This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

Tobacco use is the leading cause of preventable death in United States, causing more than 440,000 deaths annually and resulting in $193 billion in health-related economic losses each year-$96 billion in direct medical costs and $97 billion in lost productivity. Since the first U.S. Surgeon General's report on smoking in 1964, more than 29 Surgeon General's reports, drawing on data from thousands of studies, have documented the overwhelming and conclusive biologic, epidemiologic, behavioral, and pharmacologic evidence that tobacco use is deadly. This evidence base links tobacco use to the development of multiple types of cancer and other life-threatening conditions, including cardiovascular and respiratory diseases. Smoking accounts for at least 30 percent of all cancer deaths, and 80 percent of lung cancer deaths. Despite the widespread agreement on the dangers of tobacco use and considerable success in reducing tobacco use prevalence from over 40 percent at the time of the 1964 Surgeon General's report to less than 20 percent today, recent progress in reducing tobacco use has slowed. An estimated 18.9 percent of U.S. adults smoke cigarettes, nearly one in four high school seniors smoke, and 13 percent of high school males use smokeless tobacco products. In recognition that progress in combating cancer will not be fully achieved without addressing the tobacco problem, the National Cancer Policy Forum of the Institute of Medicine (IOM) convened a public workshop, Reducing Tobacco-Related Cancer Incidence and Mortality, June 11-12, 2012 in Washington, DC. In opening remarks to the workshop participants, planning committee chair Roy Herbst, professor of medicine and of pharmacology and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital, described the goals of the workshop, which were to examine the current obstacles to tobacco control and to discuss potential policy, outreach, and treatment strategies that could overcome these obstacles and reduce tobacco-related cancer incidence and mortality. Experts explored a number of topics, including: the changing demographics of tobacco users and the changing patterns of tobacco product use; the influence of tobacco use on cancer incidence and cancer treatment outcomes; tobacco dependence and cessation programs; federal and state level laws and regulations to curtail tobacco use; tobacco control education, messaging, and advocacy; financial and legal challenges to tobacco control efforts; and research and infrastructure needs to support tobacco control strategies, reduce tobacco related cancer incidence, and improve cancer patient outcomes. Reducing Tobacco-Related Cancer Incidence and Mortality summarizes the workshop.

Negative Affective States and Cognitive Impairments in Nicotine Dependence is the only book of its kind that addresses nicotine use and abuse in the context of negative reinforcement mechanisms. Written and edited by leading investigators in addiction, affective, genetic, and cognitive research, it provides researchers and advanced students with an overview of the clinical bases of these effects, allowing them to fully understand the various underlying dysfunctions that drive nicotine use in different individuals. In addition, this book examines animal models that researchers have utilized to investigate the biological bases of these dysfunctions. The combination of clinical and preclinical approaches to understanding nicotine dependence makes this book an invaluable resource for researchers and practitioners seeking to develop targeted treatments aimed at ameliorating symptoms of nicotine dependence, as well as identifying premorbid differences in affective or cognitive function. - Provides a unique perspective on nicotine dependence that emphasizes negative reinforcement rather than positive reinforcement - Examines psychiatric comorbidities and alleviation of withdrawal states as motivation for continued tobacco use - Includes both clinical and preclinical perspectives - Includes genetic and multi-neurotransmitter perspectives on nicotine use and withdrawal - Emphasizes heterogeneity of underlying reasons for smoking, the need for multiple animal models to understand this heterogeneity, and the expectation of heterogeneous responses to potential treatments, underscoring the need for personalized therapeutics

Despite persistent warnings from the medical profession about the health risks involved in cigarette smoking, millions of people continue to smoke cigarettes. With contributions from renowned experts, this ground-breaking work defines and explains nicotine addiction as a primary problem or disease, instead of as a habit or risk factor for other diseases. A comprehensive, clinical text on tobacco dependence, this book provides clinicians with essential information on how to diagnose and treat nicotine addicted patients. It also offers the medical, epidemiological and behavioral science backgrounds necessary for understanding the process and dynamics of tobacco dependence. Following the traditional format of medical texts, the book first covers etiology, pathogenesis and complications, then diagnosis and treatment, and finally public health and prevention. Part One presents an overview of the biological, psychological and social factors that contribute to nicotine dependence including such topics as a description of nicotine delivery systems, psychopharmacology, economics, natural history and epidemiology, mortality, morbidity, and environmental tobacco smoke exposure. The second part offers practical guidelines and tools for treating nicotine dependence and describes a stepped-care treatment model with brief interventions that can be easily integrated into routine medical practice. This section also covers the role of psychopharmacologic and formal treatment programs, the treatment of smokeless tobacco addiction, and treating nicotine dependence in pregnant women and in people with medical illnesses, other chemical dependencies, or psychiatric disorders. The last section focuses on worksite and community intervention programs and summarizes the research on smoking patterns and history in women, Blacks, Hispanics, youth, and older adults, and shows how intervention and prevention programs could be made more effective in these groups. Written by the nation's leading tobacco control researchers and clinicians, this important work contains new and critical information not previously available.

Practitioners helping smokers to quit can be more effective by learning key therapeutic techniques aimed at increasing any smoker’s chances of success. Cognitive-Behavioral Therapy for Smoking Cessation is a valuable guidebook to an empirically based CBT approach to smoking cessation that has been shown to be effective with or without the use of medications. This approach emphasizes techniques for enhancing the smoker’s motivation and confidence to quit, and teaching the smoker steps for preparing to quit, coping with the difficulties that emerge after quitting, and transitioning to become a long term nonsmoker. Cognitive-Behavioral Therapy for Smoking Cessation offers the fundamental counseling strategies and interventions that have been established, researched, and refined over the past decade. This program outlines essential components that should be included in the treatment of any smoker, as well as steps to take when faced with smokers likely to have particular difficulty quitting. Unique to this volume is the inclusion of a specifically tailored CBT model designed to address weight gain concerns in the smoker. Perkins, Conklin, and Levine are leading researchers on effective smoking cessation intervention for those concerned about the potential gain in weight that accompanies quitting, and offer a flexible approach that allows the practitioner to tailor interventions to each individual. An invaluable addition to any health professional’s repertoire, the treatment model presented in this book provides practitioners with the tools necessary to help their clients to quit smoking.