recommendation about smoking essay

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.

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Conclusion of the Essay on Smoking

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

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

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

Question 2: Why should we avoid smoking?

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

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Cigarette Smoking: Health Risks and How to Quit (PDQ®)–Patient Version

What is prevention.

Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.

To prevent new cancers from starting, scientists look at risk factors and protective factors . Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.

General Information About Tobacco Use

Smoking is the leading cause of cancer in the united states., smoking causes many other health problems., being exposed to secondhand smoke increases the risk of cancer and other diseases..

Smoking increases the risk of many types of cancer . These include:

Lung cancer .
Throat cancer .
Mouth cancer .
Nasal cavity cancer.
Esophageal cancer .
Stomach cancer .
Pancreatic cancer .
Kidney cancer .
Bladder cancer .
Cervical cancer .
Acute myeloid leukemia .

A smoker’s risk of cancer can be 2 to 10 times higher than it is for a person who never smoked. This depends on how much and how long the person smoked.

Lung cancer is the leading cause of cancer death in both men and women. In 2014, about 19% of adult men and about 15% of adult women were smokers. In the last 30 years, the total number of smokers has decreased, especially among men. Since the 1980s, deaths caused by lung cancer in men have been decreasing.

From 2011 to 2014, smoking decreased among middle school and high school students. Cigarette smoking among male and female high school students of all ethnic groups increased markedly during the early 1990s, with rates between 20% and 30%. By 2021, smoking in this population had declined to 2%. Raising the legal age to buy and use tobacco products is being studied as a way to prevent or decrease smoking and other tobacco use among young people.

Smoking is linked with many diseases besides cancer. These include:

Heart disease .
Emphysema .
Bronchitis .

Other health problems that may be linked to smoking are:

Cataracts .
Bone disease.
Trouble becoming pregnant .

Smoking during pregnancy may cause problems such as slow growth of the fetus and low birth weight .

Smoking can also affect the health of nonsmokers. Smoke that comes from the burning of a tobacco product or smoke that is exhaled by smokers is called secondhand smoke . Inhaling secondhand smoke is called involuntary or passive smoking.

The same cancer-causing chemicals inhaled by tobacco smokers are inhaled in lower amounts by people exposed to secondhand tobacco smoke. Nonsmokers who are exposed to secondhand smoke have a higher risk of lung cancer and coronary heart disease . Children exposed to tobacco smoke have higher risks of the following:

Sudden infant death syndrome (SIDS).
Worsened asthma .
Ear infections .
Respiratory problems such as lung infections, coughing, wheezing, or trouble breathing.

Health Risks of Smoking and Ways to Quit

Quitting smoking improves health in smokers of all ages., drug treatment, smoking reduction, there are new and different types of tobacco and nicotine products., cancer prevention clinical trials are used to study ways to prevent cancer., new ways to help smokers quit are being studied in clinical trials..

The risk of most health problems from smoking, including cancer and heart and lung disease, can be lowered by stopping smoking. People of all ages can improve their health if they quit smoking. Quitting at a younger age will improve a person's health even more. People who quit smoking cut their risk of lung cancer by 30% to 50% after 10 years compared to people who keep smoking, and they cut their risk of cancer of the mouth or esophagus in half within 5 years after quitting.

The damage caused by smoking is even worse for people who have had cancer. They have an increased risk of cancer recurrence , new cancers, and long-term side effects from cancer treatment. Quitting smoking and stopping other unhealthy behaviors can improve long-term health and quality of life .

The Public Health Service has a set of guidelines called Treating Tobacco Use and Dependence . It asks health care professionals to talk to their patients about the health problems caused by smoking and the importance of quitting smoking.

Different ways to quit smoking have been studied. The following are the most common methods used to help smokers quit:

People who have even a short counseling session with a health care professional are more likely to quit smoking. Your doctor or other health care professional may take the following steps to help you quit:

Ask about your smoking habits at every visit.
Advise you to stop smoking.
Ask you how willing you are to quit.
setting a date to quit smoking;
giving you self-help materials;
recommending drug treatment.
Plan follow-up visits with you.

The Lung Health Study found that heavy smokers who received counseling from a doctor, took part in group sessions with other smokers to change their behavior, and used nicotine gum were more likely to quit smoking compared with smokers who did not receive counseling from a doctor, take part in group sessions, and use nicotine gum. They also had a lower risk of lung cancer, other cancers, heart disease , and respiratory disease .

Childhood cancer survivors who smoke may be more likely to quit when they take part in programs that use peer-counseling. In these programs, childhood cancer survivors are trained in ways to give support to other childhood cancer survivors who smoke and want to quit. More people quit smoking with peer-counseling than with self-help programs. If you are a childhood cancer survivor and you smoke, talk to your doctor about peer-counseling programs.

Treatment with drugs is also used to help people quit smoking. These include nicotine replacement products and non-nicotine medicines . People who use any type of drug treatment are more likely to quit smoking after 6 months than those who use a placebo or no drug treatment at all.

Nicotine replacement products have nicotine in them. You slowly reduce the use of the nicotine product in order to reduce the amount of nicotine you take in. Using a nicotine replacement product can help break the addiction to nicotine. It lessens the side effects of nicotine withdrawal, such as feeling depressed or nervous, having trouble thinking clearly, or having trouble sleeping. Nicotine replacement products, used alone or in combination, have been shown to help people quit smoking. These include:

Nicotine gum.
Nicotine patches .
Nicotine nasal spray .
Nicotine inhalers .
Nicotine lozenges .

Nicotine replacement products can cause problems in some people, especially:

Women who are pregnant or breast -feeding.
Heart rhythm problems.
High blood pressure that is not controlled.
Esophagitis .
Insulin -dependent diabetes .

Other medicines that do not have nicotine in them are used to help people quit smoking. These include:

Bupropion (also called Zyban).
Varenicline (also called Chantix).

These medicines lessen nicotine craving and nicotine withdrawal symptoms .

It is important to know that bupropion and varenicline may cause serious psychiatric problems. Symptoms include:

Changes in behavior.
Aggressive behavior.
Nervousness.
Depression .
Suicidal thoughts and attempted suicide.

Varenicline may also cause serious heart problems.

Before starting to take bupropion or varenicline, talk to your doctor about the important health benefits of quitting smoking and the small but serious risk of problems with the use of these drugs.

When smokers do not quit smoking completely but smoke fewer cigarettes (smoking reduction) they may still benefit. The more you smoke, the higher your risk of lung cancer and other cancers related to smoking. Studies show that smokers who cut back are more likely to stop smoking in the future.

Smoking less is not as helpful as quitting smoking altogether, and is harmful if you inhale more deeply or smoke more of each cigarette to try to control nicotine cravings. In smokers who do not plan to quit smoking completely, nicotine replacement products have been shown to help them cut down the number of cigarettes they smoke, but this effect does not appear to last over time.

The following resources can help you quit smoking:

Consumer information about quitting smoking is available at the www.smokefree.gov website.
The online QuitGuide may help you understand reasons for smoking and the best ways to quit.
The booklet Clearing the Air: Quit Smoking Today can be ordered at 1-800-4-CANCER (1-800-422-6237) or printed here .

The use of new or different types of tobacco products and devices that deliver nicotine is increasing rapidly in the United States, especially the use of electronic-cigarettes (e-cigarettes) by adults and adolescents .

Examples of new and different tobacco and nicotine products and devices include the following:

E-cigarettes.
Small cigars .
Water pipes (hookahs) for smoking tobacco.
Flavored smokeless tobacco products.

More studies are needed to understand the risks and benefits of using these products.

Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.

The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins , minerals , or food supplements .

Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

About This PDQ Summary

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the prevention and cessation of cigarette smoking and the control of tobacco use. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board .

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website . For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Cigarette Smoking. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/quit-smoking-pdq . Accessed <MM/DD/YYYY>. [PMID: 26389305]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online . Visuals Online is a collection of more than 3,000 scientific images.

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us .

Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction (2001)

Chapter: 8 principal conclusions.

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

8 Principal Conclusions he science base for assessing tobacco harm reduction is incomplete. T Nonetheless, the presence of potential reduced-exposure products (PREPs) on the market suggests an urgent need for proactive plans to evaluate the potential risks and benefits. The potential for reduction in morbidity and mortality that could result from the use of less toxic prod- ucts by those who do not stop using tobacco justifies inclusion of harm reduction as a component in a broad program of tobacco control. To date there are two general types of PREPs: pharmaceuticals and modified to- bacco products. The pharmaceuticals include, for example, nicotine re- placement therapy (NRT) and bupropion, while modified tobacco prod- ucts include products with modified tobacco and those with modified delivery systems. Having identified conceptual and operating precepts as stated at the end of Chapter 1, the committee concludes that there can be a successful, scientifically-based harm reduction program that is justifiable and fea- sibleâbut only if implemented carefully and effectively and only if: â¢ manufacturers have the necessary incentive to develop and market products that reduce exposure to tobacco toxicants and that have a reasonable prospect of reducing the risk of tobacco-related disease; â¢ consumers are fully and accurately informed of all of the known, unknown, likely, and potential consequences of using these prod- ucts; 231

232 CLEARING THE SMOKE â¢ promotion, advertising and labeling of these products are firmly regulated to prevent false or misleading claims, explicit or implicit; â¢ health effects of using PREPs are monitored on a continuing basis; â¢ basic, clinical, and epidemiological research is conducted to estab- lish the potential use of PREPs for reducing risks for disease in individuals and for reducing harm to the population as a whole; and â¢ harm reduction is implemented as a component of a comprehen- sive national tobacco control program that emphasizes abstinence- oriented prevention and treatment. The 7 chapters of the committeeâs report that precede this and the extensive reviews found in Section II provide the documentation for the following principal conclusions regarding the four questions posed within the charge, as outlined in Chapter 1. Specific recommendations can be found within the body of the report. Conclusion 1. For many diseases attributable to tobacco use, reducing risk of disease by reducing exposure to tobacco toxicants is feasible. This conclu- sion is based on studies demonstrating that for many diseases, reduc- ing tobacco smoke exposure can result in decreased disease incidence with complete abstinence providing the greatest benefit. Key to this conclusion is the assumption that compensatory increase in exposure does NOT occur with the use of these products. Conclusion 2. PREPs have not yet been evaluated comprehensively enough (including for a sufficient time) to provide a scientific basis for concluding that they are associated with a reduced risk of disease compared to conven- tional tobacco use. (One exception is the use of nicotine replacement therapy for maintenance of cessation in the Lung Health Study. See Chapters 13 and 14.) Carefully and appropriately conducted clinical and epidemiological studies could demonstrate an effect on health. However, the impact of PREPs on the incidence of most tobacco- related diseases will not be directly or conclusively demonstrated for many years. Tobacco use causes very serious morbidity and mortality due to several different diseases. Cancer (e.g., of the lung, oral cavity, esophagus, and bladder), cardiovascular disease, chronic obstructive pulmonary disease, and low birthweight are all well-established ef- fects of tobacco use. The conditions can be diagnosed, the natural history of the diseases is reasonably well understood, and scientifi- cally appropriate studies of tobacco users who switch to PREPs could be designed. See Chapters 4 and 11-16 for supporting material. However, such research will be difficult. For example, tobacco us- ers may not use a particular PREP for long enough to see health impact; tobacco PREPs will undoubtedly change substantially over

PRINCIPAL CONCLUSIONS 233 the next decade; many subjects would be required for adequate statis- tical power. For all these and other reasons, conclusive proof of the health effects of PREPs will not be available in the near future, as new PREPs are entering the marketplace. Thus, for purposes of educating the public about PREPs and for purposes of regulating health claims, surrogate measures of health effects must be considered. Conclusion 3. Surrogate biological markers that are associated with tobacco- related diseases could be used to offer guidance as to whether or not PREPs are likely to be risk-reducing. However, these markers must be validated as robust predictors of disease occurrence, and should be able to pre- dict the range of important and common conditions associated with conventional tobacco products in order to be useful for PREP evalua- tion and regulation. PREPs may differentially affect risk of tobacco- related diseases. Furthermore, the efficacy of PREPs will likely de- pend on user population characteristics, e.g., those defined by gender, genetic susceptibility, ethnicity, tobacco history, and medical history. Chapters 12-16 describe clinical studies using surrogate indicators that could be conducted to better understand whether or not PREPs would decrease specific adverse health outcomes. The potential stud- ies vary in terms of the length of time that would be required to document the effect, the number of patients, and the power of the study to predict disease outcome. There is no one panel or group of tests that the committee could recommend at this time that would, as a whole, serve to assure that morbidity and mortality would decrease with use of PREPs. Conclusion 4. Currently available PREPs have been or could be demon- strated to reduce exposure to some of the toxicants in most conventional tobacco products. There are many techniques to assess exposure reduc- tion, but the report contains many caveats about the use of all of them, including usually an unknown predictive power for harm. Long-term use of pharmaceutical preparations for maintenance of tobacco cessation will clearly achieve exposure reduction. The safety of these products for long-term use, however, is not well established. For example, it is well known that nicotine affects the autonomic nervous system, with uncertain long-term consequences. However, even if NRT use for maintenance of cessation results in nicotine expo- sure equivalent to that achieved with conventional tobacco products, exposure to the most harmful tobacco toxicants is avoided. See Chap- ters 4, 9, and 11 for supporting material. There is insufficient evidence to decide whether concomitant use of NRT or bupropion with decreased tobacco use will lead to signifi-

234 CLEARING THE SMOKE cantly decreased exposure to tobacco toxicants such as tar and carbon monoxide. Nor is there sufficient evidence to determine how much this PREP strategy will decrease conventional tobacco use or how much compensation will occur. However, there are exposure assess- ment tools to assess this issue, as described in Chapter 7. Tobacco-related PREPs pose different exposure assessment prob- lems. PREPs characterized by the reduction (or, conceivably, elimina- tion) of one class of toxicants, such as the reduced-nitrosamine prepa- rations in varying stages of development and marketing, do result in decreased exposure per cigarette to specific toxicants. Analytic tech- niques exist to demonstrate this. However, the smoking behavior of people who use these PREPs has not been researched well enough to know whether or not compensation occurs (thus increasing net expo- sure to other toxicants and possibly maintaining exposure to the po- tentially reduced chemical). Furthermore, there are insufficient data to allow scientific judgement or prediction of the health effects of removal of one class of chemicals from tobacco products. The cigarette-like PREPs that use heat or reduced burn tempera- ture of tobacco and deliver aerosolized nicotine pose other exposure assessment problems. The prototypes available now have only just begun to be studied by researchers other than the manufacturers. It is clear that the yield of some of these products is different from that of conventional cigarettes. The pattern of yield changes suggests differ- ential reduction in exposure to toxicants. Some preliminary data sug- gest increased yield of specific toxicants concomitant with no change or decreases in others. There does not exist a standard reference product for comparison with tobacco-related PREPs. Assessment of the risk from use of a PREP requires comparison to the risk of the product avoided AND to the risk of the product (including no product, or abstinence) the PREP user would switch to if the PREP were NOT available. Conclusion 5. Regulation of all tobacco products, including conventional ones as recommended in IOM, 1994, as well as all other PREPs is a neces- sary precondition for assuring a scientific basis for judging the effects of using PREPs and for assuring that the health of the public is protected. Regulation is needed to assure that adequate research (on everything from smoke chemistry and toxicology to long-term epidemiology) is conducted and to assure that the public has current, reliable informa- tion as to the risks and benefits of PREPs. Careful regulation of claims is needed to reduce misperception and misuse of the products. If a PREP is marketed with a claim that it reduces (or could reduce) the risk of a specific disease(s) compared to the risk of the product for

