Both prevention of smoking initiation among youth and smoking cessation among established smokers may be crucial for reducing smoking prevalence and its associated negative health consequences, according to a review paper published Aug. 20 in the Journal of the American College of Cardiology (JACC).

Sara Kalkhoran, MD, MAS, et al., examined policies to achieve complete cigarette abstinence as part of efforts to reduce the risk of heart disease. They found that tobacco use can be characterized as a chronic disease beginning in childhood because nearly all cigarette smokers report that they smoked their first cigarette during adolescence and then continue to use tobacco for decades.

The authors note that multiple factors influence the initiation and maintenance of tobacco use and are categorized into levels of influence: intra-individual, interpersonal, community and organizational, and societal and policy. They explain that since tobacco use causes more than six million annual deaths and is the leading preventable cause of death worldwide, clinicians who care for patients with cardiovascular disease should give as high a priority to treating tobacco use as to managing other cardiovascular disease risk factors.

Furthermore, the authors describe the importance of broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns and restrict tobacco marketing. They also suggest that clinicians should routinely screen for tobacco use and secondhand smoke exposure with patients, provide smoking cessation intervention in the hospital and post-discharge, and offer evidence-based smoking cessation treatments to all current smokers at every visit.

"Increasing adoption and effective implementation of tobacco control policies is a key worldwide public health priority," the authors write. "Given the importance of tobacco abstinence for cardiovascular health, cardiologists can act as tobacco control advocates to help reduce smoking initiation among youth and young adults, and promote smoking cessation among adults at-risk for or already affected by cardiovascular disease."

This paper is the second in an eight-part cardiovascular health promotion JACC focus seminar, where each paper focuses on a different behavioral consideration that impacts cardiovascular health: nutrition and diet; healthy weight; exercise and physical activity; tobacco-free lifestyle; blood pressure; cholesterol; blood sugar; and psychological health.

Keywords: Tobacco, Smoking Cessation, Smoke, Tobacco Smoke Pollution, Blood Glucose, Health Priorities, Risk Factors, Smoking, Health Promotion, Tobacco Use, Cardiovascular Diseases, Chronic Disease, Diet

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