)
• Downloads: 10
• Author: vandervortmicah

Extract of sample "How to Quit Smoking"

 Introduction Millions of people used to die every year due to smoking cigarettes. It is quite difficult for a chain smoker to quit the habit of smoking and live a healthy life. It is important for the smokers to understand about the consequences of smoking. This process essay will support the following thesis statement about how to quit smoking. Thesis Statement “Effective medication process and consumption of nicotine gum can help an individual to quit smoking”. Discussion This part of the process essay has discussed about how effective medication process and consumption of nicotine gum can help to quit smoking.

First of all, it is highly important for an individual to find a doctor or an effective medication process that can help an individual to quit smoking (Carr, 2011). Nicotine replacement therapy can be considered as a significant option under the medication process that can help to change the habit of smoking of a chain cigarette smoker (Miller, 2000). This nicotine replacement therapy can help a chain smoker to release the nicotine patches from the blood stream in the body. Expert doctors always try to influence the individuals to quit smoking through the prescribed medication process (Brannon, 2013).

Several individuals do not try to go under this medication process as they love to smoke cigarettes. Fear of several withdrawal symptoms stops the smokers to consult with doctors or medication agencies (Gansler, 2010). Medication process includes therapy and prescribed nicotine spray that can help to reduce the habit of smoking cigarettes which is highly injurious to health. However, this medication process helps to minimize the possibility of withdrawal symptoms that can be raised when a chain smoker stops smoking.

Irritability, craving, anger, anxiety, headaches and feeling awful are the major consequences of this (Foody, 2007). These prescribed medication processes help to reduce the possibility of these syndromes that can influence an individual not to smoke for another time (Goldberg, 2009). This is the one process that should be considered by the smokers to quit smoking. Consumption of nicotine gum also can be considered as an effective option for the smokers to quit smoking (Hales, 2008). Consumption of nicotine gum helps people to increase the level of determination and self-confidence to quite the habit of smoking.

First of all, it is highly important for an individual to identify the consequences of havoc smoking (Hanson, 2011). It has mentioned earlier that millions of people used to die due to smoking cigarettes. Cancer, respiratory problems and high blood pressure are the major consequences of havoc smoking. Consumption of nicotine gums helps to reduce the level of consumption of nicotine in body and blood cells (Brizzer, 2011). In addition to this, this process also can help to overcome the possibility of withdrawal symptoms similar to the above mentioned medication processes considered by expert doctors (Krumhol, 2002).

ConclusionEffective medication process and consumption of nicotine gums change the motive and habit of a chain smoker from smoking to leading a healthy life. It is true that these two processes are both time and cost consuming. But, end of the day these will definitely help to increase the inner willpower of people that can help them to quit smoking.ReferencesBrannon, L. (2013). Health Psychology. Stamford: Cengage Learning.Brizzer, D. (2011). Quitting Smoking for Dummies. New Jersey: John Wiley & Sons. Carr, A. (2011).

Allen Carr’s Easy way to Stop Smoking. New York: Clarity Marketing USA.Foody, J. (2007). Preventive Cardiology. New York: Springer.Gansler, T. (2010). Reduce Your Cancer Risk. New York: Demos Medical Publishing. Goldberg, R. (2009). Drugs across the Spectrum. Stamford: Cengage Learning. Hales, D. (2008). An Invitation to Health 2009-2010. Stamford: Cengage Learning.Hanson, G. (2011). Drugs and Society. London: Jones & Bartlett.Krumhol, H. (2002). Smoking quit it before Your Life Quits you. London: Routledge.Miller, B. (2000).

How to Quit Smoking Even if you Don’t Want to. London: Trafford Publishing.

• Cited: 0 times
• Copy Citation Citation is copied Copy Citation Citation is copied Copy Citation Citation is copied

CHECK THESE SAMPLES OF How to Quit Smoking

Thinking how to quit smoking, drugs : should their sale and use be legalized, corporate strategic plan, teaching and learning for health, quitting smoking how to do it, e-cigaretee, industry analysis, the current lifestyle and how it affects sustainability.

• TERMS & CONDITIONS
• PRIVACY POLICY
• COOKIES POLICY

8 Strategies to Use if You Want to Quit Smoking in 2024

E very year, we write our lists of things we want to accomplish to become a better version of ourselves in the new year. For many people, quitting smoking is at the top of the list. Unfortunately, not everyone is successful because they haven't adequately prepared to quit. 

Making a plan that works for you is essential. Whether you want to know how to quit smoking cold turkey or how to stop smoking with a more gradual method, we're here to help. With these practical tips, you can start 2024 on the right foot and achieve your goals.

For more health tips, check out this supplement that will help you sleep and five tips to cope with sleep anxiety .