PRINCIPAL CONCLUSIONS 235 which it substitutes, regulation is needed to assure that the claim is supported by scientifically sound evidence and that pertinent epide- miological data is collected to verify that claim. The regulation pro- posed by this committee is narrowly focused on assuring that the products reduce risk of disease to the user and accumulating data that would indicate whether or not the products are harm-reducing for the population in the aggregate. Other potential regulatory ap- proaches to tobacco control are not addressed within this report. See Chapter 7 for supporting and explanatory material. Conclusion 6. The public health impact of PREPs is unknown. They are potentially beneficial, but the net impact on population health could, in fact, be negative. The effect on public health will depend upon the biologi- cal harm caused by these products and the individual and commu- nity behaviors with respect to their use. Assessing the public health impact will be difficult and will require classic public health tools of surveillance, research, education, and regulation to assure that the impact is positive. The major concern for public health is that tobacco users who might otherwise quit will use PREPs instead, or others may initiate smoking, feeling that PREPs are safe. That will lead to less harm reduction for a population (as well as less risk reduction for that individual) than would occur without the PREP, and possibly to an adverse effect on the population. PREPs should be a last resort only for people who absolutely can not or will not quit. Population- based research and surveillance can determine whether the intended impact is achieved. However, measurements of health impact at the population level can take years to document, as described in previous sections of this chapter and in the report as a whole. Regulation of PREPs can only assure that a specific PREP could be risk-reducing for a person who uses it compared to the conventional product it replaces. Regulation cannot assure that the availability of risk-reducing PREPs will lead to reduced tobacco-related disease in the population as a whole. However, a regulatory agency can assure that data are gathered that would permit the population effects to be monitored. If population tobacco product use increases or tobacco- related disease increases, these data would serve as a basis for devel- oping and implementing appropriate public health interventions. See Chapters 3, 6, and 7 for supporting material. Studies using surrogate indictors of population impact could be designed. For example, monitoring the perception that the public, particularly tobacco users and adolescents, has of the risks and ben- efits of PREPs is possible. Research indicating that people perceive PREPs to be more beneficial than scientific judgment indicates would

236 CLEARING THE SMOKE provide early evidence of the risk for an adverse public health impact. Action of various sorts (e.g., regulatory review of claims, public health education campaigns) could then be taken. Chapters 1 and 5 include discussions of the utility of a risk assessment framework for organizing the scientific basis for evaluation of PREPs. It is useful to return to that framework to put the committeeâs conclusions and recommendations into the proper light. Although the committee did not perform a risk assessment for any existing PREP, the committeeâs conclu- sions and recommendations provide a means to assure that a risk assess- ment can be done in the future. As Table 8-1 illustrates, the committeeâs principal conclusions (discussed in a preceding section of this chapter) assume use of the conventional risk assessment framework, and the con- clusions and recommendations for surveillance and regulation point a way to develop the necessary data for such an evaluation. Hazard identification is inherent in the first question of the commit- teeâs charge, Does the product decrease exposure to the harmful substances in tobacco? The principal conclusions that harm reduction is feasible and that exposure reduction can be demonstrated require identification of the toxicants within or produced by use of the PREP. The element of the proposed surveillance system related to specific tobacco constituents and several of the regulatory principles (#1, #3, #7, #8, #9) will assure that the necessary toxicology data are gathered, validated, and made available to scientists, public health officials, and regulators. Dose-response assessment is inherent in the second question of the charge, Is decreased exposure associated with decreased harm to health? An important issue when considering this question in the context of PREP assessment is that while some data are available when assessing a dose- response relationship, there are virtually no data describing the change in response due to dose reduction after a period of higher exposure. This data would reflect the extent of disease reversibility or halting of disease progression possible from exposure reduction. Dose-response assessment is also inherent in the third question of the charge, Are there useful surro- gate indicators of disease that could be used? The principal conclusion that surrogate measures could be used to predict harm reduction requires the development of surrogate disease indicators (response) so that a dose- response assessment (and therefore a risk characterization) could be made in some reasonable timeframe, without waiting decades to assess cancer morbidity and mortality. The surveillance system component addressing disease outcomes will help provide some of these necessary data and the regulatory principle #6 requiring postmarketing surveillance and epide- miologic studies for PREPs with claims will assure that the data are col- lected.

TABLE 8-1 Relationship of Conclusions and Recommendations for PREP Risk Assessment Hazard Identification Dose Response Exposure Assessment Risk Characterization Risk Management Committee 1. Does product 2. Is decreased 1. Does product 4. What are the public 4. What are the public charge decrease exposure exposure associated decrease exposure? health implications? health implications? to the harmful with decreased substances in or harm to health? produced during 3. Are there useful use of tobacco? surrogate indicators of disease that could be used? Principal 1. Risk reduction is 3. Surrogate measures 4. Exposure reduction 1. Risk reduction is 5. Regulation is a conclu- feasible could be used to can be feasible necessary sions 4. Exposure reduction predict risk demonstrated 2. Risk reduction not precondition for can be reduction yet demonstrated assuring a science demonstrated 6. Public health base and for impact is unknown assuring protection of the health of the public Elements of Specific tobacco Disease outcomes Consumption of Disease outcomes Tobacco product surveillance constituents of both tobacco products marketing, system the products and and of PREPs including PREPs the smoke they Biomarkers of generate exposure to tobacco products Personal tobacco product use and related behavioral 237 patterns

TABLE 8-1 Continued 238 Hazard Identification Dose Response Exposure Assessment Risk Characterization Risk Management Regulatory 1. Ingredient 6. Products with 2. Yield assessment 5. Labeling for 10. Enforcement principles disclosure claims would 4. With specific products with power (all refer to 3. Preclinical testing require post- claims, no increased claims cannot be tobacco- required to support marketing exposure to false or misleading related health-related surveillance and unclaimed PREPS, claims epidemiological compounds except for 7. Evidence for no studies 9. Performance 11) increased risk standards 8. Added ingredient 11. Exposure review reduction claims 9. Performance for pharmaceutical Standards PREPs Research 3. Develop 1. Sufficient data to 4. Clinical and Comprehensive Regulation is and other appropriate animal allow estimation of epidemiological surveillance is recommended recommen- models and in vitro dose-response studies in human recommended dations assays of 2. Develop validated are required pathogenesis biomarkers of disease

PRINCIPAL CONCLUSIONS 239 Exposure assessment is inherent also in the first question of the committeeâs charge. The principal conclusion that exposure reduction can be demonstrated is fairly straightforward. Several components of the pro- posed surveillance system will provide important exposure information and at least four regulatory principles (#2, #4, #9, #11) would assure that relevant data are collected. Risk characterization is the central question of the report and, indeed, of harm reduction writ large. The fourth question of the committeeâs charge regarding the public health impact of the products is perhaps the most important asked of the committee. The principal conclusions that harm reduction is feasible but not yet convincingly demonstrated and that a beneficial public health impact is not assured are two that are most easily misunderstood as contradictory if not carefully considered. They drive important considerations of the reportâharm reduction should be pur- sued and encouraged but every aspect of it should be watched and studied vigilantly. Appropriate tools of public health must be available and must be powerful. Surveillance of personal tobacco product use and related behavioral patterns and of disease outcomes will provide some of the data necessary to assure a positive population impact. The regulatory principle that labeling for PREPs with claims cannot be false or misleading is an- other necessary safeguard against a negative public health impact. Risk management, the culmination of the risk assessment process, is directly related to the committeeâs principal conclusion that regulation is a necessary precondition for advancing knowledge and for ensuring a public health benefit. Two of the most important tools for a risk manager, are knowledge, which will be developed if the research and surveillance recommendations are followed and if the regulatory principles #1-9 are adhered to, and enforcement power, which is called for in regulatory principle #10. A properly conducted risk assessment outlines gaps in the knowledge required by the risk manager and the assumptions used for the risk characterization in the absence of complete data. Explicit descrip- tion of these assumptions can help identify the research that will most significantly improve understanding of risk and, thereby, affect public policy. Questions asked by a risk manager help to integrate the scientific data and assumptions provided by the formal risk assessment into the desired public policy. The questions also assure that regulation, a risk-manage- ment tool for tobacco harm reduction proposed by this committee, is based on and informed by the risk assessment process. Questions might include: â¢ Which of the thousand known tobacco-related toxicants are most important to consider in the assessment of risk? Is the scientific data available for adequate hazard identification?

240 CLEARING THE SMOKE â¢ Are the data presented by the manufacturer based on assays re- flecting the manner in which the product is actually used by the consumer? â¢ Are the claims by the manufacturer adequately supported by the scientific data? Is the risk characterization accurately conveyed in a manner understandable to the consumer? â¢ What constitutes a substantial degree of overall risk reduction? â¢ Who has the burden of proof for each type of claim? Is the burden of proof sufficient to assure the products will provide a benefit to the user? Is the burden of proof so high that innovation will be stifled and the possible benefit never realized? â¢ What can be done immediately to manage the possible risks of these products, given that the science base is currently inadequate? â¢ Are there parties responsible for assessing and assuring harm re- duction outside this regulatory agency? And if so, are the bound- aries of risk-management responsibility and authority clear to all parties? The data presented and scientific limitations identified in Chapter 5, the surveillance system outlined in Chapter 6, and the regulatory frame- work described in Chapter 7 provide a sound basis for the risk manage- ment for tobacco harm reduction. In summary, tobacco harm reduction could lead to reduced risk of disease for those who cannot give up tobacco. Unfortunately, without the appropriate public health tools of research, surveillance, education, and regulation, tobacco harm reduction could result in a personal and public health disappointment. REFERENCES IOM (Institute of Medicine). 1994. Growing Up Tobacco Free. Washington, DC: National Academy Press. NRC (National Research Council). 1983. Risk Assessment in the Federal Government. Managing the Process. Washington, DC: National Academy Press.

Section II Evidence for the Science Base

Despite overwhelming evidence of tobacco's harmful effects and pressure from anti-smoking advocates, current surveys show that about one-quarter of all adults in the United States are smokers. This audience is the target for a wave of tobacco products and pharmaceuticals that claim to preserve tobacco pleasure while reducing its toxic effects.

Clearing the Smoke addresses the problems in evaluating whether such products actually do reduce the health risks of tobacco use. Within the context of regulating such products, the committee explores key questions:

Does the use of such products decrease exposure to harmful substances in tobacco?
Is decreased exposure associated with decreased harm to health?
Are there surrogate indicators of harm that could be measured quickly enough for regulation of these products?
What are the public health implications?

This book looks at the types of products that could reduce harm and reviews the available evidence for their impact on various forms of cancer and other major ailments. It also recommends approaches to governing these products and tracking their public health effects.

With an attitude of healthy skepticism, Clearing the Smoke will be important to health policy makers, public health officials, medical practitioners, manufacturers and marketers of "reduced-harm" tobacco products, and anyone trying to sort through product claims.

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Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

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

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

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

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

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

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

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

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

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

Argumentative Essay About Smoking Examples

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

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

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

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

Tips for Writing a Persuasive Essay About Smoking

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

Choose a Specific Angle

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

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

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

Research the Facts

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

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

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

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Make an Outline

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

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

Use Persuasive Language

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

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

Introduce Opposing Arguments

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

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

Finish Strong

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

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

To conclude,

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

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How To Write A Smoking Essay That Will Blow Your Classmates out of the Water

Writing a Smoking Essay. Complete Actionable Guide

A smoking essay might not be your first choice, but it is a common enough topic, whether it is assigned by a professor or left to your choice. Today we’ll take you through the paces of creating a compelling piece, share fresh ideas for writing teen smoking essays, and tackle the specifics of the essential parts of any paper, including an introduction and a conclusion.

Why Choose a Smoking Essay?

If you are free to select any topic, why would you open this can of worms? There are several compelling arguments in favor, such as:

A smoking essay can fit any type of writing assignment. You can craft an argumentative essay about smoking, a persuasive piece, or even a narration about someone’s struggle with quitting. It’s a rare case of a one-size-fits-all topic.
There is an endless number of environmental essay topics ideas . From the reasons and history of smoking to health and economic impact, as well as psychological and physiological factors that make quitting so challenging.
A staggering number of reliable sources are available online. You won’t have to dig deep to find medical or economic research, there are thousands of papers published in peer-reviewed journals, ready and waiting for you to use them.

Essential Considerations for Your Essay on Smoking

Whether you are writing a teenage smoking essay or a study of health-related issues, you need to stay objective and avoid including any judgment into your assignment. Even if you are firmly against smoking, do not let emotions direct your writing. You should also keep your language tolerant and free of offensive remarks or generalizations.

The rule of thumb is to keep your piece academic. It is an essay about smoking cigarettes you have to submit to your professor, not a blog post to share with friends.

How to Generate Endless Smoking Essay Topic Ideas

At first, it might seem that every theme has been covered by countless generations of your predecessors. However, there are ways to add a new spin to the dullest of topics. We’ll share a unique approach to generating new ideas and take the teenage smoking essay as an example. To make it fresh and exciting, you can:

Add a historic twist to your topic. For instance, research the teenage smoking statistics through the years and theorize the factors that influence the numbers.
Compare the data across the globe. You can select the best scale for your paper, comparing smoking rates in the neighboring cities, states, or countries.
Look at the question from an unexpected perspective. For instance, research how the adoption of social media influenced smoking or whether music preferences can be related to this habit.

The latter approach on our list will generate endless ideas for writing teen smoking essays. Select the one that fits your interests or is the easiest to research, depending on the time and effort you are willing to put into essay writing .

How To Write An Essay About Smoking Cigarettes

A smoking essay follows the same rules as an academic paper on any other topic. You start with an introduction, fill the body paragraphs with individual points, and wrap up using a conclusion. The filling of your “essay sandwich” will depend on the topic, but we can tell for sure what your opening and closing paragraphs should be like.

Smoking Essay Introduction

Whether you are working on an argumentative essay about smoking or a persuasive paper, your introduction is nothing but a vessel for a thesis statement. It is the core of your essay, and its absence is the first strike against you. Properly constructed thesis sums up your point of view on the economic research topics and lists the critical points you are about to highlight. If you allude to the opposing views in your thesis statement, the professor is sure to add extra points to your grade.

The first sentence is crucial for your essay, as it sets the tone and makes the first impression. Make it surprising, exciting, powerful with facts, statistics, or vivid images, and it will become a hook to lure the reader in deeper.

Round up the introduction with a transition to your first body passage and the point it will make. Otherwise, your essay might seem disjointed and patchy. Alternatively, you can use the first couple of sentences of the body paragraph as a transition.

Smoking Essay Conclusion

Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up your assignment.

Think of the conclusion as a mirror reflection of your introduction. Start with a transition from the last body paragraph, follow it with a retelling of your thesis statement, and complete the passage with a powerful parting thought that will stay with the reader. After all, everyone remembers the first and last points most vividly, and your opening and closing sentences are likely to have a significant influence on the final grade.

Bonus Tips on How to Write a Persuasive Essay About Smoking

With the most challenging parts of the smoking essay out of the way, here are a couple of parting tips to ensure your paper gets the highest grade possible:

Do not rely on samples you find online to guide your writing. You can never tell what grade a random essay about smoking cigarettes received. Unless you use winning submissions from essay competitions, you might copy faulty techniques and data into your paper and get a reduced grade.
Do not forget to include references after the conclusion and cite the sources throughout the paper. Otherwise, you might get accused of academic dishonesty and ruin your academic record. Ask your professor about the appropriate citation style if you are not sure whether you should use APA, MLA, or Chicago.
Do not submit your smoking essay without editing and proofreading first. The best thing you can do is leave the piece alone for a day or two and come back to it with fresh eyes and mind to check for redundancies, illogical argumentation, and irrelevant examples. Professional editing software, such as Grammarly, will help with most typos and glaring errors. Still, it is up to you to go through the paper a couple of times before submission to ensure it is as close to perfection as it can get.
Do not be shy about getting help with writing smoking essays if you are out of time. Professional writers can take over any step of the writing process, from generating ideas to the final round of proofreading. Contact our agents or skip straight to the order form if you need our help to complete this assignment.

We hope our advice and ideas for writing teen smoking essays help you get out of the slump and produce a flawless piece of writing worthy of an A. For extra assistance with choosing the topic, outlining, writing, and editing, reach out to our support managers .

Home — Essay Samples — Nursing & Health — Addictions — Smoking

Essays About Smoking

Smoking essay, types of essay about smoking.

Cause and Effect Essay: This type of essay focuses on the causes and effects of smoking. It discusses why people start smoking and the consequences of smoking on both the smoker and those around them.
Argumentative Essay: This essay type aims to persuade the reader about the negative effects of smoking. It presents an argument and provides supporting evidence to convince the reader that smoking is harmful and should be avoided.
Persuasive Essay: Similar to an argumentative essay, this type of essay aims to persuade the reader to quit smoking. It presents facts, statistics, and other relevant information to convince the reader to stop smoking.

