Nicotine Addiction

Tobacco use is the greatest potentially remedial problem throughout the world, and it is the number one preventable cause of death in the developed world. Clinicians have a particularly important role as patient advocates in health promotion, discouraging smoking initiation, encouraging and assisting smoking patients to quit, and participating in social efforts designed to curb smoking at various levels.

Smoking cigarettes kills more people in economically developed countries than any other single environmental or behavioural factor. For any environmental exposure to have an appreciable effect on public health, the exposure either has to be common or to have a major effect on disease risk. Both of these are true of cigarette smoking. Worldwide, an estimated 1.2 billion people are current smokers, including 48 million in the United States and 13 million in the United Kingdom. The prevalence of smoking in economically developed countries is typically at least 25%, and it is increasing rapidly in China and in many other areas of the world. The effect of smoking on mortality is also substantial, amounting to a one in two chance of premature death and including a one in four chance of death in middle age with a loss of as much as 25 yr of life. The major part of this premature mortality is due to lung cancer, chronic obstructive pulmonary disease, and pneumonia. Smoking is thus a cause of major health problems, and it has a particular impact on the work of pulmonary physicians. The question we address in this article is whether, even now, the effects of smoking on health, and in particular the training and involvement of physicians in the delivery of smoking cessation services, receives the recognition and attention it deserves in medicine.