Smoking Cessation

List of Abbreviations 665

List of Abbreviations

α alpha

β beta

δ delta

κ kappa

μ mu

μg/ml microgram per milliliter

15-D 15 dimensions [generic, selfadministered measure of HRQoL]

2-SORA selective receptor 2 antagonist

5 A’s Ask, Advise, Assess, Assist, Arrange

AAA abdominal aortic aneurysm

AAC Ask, Advise, Connect

AACR American Association for Cancer 

Research

AAR Ask, Advise, Refer

AARP American Association of Retired 

Persons

ABI ankle-brachial index

ACA Patient Protection and Affordable 

Care Act

ACC anterior cingulate

ACE angiotensin-converting enzyme

ACT acceptance-based therapy

ADHD attention-deficit/hyperactivity disorder

AF atrial fibrillation

aFRs adjusted fecundability ratios

AGS additive genetic score

AHRR aryl-hydrocarbon receptor repressor

AMI acute myocardial infarction

AML acute myeloid leukemia

AMPA α-amino-3-hydroxy-5-methyl-4-

isoxazolepropionic acid

ANOVA analysis of variance

AoAC aortic artery calcium

aOR adjusted odds ratio

APO apolipoprotein

APPROACH Alberta Provincial Project for 

Outcomes Assessment in Coronary 

Heart Disease

aPR adjusted prevalence ratio

AQCs alternative quality contracts

ARIC Atherosclerosis Risk in Communities

ARR absolute risk reduction

ASCO American Society of Clinical Oncology

ASSET AngloScandinavian Study of Early 

Thrombolysis

BAL bronchoalveolar lavage

BENESCO Benefits of Smoking Cessation on 

Outcomes

bid twice a day

BMI body mass index

BRFSS Behavioral Risk Factor Surveillance 

System

C3I Cancer Center Cessation Initiative

CABG coronary artery bypass grafting

CAC coronary artery calcification

CAD coronary artery disease

CAGE 50 number of segments with coronary 

artery stenosis of greater than or 

equal to 50%

CALIBER ClinicAL research using LInked 

Bespoke studies and Electronic 

health Records

CASS Coronary Artery Surgery Study

CAST Cardiac Arrhythmia Suppression Trial

CBT cognitive behavioral therapy

CCA common carotid artery

CCQ Clinical COPD Questionnaire

CCS Cancer Control Supplement

CDC Centers for Disease Control and 

Prevention

CDER Center for Drug Evaluation and 

Research

CHANCES Consortium on Health and Ageing: 

Network of Cohorts in Europe and 

the United States

CHD coronary heart disease

CHDA coronary heart disease hard, definite 

angina, probable angina if followed 

by revascularization

CHDH coronary heart disease hard [myocardial 

infarction, resuscitated cardiac arrest, 

coronary heart disease death]

