Tobacco Use

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Clinician-led interventions are proven treatments that can help smokers quit and reduce their risk for heart disease and stroke.

Tobacco Use and Heart Health

Tobacco smokers are at greater risk for diseases that affect the heart and blood vessels, including heart disease and stroke. Even people who smoke fewer than five cigarettes a day are at increased risk for these diseases. The risk increases with the number of cigarettes smoked per day and the number of years that smoking continues. Exposure to secondhand tobacco smoke also increases the risk for heart disease and stroke. People who already have heart disease are at especially high risk of adverse effects from breathing secondhand smoke and should avoid even brief exposures.

Studies have shown that comprehensive smoke-free laws that prohibit smoking in workplaces and public places like bars and restaurants help improve the health of workers and the general population as well as eliminate involuntary secondhand smoke exposure. Smoke-free laws have been shown to substantially reduce heart attack hospitalizations among nonsmokers, prevent nonsmokers from starting to smoke, and motivate tobacco users to quit.

The damage to the heart and blood vessels from smoking can be repaired quickly for most smokers who quit. Even longtime smokers can see rapid health improvements when they quit. Within a year, heart attack risk drops dramatically. Within five years, most smokers cut their risk of stroke to nearly that of a nonsmoker. Quitting smoking is hard and may require several attempts. Clinician-led cessation counseling and medication are proven treatments that can help smokers quit. However, in 2015, only 57% of current smokers reported receiving advice to quit from a health professional, and only 29% used medication.

For Clinicians

• Tobacco Cessation Change Package
  This change package presents a list of process improvements that clinicians can implement as they seek to deliver optimal treatment to patients who use tobacco. The TCCP is a quality improvement tool to help health care professionals in outpatient, inpatient, and behavioral health settings, and public health professionals who partner with these groups.
• [Protocols for Identifying and Treating Patients Who Use Tobacco
  ](https://millionhearts.hhs.gov/tools-protocols/protocols.html)Tobacco addiction is a chronic condition, often requiring multiple attempts to quit for good. Effective, evidence-based, brief clinical interventions are available to help patients who smoke. Tobacco cessation protocols can be integrated into the tobacco use identification and intervention clinical workflow.
• Identifying and Treating Patients Who Use Tobacco: Action Steps for Clinicians  [PDF – 339K]
  This guide provides evidence-based, tested tobacco use identification and intervention strategies for busy clinicians. These strategies consist of actions clinicians can take to improve care delivery and ways to increase the use of evidence-based brief interventions for patients who use tobacco.
• 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment
  This pathway provides a comprehensive and structured approach to evaluating and treating tobacco dependence. See the clinician tool for more information on medications, dosing, administration, side effects, and advantages/disadvantages of each therapy.
• Million Hearts Tobacco Cessation Change Package Video 
  CDC’s Office of Smoking and Health (OSH) has just launched a new, five-minute tutorial video featuring Dr. Brenna VanFrank. The video was filmed to help clinicians more aware that the Million Hearts Tobacco Cessation Change Package is available to help them take critical steps to make smoking cessation treatment a part of routine patient care. It compliments a suite of free CDC-Million Hearts resources, which can all be found online. In the video, Dr. VanFrank walks through how the Change Package can be used to make smoking cessation treatment a part of routine care for every patient who smokes.

For Public Health

• Million Hearts® in Municipalities Tool Kit
  Use this tool kit to assist local and state health departments to be active partners in the Million Hearts® initiative.
• Best Practices for Comprehensive Tobacco Control Programs—2014
  This evidence-based guide can help states plan and establish effective tobacco control programs to prevent and reduce tobacco use.
• States and Municipalities with Laws Regulating Use of Electronic Cigarettes [PDF – 1.7MK]
  Learn about states and municipalities that regulate the use of e-cigarettes in public indoor areas.
• Americans for Nonsmokers’ Rights: Lists & Maps
  This site provides a collection of state and local tobacco control laws, including 100% smoke-free laws and laws that regulate where e-cigarettes may be used.
• Electronic Cigarettes
  Get the facts about electronic cigarettes, their health effects and the risks of using e-cigarettes.
• About E-Cigarettes (Vapes)
  Learn more about e-cigarettes and their effect on health.
• Tips From Former Smokers 
  Hear personal stories from former smokers and access free cessation resources, including the QuitGuide app and 1-800-QUIT-NOW.

For Tobacco Users

• 1-800-QUIT-NOW (784-8669): Call for support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources.
• 1-855-DÉJELO-YA (1-855-335-3569): Call for Spanish language support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources.
• Asian Smokers’ Quitline: Call for support in quitting. Services are available in four languages:Chinese (Cantonese and Mandarin): 1-800-838-8917
• Korean: 1-800-556-5564
• Vietnamese: 1-800-778-8440
• Smokefree.gov: This site provides support, tips, tools, and expert advice to help you or someone you love quit smoking.Smokefree Text Messaging Programs

Smokefree.gov offers free text messaging programs that give 24/7 encouragement, advice, and tips for becoming smoke free and being healthier.

• Build My Quit Plan
  Build a quit plan to get ready to quit and find out what to expect along the way. Complete 7 easy steps to get your personalized quit plan.
• Smokefree Apps
  Get 24/7 support with a Smokefree app for your smartphone. These free apps offer help just for you based on your smoking patterns, moods, motivation to quit, and quitting goals.

Resources

• Clinical Practice Guideline — Treating Tobacco Use and Dependence: 2008 Update [PDF – 2M]
  This report includes effective clinical treatments for tobacco dependence that have become available since the 2000 Guideline was published. (Agency for Healthcare Research and Quality, 2008)
• U.S. Preventative Services Task Force Recommendation Statement: Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons
  Read this statement from the U.S. Preventive Services Task Force, dated January 2021, that recommends clinicians to ask all adult patients about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA–approved pharmacotherapy for cessation.
• [MMWR: Current Cigarette Smoking Among Adults — United States, 2005–2015
  ](https://www.cdc.gov/mmwr/volumes/65/wr/mm6544a2.htm)See the most recent national estimates of cigarette smoking prevalence among adults age 18 or older, using data from the 2015 National Health Interview Survey. (Morbidity and Mortality Weekly Report, November 2016)
• Community Preventive Services Task Force Recommendation on Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs
  The Community Preventive Services Task Force recommends comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure. (Community Preventive Services Task Force, 2014)

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