What is in the future for smoking?

Health care workers have become extremely active in publicizing the negative effects of smoking. In fact, health care workers have been instrumental in passing various legislation to limit smoking in public. As a result, the proportion of people in the US who smoke has dropped from 40.4% in 1965 to 22.5% in 2002 (data from the US Department of Health).

This reduction in the percent of people who smoke, however, has been significantly less in women than in men. That is, from 1965 to 2002, smoking among men dropped from 50.2% to 25.2% while during the same period, smoking among women dropped from 31.9% to 20.0%. So, in the future, efforts need to be made to understand and eliminate this difference between the genders. Moreover, with the passage of even stricter legislation, the percent of people who smoke should (hopefully) fall to single digits by the year 2010.

One interesting area of the current research on smoking is the study of the population distribution of the genes for smoking (genetic epidemiology). (Genes determine an individual's inherited characteristics.) Only a small fraction of individuals who start smoking as an adolescent will actually become nicotine dependent. So, what determines which individuals will become nicotine-dependent? Investigators have found that smoking initiation (the obligatory first step) and the development of nicotine dependence are both influenced by genetic factors. The genetic factors appear to play a larger role in nicotine dependence than in smoking initiation. The next step will be to identify these genes and learn how they work in order to facilitate the development of effective prevention and treatment strategies for tobacco addiction.

Teen smoking rates remain of concern; in 2003, approximately 22% of high school students were smokers. According to the American Cancer Society, the majority of cigarette use begins before a person reaches 18 years of age. Those who do not begin smoking by age 18 generally do not start to smoke later in life. Education of the at-risk teen population is therefore critical for prevention of tobacco use. Various celebrities and activist groups actively promote campaigns aimed at a teen audience that educate about the consequences of smoking and offer advice on smoking cessation and prevention. While teen smoking rates increased during the 1990s (36% of teens smoked in 1997), prevention and education campaigns have brought about a decrease in teen smoking in recent years.

Smoking and Quitting Smoking At A Glance

• Although smoking is an addiction, people can quit smoking.
• Secondhand smoke is harmful to the health of children, family members, and coworkers
• Quitting smoking cuts the risk of lung cancer, heart disease, stroke, and respiratory diseases The steps in quitting, each of which requires special attention and efforts by the smoker, are getting ready to quit, quitting, and staying quit
• A number of techniques are available to assist people who want to quit, including nicotine replacement therapy (NRT), behavioral modification, and self-help literature
• In nicotine replacement therapy, which is the cornerstone of most smoking cessation programs, another source of nicotine is substituted while the cigarettes are stopped (The idea of nicotine replacement therapy is to eliminate both the smoking habit - although the addiction remains - and the symptoms of withdrawal. Then, the replacement nicotine is gradually stopped.)
• Currently, three forms of nicotine replacement therapy are available over the counter: nicotine patches, nicotine gum, and nicotine lozenges, while two forms are available by prescription, an inhaler and a nasal spray
• Nicotine replacement therapy has about a 25% success rate, which increases to 35 or 40% when nicotine replacement therapy is combined with intensive behavioral counseling
• Nicotine-containing substances have side effects, interactions with other medications, effects on other medical conditions, and limitations in their use
• A prescription drug called bupropion (Zyban, Wellbutrin) has been found to be effective in helping people to stop smoking