CHF congestive heart failure

CHIP Children’s Health Insurance Program

CI confidence interval

CIMP-high CpG island methylator phenotype

CIN3 cervical intraepithelial cancer grade 3

CIS carcinoma in situ

cm centimeter
A Report of the Surgeon General

666 List of Abbreviations

CMS Centers for Medicare and Medicaid 

Services

CO carbon monoxide

COLD chronic obstructive lung disease

CONSTANCES Consultants des Centres d’Examens 

de Santé

COPD chronic obstructive pulmonary disease

cpd cigarettes smoked per day

CpG cytosine-phosphate-guanine

CPP conditioned place preference

CPS Cancer Prevention Study

CRF corticotropin-releasing factor

CRP C-reactive protein

CT computed tomography

CTP Center for Tobacco Products

CVA cerebrovascular accident

CVD cardiovascular disease

CVDA CVDH, CHDH, atherosclerotic death, 

CVD death

CVDH CHDH, stroke death, stroke

dACC dorsal anterior cingulate cortex

DALYs disability-adjusted life-years

DART Diet and Reinfarction Trial

dlPFC dorsolateral prefrontal cortex

DM diabetes mellitus

DMN default mode network

dmPFC dorsomedial prefrontal cortex

DNA deoxyribonucleic acid

DoD U.S. Department of Defense

DORs delta opioid receptors

DRD2 dopamine receptor D2 

EAGLES Evaluating Adverse Events in a 

Global Smoking Cessation Study

e-cigarettes electronic cigarettes

ECLIPSE Evaluation of COPD Longitudinally 

to Identify Predictive Surrogate 

Endpoints

ED erectile dysfunction

EHRs electronic health records

ELSA English Longitudinal Study of Aging

ELSA-Brazil Brazilian Longitudinal Study of 

Adult Health

EMS emergency management system

ENDS electronic nicotine delivery systems

EORTC European Organisation for Research 

and Treatment of Cancer

EORTC-H&N35 European Organization for Research 

and Treatment of Cancer Quality of Life 

Questionnaire, Head and Neck Module

EORTC-LC13 European Organization for Research 

and Treatment of Cancer Quality of Life 

Questionnaire, Lung Cancer Module

EPIC European Prospective Investigation 

into Cancer and Nutrition

eReferral electronic referral

ESTHER Epidemiological Investigations on 

Opportunities for Prevention, Early 

Detection and Optimised Treatment 

of Chronic Diseases in the Elderly 

Population

EURQoL European quality of life

EVALI e-cigarette- or vaping-associated 

lung injury

F females

F2:Cr F2 isoprostane:creatinine

F2RL3 factor II receptor-like 3

FCTC Framework Convention on Tobacco 

Control

FDA U.S. Food and Drug Administration

FEV1 forced expiratory volume at 1 second

FINRISK Large Finnish population survey 

on Risk factors on chronic, 

noncommunicable diseases

FMD flow-mediated dilation

fMRI functional magnetic resonance imaging

FRENA Factores de Riesgo y Enfermedad 

Arterial [Registry]

FSH follicular-stimulating hormone

FTND Fagerström Test for Nicotine 

Dependence

FVC forced vital capacity

g gram

GDM gestational diabetes mellitus

GED General Education Development

GLT glutamate transporter

GPR15 G protein-coupled receptor 15

GPS global positioning system

GRADE Grading of Recommendations 

Assessment, Development, and 

Evaluation

GWAS genomewide association study

HAPIEE Health, Alcohol, and Psychosocial 

factors In Eastern Europe

HB–IPN habenula–interpeduncular

HDL high-density lipoprotein

HDL-C high-density lipoprotein cholesterol

HEDIS Healthcare Effectiveness Data and 

Information Set

HELLP hemolysis, elevated liver enzymes, 

and low platelet count
Smoking Cessation

List of Abbreviations 667

HINTS Health Information National Trends 

Survey

HIPAA Health Insurance Portability and 

Accountability Act of 1996

HITECH Health Information Technology for 

Economic and Clinical Health

HMO health maintenance organization

HPV human papillomavirus

HR hazard ratio

HRQoL health-related quality of life

HT hypertension

IARC International Agency for Research 

on Cancer

IASLC International Association for the 

Study of Lung Cancer

ICAM-1 intercellular adhesion molecule-1

ICC invasive cervical cancer

ICD International Classification of Diseases

ICESCC International Collaboration of 

Epidemiological Studies of Cervical 

Cancer

ICH intracerebral hemorrhage

IL interleukin

IMT intimal-media thickness

IOM Institute of Medicine

IPAQ International Physical Activity 

Questionnaire

IPN interpeduncular nucleus

ISFAMI Israel Study of First Acute Myocardial 

Infarction

IVF in vitro fertilization

IVR interactive voice response

KAROLA Langzeiterfolge der Kardiologischen 

Anschlussheilbehandlung [Long Term 

Success of Cardiologic Rehabilitation 

Therapy]

kg kilogram

km kilometer

KORA Kooperative Gesundheitsforschung 

in der Region Augsburg [Cooperative 

Health Research in the Augsburg 

Region]