Smoking Essay Example: Cause and Effect

Identify the causes of smoking: Start by examining why people start smoking in the first place. Is it peer pressure, addiction, stress, or curiosity? Understanding the reasons why people smoke is crucial in creating an effective cause and effect essay.
Discuss the effects of smoking: Highlight the impact smoking has on an individual's health and the environment. Discuss the risks associated with smoking, such as lung cancer, heart disease, and respiratory problems, and explain how smoking affects non-smokers through secondhand smoke.
Use reliable sources: To make your essay more convincing, ensure that you use credible sources to back up your claims. Use scientific studies, government reports, and medical journals to support your arguments.
Provide statistical evidence: Incorporate statistical data to make your essay more impactful. Use figures to show the number of people who smoke, the effects of smoking on the environment, and the costs associated with smoking.
Offer solutions: Conclude your essay by suggesting solutions to the problem of smoking. Encourage smokers to quit by outlining the benefits of quitting smoking and offering resources for those who want to quit.

Smoking: Argumentative Essay

Choose a clear position: The writer should choose a side on the issue of smoking, either for or against it, and be clear in presenting their stance.
Gather evidence: Research and collect facts and statistics to support the writer's argument. They can find data from reliable sources like scientific journals, government reports, and reputable news organizations.
Address counterarguments: A good argumentative essay will acknowledge opposing viewpoints and then provide a counterargument to refute them.
Use persuasive language: The writer should use persuasive language to convince the reader of their position. This includes using rhetorical devices, such as ethos, pathos, and logos, to appeal to the reader's emotions and logic.
Provide a clear conclusion: The writer should summarize the key points of their argument and reiterate their stance in the conclusion.

Persuasive Essay on Smoking

Identify your audience and their beliefs about smoking.
Present compelling evidence to support your argument, such as statistics, research studies, and personal anecdotes.
Use emotional appeals, such as stories or images that show the negative impact of smoking.
Address potential counterarguments and refute them effectively.
Use strong and clear language to persuade the reader to take action.
When choosing a topic for a smoking persuasive essay, consider a specific aspect of smoking that you would like to persuade the audience to act upon.

Hook Examples for Smoking Essays

Anecdotal hook.

Imagine a teenager taking their first puff of a cigarette, unaware of the lifelong addiction they're about to face. This scenario illustrates the pervasive issue of smoking among young people.

Question Hook

Is the pleasure derived from smoking worth the serious health risks it poses? Dive into the contentious debate over tobacco use and its consequences.

Quotation Hook

"Smoking is a habit that drains your money and kills you slowly, one puff after another." — Unknown. Explore the financial and health impacts of smoking in today's society.

Statistical or Factual Hook

Did you know that smoking is responsible for nearly 8 million deaths worldwide each year? Examine the alarming statistics and data associated with tobacco-related illnesses.

Definition Hook

What exactly is smoking, and what are the various forms it takes? Delve into the definitions of smoking, including cigarettes, cigars, pipes, and emerging alternatives like e-cigarettes.

Rhetorical Question Hook

Can we truly call ourselves a smoke-free generation when new nicotine delivery devices are enticing young people? Investigate the impact of vaping and e-cigarettes on the youth.

Historical Hook

Trace the history of smoking, from its ancient roots to its prevalence in different cultures and societies. Explore how perceptions of smoking have evolved over time.

Contrast Hook

Contrast the images of the suave, cigarette-smoking characters from classic films with the grim reality of tobacco-related diseases and addiction in the modern world.

Narrative Hook

Walk in the shoes of a lifelong smoker as they recount their journey from that first cigarette to a battle with addiction and the quest to quit. Their story reflects the struggles of many.

Shocking Statement Hook

Prepare to uncover the disturbing truth about smoking—how it not only harms the smoker but also affects non-smokers through secondhand smoke exposure. It's an issue that goes beyond personal choice.

Quitting Smoking: Strategies for Success

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Can Smoking Be Prevented by Making Tobacco Illegal

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The History of Tobacco Use and Its Dangers

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The Top 5 Reasons to Quit Smoking

Almost 70% of adults who smoke say they want to quit, but that doesn’t always mean it’s easy to do. Whether it’s your first or fifteenth attempt at quitting, you can do it.

“I always tell my patients quitting is possible, no matter how difficult it may be,” says Dr. Carl Derrick , a board-certified specialist in internal medicine at Beaufort Memorial Lowcountry Medical Group . “Quitting smoking has a ton of benefits, and it’s worth the effort.”

If you need motivation, these five reasons why you should quit smoking can encourage you to start or continue your journey to becoming tobacco free.

1. Your heart and lungs will get the rest they deserve.

Twenty minutes after your last cigarette, your heart rate and blood pressure drop, which, over the long term, could lower your risk of cardiovascular disease. After three months, your circulation and lung function will improve. When you reach your one-year anniversary, your risk of coronary heart disease will be half the risk of someone who smokes.

2. You won’t put others at risk anymore.

Secondhand smoke — the smoke others breathe when another person exhales or from the lit end of someone else’s cigarette — poses a variety of health risks to the people around you, even if they have never smoked themselves. In addition to increasing their risk of lung cancer, heart attack and stroke, secondhand smoke can also exacerbate their asthma. Also, when you quit, you no longer expose your friends and loved ones to the 7,000 chemicals that exist in secondhand smoke.

“There’s also something called third-hand smoke, which is the smoke that lingers on clothes, hair, carpet and furniture after someone smokes,” Dr. Derrick says. “Like secondhand smoke, it exposes people to the carcinogens present in smoke. While those smoke particles are still on you, they can cause health problems for those around you. Quitting is the No. 1 way to reduce that risk.”

3. You can learn mindfulness or other good mental health habits.

“I find a lot of patients miss the habit of smoking when they quit,” Dr. Derrick says. “They find themselves at the bar they smoked in, or with the friend they took smoke breaks with, and before they know it, they’re smoking again. I always tell them being mindful is a good thing. It helps them recognize their patterns and avoid those situations or plan accordingly if those situations can’t be avoided.”

For many people, smoking can also be a calming ritual, which Dr. Derrick understands. However, quitting gives you an opportunity to choose healthy stress relievers, such as yoga or meditation, instead.

4. Your cancer risk will plummet.

Smoking doesn’t just increase your lung cancer risk. It also makes you more likely to develop cancers of the:

Colon and rectum

When you quit smoking, you reduce your risk of all of these types of cancer and other conditions. “We’ve found that if you quit smoking, your risk of lung cancer is back to the average nonsmoker’s risk by 15 years,” Dr. Derrick says. “That’s why, for lung cancer screenings, the U.S. Preventive Services Task Force recommends patients who currently smoke or have quit in the past 15 years have a low-dose CT scan to screen for lung cancer.”

Read More: Mike Binkowski’s Lung Cancer Survival Story

5. You’ll live a longer, happier life.

“More than anything else, I always stress to my patients that quitting smoking will improve their quality of life,” Dr. Derrick says. “You save money, you don’t smell of smoke, you can breathe easier and your body functions better. I had one gentleman who quit smoking because he didn’t want his second hand or third hand smoke to impact his new granddaughter.”

Many people who quit smoking also report that food tastes better and their sense of smell returns to normal. Daily activities won’t leave you out of breath, and you won’t have to leave your friends and family in smoke-free buildings to go outside for a cigarette. You’ll find few places in your life that aren’t improved by your decision to quit.

How to Stop Smoking

If you’re ready to quit smoking once and for all, we can connect you with the smoking cessation resources you need to be successful. You should also schedule an appointment with your primary care provider to see if you qualify for a low-dose CT lung cancer screening . These highly detailed imaging tests detect very small lung cancers, giving you the best chances of overcoming the disease before it has a significant impact on your life.

“The earlier we find lung cancer, the more likely it is you’ll survive,” Dr. Derrick says. “I’ve had patients receive lobectomies when, if it weren’t for their screening, they could have lost a lung entirely. Screenings reduce death and disease, plain and simple.”

To learn more about low-dose CT scans, call us at 843-522-5015 .

Screening requires a referral from your primary care provider. If you need a provider, find one accepting new patients .

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Tobacco: preventing uptake, promoting quitting and treating dependence

NICE guideline [NG209] Published: 30 November 2021 Last updated: 16 January 2023

Tools and resources
Information for the public
Recommendations on preventing uptake
Recommendations on promoting quitting
Recommendations on treating tobacco dependence
Recommendations on treating tobacco dependence in pregnant women
Recommendations on policy, commissioning and training
Terms used in this guideline
Recommendations for research

Rationale and impact

Finding more information and committee details
Update information

Adult-led interventions in schools

Stop-smoking interventions, advice on nicotine-containing e-cigarettes, stop-smoking support in mental health services, nicotine-containing e-cigarettes for harm reduction, supporting people trying to stop smoking, reviewing the approach for people trying to stop smoking, cutting down or stopping temporarily, identifying pregnant women who smoke and referring them for stop-smoking support, nicotine replacement therapy and other pharmacological support, incentives to stop smoking, commissioning and designing services, stop-smoking support in secondary care.

These sections briefly explain why the committee made the 2021 recommendations and how they might affect practice and services. They link to details of the evidence and a full description of the committee's discussion.

Recommendations 1.6.3 and 1.6.4

Why the committee made the recommendations

The committee wanted to discourage e‑cigarette use among young people and young adults who do not smoke because evidence shows that use of e‑cigarettes is linked with a higher chance of ever smoking later in life. The committee members agreed that ideas about smoking and what is normal can start from a young age so the recommendation should also apply to this age group.

The committee agreed that school-based interventions could help to discourage e‑cigarette use among those who do not smoke.

The committee noted the need to not inadvertently make e‑cigarettes desirable. They also emphasised that e‑cigarettes should not be confused with tobacco products, so talking about them separately is important.

The committee agreed that more evidence is needed about whether e‑cigarette use is linked with habitual smoking (rather than experimental smoking) in the future, the factors that determine this link, and the levels of e‑cigarette use in people under 25 (see the recommendation for research on e-cigarettes and established future smoking ).

How the recommendations might affect practice

Adding information about e‑cigarettes to existing curriculum-based interventions to stop people taking up smoking is a change to current practice, but it should have little resource impact.

Return to recommendations

Recommendations 1.12.1 to 1.12.8

The committee looked at a large amount of evidence assessing the relative effectiveness of several interventions, including medicinally licensed products (varenicline, bupropion and nicotine replacement therapy [NRT]) and nicotine-containing e‑cigarettes. They also looked at these interventions combined with each other. Most of the interventions or combinations of interventions were delivered with behavioural support. Most evidence investigated medicinally licensed products, with fewer studies about e‑cigarettes.

The evidence found that these interventions were effective, and that some were likely to be more effective than others, especially in combination with behavioural support. The committee also agreed with the evidence that a combination of short- and long-acting NRT was effective as well.

Based on the evidence of relative effectiveness and their expertise, the committee agreed that several individual products, as well as short-acting and long-acting NRT in combination, were likely to lead to people successfully stopping smoking when used alongside behavioural support. The committee agreed that people should first be told about all the available options so they can make their own choice. If people do want more information about which options are likely to work best, it is important that people providing stop-smoking support or advice can make this clear. The committee discussed very brief advice and using opportunities to tell people who smoke about the range of interventions available, along with having longer discussions about these options and providing more detailed advice. They agreed these align well with the principles of NHS England's making every contact count and NICE's making every contact count resources .

The committee looked at the evidence for Allen Carr's Easyway to stop smoking in-person group seminars. This is an approach that uses cognitive behavioural therapy and relaxation methods without pharmacotherapy. It also includes a final ritual cigarette at the end of the seminar, regular follow-ups and optional shorter follow-up sessions.

The evidence considered by the committee compared Allen Carr's Easyway in-person group seminar with 1-to-1 support provided by an NHS stop smoking service (which includes behavioural support and the use of medicinally licensed products) and with a remote stop smoking service (which included behavioural support and information about how to access medicinally licensed products). The committee agreed the evidence showed it was as good as other methods such as 1-to-1 support provided by local stop-smoking services, but there was not enough evidence to position Allen Carr's Easyway in-person group seminar within the hierarchy of effectiveness of interventions in recommendations 1.12.7 or 1.12.8.

The committee noted that evidence suggests Allen Carr's Easyway in-person group seminar is cost effective and represents good value for money from an NHS and public sector perspective. They agreed that making it available through the NHS and local authorities alongside other interventions would broaden people's choice, and that the more choice people have the more likely they are to find the right intervention for them. They also agreed that some people are reluctant to use pharmacotherapy, and Allen Carr's Easyway would potentially increase the number of people attempting to stop smoking by offering an alternative to interventions that include pharmacotherapy.

The committee discussed various ways of providing the seminar, including online, but noted that the evidence they saw was only for the in-person group seminar (although in 1 study an online follow up was offered). Therefore they were unable to generalise from this evidence to formats other than the in-person group seminar.

The committee discussed the funding of studies of the intervention. One was funded by Allen Carr's Easyway, but the committee agreed that the methods used to conduct the study minimised any risk of bias associated with this.

The committee discussed the potential effect of Allen Carr's Easyway on inequalities in health. They noted that the length of the seminar (4.5 to 6 hours) and any travel costs to attend the seminar might be difficult for some people, and that people who are housebound would not be able to attend an in-person group seminar at all. They also noted that the evidence did not include any analysis by age, family background, or pregnancy and so it was not clear whether its effectiveness differed in these groups. The committee were unaware whether the in-person group seminars were available in languages other than English, and agreed this was a potential barrier for some people. The evidence also showed that the quit rate was greater in people with higher education in the Allen Carr Easyway in-person group seminar arm. The committee discussed that commissioners would need to know and understand the needs of their local populations to be able to commission Allen Carr's Easyway in a way that would maximise access and use of the service.

The committee agreed that more research on the effects of Allen Carr's Easyway in different population groups, and on the effectiveness of other ways to deliver the programme (for example the online and book versions) would be useful (see the recommendations for research on Allen Carr's Easyway ).

The committee decided not to recommend some combinations of interventions even though they were as effective as individual options. This was because, based on their experience, they had concerns over adherence rates, the difficulty of obtaining prescriptions for multiple interventions at once and a lack of information on contraindications that made these combinations less feasible than other options.

In most of the evidence, the stop-smoking product (medicinally licensed products or nicotine-containing e‑cigarettes) was combined with some form of behavioural support. This meant that the results of the evidence depended on behavioural support being given alongside. The committee agreed that people providing stop-smoking support should offer behavioural support alongside any nicotine-containing products the person is using, irrespective of whether they are providing the product. This is to give people a better chance of stopping smoking. They also agreed that offering behavioural support to people using nicotine-containing e‑cigarettes would increase their chances of stopping smoking.

In addition, the committee recognised the need for more evidence about what factors may prevent those who smoke from using other forms of nicotine, particularly among population groups with higher smoking prevalence. (See the recommendation for research on factors that may influence the use of nicotine replacement therapy and e-cigarettes .)

Conversations guided by each person's preference are good practice and should already be taking place. However, extra time may be needed for people providing stop-smoking support or advice to discuss the intervention options with people who want to stop smoking, especially for the additional advice on e‑cigarettes. If these recommendations lead people to quit successfully with fewer unsuccessful attempts, this may mean fewer appointments per person.

Commissioning Allen Carr's Easyway in-person group seminar through the NHS or local authority would have resource implications for stop smoking services. But the intervention is cost effective and although the initial cost was higher than the comparator (Quit.ie or local stop smoking services group) this would be quickly offset (within 5 to 7 years) by the reduction in comorbidities and associated healthcare costs. The committee were also advised that the NHS or local authority is likely to be able to negotiate a discount for the intervention if enough people take up the offer.

The committee noted that some people living in rural areas may need help with travel costs if they need to travel long distances to attend the in-person seminar.

Recommendations 1.12.13 to 1.12.17

Evidence showed that nicotine-containing e‑cigarettes can help people to stop smoking and are of similar effectiveness to other cessation options such as varenicline or long-acting and short-acting NRT.

Benefits and harms of e-cigarettes

The extensive harms of smoking are well known, and the committee agreed it is unlikely that e‑cigarettes could cause similar levels of harm. But they also agreed that for people who do not smoke, it is unlikely that inhaling vapour from an e‑cigarette is as low risk as not doing so, although the extent of that risk is not yet known. They discussed the potential benefits and risks of using nicotine-containing e‑cigarettes to stop smoking.

There was a small amount of evidence about short-term adverse events of e‑cigarettes that did not show that they caused any more adverse events than NRT, e‑cigarettes without nicotine or no treatment. The committee had low confidence in this evidence because studies were usually designed to investigate effectiveness and not adverse events, meaning they may not have been large enough to show an effect.

There were only 2 studies about the long-term harms of using nicotine-containing e‑cigarettes, and the committee discussed the uncertainty of the evidence and their concerns with these studies. A call for evidence did not produce any additional evidence in this area.

