My job today is to update you on trends in cigarette smoking, and, more importantly, smoking cessation in the US; to examine recent patterns of quitting activity in the nation; and to discuss the issue of the ‘hard-core’ smoker. I will discuss cessation methods and a recent report in JAMA by Fiore and colleagues¹ on this topic. I will end my discussion with a look at the opportunities for progress that are currently available.

Cigarette smoking kills more than 400 000 Americans annually.² It is the single most important preventable cause of premature mortality in the US.³ We can reduce this annual burden of suffering, as Dr Schelling pointed out, by preventing initiation and by increasing cessation.

The upcoming report of the Surgeon General will focus on preventing the initiation of tobacco use among young people. The 1990 report of the Surgeon General addressed the health benefits of cessation and stated un-equivocally that smoking cessation represents the single most important step that smokers can take to enhance the length and quality of their lives.⁴

The report demonstrated that smoking cessation has major and immediate health benefits for men and women of all ages; these benefits apply to persons with and without smoking- related disease. There are benefits in terms of overall mortality. For example, former smokers live longer than do persons who continue to smoke. Persons who quit smoking before the age of 50 have half the risk of dying in the next 15 years than do persons who continue to smoke. Smoking cessation decreases the risk of lung and other cancers, heart attack, stroke, and chronic lung disease. It also has benefits in pregnancy.⁴

What is going on in terms of adult prevalence? We track prevalence in the nation using the National Health Interview …