KORs kappa opioid receptors L liter

lbs pounds

LDCT low-dose computed tomography

LDL low-density lipoprotein

LDL-C low-density lipoprotein cholesterol

LDTg laterodorsal tegmental nucleus

LGBT lesbian, gay, bisexual, and transgender

LVEF left ventricular ejection fraction M males

MAO monoamine oxidase

MAOI monoamine oxidase inhibitor

MassHealth Massachusetts Medicaid

MCS Mental Component Summary

MEPS Medical Expenditure Panel Survey

MESA Multi-Ethnic Study of Atherosclerosis

MeSH Medical Subject Headings

MF males and females

mg milligram

mg/dL milligram per deciliter

mGluR metabotropic glutamate receptor

Mh to search Medical Subjects Headings 

in MEDLINE or PubMed

MHb medial habenula

MHb-IPN medial habenulo-interpeduncular 

nucleus

mHealth mobile health

MI myocardial infarction

MILIS Multicenter Investigation of 

Limitation of Infarct Size

mL milliliter

mm millimeter

mmol millimole

MORGAM Monica Risk Genetics Archiving 

and Monograph

MORs mu opioid receptors

MPEP 2-methyl-6-(phenylethynyl) pyridine

MRFIT Multiple Risk Factor Intervention Trial

MRI magnetic resonance imaging

MRTP modified risk tobacco product

MSA Master Settlement Agreement

MSI-high microsatellite instability

MTF Monitoring the Future

NA not applicable

NA not available

NAc nucleus accumbens

nAChR nicotinic acetylcholine receptor

NAM negative allosteric modulator

NAMCS National Ambulatory Medical Care 

Survey

NATS National Adult Tobacco Survey

NCCN National Comprehensive Cancer 

Network

NCHS National Center for Health Statistics

NCI National Cancer Institute
A Report of the Surgeon General

668 List of Abbreviations

NCQA National Committee for Quality 

Assurance

ng/mL nanogram per milliliter

NHANES National Health and Nutrition 

Examination Survey

NHIS National Health Interview Survey

NIBS noninvasive brain stimulation

NICU neonatal intensive care unit

NIH National Institutes of Health

NIH-AARP National Institutes of Health-American 

Association of Retired Persons

NMDA N-methyl-D-aspartate

NMR nicotine metabolite ratio

NQF National Quality Forum

NRT nicotine replacement therapy

NSDUH National Survey on Drug Use and 

Health

NTCP National Tobacco Control Program

NYTS National Youth Tobacco Survey

OACIS Osaka Acute Coronary Insufficiency 

Study

OASIS Organization to Assess Strategies in 

Ischemic Syndromes

OFC orbitofrontal cortex

OR odds ratio

OTC over the counter

PAD peripheral artery disease

PAM positive allosteric modulator

PAS pharmacists action on smoking

PATH Population Assessment of Tobacco 

and Health

PCASRM Practice Committee of American 

Society for Reproductive Medicine

PCC posterior cingulate cortex

PCI percutaneous coronary intervention

PCS Physical Component Summary

PEF peak expiratory flow

PEFR peak expiratory flow rate

PET positron emission tomography

PFC prefrontal cortex

PHS U.S. Public Health Service

PIGF placental growth factor

PLCO Prostate, Lung, Colorectal, and 

Ovarian cancer screening

PMTA Premarket Tobacco Product Application

po by mouth

PPROM preterm premature rupture of 

the membranes

PPTg pedunculopontine tegmental nucleus

PRAMS Pregnancy Risk Assessment 

Monitoring System

PROM premature rupture of the membranes

PTCA percutaneous transluminal coronary 

angioplasty

PVD peripheral vascular disease

q every

QALYs quality-adjusted life years

QLQ-30 quality of life questionnaire 30 items

QoL quality of life

RCT randomized controlled trial

RE-AIM Reach, Effectiveness, Adoption, 

Implementation, and Maintenance 

RIVM chronic disease model developed 

at the National Institute of Public 

Health and the Environment in 

The Netherlands

RNA ribonucleic acid

RR relative risk

RR risk ratio

RSE relative standard error

RV residual volume

Rx prescription product

SAH subarachnoid hemorrhage

SAMMEC Smoking-Attributable Mortality, 

Morbidity and Economic Costs

SAST serum aspartate amino transferase 

SAVE Sleep Apnea Cardiovascular 

Endpoints Trial

SBRT stereotactic body radiation therapy

SCD sudden cardiac death

SCHIP State Children’s Health Insurance 

Program

SCQoL Smoking Cessation Quality of Life

SD standard deviation

SDT self-determination therapy

SE standard error

SENECA Survey Europe on Nutrition in 

the Elderly

sEng soluble endoglin

SF Short Form [survey]

sFlt-1 soluble fms-like tyrosine kinase 1

SGA small-for-gestational age

SHARE Survey of Health, Aging, and 

Retirement in Europe

SMC Swedish Mammography Cohort

SMS short text message

SNP single nucleotide polymorphism

SNpc substantia nigra pars compacta
Smoking Cessation

List of Abbreviations 669

SP-A surface protein A

SR sustained release

sRAGE soluble Receptor for Advanced 

Glycation End [product]

