Smoking is public enemy #1.  Every week in the U.S., tobacco kills three times as many people as Al-Qaeda did in it's attack on the World Trade Center and the Pentagon.  The death toll of tobacco goes on week after week, year after year.  Just in the past 10 years, it has killed over 4,000,000 Americans!  I have a number of stop-smoking treatment strategies which I use to help my patients.  I have also been very active in the past 10 years in attempting to prevent tobacco sales to minors and in attempting to get government to do more.  Happily, underage smoking is decreasing in the U.S. to its lowest level since the 1930's.

My favorite treatment strategy, a mild for of aversion therapy, has a high success rate of over 40% at one-year vs. 16% for the next best treatment approach in matched groups.   Indeed, 40% of smokers try to quit each year, but only 2% of these succeed!  So, 40% is very, very good.  Actually, I am getting better and hope to get my percentage up to 70%.  The treatment is aimed at eliminating the urges to smoke.  With many fewer urges, it becomes much easier to maintain abstinence.

Tobacco Kills 4 Million a Year:  Smokers worldwide are an estimated 1.2 billion. Half of these will die prematurely due to their smoking, losing an average of eight years of life; or four million smokers each year worldwide. Deaths from smoking are projected to increase to more than 10 million a year by 2030, by which time 70% of deaths will be in developing countries. Adult male smoking is 29% in the U.K., 45% in India, 53% in Japan, 63% in China, 69% in Indonesia, and 73% in Vietnam.  In the U.S. and U.K., smoking rates are far higher among the lowest social classes. Brit Med J 1/23/04

Smoking Down Only Slightly: About 440,000 Americans die each year from lung cancer and other diseases related to tobacco use, making smoking the leading preventable cause of death. In 2001, 46.2 million adults, or 22.8% of those 18 years or older, reported that they were current smokers, according to an annual survey by the Centers for Disease Control and Prevention.  23.3% of adults smoked in 2000 and 25% smoked in 1993. Afro-Americans in particular registered sharp declines in smoking in 2001. Morb Mortal Wkly Rep CDC Surveill Summ 2003;52:953-956

Smoking Ban Cut Heart Attack Deaths in Half: A six-month ban on smoking in all public places slashed the number of heart attacks in a U.S. town by almost a half, a new study has revealed. The researchers attribute the dramatic drop to the "near elimination" of harmful effects of "second-hand" smoke - passive smoking. A smoke-free environment also encourages smokers to reduce smoking or quit altogether, the team adds. Stanton Glantz, at the University of California, San Francisco, and colleagues studied heart attacks in Helena, Montana. Ed: Unfortunately, the ban was repealed and a later study found the death rate doubled, i.e., back to its original level!

Film Smoking Powerful Effect: 52 percent of the youngsters in the study who smoked started entirely because of seeing movie stars smoke on screen. "This effect is stronger than the effect of traditional cigarette advertising and promotion, which accounts for only 34 percent of new experimentation," said Stanton Glantz. Lancet 6/10/03. Dartmouth Medical School studied 2,603 children from Vermont and New Hampshire aged between 10 and 14 at the start of the study in 1999 and had never smoked a cigarette. Asked at the beginning of the study which movies they had seen from a list of 50 movies released between 1988 and 1999. Investigators counted the number of times smoking was depicted in each movie and determined how many smoking incidents each of the adolescents had seen. Exposure was categorized into four groups, with the lowest level involving between zero and 531 occurrences of smoking and the highest involving between 1,665 and 5,308 incidents of smoking. There were about 650 adolescents in each exposure group. Within two years, 259, or 10 percent, of the youths reported they had started to smoke or had at least taken a few puffs. Twenty-two of those exposed to the least on-screen smoking took up the habit, compared with 107 in the highest exposure group — a fivefold difference. However, after taking into account factors known to be linked with starting smoking, such as sensation-seeking, rebelliousness or having a friend or relative who smokes, the real effect was reduced to a threefold difference.

European Student Smoking Up: In 1990, 10,000 college students interviewed and 10,000 other students in 2000 in 13 countries. Large between country variations. Smoking increased, fruit consumption decreased, exercise was stable. Results called "disappointing." Prev Med 2002 Aug;35(2):97-104

Depression: Smoking Relapse No Greater in Depressed: A meta-analysis of 15 smoking cessation studies concluded that individuals suffering from depression did just as well at getting off and staying off of tobacco as those without depression. History of depression and smoking cessation outcome: a meta-analysis. Hitsman B, Borrelli B, McChargue DE, Spring B, Niaura R. J Consult Clin Psychol. 2003 Aug;71(4):657-63. Ed: This one surprised me, although I have had a fair number of my patients get off of tobacco.  Several anti-depressants including nortriptyline and bupropion have been shown in DB PC studies to somewhat increase tobacco cessation abstinence rates even in the non-depressed. 

College Smoking Up: From ‘93 to ’97 smoking at 116 American colleges increased 28% from 22.3% to 28.5%. 11% college smokers had their first cig after age 19 and 28% began smoking regularly after age 19. H Wechsler, Harvd, JAMA ’98;280:1673-8; In a 1999 cross-sectional survey of students at 119 US 4-year colleges, Rigotti and colleagues found that almost half of respondents reported using a tobacco product in the past year. Current prevalence of cigarette smoking was 28.5% and of cigar use, 8.5%, JAMA 8/2000

Smoking & Drinking Teens High in Spain: 816 secondary school students in Spain surveyed. 84% have used alcohol and 61% tobacco with 1^st age use 13.5 for alcohol, and 13.5 for tobacco with males and even earlier at 12.9 for alcohol and 13.9 for tobacco for females. Pilar Saiz, U Oviedo, APA 5/17/99

European Teens 100% Worse Than U.S. for Tobacco & Alcohol: In England in this age group 24% of girls and 21% of boys smoked daily, and 36% of girls and 47% of boys drank weekly. For both smoking and drinking, US teenagers in this age group were more restrained than their counterparts in most European and former Soviet countries just 12% of boys and 13% of girls smoked daily, and only 15% of girls and 23% of boys consumed alcohol on a weekly basis. WHO study of 120,000 teens in 28 countries in Europe, Russia & US. BMJ 2000;320:402 (12 February )

Psychiatrists and Mental Health Workers in Texas Don't Take Nicotine Seriously: In a study of mental health records, researchers found that the use or non-use of tobacco was documented in 87% of charts.  However, only 7% of patients meeting criterion for nicotine dependence received a diagnosis of nicotine dependence. Assessment and diagnosis of nicotine dependence in mental health settings. Peterson AL, Hryshko-Mullen AS, Cortez Y. Am J Addict. 2003 May-Jun;12(3):192-7

No Benefit in California Since ’94: California's program initially helped decreased smoking faster than rest of U.S. but no improvement since ’94 JAMA 9/9/98

Thomas E. Radecki, M.D., J.D.

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