The committee agreed that there is insufficient evidence to tell whether e‑cigarettes cause long-term effects. E‑cigarettes are relatively new devices, and it is important to understand whether they cause any health harms or benefits aside from their potential to reduce smoking-related harm (see the recommendation for research on health effects of e-cigarettes ).

The committee recognised the need for evidence about what factors may influence use of e‑cigarettes. So they made recommendations for research relating to any possible impacts of the amount of nicotine and frequency of use , and flavourings .

The committee discussed the outbreak of serious lung disease in the US in 2019, which US authorities identified was largely caused by vaping cannabis products containing vitamin E acetate. They also noted there has been a Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update highlighting serious lung injury with e‑cigarettes issued in January 2020 ( E-cigarette use or vaping: reporting suspected adverse reactions, including lung injury ). The committee discussed that the UK has well-established regulations for e‑cigarettes that restrict what they can contain.

Experts from the MHRA described to the committee the monitoring process for both short- and long-term harms of using e‑cigarettes. Monitoring is ongoing and the evidence may change in the future, but the committee was not aware of any major concerns being identified. Accurate information relies on adverse events being reported, so the committee recommended that people providing stop-smoking support or advice should actively report any suspected adverse events and encourage people to report any that they experience.

The committee used their knowledge and experience to supplement the very limited and uncertain evidence about harms. They agreed that because many of the harmful components of cigarettes are not present in e‑cigarettes, switching to nicotine-containing e‑cigarettes was likely to be significantly less harmful than continuing smoking. So, the committee agreed that people should be able to access them as part of the range of interventions they can choose to use (see the section on stop-smoking interventions ). They also agreed that people should be given up-to-date information on what is known about e‑cigarettes to help them make an informed decision about whether to use them.

The committee agreed that with the limited data on effects of longer-term use, people should only use e‑cigarettes for as long as they help prevent them going back to smoking. They also agreed that people should be discouraged from continuing to smoke when using e‑cigarettes, even if they are smoking less, because there is no information on whether this will reduce their harm from smoking.

The committee discussed that it is more likely that people will not get enough nicotine to help them stop smoking, than get too much. They agreed that not getting enough nicotine is likely to increase the risk that the person will return to smoking, so they recommended that people should be encouraged to use as much as they need and told how to use the products effectively.

Extra time may be needed to discuss e‑cigarettes with people who are interested in using them. If these recommendations lead to more successful quit attempts, this may mean fewer appointments per person and substantial savings in downstream costs associated with smoking.

Recommendation 1.14.19

Why the committee made the recommendation

The committee agreed the importance of stop-smoking support being available to all, and that people with mental health conditions should not be treated differently in this. However, because those with mental health conditions have a higher prevalence of smoking, and are less likely to access standard smoking cessation services and have lower quit rates, it is important to look at whether additional support could be appropriate.

There was a small amount of evidence about tailored smoking cessation interventions for people with mental health conditions. The evidence of effectiveness identified was in populations with severe mental health conditions such as bipolar disorder, schizophrenia or post-traumatic stress disorder. However, the committee noted there was a lack of consensus of what constitutes a severe mental health condition. They heard from experts that people with other mental health conditions may need additional support as well. This applies both at an individual level and, for those in mental health settings, at a system level. The committee agreed that additional support should be offered to people with severe mental health conditions, and although it might be considered for other people with mental health conditions, there was insufficient evidence to make a wider recommendation. The committee noted that the recommended additional support would fit with current stop-smoking provision. Furthermore, the committee identified this as an important research gap that needs to be addressed to reduce health inequalities (see the recommendation for research on support for people with mental health conditions to stop smoking ).

How the recommendation might affect practice

This potential additional support may need extra time and additional appointments. If these recommendations lead to more successful quit attempts, this may mean fewer appointments per person and substantial savings in downstream costs associated with smoking.

Recommendation for research 6

Why the committee made the recommendation for research

No evidence was found on the use of e‑cigarettes specifically for harm reduction for people who do not want, or are not ready, to stop smoking in one go. So, the committee chose not to make recommendations on using e‑cigarettes for harm reduction. They did discuss that e‑cigarettes may be used in this way and that there may be substantial dual use; that is, when someone is both smoking and using e‑cigarettes.

The committee agreed that more information is needed about the use of e‑cigarettes for those who may wish to reduce the amount they smoke.

Return to the recommendation for research

Recommendations 1.17.1 and 1.17.2

The committee agreed that strategies to avoid relapsing are an important part of stop-smoking advice and support, and are likely to be most effective when introduced early in the process and regularly revisited.

Evidence about NRT for preventing relapse was mixed. Although there was evidence that they may be effective in people who had recently quit, using a single type of fast-acting NRT did not reduce relapse with any certainty when people had stopped smoking for longer. The committee discussed this evidence and noted that in their experience, using NRT for longer can stop people relapsing to smoking, particularly if more than 1 type of NRT is used (usually combining patches with a fast-acting form of NRT). They discussed that only offering NRT for 12 weeks could cause people to relapse.

Evidence showed that if people who have used varenicline and bupropion to stop smoking continue taking it for longer, this improves their chances of staying stopped. This included people diagnosed with serious mental illness. There were a small number of studies and they investigated different groups of people and used varenicline in different ways, so the committee had some uncertainty about the evidence.

The committee reflected on the mixed findings from the evidence. They agreed that, because preventing relapse is so important for people who have been able to stop smoking, offering longer-term pharmacotherapy to help prevent relapse was reasonable. The committee noted that bupropion was not licensed for relapse prevention. The studies that evaluated bupropion for this indication had different dosing regimens, so the committee did not specify what dose or duration of bupropion was most effective for preventing relapse.

The committee recognised the need for more evidence about which nicotine-containing products or combination of products are best at preventing relapse after a successful quit attempt (see the recommendations for research on relapse prevention and relapse prevention after enforced, temporary quit ).

Stop-smoking advisers can use existing appointments to provide information about preventing relapse to people who want to stop smoking, so this is not expected to have a resource impact, though there may costs associated with prescribing additional pharmacotherapies.

Recommendations 1.17.6 and 1.17.7

The committee discussed that it is important to review any stop-smoking or harm-reduction approach taken so that any problems can be addressed. They agreed that it can take someone multiple attempts to stop smoking for good. Encouraging people who have relapsed to smoking and talking to them about trying again may mean that they stay in touch with the service and are more likely to stop smoking in the long term.

Stop-smoking advisers can use existing appointments to discuss with people the approach they are taking and future attempts to stop or reduce harm from smoking, so this is not expected to have a resource impact.

Recommendations 1.18.1 to 1.18.3

Stopping smoking in pregnancy is important for the health of both the woman and her baby.

Existing recommended practice, based on NICE's previous guideline on stopping smoking in pregnancy and after childbirth, is to offer opt-out provision for pregnant women. The evidence about opt-out referral systems was mixed, but the most recent evidence showed that it resulted in higher self-reported quit rates and more engagement with stop-smoking support.

Most current evidence uses carbon monoxide levels of 4 parts per million (ppm) as the cut-off for referral. Based on this and their expertise, the committee recommended that a carbon monoxide reading of 4 ppm or above would be an appropriate level to automatically refer women for stop-smoking support. This also aligns with the NHS Saving Babies' Lives Care Bundle .

The evidence about women's views on opt-out referral showed that giving women information on carbon monoxide testing and the automatic referral was an important factor in whether they accepted the referral and took up the support. The committee discussed whether there was a specific need for a recommendation on giving information, because all clinical treatment pathways should ensure that people are fully informed and take an active part in their care. They agreed that a recommendation would be helpful in this case, because they considered opt-out treatment is not common in most areas of care.

During development of this guideline, carbon monoxide monitoring was not being used because of COVID‑19 practice changes. The committee acknowledged that during the COVID‑19 pandemic referral decisions may need to be made without using carbon monoxide monitoring.

The recommendations reflect current widespread practice and so should have little resource impact.

Recommendations 1.20.6 to 1.20.8 and 1.20.10

NICE's 2010 guideline on stopping smoking in pregnancy and after childbirth (replaced by this guideline) recommended nicotine replacement therapy (NRT) for pregnant women only if they are not able to stop smoking using a behavioural intervention without NRT, and once they have stopped smoking. New evidence showed that NRT may help women stop smoking in pregnancy when added to a behavioural intervention.

The committee discussed that women may stop smoking temporarily during pregnancy and relapse afterwards. There was no evidence about continuing NRT after pregnancy to prevent this but, based on their expert opinion, the committee agreed it may be useful.

Evidence showed that advice from healthcare professionals, particularly midwives, was valuable to pregnant women and contributed to their decisions about using NRT. The evidence also showed that consistent advice addressing the main concerns women tend to have about NRT during pregnancy (such as addictiveness, potential side effects and any pregnancy impacts) may help women to feel comfortable using NRT during and after pregnancy.

There is little evidence about the effectiveness or safety of using nicotine-containing e‑cigarettes to help women stop smoking in pregnancy. Many of the studies in the effectiveness meta-analysis for nicotine replacement therapies were over 10 years old and most used doses of nicotine that would now be considered to be low. The committee therefore made recommendations for research to help understand what type and dose of NRT is most effective and the views and concerns of pregnant women and their healthcare professionals about using nicotine-containing e-cigarettes in pregnancy .

Since the publication of this guideline, a National Institute for Health and Care Research trial on helping pregnant smokers quit has been published comparing e‑cigarettes and nicotine patches. NICE reviewed this trial with the help of topic experts (see the 2023 exceptional surveillance review ). Although it provides some new data, there are still important gaps in the evidence - particularly for longer term outcomes. So NICE decided that more evidence on effectiveness and safety is still needed before it can update these recommendations.

The change in recommendations since NICE's previous guideline may increase prescriptions of NRT to pregnant women, and potentially increase how long it is prescribed for. If this leads to more cases of successful quitting, it will create considerable savings downstream.

Recommendations 1.20.12 to 1.20.14

Evidence showed that offering financial incentives to help pregnant women stop smoking was both effective and cost effective. Voucher incentives were acceptable to many pregnant women and healthcare providers. The committee noted that these are already being used in some areas.

The committee discussed and agreed with the evidence that 'contingent rewards' (given only if biochemical tests prove the woman has stopped) were more effective than guaranteed payments given whether the woman has stopped or not.

More evidence is needed to find out what value of incentive works best. Evidence from the UK showed that schemes in which around £400 could be gained in vouchers staggered over time (with reductions for each relapse made) were effective and cost effective, so the committee included this amount as a guide.

Based on the evidence and their expertise, the committee agreed that incentive schemes that include both the pregnant woman and a significant other supporter could have a better chance of success.

They also agreed that some staff may be unfamiliar with incentive schemes and would benefit from training to help deliver them.

Although the guideline recommends that vouchers should be provided only to those with an abstinence validated by a biochemical method, the committee acknowledged that during the COVID‑19 pandemic carbon monoxide validation may not be being used. While this is the case, vouchers are recommended even if biochemical validation using carbon monoxide is not possible.

Incentive schemes are already used in some areas. Areas that do not already use them will need staff time to run them, and financial resources to award the vouchers. Training for people promoting and delivering the incentive schemes may need resources.

Recommendations 1.22.1 and 1.22.2

The committee looked at a large amount of evidence assessing the relative effectiveness of interventions for stopping smoking (medicinally licensed products and nicotine-containing e‑cigarettes, alone or in combination). Most of the interventions or combinations of interventions were delivered with behavioural support. The committee agreed which interventions should be accessible (see the rationale and impact section for stop-smoking interventions). They agreed that the recommendation from NICE's 2018 guideline on stop-smoking interventions and services (replaced by this guideline) to make stop-smoking interventions available through local plans and approaches to health and wellbeing was still relevant, so they drew on that to make a new recommendation.

The committee noted that not all medicinally licensed products are available in all stop-smoking services, and so local arrangements are in place to ensure that these are accessible when needed. Nicotine-containing e‑cigarettes are not licensed medicines so cannot currently be provided on prescription. However, there are ways of increasing their accessibility, for example by giving evidence-based advice about them and information on where people can access them. The committee were aware that some services use vouchers or starter pack schemes.

Based on evidence and their experience of the use of NRT for preventing relapse, the committee recommended it for longer-term use (see the rationale and impact section for supporting people trying to stop smoking) and agreed this needed to be reflected in service specifications to make sure it was made available.

The committee heard from experts that smoking prevalence is high in some population groups that may not be well served by existing stop-smoking provision (such as those with mental health conditions, or those who identify as LGBT+, or those with low income). And that although these groups may be motivated to stop smoking, they may experience additional challenges to successfully stopping (see the equality impact assessment ).

We did not find any evidence on how to tailor effective and cost-effective interventions to ensure that they are engaging and accessible for under-served groups, or how acceptable those interventions may be for those groups. The committee identified this as an important gap that needs to be addressed to reduce health inequalities (see the recommendation for research on stop-smoking interventions for under-served groups ).

The committee noted that schemes are already in place in some areas to support starting the use of nicotine-containing e‑cigarettes for stopping smoking.

NICE's 2013 guideline on smoking harm reduction already recommended that service specifications require providers of stop-smoking support to offer long-term NRT.

Recommendation 1.22.14

The committee agreed that nicotine-containing products should be available for sale in secondary care settings to help people stop smoking and to support temporary abstinence for patients, staff and visitors because hospital grounds are covered by smokefree legislation.

Making the full range of effective options available for sale may be a change to current practice, but it is not expected to have a large impact on resources.

National Institute for Health and Care Excellence (NICE)

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Essays on Smoking

Essay-writers in each smoking essay emphasize the dangers of smoking, and fairly so. After all, smoking is one of the most widespread bad habits in the world – there are about 2 billion smokers worldwide. It is a detrimental habit, as cigarette smoke contains more than 30 toxic components – you can go into them one by one in your essays on smoking. It's no secret how dangerous smoking is, however, around 18 billion cigarettes are sold globally every day. Smoking essays often include a lot of statistics, as facts speak louder than opinions. An estimated $50 billion a year is spent on treating smoking-related diseases in the United States alone. This means that for every pack of cigarettes, about $2 are spent on treating smoking-related diseases. Crazy, right? If you need more info on smoking for your essays, review our smoking essay samples.

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The World Health Organization suggests that approximately 5 million people die every year in the world because of tobacco use. Further, the report argues that, “the use of tobacco may cause about one billion deaths in the 21st century if current trends continue” (World Health Organization, " Research for International...

The Health Risks of Public Smoking The ban on smoking in public spaces has been an ongoing topic of discussion in different health platforms all over the world. Every year, several people are reported to die from lung cancer and other smoking-related health conditions. Nonetheless, despite the several reported deaths, tobacco...

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The number of the individuals who smoke has risen over the years. Even though they are aware of how harmful smoking can be, the public still decides to use a cigarette. It is an individual decision, and it is a habit which is extremely addictive. It is not the responsibility...

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235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

🏆 Best Smoking Essay Examples & Topic Ideas

🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

You should also discuss the various consequences of cigarette use, such as lung cancer, and identify their relationship with the habit. By discussing both sides of the issue, you will be able to write an excellent essay.

Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

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Causes and Effects of Smoking in Public The research has further indicated that the carcinogens are in higher concentrations in the second hand smoke rather than in the mainstream smoke which makes it more harmful for people to smoke publicly.
Summary of “Smokers Get a Raw Deal” by Stanley Scott Lafayette explains that people who make laws and influence other people to exercise these laws are obviously at the top of the ladder and should be able to understand the difference between the harm sugar […]
Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
Aspects of Anti-Smoking Advertising Thus, it is safe to say that the authors’ main and intended audience is the creators of anti-smoking public health advertisements.
Smoking Among Teenagers as Highlighted in Articles The use of tobacco through smoking is a trend among adolescents and teenagers with the number of young people who involve themselves in smoking is growing each day.
Teenage Smoking and Solution to This Problem Overall, the attempts made by anti-smoking campaigners hardly yield any results, because they mostly focus on harmfulness of tobacco smoking and the publics’ awareness of the problem, itself, but they do not eradicate the underlying […]
Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
Smoking Cessation and Health Promotion Plan Patients addicted to tobacco are one of the major concerns of up-to-date medicine as constant nicotine intake leads to various disorders and worsens the health state and life quality of the users.
How Smoking Cigarettes Effects Your Health Cigarette smoking largely aggravates the condition of the heart and the lung. In addition, the presence of nicotine makes the blood to be sticky and thick leading to damage to the lining of the blood […]
Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
Smoking Culture in Society Smoking culture refers to the practice of smoking tobacco by people in the society for the sheer satisfaction and delight it offers.
Should Cigarettes Be Banned? Essay Banning cigarette smoking would be of great benefit to the young people. Banning of cigarette smoking would therefore reduce stress levels in people.
Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
Smoking Ban and UK’s Beer Industry However, there is an intricate type of relationship between the UK beer sector, the smoking ban, and the authorities that one can only understand by going through the study in detail The history of smoking […]
Health Promotion for Smokers The purpose of this paper is to show the negative health complications that stem from tobacco use, more specifically coronary heart disease, and how the health belief model can help healthcare professionals emphasize the importance […]
Gender-Based Assessment of Cigarette Smoking Harm Thus, the following hypothesis is tested: Women are more likely than men to believe that smoking is more harmful to health.
Hazards of Smoking and Benefits of Cessation Prabhat Jha is the author of the article “The Hazards of Smoking and the Benefits of Cessation,” published in a not-for-profit scientific journal, eLife, in 2020.
The Impact of Warning Labels on Cigarette Smoking The regulations requiring tobacco companies to include warning labels are founded on the need to reduce nicotine intake, limit cigarette dependence, and mitigate the adverse effects associated with addiction to smoking.
Psilocybin as a Smoking Addiction Remedy Additionally, the biotech company hopes to seek approval from FDA for psilocybin-based therapy treatment as a cigarette smoking addiction long-term remedy.
Tobacco Smoking: The Health Outcomes Tobacco smoke passing through the upper respiratory tract irritates the membrane of the nasopharynx, and other organism parts, generating copious separation of mucus and saliva.
Investing Savings from Quitting Smoking: A Financial Analysis The progression of interest is approximately $50 per year, and if we assume n equal to 45 using the formula of the first n-terms of the arithmetic progression, then it comes out to about 105 […]
Smoking as a Community Issue: The Influence of Smoking A review of the literature shows the use of tobacco declined between 1980 and 2012, but the number of people using tobacco in the world is increasing because of the rise in the global population.
Smoking Public Education Campaign Assessment The major influence of the real cost campaign was to prevent the initiation of smoking among the youth and prevent the prevalence of lifelong smokers.
Smoking Cessation Therapy: Effectiveness of Electronic Cigarettes Based on the practical experiments, the changes in the patients’ vascular health using nicotine and electronic cigarettes are improved within one-month time period. The usage only of electronic cigarettes is efficient compared to when people […]
Quitting Smoking and Related Health Benefits The regeneration of the lungs will begin: the process will touch the cells called acini, from which the mucous membrane is built. Therefore, quitting the habit of smoking a person can radically change his life […]
Smoking and Stress Among Veterans The topic is significant to explore because of the misconception that smoking can alleviate the emotional burden of stress and anxiety when in reality, it has an exacerbating effect on emotional stress.
Smoking as a Predictor of Underachievement By comparing two groups smoking and non-smoking adolescents through a parametric t-test, it is possible to examine this assumption and draw conclusions based on the resulting p-value.
Smoking and the Pandemic in West Virginia In this case, the use of the income variable is an additional facet of the hypothesis described, allowing us to evaluate whether there is any divergence in trends between the rich and the poor.
Anti-Smoking Policy in Australia and the US The anti-smoking policy is to discourage people from smoking through various means and promotion of a healthy lifestyle, as well as to prevent the spread of the desire to smoke.
Smoking Prevalence in Bankstown, Australia The secondary objective of the project was to gather and analyze a sufficient amount of auxiliary scholarly sources on smoking cessation initiatives and smoking prevalence in Australia.
Drug Addiction in Teenagers: Smoking and Other Lifestyles In the first part of this assignment, the health problem of drug addiction was considered among teens and the most vulnerable group was established.
Anti-Smoking Communication Campaign’s Analysis Defining the target audience for an anti-smoking campaign is complicated by the different layers of adherence to the issue of the general audience of young adults.
Smoking as a Risk Factor for Lung Cancer Lung cancer is one of the most frequent types of the condition, and with the low recovery rates. If the problem is detected early and the malignant cells are contained to a small region, surgery […]
Smoking Cessation Project Implementation In addition, the review will include the strengths and weaknesses of the evidence presented in the literature while identifying gaps and limitations.
Maternal and Infant Health: Smoking Prevention Strategies It is known that many women know the dangers of smoking when pregnant and they always try to quit smoking to protect the lives of themselves and the child.
A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.
Tackling Teenage Smoking in Community The study of the problem should be comprehensive and should not be limited by the medical aspect of the issue. The study of the psychological factor is aimed at identifying the behavioral characteristics of smoking […]
Peer Pressure and Smoking Influence on Teenagers The study results indicate that teenagers understand the health and social implications of smoking, but peer pressure contributes to the activity’s uptake.
Smoking: Benefits or Harms? Hundreds of smokers every day are looking for a way to get rid of the noose, which is a yoke around the neck, a cigarette.
The Culture of Smoking Changed in Poland In the 1980-90s, Poland faced the challenge of being a country with the highest rates of smoking, associated lung cancer, and premature mortality in the world.
The Stop Smoking Movement Analysis The paper discusses the ideology, objective, characteristics, context, special techniques, organization culture, target audience, media strategies, audience reaction, counter-propaganda and the effectiveness of the “Stop Smoking” Movement.”The Stop Smoking” campaign is a prevalent example of […]
Health Promotion Plan: Smokers in Mississippi The main strategies of the training session are to reduce the number of smokers in Mississippi, conduct a training program on the dangers of smoking and work with tobacco producers.
Smoking Health Problem Assessment The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
Integration of Smoking Cessation Into Daily Nursing Practice Generally, smoking cessation refers to a process structured to help a person to discontinue inhaling smoked substances. It can also be referred to as quitting smoking.
E-Cigarettes and Smoking Cessation Many people argue that e-cigarettes do not produce secondhand smoke. They believe that the e-fluids contained in such cigarettes produce vapor and not smoke.
Introducing Smoking Cessation Program: 5 A’s Intervention Plan The second problem arises in an attempt to solve the issue of the lack of counseling in the unit by referring patients to the outpatient counseling center post-hospital discharge to continue the cessation program.
Outdoor Smoking Ban in Public Areas of the Community These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their […]
Nicotine Replacement Therapy for Adult Smokers With a Psychiatric Disorder The qualitative research methodology underlines the issue of the lack of relevant findings in the field of nicotine replacement therapy in people and the necessity of treatment, especially in the early stages of implementation.
Smoking and Drinking: Age Factor in the US As smoking and drinking behavior were both strongly related to age, it could be the case that the observed relationship is due to the fact that older pupils were more likely to smoke and drink […]
Poland’s Smoking Culture From Nursing Perspective Per Kinder, the nation’s status as one of Europe’s largest tobacco producers and the overall increase in smoking across the developing nations of Central and Eastern Europe caused its massive tobacco consumption issues.
Smoking Cessation Clinic Analysis The main aim of this project is to establish a smoking cessation clinic that will guide smoker through the process of quitting smoking.
Cigarette Smoking Among Teenagers in the Baltimore Community, Maryland The paper uses the Baltimore community in Maryland as the area to focus the event of creating awareness of cigarette smoking among the teens of this community.
Advocating for Smoking Cessation: Health Professional Role Health professionals can contribute significantly to tobacco control in Australia and the health of the community by providing opportunities for smoking patients to quit smoking.
Lifestyle Management While Quitting Smoking Realistically, not all of the set goals can be achieved; this is due to laxity in implementing them and the associated difficulty in letting go of the past lifestyle.
Smoking in the Actuality The current use of aggressive marketing and advertising strategies has continued to support the smoking of e-cigarettes. The study has also indicated that “the use of such e-cigarettes may contribute to the normalization of smoking”.
Analysis of the Family Smoking Prevention and Tobacco Control Act The law ensures that the FDA has the power to tackle issues of interest to the public such as the use of tobacco by minors.
“50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al. Thun is affiliated with the American Cancer Society, but his research interests cover several areas. Carter is affiliated with the American Cancer Society, Epidemiology Research Program.
Pulmonology: Emphysema Caused by Smoking The further development of emphysema in CH can lead to such complications caused by described pathological processes as pneumothorax that is associated with the air surrounding the lungs.
Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
Health Promotion and Smoking Cessation I will also complete a wide range of activities in an attempt to support the agency’s goals. As well, new studies will be conducted in order to support the proposed programs.
Maternal Mental Health and Prenatal Smoking It was important to determine the variables that may lead to postpartum relapse or a relapse during the period of pregnancy. It is important to note that the findings are also consistent with the popular […]
Nursing Interventions for Smoking Cessation For instance, the authors are able to recognize the need to classify the level of intensity in respect to the intervention that is employed by nurses towards smoking cessation.
Marketing Plan: Creating a Smoking Cessation Program for Newton Healthcare Center The fourth objective is to integrate a smoking cessation program that covers the diagnosis of smoking, counseling of smokers, and patient care system to help the smokers quit their smoking habits. The comprehensive healthcare needs […]
Smoking Among the Youth Population Between 12-25 Years I will use the theory to strengthen the group’s beliefs and ideas about smoking. I will inform the group about the relationship between smoking and human health.
Risks of Smoking Cigarettes Among Preteens Despite the good news that the number of preteen smokers has been significantly reducing since the 1990s, there is still much to be done as the effects of smoking are increasingly building an unhealthy population […]
Public Health Education: Anti-smoking Project The workshop initiative aimed to achieve the following objectives: To assess the issues related to smoking and tobacco use. To enhance the health advantages of clean air spaces.
Healthy People Program: Smoking Issue in Wisconsin That is why to respond to the program’s effective realization, it is important to discuss the particular features of the target population in the definite community of Wisconsin; to focus on the community-based response to […]
Health Campaign: Smoking in the USA and How to Reduce It That is why, the government is oriented to complete such objectives associated with the tobacco use within the nation as the reduction of tobacco use by adults and adolescents, reduction of initiation of tobacco use […]
Smoking Differentials Across Social Classes The author inferred her affirmations from the participant’s words and therefore came to the right conclusion; that low income workers had the least justification for smoking and therefore took on a passive approach to their […]
Cigarette Smoking Side Effects Nicotine is a highly venomous and addictive substance absorbed through the mucous membrane in the mouth as well as alveoli in the lungs.
Long-Term Effects of Smoking The difference between passive smoking and active smoking lies in the fact that, the former involves the exposure of people to environmental tobacco smoke while the latter involves people who smoke directly.
Smoking Cessation Program Evaluation in Dubai The most important program of this campaign is the Quit and Win campaign, which is a unique idea, launched by the DHCC and is in the form of an open contest.
Preterm Birth and Maternal Smoking in Pregnancy The major finding of the discussed research is that both preterm birth and maternal smoking during pregnancy contribute, although independently, to the aortic narrowing of adolescents.
Enforcement of Michigan’s Non-Smoking Law This paper is aimed at identifying a plan and strategy for the enforcement of the Michigan non-smoking law that has recently been signed by the governor of this state.
Smoking Cessation for Patients With Cardio Disorders It highlights the key role of nurses in the success of such programs and the importance of their awareness and initiative in determining prognosis.
Legalizing Electronic Vaping as the Means of Curbing the Rates of Smoking However, due to significantly less harmful effects that vaping produces on health and physical development, I can be considered a legitimate solution to reducing the levels of smoking, which is why it needs to be […]
Drinking, Smoking, and Violence in Queer Community Consequently, the inequality and discrimination against LGBTQ + students in high school harm their mental, emotional, and physical health due to the high level of stress and abuse of various substances that it causes.
Self-Efficacy and Smoking Urges in Homeless Individuals Pinsker et al.point out that the levels of self-efficacy and the severity of smoking urges change significantly during the smoking cessation treatment.
“Cigarette Smoking: An Overview” by Ellen Bailey and Nancy Sprague The authors of the article mentioned above have presented a fair argument about the effects of cigarette smoking and debate on banning the production and use of tobacco in America.
“The Smoking Plant” Project: Artist Statement It is the case when the art is used to pass the important message to the observer. The live cigarette may symbolize the smokers while the plant is used to denote those who do not […]
Dangers of Smoking While Pregnant In this respect, T-test results show that mean birthweight of baby of the non-smoking mother is 3647 grams, while the birthweight of smoking mother is 3373 grams. Results show that gestation value and smoking habit […]
The Cultural Differences of the Tobacco Smoking The Middle East culture is connected to the hookah, the Native American cultures use pipes, and the Canadian culture is linked to cigarettes.
Ban on Smoking in Enclosed Public Places in Scotland The theory of externality explains the benefit or cost incurred by a third party who was not a party to the reasoning behind the benefit or cost. This will also lead to offer of a […]
Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
Smoking Prohibition: Local Issues, Personal Views This is due to the weakening of blood vessels in the penis. For example, death rate due to smoking is higher in Kentucky than in other parts of the country.
Smoking During Pregnancy Issues Three things to be learned from the research are the impact of smoking on a woman, possible dangers and complications and the importance of smoking cessation interventions.
The Smoking Problem: Mortality, Control, and Prevention The article presents smoking as one of the central problems for many countries throughout the world; the most shocking are the figures related to smoking rate among students. Summary: The article is dedicated to the […]
Tobacco Smoking: Bootleggers and Baptists Legislation or Regulation The issue is based on the fact that tobacco smoking also reduces the quality of life and ruins the body in numerous ways.
Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
Smoking Behavior Under Clinical Observation The physiological aspect that influences smokers and is perceived as the immediate effect of smoking can be summarized as follows: Within ten seconds of the first inhalation, nicotine, a potent alkaloid, passes into the bloodstream, […]
Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
Smoking and Its Effects on Human Body The investigators explain the effects of smoking on the breath as follows: the rapid pulse rate of smokers decreases the stroke volume during rest since the venous return is not affected and the ventricles lose […]
Post Smoking Cessation Weight Gain The aim of this paper is to present, in brief, the correlation between smoking cessation and weigh gain from biological and psychological viewpoints.
Marketing a Smoking Cessation Program In the case of the smoking cessation program, the target group is made up of smokers who can be further subdivided into segments such as heavy, medium, and light smokers.
Smoking Cessation for Ages 15-30 The Encyclopedia of Surgery defines the term “Smoking Cessation” as an effort to “quit smoking” or “withdrawal from smoking”. I aim to discuss the importance of the issue by highlighting the most recent statistics as […]
Smoking Qualitative Research: Critical Analysis Qualitative research allows researchers to explore a wide array of dimensions of the social world, including the texture and weave of everyday life, the understandings, experiences and imaginings of our research participants, the way that […]
Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
“Passive Smoking Greater Health Hazard: Nimhans” by Stephen David The article focuses on analyzing the findings of the study and compares them to the reactions to the ban on public smoking.
Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
Cigar Smoking and Relation to Disease The article “Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease and cancer in Men” by Iribarren et al.is a longitudinal study of cigar smokers and the impact of cigar […]
Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
The Importance of Nurses in Smoking-Cessation Programs When a patient is admitted to the hospital, the nursing staff has the best opportunity to assist them in quitting in part because of the inability to smoke in the hospital combined with the educational […]
Smoking and Youth Culture in Germany The report also assailed the Federal Government for siding the interest of the cigarette industry instead of the health of the citizens.
New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
Female Smokers Study: Inferential Statistics Article The article “Differential Effects of a Body Image Exposure Session on Smoking Urge between Physically Active and Sedentary Female Smokers” deepens the behavioral mechanisms that correlate urge to smoke, body image, and physical activity among […]
Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
Smoking in the US: Statistics and Healthcare Costs According to the Centers for Disease Control and Prevention, tobacco smoking is the greatest preventable cause of death in the US.
Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
Tobacco Debates in “Thank You for Smoking” The advantage of Nick’s strategy is that it offers the consumer a role model to follow: if smoking is considered to be ‘cool’, more people, especially young ones, will try to become ‘cool’ using cigarettes.
Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
Teenagers Motivated to Smoking While the rest of the factors also matter much in the process of shaping the habit of smoking, it is the necessity to mimic the company members, the leader, or any other authority that defines […]
Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
Stopping Tobacco Smoking: Lifestyle Management Plan In addition, to set objective goals, I have learned that undertaking my plan with reference to the modifying behaviour is essential for the achievement of the intended goals. The main intention of the plan is […]
Smoking Epidemiology Among High School Students In this way, with the help of a cross-sectional study, professionals can minimalize the risk of students being afraid to reveal the fact that they smoke. In this way, the number of students who smoke […]
Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
Vancouver Coastal Health Smoking Cessation Program The present paper provides an evaluation of the Vancouver Coastal Health smoking cessation program from the viewpoint of the social cognitive theory and the theory of planned behavior.
Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
Tobacco Smoking and Its Dangers Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders.
Cigarette Smoking and Parkinson’s Disease Risk Therefore, given the knowledge that cigarette smoking protects against the disease, it is necessary to determine the validity of these observations by finding the precise relationship between nicotine and PD.
Tuberculosis Statistics Among Cigarette Smokers The proposal outlines the statistical applications of one-way ANOVA, the study participants, the variables, study methods, expected results and biases, and the practical significance of the expected results.
Smoking Habit, Its Causes and Effects Smoking is one of the factors that are considered the leading causes of several health problems in the current society. Smoking is a habit that may be easy to start, but getting out of this […]
Status of Smoking around the World Economic factors and level of education have contributed a lot to the shift of balance in the status of smoking in the world.
Redwood Associates Company’s Smoking Ethical Issues Although employees are expected to know what morally they are supposed to undertake at their work place, it is the responsibility of the management and generally the Redwood’s hiring authority to give direction to its […]
Smokers’ Campaign: Finding a Home for Ciggy Butts When carrying out the campaign, it is important to know what the situation on the ground is to be able to address the root cause of the problem facing the population.
Mobile Applications to Quit Smoking A critical insight that can be gleaned from the said report is that one of the major factors linked to failure is the fact that smokers were unable to quit the habit on their own […]
Behavior Modification Technique: Smoking Cessation Some of its advantages include: its mode of application is in a way similar to the act of smoking and it has very few side effects.
Quitting Smoking: Strategies and Consequences Thus, for the world to realize a common positive improvement in population health, people must know the consequences of smoking not only for the smoker but also the society. The first step towards quitting smoking […]
Effects of Thought Suppression on Smoking Behavior In the article under analysis called I suppress, Therefore I smoke: Effects of Thought Suppression on Smoking Behavior, the authors dedicate their study to the evaluation of human behavior as well as the influence of […]
Suppressing Smoking Behavior and Its Effects The researchers observed that during the first and the second weeks of the suppressed behavior, the participants successfully managed to reduce their intake of cigarettes.
Smoking Cessation Methods
Understanding Advertising: Second-Hand Smoking
People Should Quit Smoking
Importance of Quitting Smoking
Cigarette Smoking in Public Places
Ban of Tobacco Smoking in Jamaica
Anti-Smoking Campaign in Canada
Electronic Cigarettes: Could They Help University Students Give Smoking Up?
The Change of my Smoking Behavior
Psychosocial Smoking Rehabilitation
The Program on Smoking Cessation for Employees
Tips From Former Smokers (Campaign)
Combating Smoking: Taxation Policies vs. Education Policies
The Program to Quit Smoking
Possible Smoking Policies in Florida
Smoking Ban in the State of Florida
Core Functions of Public Health in the Context of Smoking and Heart Disease
Smoking: Pathophysiological Effects
Putting Out the Fires: Will Higher Taxes Reduce the Onset of Youth Smoking?
Smoking Bans in US
Smoking as Activity Enhancer: Schizophrenia and Gender
Health Care Costs for Smokers
Medical Coverage for Smoking Related Diseases
Exposure to mass media proliferate smoking
The Realm of reality: Smoking
Ethical Problem of Smoking
The Rate of Smoking Among HIV Positive Cases.
Studying the Government’s Anti-Smoking Measures
Smoking Should Be Banned In the United States
Effectiveness of Cognitive Behavioral Theory on Smoking Cessation
Effectiveness of the Cognitive Behavioral Therapy for Smoking Cessation
Wayco Company’s Non-smoking Policy
Adverse Aspects of Smoking
Negative Impacts of Smoking on Individuals and Society
Dealing With the Increase in the Number of Smokers Between Ages 17 and 45
Cannabis Smoking in Canada
Smoking Ban in the United States of America
Dangers of Smoking Campaign
Smoking Ban in New York
Smoking and Adolescents
Trends in Smoking Prevalence by Race/Ethnicity
Business Ethics: Smoking Issue
Should Smoking Tobacco Be Classified As an Illegal Drug?
Where Does the Path to Smoking Addiction Start?
Public Health Communication: Quit Smoking
Are Estimated Peer Effects on Smoking Robust?
Are There Safe Smoking and Tobacco Options?
What Are the Health Risks of Smoking?
Does Cigarette Smoking Affect Body Weight?
Does Cigarette Smuggling Prop Up Smoking Rates?
What Foods Help You Quit Smoking?
How Can People Relax Without Smoking?
Does Education Affect Smoking Behaviors?
Is Vaping Worse Than Smoking?
Do Movies Affect Teen Smoking?
What Is Worse: Drinking or Smoking?
Does Smoking Affect Breathing Capacity?
Does Smoking Cause Lung Cancer?
Does Having More Children Increase the Likelihood of Parental Smoking?
Does Smoking Cigarettes Relieve Stress?
Does Time Preference Affect Smoking Behavior?
How Does Smoking Affect Cardiovascular Endurance?
How Hypnosis Can Help You Quit Smoking?
How Does Smoking Affect Brain?
How Nicotine Affects Your Quit Smoking Victory?
How Does Secondhand Smoking Affect Us?
Why Is Smoking Addictive?
How Smoking Bans Are Bad for Business?
Why Smoking Should Not Be Permitted in Restaurants?
Why Public Smoking Should Be Banned?
Why Has Cigarette Smoking Become So Prominent Within the American Culture?
What Makes Smoking and Computers Similar?
Does Smoking Affect Schooling?
What Effects Can Cigarette Smoking Have on the Respiratory System?
What Are the Most Prevalent Dangers of Smoking and Drinking?
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Smoking Patients. Practice Recommendations