SYNTAX Synergy between Percutaneous 

Coronary Intervention with Taxus 

and Cardiac Surgery Trial

TDD telecommunications device for the deaf

THC tetrahydrocannabinol

TLC total lung capacity

TPSAC Tobacco Product Scientific Advisory 

Committee

TUS-CPS Tobacco Use Supplement to the 

Current Population Survey

UCSD University of California–San Diego

UK United Kingdom

USAF United States Air Force

USDHEW U.S. Department of Health, Education, 

and Welfare

USDHHS U.S. Department of Health and 

Human Services

USPSTF U.S. Preventive Services Task Force

VA U.S. Department of Veterans Affairs

VascuQoL Vascular Quality of Life [questionnaire]

VC vital capacity

VEGF vascular endothelial growth factor

VLNC very-low-nicotine-content

VTA ventral tegmental area

VTE venous thromboembolism

WHO World Health Organization

WHOQoL-BREF World Health Organization Quality 

of Life-BREF

WPS Work Performance Scale

xCT cystine/glutamate exchanger

YRBS Youth Risk Behavior Survey

YRBSS Youth Risk Behavior Surveillance 

System

Smoking Cessation

List of Tables and Figures 671

List of Tables and Figures

Executive Summary1

Figure ES.1 Trends in prevalence (%) of current and former 

cigarette smoking among adults 18 years of age 

and older, by sex; National Health Interview 

Survey (NHIS) 1965–2017; United States 2

Chapter 1. 

Introduction, Conclusions, and the Evolving Landscape 

of Smoking Cessation

Figure 1.1 Trends in prevalence (%) of current and former 

cigarette smoking among adults 18 years of age 

and older, by sex; National Health Interview 

Survey (NHIS) 1965–2017; United States 4

Chapter 2. 

Patterns of Smoking Cessation Among U.S. Adults, 

Young Adults, and Youth

Table 2.1 Sources of national survey data on smoking 

cessation used for this report, 1965–2017; 

United States 38

Table 2.2 Distribution of selected demographic 

characteristics of adult current cigarette 

smokers 18 years of age and older; National 

Health Interview Survey (NHIS) 2000, 2005, 

2010, 2015, and 2017; United States 49

Table 2.3 Distribution of tobacco use characteristics 

among adult current cigarette smokers 18 years 

of age and older; National Health Interview 

Survey (NHIS) 2000, 2005, 2010, 2015, and 

2017; United States 52

Table 2.4 Distribution of selected demographic 

characteristics of young adult current cigarette 

smokers 18–24 years of age; National Health 

Interview Survey (NHIS) 2000, 2005, 2010, 

2015, and 2017; United States 53

Table 2.5 Distribution of tobacco use characteristics of 

young adult current cigarette smokers 18–24 

years of age; National Health Interview Survey 

(NHIS) 2000, 2005, 2010, 2015, and 2017; 

United States 54

Table 2.6 Distribution of demographic characteristics of 

high school students who are frequent cigarette 

smokers; National Youth Risk Behavior Survey 

(YRBS) 2001, 2005, 2009, 2015, and 2017; 

United States 55

Table 2.7 Prevalence of use of other tobacco products 

among high school students who are frequent 

cigarette smokers; National Youth Risk Behavior 

Survey (YRBS) 2001, 2005, 2009, 2015, and 

2017; United States 56

Table 2.8 Prevalence of use of menthol cigarettes among 

high school students who currently smoke 

cigarettes, by frequency of smoking; National 

Youth Tobacco Survey (NYTS) 2000, 2004, 2009, 

2015, and 2017; United States 56

Table 2.9 Percentage of ever cigarette smokers 18 years 

of age and older who have recently successfully 

quit and quit smoking (quit ratio), by selected 

characteristics; National Health Interview 

Survey (NHIS) 2017; United States 62

Table 2.10 Percentage of current and ever smokers 18 years 

of age and older who quit smoking (quit ratio) 

and prevalence of recent successful cessation 

and a past-year quit attempt, by state; Behavioral 

Risk Factor Surveillance System (BRFSS) 2017; 

