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Tobacco smoking is widespread and is one of the world's most prevalent modifiable risk factors for morbidity and mortality. It is important to facilitate smoking cessation better in order to reduce the health consequences of tobacco use. The most effective approach assisting smokers in their quit attempts combines both pharmacotherapy and nonpharmacological interventions. This review summarizes the latest international epidemiological data available on tobacco use, considers the associated effects on health, and reviews existing policies against tobacco use. Among the interventions for smoking cessation, the three major pharmacotherapies (which have demonstrated efficacy when combined with behavioral support) are discussed: nicotine replacement therapy (NRT), bupropion, and varenicline. As the newest pharmacotherapy made available in this area, particular consideration is given to varenicline, and a review of our clinical experience is offered.

The relationships between tobacco smoking and both alcohol and drug consumption were investigated in 2 431 healthy individuals aged 18-29 y. We used a questionnaire to evaluate smoking habits and alcohol and drug intake, and these parameters (i.e., cotinine-to-creatinine concentration ratio, amphetamines, cannabinoids, opiates, and cocaine) were quantified via urine analyses. Urinary cotinine concentration was significantly higher in current smokers (mean +/- standard deviation: 717 +/- 61 ng/mg creatinine, n = 881) than in non- or exsmokers (32 +/- 16 ng/mg creatinine, n = 1550). Information gleaned from the questionnaires revealed that there was a greater proportion of current smokers among consumers of alcohol than among nonconsumers. Significantly (p < .001) more current smokers than non- or exsmokers self-reported that they consumed sedatives, stimulants, or illegal drugs. Urinary cotinine concentrations were highest in consumers of alcohol and in self-reported consumers of sedatives (p < .0001), stimulants (p = .01), and illegal drugs (p < .0001). We found higher urinary cotinine concentrations in subjects who had positive urinary amphetamines, cannabinoids, or opiates. Even though the prevalence of alcohol and drug consumption remained low in the population we studied, such behaviors were clearly related to tobacco smoking.

The relationship between psychotechnic and education levels and smoking habits was evaluated in a population of 2,430 Belgian male army conscripts who were 18-29 y of age. Smoking habits were quantified by a questionnaire and by urinary cotinine-to-creatinine concentration ratio. The results were analyzed relative to education level (graded 1-4) and to results of psychotechnic tests (scored 1-9). The urinary cotinine-to-creatinine concentration ratio was correlated strongly with the number of cigarettes smoked/d (r = .76, p < .00005). The concentrations averaged 27 +/- 153 ng/mg (mean +/- standard deviation) creatinine in nonsmokers, 69 +/- 186 ng/mg creatinine in exsmokers, and 388 +/- 392 and 867 +/- 833 ng/mg creatinine in subjects who smoked fewer than or more than 10 cigarettes/d, respectively. Significant inverse relationships were observed between the urinary cotinine-to-creatinine concentration ratio and both education (p < .0001) and psychotechnic levels (p < .0001). The inverse relationship between smoking and both the education and psychotechnic levels underlined the importance of adapting smoking prevention programs to the intellectual capacities of the populations targeted.