Evidence for practice recommendations, application of practice recommendation, reflection on the three practice recommendations.

There are several ways to handle smoking patients. 1.1 work recommendation relating to integrating tobacco management into daily practice suggests “brief interventions to screen all clients for all forms of tobacco use and initiate treatment as appropriate” (RNAO, 2017). This nursing necessity fits in Mr. Philobosan’s case because he has just realized that his cigarette use has led him to chronic obstructive pulmonary disease (COPD). Mr Philobosan wishes he could stop smoking, and the health care provider has to assess to understand whether Mr. Philobosan wants to change or is scared of the present situation.

The second strategy, as per 2.1 working manual notes, is to “develop a person-centered tobacco intervention plan with the client” (RNAO, 2017). This medical requirement is applicable in Mr. Philobosan’s case because he has used tobacco for the better part of his life. For a nurse to get any good results with this client, treatment has to focus on unique features to Mr. Philobosan concerning smoking.

Thirdly, section 3.1 recommendation says that it is necessary to “provide clients with, refer them to, intensive interventions and counseling on the use of pharmacotherapy, and express an interest in reducing or quitting tobacco use” (RNAO, 2017). This section is relevant to the client because he has smoked for more than half of his life. The aforementioned means that tobacco is part of Mr. Philobosan’s living, and quitting will not be an easy task as it will require serious treatment, and medical and psychological intervention.

Evidence to support practice recommendation 1.1 argues that brief treatment can raise the probability of an effective quit trial. The initial intercession further increases the time a patient remains free from tobacco after starting their medication. The short-term therapy has the possibility of leading to long-term healing goals (RNAO, 2017). Moreover, the evidence shows that smoking termination therapy offered by clinicians who have the first conduct with the patient are efficient in helping individuals quit smoking.

Working sanction 2.1 indicates that each client is unique and comes with special needs and characteristics which should be looked at for effective service delivery. The personal aspects might be physical, emotional, psychological, cultural or socio-economical, influencing individual lifestyles (RNAO, 2017). Additionally, the therapist should be aware of their biases which can hinder the client’s healing process and focus mainly on what benefits the patient. The medics and their customers should collaborate to pinpoint obstacles to stopping client-specific tobacco use.

Information to validate nursing guideline 3.1 suggests that intensive interventions are a phase to evaluate the inspiration behind the need for the client to stop using tobacco. This practice also incorporates categorization of risky circumstances, triggers to smoke, and discussion of problem-solving tactics to control the hazardous environments. Exhaustive therapy contains behavioral management and counseling, nicotine replacement therapy and prescription medicine (RNAO, 2017). It is recommended that if the clinician is not able to offer thorough treatment, he or she should refer the patient to where they can get the resources.

In the case scenario, Mr. Philobosan has developed chronic obstructive pulmonary disease and is suspected of having a lung infection from smoking tobacco. Using nursing guideline 1.1 as a nurse taking care of him, I will do a thorough screening on his tobacco use history. I will then proceed with brief interventions and inform Mr. Philobosan how tobacco has damaged his lungs leading to infection and his current condition of inability to breathe normally. Further, I will request him not to use tobacco while admitted to the hospital. I will be concurrently medicating for the withdrawal symptoms if Mr. Philobosan exhibits any.

The 2.1 clinical guidelines in integrating tobacco interventions in daily practice will help me explore with the client and develop a unique rehabilitation plan for Mr. Philobosan. First, I would assess how and why he began using nicotine. Secondly, I could investigate what has encouraged his behavior for so many years. Thirdly, I might ask to what extent he thinks he can quit his fifty-year lifestyle. Lastly, I can enquire to understand how he thinks he can end smoking. With the above information, I will develop a client-centered model which considers client characteristics which can impact healing and those which can trigger a relapse.

After developing the client-centered approach plan, 3.1 clinical sanctions will guide me in begging intensive interventions for Mr. Philobosam. In this stage, I can engage both counseling and medication. I will take the client through the first therapeutic session and explain the exact condition he is in currently. The following sessions will deal with factors that have influenced the client’s behavior in the past and aspects that could hinder the healing process. The psychological treatment will be done together with relevant medication. This will commence if my client is ready and willing to change.

From the three best practice guidelines used in this case study, I have learned that most patients do not fully realize the magnitude of their illnesses or conditions until it is elaborated by a professional. As a medic, I have understood that it is our duty to support these clients and guide them systematically through the healing process. One important thing I have learned is that every person whom we serve is unique, and treatment should be client-centered. I have captured that it is essential to work together with the patient to achieve maximum recovery.

RNAO. (2017). Integrating Tobacco interventions into daily practice . Registered Nurses’ Association of Ontario.

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WHO Recommendations for the Prevention and Management of Tobacco Use and Second-Hand Smoke Exposure in Pregnancy. Geneva: World Health Organization; 2013.

WHO Recommendations for the Prevention and Management of Tobacco Use and Second-Hand Smoke Exposure in Pregnancy.

Recommendations.

To assist in the formulation of the recommendations, the GDG outlined a number of overarching principles that it agreed should underpin all recommendations for optimal identification and management of tobacco use by and SHS exposure in pregnant women. These principles are based on the human rights and ethics values, outlined in the WHO FCTC ( 24 ), Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) ( 34 ), and the Programme of Action of the International Conference on Population and Development (ICPD) ( 35 ). These principles, together with the implementation strategies and indicators for monitoring and evaluation presented later in the document, should guide stakeholders and policy-makers in the process of planning, implementing and evaluating the most suitable and relevant recommendation for their own circumstances.

It is necessary to note that all population-level policies and interventions for comprehensive tobacco control that are proven to be effective for the general population, would also help protect the health of pregnant women as well. These policies create an enabling environment which is promotive of non-use of tobacco, and enable and empower women to be able to implement their own choices.

OVERARCHING PRINCIPLES

It is a basic right of every pregnant woman to be informed about the harms of tobacco use in any form, as well as the harms of SHS exposure.

Every pregnant woman has the right to a smoke-free environment at the home, and at work and in public places.

All interventions addressing the prevention of tobacco use and SHS exposure in pregnancy should be:

woman-centred and gender-sensitive;
culturally appropriate and socially acceptable; and
delivered in a non-judgemental and non-stigmatizing manner.

Health centres, hospitals and clinics need to ‘practice what their providers preach’ by providing tobacco-free health-care facilities, and having the health-care providers as ‘tobacco-free role models’.

The presented recommendations are consistent with the guiding principles set out in the WHO FCTC ( 24 ).

This section includes nine recommendations for the prevention and management of tobacco use and SHS exposure in pregnancy. Each recommendation is followed by specific remarks related to that recommendation, which are intended to explain the context in which these recommendations were made. Narrative summaries of evidence supporting the recommendations are also included below each recommendation. (The decision tables summarizing the values, preferences and judgements made about the strength of the recommendations are available in Annex 7 .)

IDENTIFICATION OF TOBACCO USE AND SECOND-HAND SMOKE EXPOSURE

RECOMMENDATION 1. Assessment of tobacco use and second-hand smoke exposure in pregnancy

Health-care providers should ask all pregnant women about their tobacco use (past and present) and exposure to SHS as early as possible in the pregnancy and at every antenatal care visit.

Strength of recommendation: Strong . Quality of evidence: Low

Tobacco use includes all forms of smoking and use of smokeless tobacco.

Second-hand smoke exposure includes exposure to smoke from combustible tobacco products at home, work and in public places.

Tobacco use (smoking and smokeless) status of husbands/partners and other household members should also be assessed.

At the first prenatal visit, health-care providers should ask all pregnant women about their tobacco use (past and present). Pregnant women with prior history of tobacco use should be asked about their present tobacco use at every antenatal care visit. Providers should ask women about their SHS exposure at the first prenatal visit, and whenever there is a change in living or work status and when SHS intervention has been initiated.

Before assessment is initiated in a clinic setting:

training and resource materials should be provided to clinicians and other health-care workers to enable effective and non-judgemental assessment of tobacco use; and
clinicians and other health-care workers should be trained to refer or intervene with all pregnant women who are identified as tobacco users (past and present) or exposed to SHS.

EVIDENCE FOR RECOMMENDATION 1

Overall question: what are the necessary elements for effective screening of pregnant women for smoking and smokeless tobacco use.

The first step in treating tobacco use and dependence is to identify tobacco users. Identification of smokers increases rates of clinician intervention. Effective identification of tobacco-use status not only opens the door for successful interventions (e.g. clinician advice and treatment), but also guides clinicians to identify appropriate interventions based on the tobacco-use status of patients and their willingness to quit.

PICO (Population, Intervention, Comparison, and Outcome) question used to examine evidence

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SYSTEMATIC REVIEWS AND OTHER SOURCES (E.G. QUALITATIVE STUDIES, COST-EFFECTIVENESS ANALYSES) IDENTIFIED BY THE SEARCH PROCESS

Although the search for evidence did not identify any relevant recent systematic reviews on screening pregnant women for tobacco use or SHS exposure, previous research has indicated efficacy of screening in a general health-care setting on successful cessation efforts (or intent) ( 36 ). WHO has developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), an instrument to detect and manage substance use and related problems in primary and general medical care settings. This instrument provides some information on how to assess tobacco use and provide brief intervention, but does not include any recommended action for the management of smokeless tobacco use or SHS exposure ( 37 ). The current recommendations have used guidance from various national guidelines as well as resource documents from international agencies to develop the narrative synthesis.

Methods for evaluating tobacco control policies. IARC Handbook of Cancer Prevention (Volume 12), 2008 ( 38 ).
Treating tobacco use and dependence: 2008 update. US Department of Health and Human Services, 2008 ( 36 ).
How to stop smoking in pregnancy and following childbirth . National Institute for Health and Clinical Excellence (NICE), the United Kingdom, 2010 ( 39 ).
Flemming H et al. (2012) Using qualitative research to inform interventions to reduce smoking in pregnancy in England: a systematic review of qualitative studies. The Journal of Advanced Nursing, 2010 ( 40 ).
The WHO ASSIST package: Manuals for the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the ASSIST-linked brief interventions, 2010 ( 37 ).
Gender, women, and the tobacco epidemic . WHO monograph, 2010 ( 41 ).
WHO guidelines for control and monitoring the tobacco epidemic. World Health Organization, 1998 ( 42 ).

NARRATIVE SYNTHESIS OF KEY FINDINGS

Tobacco use.

The first step in effective intervention for tobacco cessation is assessment of tobacco-use status. The 2008 USA guidelines on ‘Treating tobacco use and dependence’, recommend that clinicians and health-care systems should use health-care visits for universal assessment and intervention for tobacco use ( 36 ). Specifically, it is recommended that every patient who presents to a health-care facility be asked if she/he uses tobacco. All patients should have their tobacco-use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco-use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of intervention by health-care providers ( 36 ).

Studies have shown that not all health-care staff ask all pregnant women about their smoking status during consultations ( 39 ). There is evidence that health-care staff may not ask about smoking status fearing that doing so will negatively impact the relationship between themselves and their pregnant patients.