United States 63

Table 2.11 Prevalence of a past-year quit attempt and interest

in quitting smoking among adult cigarette 

smokers 18 years of age and older, by selected 

characteristics; National Health Interview Survey 

(NHIS) 2015; United States 68

Table 2.12 Prevalence of a past-year quit attempt among 

adult current cigarette smokers 18 years of 

age and older, by selected smoking-related 

and demographic characteristics; National 

Health Interview Survey (NHIS) 2015; United 

States 69

Table 2.13a Quitting behaviors among current cigarette 

smokers in high school (grades 9–12); National 

Youth Tobacco Survey (NYTS) 2000, 2004, 2009, 

2015, and 2017; United States 72

Table 2.13b Quitting behaviors among current cigarette 

smokers in middle school (grades 6–8); National 

Youth Tobacco Survey (NYTS) 2000, 2004, 2009, 

2015, and 2017; United States 73

Table 2.14 Quitting behaviors among current cigarette 

smokers 18 years of age and older, by year; Tobacco 

Use Supplement to the Current  Population 

Survey (TUS-CPS) 2001–2002, 2006–2007, 

2010–2011, and 2014–2015; United States 76

1The Executive Summary is not part of the main report. Instead, it is available online at https://www.hhs.gov/surgeongeneral/reportsand-publications/index.html
A Report of the Surgeon General

672 List of Tables and Figures

Table 2.15 Quitting behaviors among current cigarette 

smokers 18–24 years of age, by year; Tobacco Use 

Supplement to the Current Population Survey 

(TUS-CPS) 2001–2002, 2006–2007, 2010–2011, 

2014–2015; United States 77

Table 2.16 Prevalence of cessation behaviors and attitudes 

among high school seniors who are current 

cigarette smokers; Monitoring the Future 

(MTF) Study 2011–2017 combined data; United 

States 79

Table 2.17 Prevalence of cessation behaviors and attitudes 

among high school seniors who are current 

cigarette smokers, by year; Monitoring the 

Future (MTF) Study 2000–2004, 2005–2009, 

2010–2014, and 2015–2017 combined data; 

United States 80

Table 2.18 Prevalence of a past-year quit attempt for 

cigarette smoking and all tobacco use by type of 

tobacco used among adult current tobacco users 

18 years of age and older, by selected demographic 

characteristics; National Health Interview Survey 

(NHIS) 2012–2014; United States 83

Table 2.19 Quitting behaviors among current users of two 

or more tobacco products, by grade in school; 

National Youth Tobacco Survey (NYTS) 2017; 

United States 85

Table 2.20 Receipt of screening for tobacco use, counseling, 

and a prescription for a cessation medication 

during outpatient visits to office-based physicians 

among adults 18 years of age and older, by 

patient and physician characteristics; National 

Ambulatory Medical Care Survey (NAMCS) 

2009–2011 combined data; United States 87

Table 2.21 Prevalence of receiving a health professional’s 

advice to quit smoking and use of counseling 

and medications for cessation among cigarette 

smokers 18 years of age and older, by selected 

characteristics; National Health Interview Survey 

(NHIS) 2015; United States 89

Table 2.22 Prevalence of interest in quitting, past-year quit 

attempt, receipt of a health professional’s advice 

to quit, use of counseling and/or medication, 

quit ratio, and recent successful cessation among 

smokers 18 years of age and older, by selected 

subpopulations; National Health Interview 

Survey (NHIS) 2015, 2017; United States 91

Table 2.23a Prevalence of being asked about tobacco use 

and being advised not to use tobacco among 

high school students (grades 9–12) who saw 

a healthcare provider during the past year, by 

grade in school; National Youth Tobacco Survey 

(NYTS) 2015; United States 94

Table 2.23b Prevalence of being asked about tobacco use 

and being advised not to use tobacco among 

middle school students (grades 6–8) who saw 

a healthcare provider during the past year, by 

grade in school; National Youth Tobacco Survey 

(NYTS) 2015; United States 94

Table 2.24 Prevalence of using strategies to quit cigarette 

smoking among current cigarette smokers 18 

years of age and older who tried to quit during the 

past year, by selected characteristics; Tobacco Use 

Supplement to the Current Population Survey 

(TUS-CPS) 2014–2015; United States 96

Table 2.25 Strategies used to quit smoking among high 

school and middle school current cigarette 

smokers who tried to quit during the past year; 

National Youth Tobacco Survey (NYTS) 2000, 

2004, 2009, and 2015; United States 97

Table 2.26 Percentage of ever cigarette smokers 18 years of 

age and older who quit smoking (quit ratio) and 

prevalence of recent successful cessation and a 

past-year quit attempt, by urban or rural status; 

