74 © Postgraduate Medicine, Volume 122, Issue 2, March 2010, ISSN – 0032-5481, e-ISSN – 1941-9260 CLINICAL FOCUS: CARDIOVASCULAR EVENTS AND GI DISORDERS Abstract: Cigarette smoking represents the most important source of preventable morbidity and premature mortality worldwide. Approximately 100 million deaths were caused by tobacco use in the 20th century. There are  1 billion smokers worldwide, and globally the use of tobacco products is increasing, with the epidemic shifting to the developing world. Tobacco dependence is a chronic condition that often requires repeated intervention for success. Just informing a patient about health risks, although necessary, is usually not sufficient for a decision to change. Smokers should be provided with counseling when attempting to quit. Pharmacologic smoking cessation aids are recommended for all smokers who are trying to quit, unless contraindicated. Evidence-based guidelines recommend nicotine replacement therapy, bupropion SR, and varenicline as effective alternatives for smoking cessation therapy, especially when combined with behavioral interventions. Combination pharmacotherapy is indicated for highly nicotine- dependent smokers, patients who have failed with monotherapy, and patients with breakthrough cravings. An additional form of nicotine replacement therapy or an addition of a non-nicotine replacement therapy oral medication (bupropion or varenicline) may be helpful. The rate of successful smoking cessation at 1 year is 3% to 5% when the patient simply tries to stop, 7% to 16% if the smoker undergoes behavioral intervention, and up to 24% when receiving phar- macological treatment and behavioral support. Keywords: smoking cessation; nicotine; bupropion; varenicline Introduction Cigarette smoking represents the most important source of preventable morbidity and premature mortality worldwide. 1 Tobacco use is a risk factor for 6 of the 8 leading causes of death worldwide. Its use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for myocardial infarction, chronic obstructive pulmonary disease (COPD), and lung cancer. 1 However, it is also related to stroke, larynx, oral, and pancreatic cancer, peripheral vascular disease, hyperten- sion, 1–3 and type 2 diabetes. 4 Approximately 100 million deaths were caused by tobacco in the 20th century, and if current trends continue, there will be up to 1 billion deaths attributed to tobacco use in the 21st century. 3,4 There are  1 billion smokers world- wide, and global use of tobacco products is increasing, with the epidemic shifting to the developing world. 1 Tobacco use kills 5.4 million people annually—an average of 10 persons every minute—and accounts for 10% of adult deaths worldwide. 3,4 Smoking is responsible for approximately 1 in 5 deaths in the United States. 5 Among adults in the United States, most smoking-attributable deaths are from lung cancer, coronary heart disease, and COPD. 5 Adult men and women lose an average of 13.2 and 14.5 years of life, respectively, as a result of smoking. 5 Smoking during pregnancy remains the most important preventable risk factor for fetal death, low birth weight, and other complications of pregnancy. 6,7 The exposure of infants to environmental Smoking Cessation Intervention: An Evidence-Based Approach Rafael Laniado-Laborín MD, MPH, FCCP 1 1 Facultad de Medicina Tijuana, Universidad Autónoma de Baja California, San Ysidro, CA Correspondence: Rafael Laniado-Laborín, MD, MPH, FCCP, PO Box 436338, San Ysidro, CA 92143-6338. Tel: 011-52 (664) 6865626 Fax: 011-52 (664) 6865626 E-mail: rafaellaniado@gmail.com Global reprints distributed only by Postgraduate Medicine USA. No part of Postgraduate Medicine may be reproduced or transmitted in any form without written permission from the publisher. All permission requests to reproduce or adapt published material must be directed to the journal office in Berwyn, PA, no other persons or offices are authorized to act on our behalf. Requests should include a statement describing how material will be used, the complete article citation, a copy of the figure or table of interest as it appeared in the journal, and a copy of the “new” (adapted) material if appropriate 71508e