When asking about tobacco use, health-care staff should screen for current use as well as for past tobacco use, in order to identify pregnant women who may have quit recently (in the pre-conception period or early in the pregnancy) and are therefore vulnerable to relapse ( 36 ).

Research has shown that the use of multiple choice questions, as opposed to a simple yes/no question, can increase disclosure of tobacco use among pregnant women by as much as 40%. For example, giving women the opportunity to answer, ‘I am still smoking but I have cut down on my use’ or a similar response when asked about their tobacco-use status provides women with an opportunity to disclose that they are smoking while also showing they have taken steps to reduce exposure ( 36 ). It is important to communicate with the pregnant women in a sensitive, client-centred manner, particularly as some pregnant women find it difficult to say that they smoke. Such an approach is important in reducing the likelihood that pregnant women will conceal their tobacco use and thus miss out on the opportunity to get help ( 39 ).

Nicotine dependence

Nicotine dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit ( 36 ). Nicotine is the drug in tobacco products that causes dependence. Nicotine dependence among adult smokers is characterized by the emergence of withdrawal symptoms in response to abstinence and by unsuccessful attempts to reduce the use of tobacco or to quit altogether. This dependence is not limited to smoked tobacco products: use of smokeless tobacco also results in nicotine dependence. The IARC handbook of cancer prevention on ‘Methods for Evaluating Tobacco Control Policies’ provides a list of instruments which could be used in different settings to assess tobacco dependence for various tobacco products ( 38 ).

Second-hand smoke exposure

The United Kingdom's guidance on ‘Quitting smoking in pregnancy and following childbirth’ recommends that during the first face-to-face antenatal care visit, health-care staff enquire if anyone else in the household smokes. This includes the woman's husband or partner if applicable ( 39 ). This is intended to determine both support for cessation, as well as an assessment of SHS exposure from other family members.

Frequency of assessment for tobacco use and SHS exposure

Although quitting early in pregnancy and remaining abstinent through the pregnancy will produce the greatest benefits to the fetus and expectant mother, even quitting at a late stage during pregnancy can yield benefits ( 36 ). Hence, the tobacco control programmes should strive to reach pregnant smokers as early as possible in the pregnancy and follow them throughout the pregnancy, and early postpartum to promote and support sustained smoking cessation ( 41 ). There is evidence that many women under-report smoking in pregnancy due to a strong stigma against smoking ( 36 , 39 , 43 ). During the multiple interactions with the health-care providers, women may become sufficiently comfortable to disclose their tobacco-use status. Therefore, it is important that clinicians assess tobacco-use status of pregnant women not only at the first prenatal visit, but also throughout the course of pregnancy as indicated.

Health-care workers should assess SHS exposure at the first prenatal visit as well as throughout the course of pregnancy, as circumstances may change at home or in the workplace (e.g. the arrival of a relative who smokes indoors, career moves, etc.).

The USA guidelines also advise that once a tobacco user is identified, the clinician should assess the patient's willingness to quit at this time ( 36 ). The patient should be asked, ‘Are you willing to make a quit attempt at this time?’ Such an assessment (willing or unwilling) is a necessary first step in treatment. In addition, every patient should be assessed for social, physical or existing medical conditions that may affect the use of planned cessation treatments ( 36 ).

Grading of evidence: Evidence was graded as low due to indirectness.

STRENGTH OF THE RECOMMENDATION

The GDG reviewed the above evidence and considered the harms, benefits, values, preferences, feasibility and cost-effectiveness of the proposed recommendation when drafting the recommendation. It was decided that the potential benefits strongly outweighed any harms, values were in support, and that it was cost effective and feasible in the antenatal care settings, and therefore should be classified as a strong recommendation . (See Annex 7 for detailed description of all issues considered in these domains.)

INTERVENTIONS FOR TOBACCO-USE CESSATION

RECOMMENDATION 2. Psychosocial interventions for tobacco-use cessation in pregnancy

Health-care providers should routinely offer advice and psychosocial interventions for tobacco cessation to all pregnant women, who are either current tobacco users or recent tobacco quitters.

Strength of recommendation: Strong . Quality of evidence: Moderate

Psychosocial interventions involve behavioural support that may include one or more of the following: counselling, health education, incentives and peer or social support.

Psychosocial interventions should be offered to pregnant women who are current or former tobacco users as early in pregnancy as possible.

The recommendation for recent tobacco quitters is based on population-based studies in non-pregnant populations. Recent tobacco quitters may include women who used tobacco before the pregnancy, and who have either spontaneously quit or stopped tobacco use in the pre-conception period or in early pregnancy, before their first antenatal visit.

There is emerging evidence from some countries that the use of financial incentives may be more effective than other interventions. However, it is difficult to generalize the reported effectiveness to the global population as the evidence is limited and is derived from select small populations.

The Stages of Change approach is not effective in pregnancy. The Stages of Change approach to tobacco cessation suggests that health behaviour change involves progress through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination ( 44 ). As this approach is not effective, all women should be offered support irrespective of their intention to quit.

More heavily dependent tobacco users may require high intensity interventions.

Interventions should address concerns of the pregnant smokers about gaining weight as a result of tobacco cessation.

Interventions should recognize and address the impact of partner's smoking status and their attitudes towards tobacco use or cessation.

Recognizing that there is no safe level of tobacco use, there is evidence of some benefit from reduction in smoking if quitting is not achieved.

Almost all existing evidence for interventions is for smokers of manufactured cigarettes, but emerging evidence suggests that similar psychosocial strategies could be applied to users of other forms of tobacco (smokeless tobacco, waterpipes, etc.). There is limited evidence that stopping use of smokeless and other forms of tobacco may improve some birth outcomes.

Given the cost-effectiveness of these interventions, and long-term cost recovery to the health system through tobacco-related disease burden being averted, programme cost should not be a deterrent to immediate implementation.

EVIDENCE FOR RECOMMENDATION 2

Overall question: is use of psychosocial interventions for tobacco dependence effective in pregnancy.

The complexity of smoking in pregnancy has generated many perspectives about the most appropriate approaches and strategies to support cessation.

Cochrane systematic reviews of the range of interventions to support smoking cessation have been performed since 1995. The most recently published Cochrane review on this topic was carried out in 2009 ( 45 ). The 2009 review was then updated in 2012. The 2012 update was split into two separate reviews. Coleman et al. in 2012 evaluated pharmacotherapy to support smoking cessation (presented in a separate evidence profile on pharmacotherapy) ( 46 ), while Chamberlain et al. in 2012 evaluated the effectiveness of individual psychosocial interventions for supporting women to stop smoking in pregnancy and interventions to prevent smoking relapse among women who have spontaneously quit ( 47 ).

In addition to the Cochrane reviews, the following reviews were also used for the evidence retrieval and to inform the discussion on the values and preferences.

Baxter et al. Systematic review of how to stop smoking in pregnancy and following childbirth: review 2: factors aiding delivery of effective interventions (review prepared for NICE Public Health guidance 26), 2008 ( 48 ).
Taylor M. Economic analysis of interventions for smoking cessation aimed at pregnant women (paper prepared for NICE, the United Kingdom guidelines), 2009 ( 49 ).
Ebbert et al. Cochrane systematic review on interventions for smokeless tobacco-use cessation, 2011 ( 50 ).
Flemming H et al. Using qualitative research to inform interventions to reduce smoking in pregnancy in England: a systematic review of qualitative studies, 2012 ( 40 ).

A major limitation was the lack of studies conducted in low- to middle-income countries. Only 2 of 65 studies on psychosocial interventions during pregnancy were from low- or middle-income countries (Poland and four countries in South America). The criteria for ‘smoker’ varied, and only one study included women using smokeless tobacco products.

Many of the trials had multimodal interventions, but the main intervention strategies involved counselling (39 trials), health education (7 trials), feedback (7 trials), incentives (3 trials), and peer or social support (11 trials). Three trials offered optional nicotine replacement therapy as part of a multimodal intervention. Women in the control groups in 38 of the 67 trials received information about the risks of smoking in pregnancy and were advised to quit as part of ‘usual care’. The most frequent comparison was ‘usual care’ from a woman's antenatal care provider (30 trials).

Pooled data from 63 trials revealed that women receiving psychosocial interventions (counselling, health education, feedback, incentives, or peer or social support) were approximately 30% more likely to not smoke (i.e. be abstinent) late in pregnancy (RR=1.36, 95% confidence interval [CI] 1.22–1.52), compared to women in the comparison group (Number Needed to Benefit [NNTB]=25, 95% CI 17–40). This included both self-reported and biochemically validated smoking cessation. However, the heterogeneity was high (I 2 =58%).

The effect of the intervention on smoking in late pregnancy was still statistically significant among a subgroup of 17 trials with biochemically validated smoking cessation, assessed as ‘low risk of bias’ in this review (RR=1.43, 95% CI 1.13–1.80). It is unclear whether interventions to support women who spontaneously quit in early pregnancy reduce the rate of relapse in late pregnancy (RR=0.89, 95% CI 0.74–1.08). Although the effect on smoking in late pregnancy was still statistically significant among a subgroup of trials with ‘low risk of bias’, caution is urged in interpreting other results as potential sources of bias were identified and there is high heterogeneity. There was some weak evidence that women in intervention groups reduced smoking in late pregnancy, but the evidence was not consistent.

Among a subset of studies that examined cessation in the postpartum period, women receiving the psychosocial interventions were significantly more likely to remain abstinent in the early postpartum period (1–5 months) (RR=1.33, 95% CI 1.07–1.66), but this was not sustained in the longer term (6–12 months) (RR=1.10, 95% CI 0.83–1.44).

Interventions were grouped into five main intervention strategies: (i) counselling (n=38), (ii) health education (n=6), (iii) feedback (n=5), (iv) incentives (n=3), and (v) peer or social support (n=11). Interventions with incentives were the most effective (RR=2.86, 95% CI 2.25–3.46; n=3). This was followed by feedback (RR=2.26, 95% CI 1.77–2.75; n=5) and then counselling (RR=1.34, 05% CI 1.19–1.48; n=38). The pooled effect size estimates for social/peer support (RR=1.20, 95% CI 0.98–1.42; n=11) and health education (RR=1.14, 95% CI 0.69–1.59; n=6) were not statistically different.

Pooled data from 14 trials demonstrated that psychosocial interventions to support women to stop smoking in pregnancy reduce the rate of infants born low birth weight (<2500 g) (RR=0.83, 95% CI 0.71–0.97; NNTB=61, 95% CI 37–292) and preterm birth (<37 weeks) (RR=0.85, 95% CI 0.72–0.99; NNTB=97, 95% CI 53–1554). It is unclear whether interventions to stop smoking reduce: the rate of infants born very low birth weight (<1500 g); neonatal deaths; neonatal intensive care admissions or total perinatal mortality, as the outcome numbers were small. There were no differences reported in rates of caesarean section (two trials). One study examined maternal weight gain as an outcome, and found a mean excess weight of 2.8 kg among women who had stopped smoking compared to the women who did not quit.

The review defined intensity rating of interventions and controls as follows:

Interventions categorized as ‘high intensity’, such as counselling (Pooled RR=1.36, 95% CI 1.20–1.54) are slightly more effective than those categorized as ‘low intensity’, such as provision of advice and self-help materials (Pooled RR=1.30, 95% CI 1.00–1.70), in supporting women to stop smoking. There was strong significant correlation between the intensity of both the intervention and control arms (i.e. higher intensity interventions were compared with higher intensity control conditions, and trials with lower intensity interventions were compared with lower intensity controls).

Newly included studies in this update of the review demonstrated a borderline effect of smoking cessation interventions in supporting pregnant women to stop smoking (RR=1.28, 95% CI 1.00–1.60), when compared to studies in the previous version of this review (RR=1.40, 95% CI 1.23–1.60) ( 45 ). The median intensity of ‘standard care’ provided in antenatal care in the comparison group has also increased over time, perhaps explaining attenuation of the association between the intervention and cessation.

There does not appear to be psychological harm caused by psychosocial interventions and two studies suggest some interventions may improve psychological well-being for women. Studies reporting women's views regarding the interventions (n=13) suggest personal contact may be important, though trials of emerging technologies, such as computer-based interventions and telephone support, have received positive feedback from women. In six studies looking at peer and partner support for smoking cessation, women reported mixed (both positive and negative) support experiences.

Studies reporting provider's views of the interventions suggest challenges to implementation in clinical settings, including competing demands on time and uncertainty over the effectiveness of interventions. These barriers may be overcome by including educational interventions directed at providers, use of referral services and technological aids.

Although psychosocial interventions administered in randomized controlled trials (RCTs) were effective (RR=1.37, 95% CI 1.22–1.54), the effect of interventions provided in cluster-randomized trials was smaller and not statistically significant (RR=1.23, 95% CI 0.84–1.78), suggesting challenges implementing research evidence into more general settings. However, the group noted that there were few cluster RCTs in general for smoking cessation in pregnancy and the data could be more robust if evidence from more RCTs was available.

Four studies conducted in high-income countries reported that the interventions were highly cost effective using a variety of measures. Pregnancy-specific self-help materials were more cost effective than standard smoking cessation information or self-help materials.

Tobacco control programme interventions should reach a pregnant smoker as early as possible in the pregnancy and follow her throughout the pregnancy and early postpartum to promote and support sustained smoking cessation ( 41 ).

Use of psychosocial interventions to support smokeless tobacco cessation in pregnant women

There have been no trials to study effect of psychosocial intervention in pregnant women using smokeless tobacco (ST). A 2011 Cochrane review of interventions for smokeless tobacco cessation identified 12 trials involving behavioural interventions in the adults, but these trials did not involve pregnant women ( 50 ). The results are as follows:

Behavioural interventions appear to be effective for increasing tobacco abstinence rates among smokeless tobacco users.

Behavioural interventions which include telephone support or an oral examination with feedback may be effective for increasing tobacco abstinence rates among smokeless tobacco users. These estimates combine both population-based interventions and individuals self-selecting for treatment.

The 2008 USA guidelines on ‘Treating tobacco use and dependence’ also recommend that smokeless tobacco users should be identified, strongly urged to quit, and provided counselling cessation interventions.

Grading of evidence: The quality of the evidence in Chamberlain et al. was graded as moderate quality for all outcomes. (See Annex 6 for GRADE tables.)

The GDG reviewed the above evidence and considered the harms, benefits, values, preferences, feasibility and cost-effectiveness of the proposed recommendation when drafting the recommendation. It was decided that the benefits strongly outweighed any harms, values were in support, and that it was cost-effective and feasible, and therefore should be classified as a strong recommendation . (See Annex 7 for detailed description of all issues considered in these domains)

RECOMMENDATIONS 3–5. Use of pharmacotherapy for tobacco-use cessation in pregnancy

The panel cannot make a recommendation on use or non-use of nicotine replacement therapy (NRT) to support cessation of tobacco use in pregnancy.

Strength of recommendation: Not applicable . Quality of evidence: Moderate

The panel does not recommend use of bupropion or varenicline to support cessation of tobacco use in pregnancy.

Strength of recommendation: Strong . Quality of evidence: No evidence available

The panel recommends that further research be carried out in pregnant women on safety, efficacy and factors affecting adherence to pharmacotherapeutic agents for tobacco-use cessation.

Strength of recommendation: Strong . Quality of evidence: Not applicable

The evidence search found no quality evidence on the use of pharmacotherapy with bupropion or varenicline for tobacco-use cessation in pregnancy.

There is currently insufficient evidence to determine whether or not pharmacotherapy (NRT, bupropion, varenicline) is effective when used in pregnancy for tobacco-use cessation.

There is currently insufficient evidence to determine whether or not pharmacotherapy (NRT, bupropion, varenicline) is safe when used in pregnancy for tobacco-use cessation.

Given the known considerable harms caused by tobacco smoking in pregnancy and the known benefits of using NRT from studies in the general population, it is acknowledged that various national guidelines have recommended use of NRT in pregnancy under medical supervision.

Urgently needed research includes: studies of factors improving or impeding adherence to pharmacotherapeutic agents; a review of the effects (safety profiles, effectiveness) of use of NRT in pregnant women, particularly in the United Kingdom where a historical cohort exists for use of NRT in pregnancy; use of client preference trials (client's preference of pharmacotherapy treatment versus no treatment); and surveillance of current use of pharmacotherapy in pregnancy (focused on determining whether women use pharmacotherapy when recommended or prescribed by health-care providers).