Behavioral Risk Factor Surveillance System 

(BRFSS) 2017; United States 101

Figure 2.1 Trends in prevalence (%) of current and former 

cigarette smoking among adults 18 years of age 

and older, by sex; National Health Interview 

Survey (NHIS) 1965–2017; United States 44

Figure 2.2 Trends in prevalence (%) of current and former 

cigarette smoking among adults 18 years of age 

and older, by race/ethnicity; National Health 

Interview Survey (NHIS) 1965–2017; United 

States 44

Figure 2.3 Trends in prevalence (%) of current and former 

cigarette smoking among young adults 18–24 

years of age, by sex; National Health Interview 

Survey (NHIS) 1965–2017; United States 45

Figure 2.4 Trends in prevalence (%) of current and former 

cigarette smoking among young adults 18–24 

years of age, by race/ethnicity; National Health 

Interview Survey (NHIS) 1965–2017; United 

States 46

Figure 2.5 Trends in prevalence (%) of current frequent, 

former daily, and former nondaily cigarette 

smoking among high school students; National 

Youth Risk Behavior Survey (YRBS) 1991–2017; 

United States 47

Figure 2.6a Trends in prevalence (%) of current frequent 

cigarette smoking among high school students, 

by race/ethnicity; National Youth Risk Behavior 

Survey (YRBS) 1991–2017; United States 48

Figure 2.6b Trends in prevalence (%) of former daily and 

former nondaily cigarette smoking among high 

school students, by race/ethnicity; National 

Youth Risk Behavior Survey (YRBS) 1991–2017; 

United States 48

Figure 2.7a Prevalence of current cigarette smoking by 

level of education and presence or absence of 

serious psychological distress and poverty status 

among adults 25 years of age and older: National 

Health Interview Survey (NHIS) 2017; United 

States 60
Smoking Cessation

List of Tables and Figures 673

Figure 2.7b Prevalence of current cigarette smoking by level 

of education and status of health insurance 

among adults 25 years of age and older: National 

Health Interview Survey (NHIS) 2017; United 

States 60

Figure 2.8a Percentage of ever smokers 18 years of age 

and older who quit smoking (quit ratio), by 

age group; National Health Interview Survey 

(NHIS), 1965–2017; United States 65

Figure 2.8b Percentage of ever smokers 18 years of age and 

older who quit smoking (quit ratio), by race/

ethnicity; National Health Interview Survey 

(NHIS), 1965–2017; United States 65

Figure 2.9 Cessation continuum for current cigarette 

smokers 18 years of age and older; Tobacco Use 

Supplement to the Current Population Survey 

(TUS-CPS) 2006–2007, 2010–2011, 2014–2015; 

United States 67

Figure 2.10 Prevalence of past-year quit attempts among 

adult cigarette smokers 18 years of age and 

older, by sex; National Health Interview Survey 

(NHIS) 1997–2017; United States 74

Figure 2.11 Prevalence of past-year quit attempts among 

adult cigarette smokers 18 years of age and older, 

by race/ethnicity; National Health Interview 

Survey (NHIS) 1997–2017; United States 74

Figure 2.12 Prevalence of past-year quit attempts among 

students in grades 9–12 who currently smoke 

cigarettes, by sex; National Youth Risk Behavior 

Survey (YRBS) 2001–2015; United States 75

Figure 2.13 Prevalence of use of counseling or medications 

for cessation among adult smokers 18 years of 

age and older, by race/ethnicity; National Health 

Interview Survey (NHIS) 2000–2015; United 

States 98

Figure 2.14 Quarterly, inflation-adjusted dollar sales of overthe-counter nicotine replacement therapy, by 

type; Quarter 2, 2014–Quarter 4, 2018; United 

States 99

Chapter 3. 

New Biological Insights into Smoking Cessation

Table 3.1 Current pharmacotherapies for smoking 

cessation 130

Table 3.2 Novel pharmacologic targets for smoking 

cessation 133

Figure 3.1 Stages of the addiction cycle 127

Figure 3.2 Structure and properties of nAChRs 128

Figure 3.3 Neuronal mechanisms involved in nicotine 

addiction: A model 145

Chapter 4. 

