Tobacco Use and Dependence

Abstract

Tobacco use and dependence remains the number one preventable cause of disease and death. While smoking rates have dropped significantly over the past 50 years, they remain high in certain populations, including those with serious mental health conditions and in low-income and low-education populations. Patients may utilize multiple forms of tobacco, including cigarettes, cigars, smokeless tobacco, and electronic nicotine delivery systems (also called e-cigarettes or vapes). Tobacco use causes or contributes to many chronic diseases, and tobacco dependence is considered a chronic disease itself. Tobacco cessation counseling, even if brief, significantly improves cessation outcomes. Successful cessation often requires repeated intervention and multiple attempts to quit. The Chronic Care Model can improve health outcomes through system changes and a population health approach to support patient-centered and evidence-based care, including team-based care, planned interventions, self-management tools, telehealth, connection to community resources, integrated decision support, patient registries, information technology supports, and quality improvement initiatives. A comprehensive tobacco control program includes policy enactment and enforcement, including effective clean air policies, higher taxes on tobacco products, media campaigns, marketing and tobacco access restrictions, and access to treatment services.