How to make a plan to quit smoking that works for you

Setting up a plan is a great way to start the process of giving up nicotine. That plan begins with examining your habits and considering what will work best for you.

Examine your current smoking habits 

Once you've decided you want to stop smoking, it's a good practice to come up with a plan you will follow through with. That starts with looking at your smoking habits and figuring out how to change them

• Become aware of how much you smoke: Before you cut back, it's important to understand how much you're smoking to begin with. It might be more than you think. Count how many cigarettes you're smoking each day and write it down so you can look at that number. 
• Identify the reasons you smoke: There are certainly reasons that you smoke or use tobacco and the next step in your journey is understanding them. There's a good possibility that it's a years-old habit that doesn't feel like it has its reasons anymore -- but think about why you started in the first place and why you turn to it throughout the day now. Every time you want to smoke, write down why you're doing it. 
• Think about why you want to quit smoking: Having a reason in place will help you stick to your guns when it comes to giving up tobacco. Whether it's for your health, the sake of your children or another reason, figure out why you really want to quit smoking -- beyond just quitting for the sake of quitting. While that is a great way to start, having something you can visualize in the tough parts of this journey can help you push through when you feel like giving up.

Learn how smoking affects your body

Smoking and general tobacco use can have a very negative effect on your body. According to the Centers for Disease Control and Prevention , "smoking can cause cancer, heart disease, stroke, lung diseases, diabetes and chronic obstructive pulmonary disease, which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases and problems of the immune system, including rheumatoid arthritis." All of these physical concerns can also lead to issues with your mental health with the added stress of a medical condition.

Studies have also proven that smoking at night may be a direct cause of insomnia , and poor sleep health can lead to other health issues like obesity and heart problems. The CDC also points out how harmful secondhand smoke is, especially around children: Secondhand smoke causes around 400 infant deaths each year.

Set a goal 

Goals can help keep you motivated, but beyond one big goal of "quit smoking," set smaller goals that you can achieve along the way. Maybe you start with giving up smoking one day at a time. For a month, commit to not smoking on weekends. When you make it through the month, treat yourself and move on to the next goal. This feels more manageable than quitting cold turkey (although that method certainly works for some people). 

Try nicotine replacement therapy 

Nicotine replacement therapy -- like a nicotine patch or gum -- can help curb cravings for nicotine. These low doses of nicotine have been proven in numerous studies as a positive resource in giving up smoking. If you're considering nicotine replacement therapy, it's not a bad idea to speak to your healthcare provider to decide which product may work best for you.

Consider prescription pills 

You can also speak to your doctor about a prescription medication to help you quit smoking. Chantix and Zyban are two popular prescription medications for smoking cessation that you can discuss with your doctor. Pfizer shared research on the effectiveness of Chantix , with various studies demonstrating upwards of 40% of participants successfully abstaining from smoking while using the drug. 

Create a support system 

Surrounding yourself with people to lean on while you're going through what will certainly be a difficult time can help you not only be successful but also stay motivated. When you're feeling like you want to give up, these people can help you keep going.

• Let your friends and family know your goals: Share your goals with your trusted circle who will support you -- but leave out anyone who won't. Let them know what your goals are and let them know how they can help you. If you want them to not smoke around you, mention it. If you want them to cheer you on, tell them that. If you want them to be a silent supporter, express just that. 
• Create your community: It's also important to find people who are either currently going through the same journey as you or have at some point because they'll understand you better than anyone. Online communities and in-person communities like Nicotine Anonymous and Smokers Anonymous can be helpful.
• Seek professional help: You can also turn to your doctor or therapist for guidance and support while you give up smoking. They can provide you with further resources or medically backed reasons for quitting. They can also help you see the positive effects your physical and mental health are going through as you smoke less and less, which can help keep you motivated.

Plan for the side effects 

Most people who give up smoking experience withdrawal symptoms. When weaning yourself off tobacco, the CDC says you can expect to feel irritable, restless, hungry, depressed, and sad. You may also have trouble sleeping and see some weight gain. All of these are common but speak to your doctor about anything that doesn't feel right to you. 

The CDC also recommends exercise to deal with restless, anxious feelings. Exercise will raise your heart rate and get your endorphins going, which can improve your mood. Plus, it's a way to channel those negative side effects into something positive. 

Celebrate your wins 

While it's great to celebrate reaching your big goal, it's just as important to celebrate smaller goals along the way. The first day you fully go without smoking, treat yourself. Once you hit a week, treat yourself again. Buy yourself a nice meal out or go get ice cream. Go have a spa day or buy yourself some shoes you've been eyeing. When you start, set up a bank of rewards you'll give yourself so you know exactly what you're working toward.

Practical Advice on How To Quit Cannabis

Understanding the challenge and gathering the tools prepare you for success..

