Tobacco: what is it and why do people continue to use it?

C smoking among adults has remained at about 20.8% since 2004 (Centers for Disease Control and Prevention [CDC], 2005b). Those most likely to smoke include men, adults less than age 40, and those living below the poverty line. American Indians/ Alaskan Natives smoke at a much higher rate (32.4%) than nonHispanic Blacks (23.0%), non-Hispanic Whites (21.9%), or Hispanics (15.2%). Cigarette smoking among adolescents has stopped declining since 2005 at a level of 23% (CDC, 2005c, 2005d). Adolescent males and females are equally likely to smoke (22.9% vs. 23.0%), with White adolescents smoking more often (25.9%) than Hispanic (22.0%) or non-Hispanic Black (12.9%) adolescents. While most people recognize the harmful effects of tobacco use, and particularly smoking, few are able to quit easily. Relapse is common among people trying to quit, with up to a 80% relapse rate (U.S. Department of Health and Human Services [HHS], 2006). Additionally, most people experience a relapse in the first 3 months after the quit attempt (National Institute on Drug Abuse, 2006). Only about 6% of those who try to quit are successful for over a month. Tobacco use is particularly difficult to address because the addiction produced by nicotine is very strong; the cravings and withdrawal symptoms have been compared to those of cocaine (HHS, 1988). More than 4,000 individual chemicals have been identified in tobacco (see Table 1), including more than 60 that are known carcinogens (cancer-causing agents) (see Table 2). Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of cancers of the lung, larynx, oral cavity, pharynx, esophagus, and bladder, and it contributes to the development of cancers of the kidney, pancreas, cervix, and stomach (HHS, 2004). Smoking also is a major contributor to heart disease, aneurysms, bronchitis, emphysema, male and female reproCNE Objectives and Evaluation Form appear on page 202.