The Health Benefits of Smoking Cessation

Table 4.1 Conclusions from the 1990 Surgeon General’s 

report on the health benefits of smoking 

cessation and cancer 178

Table 4.2 Relative risk of lung cancer incidence or 

mortality by number of years since smoking 

cessation, compared with continued smoking, 

in three large U.S. cohorts 181

Table 4.3 Relative risk of lung cancer incidence or 

mortality by number of years since smoking 

cessation, compared with never smokers, in 

three large U.S. cohorts 182

Table 4.4 Cohort studies of stomach cancer incidence or 

mortality, by number of years since smoking 

cessation 183

Table 4.5 Cohort studies of colorectal cancer incidence 

or mortality, by number of years since smoking 

cessation 189

Table 4.6 Studies of liver cancer incidence or mortality, by 

number of years since smoking cessation 196

Table 4.7 Studies of cervical cancer incidence by years 

since smoking cessation 198

Table 4.8 Studies of kidney cancer incidence by number of 

years since smoking cessation 200

Table 4.9 Cohort studies that compared all-cause mortality 

in persons who were smokers at the time of a 

cancer diagnosis but had quit smoking after the 

diagnosis with those who continued smoking 

after the diagnosis 208

Table 4.10 Conclusions from previous Surgeon General’s 

reports on smoking cessation and cardiovascular 

disease 215

Table 4.11 Studies on the association between smoking 

cessation and subclinical atherosclerosis 221

Table 4.12 Meta-analyses of observational studies on 

smoking cessation and incidence of total 

cardiovascular disease 228

Table 4.13 Observational studies on smoking cessation and 

cardiovascular disease 231

Table 4.14 Meta-analyses and a pooled analysis of 

observational studies on smoking cessation and 

incidence of coronary heart disease 235

Table 4.15 Observational studies on smoking cessation and 

incident coronary heart disease 237

Table 4.16 Observational studies (meta-analyses and 

pooled analyses) on smoking cessation and 

cerebrovascular disease 240

Table 4.17 Observational studies on smoking cessation and 

cerebrovascular disease 244
A Report of the Surgeon General

674 List of Tables and Figures

Table 4.18 Observational studies on smoking cessation and 

heart failure (incident heart failure and heart 

failure-related complications) 252

Table 4.19 Observational studies on smoking cessation and 

abdominal aortic aneurysm 261

Table 4.20 Observational studies (meta-analyses and 

individual cohorts) on smoking cessation 

and prognosis of coronary heart disease or 

cardiovascular disease 268

Table 4.21 Summary of results from prospective cohort 

studies of patients with coronary heart disease who 

were cigarette smokers at diagnosis, comparing 

all-cause mortality in those who quit smoking 

with persistent cigarette smokers 273

Table 4.22 Summary of results from prospective cohort 

studies of patients with coronary heart disease 

who were cigarette smokers at diagnosis, 

comparing all-cause mortality in those who 

remained persistent smokers with those who quit 

smoking 282

Table 4.23 Summary of results from prospective cohort 

studies of patients with coronary heart disease 

who were cigarette smokers at diagnosis, 

comparing cause-specific mortality from cardiac 

endpoints and sudden death in those who 

remained persistent cigarette smokers with 

those who quit smoking 286

Table 4.24 Summary of results from prospective cohort 

studies of patients with coronary heart disease 

who were cigarette smokers at diagnosis, 

comparing incidence of cardiac endpoints in 

those who remained persistent cigarette smokers 

with those who quit smoking or vice versa 291

Table 4.25 Conclusions about smoking cessation and 

chronic respiratory disease from previous 

Surgeon General’s reports 306

Table 4.26 Studies on smoking cessation and 

chronic obstructive pulmonary disease, 

2009–2017 310

Table 4.27 Studies on smoking cessation and asthma, 

2009–2017 319

Table 4.28 Conclusions from the 1990 Surgeon General’s 

report on the health benefits of smoking 

cessation and reproductive health 322

Table 4.29 PubMed systematic search strategy 322

Table 4.30 Studies on smoking cessation and 

preeclampsia 328

Table 4.31 Studies on smoking cessation and gestational 

weight gain 332

Table 4.32 Studies on smoking cessation and birth 

weight 342

Table 4.33 Studies on smoking cessation and small for 

gestational age infants 361

Table 4.34 Studies on smoking cessation and preterm 

delivery 372

Table 4.35 Studies on smoking cessation and 

stillbirth 387

Table 4.36 Studies on smoking cessation and perinatal 