Posted April 16, 2024 | Reviewed by Monica Vilhauer

• Practical steps for quitting cannabis begin with understanding how frequent cannabis use alters the brain.
• There are five signs that are useful for evaluating if you have been using cannabis too frequently.
• Bottom Line: The only way to assess the impact of cannabis is to abstain for a few months.

I recently received an email from a reader whose life is basically under good control but who keeps slipping back into old habits when he attempts to quit cannabis for a few months to assess if his use impacts him in ways he is unaware of. He wrote to ask for guidance on how he could successfully stop using cannabis. After reading both of my books on cannabis ( From Bud to Brain and Marijuana on My Mind: The Science and Mystique of Cannabis ), he understood how the impact of frequent cannabis use on cognition , emotions, and relationships can be subtle enough to be difficult to recognize but pervasive enough to be important. The simplest way to explore whether any effects exist from your cannabis use is to take a vacation from use for 2-3 months. If this is not possible, the likelihood cannabis has a hold on your brain becomes even more clear.

I understood the reader’s difficulty and responded with the following advice, which I now am sharing more broadly in this blog post:

1. Our brain is altered by THC and CBD , which produces precisely the experience people like. However, too frequent cannabis use has a cumulative effect on the number of our functional cannabinoid receptors. This results in a deficit of receptors in between times we are high, and this deficit explains the ongoing impact of too frequent use. “Too frequent” is different for different individuals but may be as often as once a week for some people.

2. There are five signs you're using cannabis frequently enough to leave an ongoing deficit of receptors, and all are experienced as the opposite of being high (see 5 Signs of Using Cannabis Too Frequently for more detailed descriptions).

• Anxiety and stress , instead of calm and “chill”
• Physical restlessness, instead of physical relaxation
• Boredom , instead of fascination and awe
• Decreased appetite , instead of “munchies”
• Insomnia, instead of sleepiness

3. Search your experience honestly and note any of these five signs of using too frequently. Your brain’s cannabinoid receptors can take up to six weeks to return to their normal number. It is premature to assume any anxiety or insomnia during the first few weeks of abstinence is necessarily a sign of an underlying anxiety or sleep disorder . Insomnia, for example, is the longest-lasting withdrawal symptom and can last a full six weeks. When an underlying anxiety or sleep disorder does in fact exist, symptoms will persist and need thorough medical evaluation to recommend their proper treatment.

4. In addition to reducing your cannabinoid receptors, too frequent use can also prime the brain’s reward center to reflexively motivate you toward using cannabis when anxious or under stress. Counteracting this reflexive turning to cannabis requires developing interests and pleasures other than cannabis that you can turn to when the urge to use occurs. Get busy and get connected to other people during times of craving. Investing in interests that give a sense of purpose and meaning is especially useful. Sometimes people continue using simply because they have not developed the psychological tools and skills for self-soothing. Without psychological tools for dealing with stress and anxiety, we are more likely to resort to chemical tools — cannabis.

5. If you plan to stop using cannabis, you are more likely to succeed if you make yourself accountable to a few trusted friends. Let them know when you quit and promise them you will check in twice a week to honestly report what has happened. Even better is if you can connect with someone who has already successfully quit cannabis. If you don’t know anyone who has gone before you, check online for the nearest Marijuana Anonymous meeting. The people there have a lot of experience that can be useful.

6. You may have fewer withdrawal symptoms by cutting your use in half for 5-7 days, then cutting it in half again for another 5-7 days, before totally abstaining.

7. It is helpful to construct barriers to your use. Get rid of all cannabis in your home. Choose a time when you will be busy, or away on vacation. Set a quit date and tell your partner or a close friend the date you intend to quit.

8. Finally, there are some reports that a supplement called N-acetylcysteine (NAC) is associated with success in quitting cannabis when given to people in a structured treatment program. I tell you this for what it is worth, which is still uncertain. What is certain is that tobacco cessation products, including Zyban (Wellbutrin), have not been shown to be useful in quitting cannabis.

Quitting cannabis can be as difficult as quitting tobacco, with many withdrawal symptoms being equally severe. The benefits of quitting are different for everyone, but one benefit is common to everyone. Quitting is the only way to know for sure how your cannabis use is impacting your life.

Good Luck. The harder it is to quit, the more important it probably is for you to keep trying. Consulting an addiction professional or entering a treatment program may eventually be necessary for some. Whatever is required, success is worth the effort.

To find a therapist, visit the Psychology Today Therapy Directory .

Timmen L. Cermak, MD, is a psychiatrist who specializes in addiction medicine. He is the author of numerous books, including From Bud to Brain and Marijuana on My Mind.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Teletherapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Therapy Center NEW
• Diagnosis Dictionary
• Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

• Coronavirus Disease 2019
• Affective Forecasting
• Neuroscience