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Tobacco Cessation Programs and Treatments

Although the dangers of tobacco use are well documented, the Centers for Disease Control and Prevention (CDC) reported that approximately 46 million adults in the United States smoke cigarettes. Perhaps the most central reason that smoking remains such a common phenomenon is that persons who become daily users are unable to quit easily or for long periods of time. For example, the CDC estimates that although approximately 15 million adult smokers attempt to quit smoking each year, only approximately 5% are abstinent 1 year later. Unless the prevalence of tobacco use is reduced in a meaningful fashion, according to the CDC, 1 out of every 2 smokers in the United States will die prematurely. The purpose of this entry is to overview (1) the nature of tobacco use, (2) the major treatment programs designed for smoking cessation, and (3) the core elements of the clinical practice guidelines for tobacco dependence.

Nature of Tobacco Use

Cigarette Smoking

Cigarette smoking is widely recognized as the most popular form of tobacco use and as a major public health problem. Indeed, cigarette smoking remains a leading preventable cause of death and disability in the United States. Smoking is considered a key factor in various types of medical illness, including heart disease, a variety of pulmonary diseases (e.g., chronic obstructive pulmonary disease), and many types of cancer. For instance, the American Cancer Society reported that smoking is responsible for almost 30% of all cancer-related deaths. Although smoking increases the risk for developing many of these lethal medical diseases, quitting smoking decreases the risk of developing such problems and may increase the survival time among persons who have already developed such medical problems.

Despite a reduction in smoking prevalence over the past 25 years, approximately 22% to 25% of adults in the United States currently smoke, which translates into 45 million to 48 million Americans. Though nearly 70% of these smokers are motivated to quit, approximately 90% to 95% of smokers who do try to quit smoking on their own, and 60% to 80% of those who attend treatment programs, relapse to smoking, according to the CDC. Additional work suggests that 64% of youth (adolescents) report having tried cigarettes, and 14% have smoked frequently in the past month (i.e., 20 out of the past 30 days). Thus, there is evidence not only that smoking is a major source of death and disability but that once started, it is often difficult to stop.

Smokeless Tobacco

Although cigarette smoking is the most common type of tobacco use, there also is a significant population of smokeless tobacco users in the United States and the world. Epidemiological data in the United States reported by the American Cancer Society, for example, suggest that approximately 3% of individuals have used some form of smokeless tobacco—either snuff (finely ground, shredded tobacco) or chewing tobacco—in the past month. These rates of use are higher among young Caucasian males compared with females, among those in southeastern and north central states compared with other regions, and in rural compared with urban settings. For example, past work reported by the CDC suggests that the highest rates of current use (16.6%) are among Caucasian males 18 to 25 years of age.

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