mortality 389

Table 4.37 Studies on smoking cessation and infant 

mortality 391

Table 4.38 Studies on smoking cessation and erectile 

dysfunction 397

Figure 4.1 Relative risk of lung cancer incidence or mortality 

by number of years since smoking cessation, 

compared with continued smoking, in three 

large U.S. cohorts 180

Figure 4.2a Results from the meta-analyses of the association 

between current and never smoking status and 

cardiovascular mortality 229

Figure 4.2b Results from the meta-analyses of the association 

between former and never smoking status and 

cardiovascular mortality 230

Figure 4.3 Comparison of risk of peripheral arterial disease 

between former and never smokers 257

Figure 4.4 Relative risk for all-cause mortality after cardiac 

event among those who were current smokers 

when diagnosed, by smoking status 297

Figure 4.5 Cause-specific mortality from cardiovascular 

endpoints and sudden death in persistent 

smokers versus quitters 300

Figure 4.6 Comparison of incidence of new cardiac endpoints 

among persistent smokers and quitters 301

Figure 4.7 Flow-volume loops for a person with (obstruction) 

and without (normal) chronic obstructive 

pulmonary disease 307

Figure 4.8 Impact of smoking cessation and resumption on 

FEV1 decline in the Lung Health Study cohort 

of patients with chronic obstructive pulmonary 

disease 309

Figure 4.9 Cigarette smoking and DNA methylation 314

Figure 4.10 Epigenome-wide association study Manhattan 

plot and Q-Q plot for smoking status in the 

Cardiogenics Cohort 315

Chapter 5. 

The Benefits of Smoking Cessation on Overall 

Morbidity, Mortality, and Economic Costs

Table 5.1 Cross-sectional studies about smoking status 

and quality of life 441

Table 5.2 Prospective studies about smoking status and 

quality of life 448
Smoking Cessation

List of Tables and Figures 675

Table 5.3 Prospective studies of populations undergoing 

cessation treatment 451

Table 5.4 Prospective studies of special populations 454

Table 5.5a Relative risks by smoking status and age group 

among adult men 35 years of age and older, 

United States 463

Table 5.5b Relative risks by smoking status and age group 

among adult women 35 years of age and older, 

United States 464

Table 5.6 Summary of economic evaluations of nicotinebased pharmacotherapies for smoking 

cessation 469

Table 5.7 Summary of economic evaluations of nonnicotine-based pharmacotherapies for smoking 

cessation 474

Table 5.8 Summary of economic evaluations of brief 

counseling for smoking cessation 478

Table 5.9 Summary of economic evaluations of nonclinical 

interventions for smoking cessation 483

Figure 5.1a Incidence rate ratios for death from any cause, 

by smoking status 462

Figure 5.1b Incidence rate ratios for death from lung cancer, 

by smoking status 462

Chapter 6. 

Interventions for Smoking Cessation and Treatments 

for Nicotine Dependence

Table 6.1 The 5 A’s model for treating tobacco use and 

dependence 502

Table 6.2 Pharmacologic product guide: FDA-approved 

medications for smoking cessation 510

Figure 6.1 The evolution of e-cigarettes, by product 

generation and characteristics 525

Chapter 7. 

Clinical-, System-, and Population-Level Strategies 

that Promote Smoking Cessation

Table 7.1 Summary of policies from the 2014 Surgeon 

General’s report that encourage smoking 

cessation 580

Table 7.2 Systems-level changes reviewed in the 2008 

Clinical Practice Guideline to encourage 

smoking cessation 584

Table 7.3 Affordable Care Act guidance of coverage of 

tobacco cessation treatment 589

Table 7.4 Models of comprehensive tobacco cessation 

coverage and health insurance benefits 591

Table 7.5 Healthcare system approaches designed to 

encourage smoking cessation 593

Figure 7.1 CDC’s conceptual population health and 

prevention framework 581

Figure 7.2 Intensity of ad placement for Tips From Former 

Smokers (Tips) campaign and call volume to 

1-800-QUIT-NOW, 2013 604

Figure 7.3 Pictorial warning on cigarette packages in 

Australia 608

Figure 7.4 Effects of individual and combined policies on 

the prevalence of smoking among men and 

women 18 years of age and older, using the 

SimSmoke Model 615

Chapter 8. 

A Vision for the Future

Table 8.1 Summary of milestones aimed at increasing 

tobacco cessation in the United States 645

Table 8.2 Potential end-game strategies discussed in the 

50th anniversary Surgeon General’s report, 

2014 654

Figure 8.1 Per capita annual cigarette consumption among 

adults, 18 years of age and older, and major 

smoking and health events in the United States, 

1900–2017 644


U.S. Department of Health and Human Services