Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk of tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis.

Smoking also increases the risk for many cancers, including lung, mouth, throat, larynx (voice box), esophagus, bladder, kidney, pancreas, stomach, liver, colon and rectum, and acute myeloid leukemia.

Surgeons recommend patients quit smoking before orthopedic surgery because tobacco use significantly increases the risk of complications, such as infections, poor bone and wound healing, and delayed recovery, which can necessitate further surgeries. Quitting smoking, ideally at least 4-6 weeks before a procedure, allows the body to heal from the harmful effects of nicotine and improve surgical outcomes.

With respect to Vaping: It is dangerous because it exposes users to addictive nicotine, which harms the developing adolescent brain and can lead to heart and lung problems like EVALI (E-cigarette or vaping product use-associated lung injury), Interstitial Lung Disease (popcorn lung), asthma, and bronchitis.

The aerosol contains harmful chemicals such as formaldehyde, acrolein, and diacetyl, which can cause inflammation, scarring, and even cancer. Additionally, vaping increases the risk of transitioning to traditional cigarettes, especially among youth, and can also lead to physical hazards like poisoning and burns from device malfunctions.

Treatment

Smoking cessation treatments include FDA-approved medications like nicotine replacement therapies (patches, gum, lozenges) and prescription drugs (varenicline, bupropion) that reduce cravings and withdrawal symptoms. Combining these medications with behavioral counseling, support groups, or smartphone apps significantly increases the chances of quitting successfully.

Nicotine Replacement Therapy (NRT)

  • NRT provides nicotine without the toxins in tobacco smoke to alleviate withdrawal.
  • Over the Counter (OTC): Patches (steady, long-acting dose), gum (fast-acting, requires “chew and park” method), and lozenges.
  • Prescription: Nicotine nasal spray (fastest acting) and nicotine inhalers.

Prescription Medications (Non-Nicotine)

Behavioral Counseling & Support

  • Counseling: Individual, group, or telephone counseling (quit lines) helps develop coping skills.
  • Behavioral Therapies: Cognitive Behavioral Therapy (CBT), motivational interviewing, and contingency management (incentive-based).
  • Resources: Quit-smoking apps, websites (smokefree.gov), and texting programs.

Alternative Approaches

  • Acupuncture: Can help control withdrawal symptoms, especially when combined with counseling.
  • Hypnotherapy: Used to alter smoking habits, though evidence is limited.
  • Combine Methods: Using a long-acting method (patch) with a short-acting method (gum/lozenge) is highly effective. Or combining a prescription like Chantix with a transdermal nicotine patch.
  • Set a Quit Date: Create a formal plan, inform family/friends, and remove cigarettes from your environment.

Smoking Trends

According to the American Lung Association, Cigarette smoking in the U.S. has dropped to historic lows, falling from 42.4% in 1965 to 11.6% in 2022 and further to 9.9% in 2024. While overall rates are declining, particularly among younger adults, significant disparities remain, and nicotine addiction is shifting toward e-cigarettes and a potential resurgence of cigarettes among younger populations.

Key Smoking Trends

  • Declining Prevalence: Cigarette use has declined significantly over decades. However, about 18.8% of U.S. adults (47.7 million) still used at least one tobacco product in 2024, including cigarettes, cigars, and e-cigarettes.
  • Youth Trends: Youth vaping grew rapidly, and while cigarette smoking declined, there is emerging concern regarding a comeback, with smoking becoming more common on social media and TV shows, influencing Gen Z as a “retro” trend.
  • E-Cigarette Popularity: E-cigarettes are the second most common type of tobacco product used, with high prevalence among young adults (18-24 years).
  • Age Disparities: Adults aged 45–64 have the highest cigarette smoking prevalence. Smoking rates among adults aged 18–24 dropped significantly from 2011 to 2022, while rates for those 65 and older remained higher.
  • Demographic Factors: Smoking rates are highest among adults with low household income (18.3%) compared to high income (6.7%).
  • Global Trends: While male smoking prevalence is declining in many countries, it is still rising in others.