EVIDENCE FOR RECOMMENDATIONS 3–5

Overall question: is use of pharmacological treatment for tobacco dependence safe and effective in pregnancy.

Three first-line pharmacological agents were approved by the United States Food and Drug Administration (FDA) to treat tobacco-use dependence ( 36 ). The following agents have been found to be safe and effective in assisting with tobacco cessation (smoking and smokeless tobacco) in the general population:

Nicotine replacement therapy (NRT) in several forms (patches, gum, nasal sprays, oral sprays, inhalers, microtabs and lozenges)
Varenicline

The evidence search found randomized controlled trials and observational studies on the use of NRT in pregnancy, one observational study on use of bupropion in pregnancy and none for varenicline. The latter two medications are not recommended for use in pregnancy in most countries ( 36 , 39 ).

Nicotine replacement therapy is available as patches, gum, nasal sprays, inhalers, and lozenges; all have been used to treat tobacco dependence in pregnancy. Concerns about fetal safety and possible adverse maternal outcomes have led to limitations on its use in pregnancy in many countries. National and professional guidelines from Canada and the United Kingdom recommend use of NRT in pregnancy only when psychosocial interventions fail ( 39 , 51 ). Randomized controlled trials of NRT have been performed, all of them in high-income countries, measuring continuous smoking abstinence or point prevalence of smoking abstinence and comparing adverse effects – maternal and fetal – between the intervention and control groups.

The following Cochrane and other systematic reviews were used for evidence retrieval.

Coleman et al. Pharmacological interventions for promoting smoking cessation in pregnancy, 2012 ( 46 ).
Myung et al. Efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis, 2010 ( 52 ).
Taylor M. Economic analysis of interventions for smoking cessation aimed at pregnant women (paper prepared for NICE Public Health guidance 26), 2009 ( 49 ).
Ebbert et al. Cochrane systematic review on interventions for smokeless tobacco-use cessation in general population, 2011 ( 50 ).
Inclusions: systematic reviews performed within the past two years.
Exclusions: Myung et al., 2012, was not used for grading of evidence on NRT because it gave a pooled effect using combined studies on NRT and one using bupropion. However, information on side effects and attitudes in this review was used to inform values and preferences domains for this recommendation.

Use of NRT to support smoking cessation in pregnant women

Coleman et al. found that NRT had a small (RR=1.3, 95% CI 0.93–1.91) but non-significant effect on smoking cessation ( 46 ). There were non-significant increases in rates of stillbirth, miscarriage and birth by caesarean section, and non-significant reductions in preterm births, neonatal intensive care admissions and neonatal deaths. Adherence to recommended treatment was generally low in the included studies. Nicotine is metabolized faster in pregnant women than in non-pregnant women. This means that pregnant women are likely to need higher doses of NRT as compared to non-pregnant women to substitute for nicotine received from tobacco. Subsequently a higher dose of NRT may be needed for cessation. Many of the studies in the Coleman review used the standard NRT dose (principally 15 mg, delivered via a 16-hour patch). This, together with low adherence would lead to very low exposure to the intervention, which may explain the lack of observed effect.

Use of pharmacotherapy to support smokeless tobacco cessation in pregnant women

There have been no trials comparing pharmacotherapy to placebo in pregnant women using smokeless tobacco. A 2011 Cochrane review of interventions for smokeless tobacco cessation identified 11 trials comparing pharmacotherapy to a placebo in the adults but these trials did not involve pregnant women ( 50 ). The results are as follows:

Two small trials of bupropion did not detect an effect on smokeless tobacco abstinence, although the wide confidence intervals (OR=0.86, 95% CI 0.47–1.57) do not rule out a small benefit.

Four trials of nicotine patch did not detect a benefit (OR=1.16, 95% CI 0.88–1.54), nor did two trials of nicotine gum (OR=0.98, 95% CI 0.59–1.63).

Data from one study among Swedish snus users suggests that varenicline can increase tobacco abstinence rates at six months (OR=1.6, 95% CI 1.08–2.36).

Grading of evidence: The quality of the evidence in Coleman et al. was graded as moderate. (See Annex 6 for GRADE tables.)

The GDG reviewed the above evidence and considered the harms, benefits, values, preferences, feasibility and cost-effectiveness of the proposed recommendation during the recommendation drafting process. Given that there was good quality but inconclusive evidence on both the effectiveness and impact on fetal outcomes for NRT, and acknowledging that in some countries NRT is recommended for smoking cessation in pregnant women when behavioural therapy fails, the panel decided they could not make a specific recommendation on the use or non-use of NRT. The group also noted that this is an area of great public health importance where presently there are large gaps in research and evidence, and made a strong recommendation for further research to be carried out on safety, efficacy and factors affecting adherence to pharmacotherapeutic agents in pregnant women for tobacco-use cessation . (See Annex 7 for a detailed description of all issues considered in these domains.)

PROTECTION FROM SECOND-HAND SMOKE

RECOMMENDATIONS 6–7. Protection from second-hand smoke in pregnancy (smoke-free public places)

All health-care facilities should be smoke-free to protect the health of all staff, patients and visitors including pregnant women.

All work and public places should be smoke-free for the protection of everyone including pregnant women.

Health-facility staff who use tobacco should be offered cessation services.

EVIDENCE FOR RECOMMENDATIONS 6–7

Overall question: what are the effective interventions to prevent shs exposure to pregnant women at health-care facilities, workplaces and other public places.

Article 8 of the WHO Framework Convention for Tobacco Control (WHO FCTC) on protection from exposure to tobacco smoke obliges WHO Member States who have ratified the treaty (176 parties as of 23 August 2012) to protect all people from exposure to SHS in indoor workplaces, public transport and indoor public places. As a result, many countries around the world have banned smoking in public places ( 24 ). At its second session in July 2007, the Conference of the Parties (COP) adopted guidelines for implementation of Article 8 of the WHO FCTC on protection from exposure to SHS ( 53 ).

Many countries, regardless of their FCTC ratification status, are taking steps to protect their citizens from the harms of SHS in public places, through either planning the steps or implementing national smoke-free laws for public places or workplaces. As of December 2010, more than 739 million people globally were protected by comprehensive, national smoke-free laws. However, 107 countries spanning all levels of economic development still have the lowest level of legal protection, i.e. no smoke-free policies in place at all, or policies that cover only one or two of the eight types of public places assessed ( 16 ). Furthermore, in many countries smoke-free laws are not fully enforced, leading to variable compliance of the public with the legislation.

Status of smoke-free policies for public places in WHO Member States as of 2011 *

A country may have more than one type of ban.

No recent systematic reviews were identified that were specific to the impact of the smoke-free policies on SHS exposure in pregnant women. However, there is strong evidence to support smoke-free policies to protect the general population from SHS; in turn these policies will also benefit the subpopulation of pregnant women.

The following systematic reviews and peer-review publications were used to develop the narrative synthesis.

Callinan et al. Legislative smoking bans for reducing SHS exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews, 2010 ( 54 ).
Charrier et al. Smoking habits in Italian pregnant women: any changes after the ban? 2010 ( 55 ).
Puig et al. Assessment of prenatal exposure to tobacco smoke by cotinine in cord blood for the evaluation of smoking control policies in Spain, 2012 ( 56 ).
Mackay et al. Impact of Scotland's smoke-free legislation on pregnancy complications: retrospective cohort study, 2012 ( 57 ).
Adams et al. Reducing prenatal smoking: the role of state policies, 2012 ( 58 ).

There has been an increase in the number of countries implementing national and subnational policies which ban or restrict smoking in public places and workplaces. The main reason for these policies is to protect non-smokers from the harmful health effects of exposure to SHS ( 54 ). Smoke-free environments also help smokers who want to quit, and bans on smoking in public places and workplaces may also encourage people to make their homes smoke-free to protect the non-smokers ( 59 ).

Impact of smoke-free policies on SHS exposure

General population : A 2010 Cochrane review looking at the impact of smoke-free policies on exposure to SHS in the general population found that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places. Hospitality workers experienced a greater reduction in exposure to SHS after implementing the ban as compared to the general population. There was no change in exposure to SHS in private cars. In general, there was no change in the levels of SHS exposure at home after the implementation of the smoking bans across all studies, though some studies reported reductions in exposure to SHS at home after public smoking bans were implemented ( 54 ). Following the implementation of legislation in Scotland prohibiting smoking in all partially or completely enclosed public spaces in 2006, many studies have shown a reduction in smoking and in SHS exposure in adults and children ( 57 ).

Pregnant women: Italy introduced smoke-free legislation in 2005. A study looking at the impact of the ban on smoking in indoor public places on pregnant women in Italy, reported a marked drop in exposure to SHS in pregnant women in the workplace but not in the home ( 55 ). Spain introduced smoke-free legislation to reduce SHS in 2005. A cross-sectional survey assessed cotinine concentrations in infant cord blood in separate cohorts of mothers and newborns at three time points: 1996–98, 2002–04 (immediately before implementation in 2005), and 2008 (after implementation) of smoke-free workplace bans in Spain. In the 2008 cohort, the percentage of infants with no prenatal SHS exposure (cord blood cotinine 0.2–1 ng/mL) was 73.4%, compared to 56.9% in 2002–04, and 10.8% in 1996–98, showing that public smoking bans reduced prenatal SHS exposure ( 56 ).

Impact of smoke-free policies on smoking prevalence

General population : There is limited evidence regarding the impact of smoke-free legislation on reduction in active smoking ( 54 ).

Pregnant women: In Scotland, researchers found that following implementation of the smoking bans, rates of current smoking among pregnant women dropped significantly from 25.4% to 18.8% ( 57 ). Similar results were also observed in a study from the United States, in which pooled data from 225 445 women with live births during 2000–2005 in 29 states and New York City were analyzed. The researchers found that implementing a full private worksite smoking ban increased third trimester quit prevalence by five percentage points. This suggests that national and local tobacco control policies can effect an increase in smoking cessation in pregnant women ( 58 ).

Impact of smoke-free policies on health outcomes

General population : There is strong evidence to suggest that the health of those affected by the smoking ban improves as a result of implementation of the ban ( 54 ). A 2010 Institute of Medicine report concluded that smoking bans are effective in reducing the risk of coronary heart disease and heart attack ( 59 ). The implementation of smoke-free legislation in Scotland has been accompanied by significant reductions in the incidence of both cardiovascular and respiratory disease ( 57 ).

Pregnant women: Few studies have demonstrated improvement in birth outcomes following smoking bans. Following the introduction of national, comprehensive smoke-free legislation in Scotland, there was a significant drop in overall preterm births (-11.72%, 95% CI -15.87, -7.35, p<0.001), and spontaneous preterm labour (-11.35%, 95% CI -17.20, -5.09, p=0.001), which remained after adjustment for potential confounding factors. Likewise, there was a significant decrease in the number of infants born small for gestational age (24.52%, 95% CI 28.28, 20.60, p=0.024). These significant reductions occurred in both smoking and never-smoking mothers, suggesting that the introduction of smoking bans in Scotland was associated with significant reductions in preterm birth and babies being born small for gestational age ( 57 ).

The GDG reviewed the above evidence and considered the harms, benefits, values, preferences, feasibility and cost-effectiveness of the proposed recommendation during the drafting process. It was decided that potential benefits strongly outweighed harms, values were in support, and that it was cost effective and feasible and therefore should be classified as a strong recommendation . (See Annex 7 for a detailed description of all issues considered in these domains.)

RECOMMENDATIONS 8–9: Protection from second-hand smoke in pregnancy (smoke-free homes)

Health-care providers should provide pregnant women, their partners and other household members with advice and information about the risks of SHS exposure as well as strategies to reduce SHS in the home.

Strength of recommendation: Strong. Quality of evidence: Low

Health-care providers should, wherever possible, engage directly with partners and other household members to inform them of the risks of SHS exposure to pregnant women and to promote reduction of exposure and offer smoking cessation support.

The overall goal of the intervention should be to eliminate SHS exposure at home.

Efforts to reduce SHS exposure can also help to reduce active tobacco use in pregnant women.

EVIDENCE FOR RECOMMENDATIONS 8–9

Overall question: what interventions are effective for reducing shs exposure in the home.

No recent systematic reviews of interventions to reduce the exposure of pregnant women to SHS at home were identified. Although the following two reviews focused on the reduction of SHS exposure of infants rather than pregnant women, these were used for evidence retrieval for interventions aimed at fathers or partners of pregnant women to make homes smoke-free.

Baxter et al. Which interventions are effective and cost-effective in encouraging the establishment of smoke-free homes? 2009 ( 48 , 60 ).
Hemsing et al. Interventions to improve partner support and partner cessation in pregnancy, 2012 ( 61 ).

There is mixed evidence in regard to the effect of counselling plus other interventions (such as provision of written materials or telephone support) on making homes of pregnant women smoke-free. There was also mixed evidence from studies reporting on interventions based on the use of motivational interviewing of parents to promote smoke-free homes, and evaluations of individually adapted smoke-free home plans.

WHO commissioned a systematic review on ‘Interventions to reduce SHS exposure among non-smoking pregnant women’, which searched the Cochrane library and eight databases, yielding five studies ( 62 ). The results from this review are reported as a narrative synthesis below.

Five studies were found that evaluated a clinical intervention to reduce SHS exposure among non-smoking pregnant women. One RCT conducted in the United States (Washington, DC) among non-smoking African-American pregnant women tested a behavioural intervention that included counselling, role play, skills practice and building negotiation skills with partners and household members who smoked ( 63 ). Pregnant women in the intervention group were less likely to report SHS exposure than women in the control group (OR=0.57, 95% CI 0.38–0.84). In an RCT conducted in Guangzhou, China, pregnant women in the intervention group received educational materials and brief advice (2–3 minutes) on the harms of SHS from their obstetrician ( 64 ). Husbands of women in the intervention group were more likely than those in the control group to not smoke in the previous seven days (8.4% versus 4.8%, p=0.04); however, no difference was found in reported not smoking in the previous 30 days (6.1% versus 4.2%, p=0.26). Another study conducted in Sichuan, China found that by providing educational materials on SHS as well as counselling by obstetricians, significantly decreased mean nicotine concentration in the hair of the mothers in the intervention compared to the controls (for intervention: 0.3 log micro g/g at follow-up compared to 0.5 at baseline; and for control: 0.5 log micro g/g at follow-up compared to 0.4 at baseline) ( 65 ).

In an RCT conducted in Isfahan, Iran, midwives were trained to provide 15–20 minutes of education during prenatal care visits on the harms of SHS exposure during prenatal care visits ( 66 ). The authors found that pregnant women's self-reported weekly SHS exposure was lower in the intervention group compared with the control group at each of the third, fourth, and fifth prenatal care sessions, p<0.001 (e.g. at the fifth visit, 12.3 versus 25.4 weekly mean number of cigarettes husband smoked near the woman). There was no difference between the two groups at the initial session. The fifth study in Brisbane, Australia, involved both counselling by a general practitioner and use of a nicotine patch to help partners of pregnant women to quit smoking ( 67 ). The authors found that 48 out of 291 men (16.5%) in the intervention group self-reported quitting compared to 25 out of 270 men (9.3%) in the control group (p=0.011, OR=0.52, 95% CI 0.31–0.86); biochemical verification (carbon monoxide testing) was carried out on a subsample of men who reported quitting.

Interventions

A small number of randomized controlled trials suggest that providing brief advice or counselling to non-smoking pregnant women may reduce SHS exposure; however, studies are needed with biochemical measures of SHS exposure.

Only one study has examined the effect of partner cessation in reducing SHS exposure among non-smoking pregnant women. Similar to other studies in the general population, this study found that counselling and use of a nicotine patch increased quitting among the partners or husbands of pregnant women.

Cost effectiveness: No evidence

Adverse outcomes: No evidence

Grading of evidence: The evidence has been graded as low indicating we are uncertain about the estimate of effect. (See annex 6 for GRADE tables.)

The GDG reviewed the above evidence and considered the harms, benefits, values, preferences, feasibility and cost-effectiveness of the proposed recommendation when drafting the recommendation. It was decided that the potential benefits strongly outweighed the harms, values were in support, and that it was feasible and therefore should be classified as a strong recommendation . (See Annex 7 for a detailed description of all issues considered in these domains.)

All rights reserved. Publications of the World Health Organization are available on the WHO web site ( www.who.int ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob ).

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Cite this Page WHO Recommendations for the Prevention and Management of Tobacco Use and Second-Hand Smoke Exposure in Pregnancy. Geneva: World Health Organization; 2013. Recommendations.
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