7.1 Health and other benefits of quitting

A substantial body of research has established that quitting smoking has immediate as well as long-term health benefits for men and women of all ages, reducing risks for diseases caused by smoking and improving health in general.14

The strongest evidence for this comes from a landmark 50-year follow-up of 34 000 British male doctors first studied in 1951.5–7 Many participants quit as the evidence on smoking and health accumulated from the 1950s onwards, providing a natural experiment demonstrating the impact of number of years smoking on health and eventual mortality. The study showed just how hazardous tobacco is and estimated that almost two-thirds of persistent smokers were killed by their smoking. Among those who quit, the greatest benefit was seen in those who quit earliest in life.7 Quitting at age 50 halved the risk of smoking-related death, but cessation by age 30 avoided almost all of the excess risk. Stopping at age 60, 50, 40 or 30 resulted in gains, respectively, of about 3, 6, 9 or 10 years of life expectancy.7,8

Changes in disease risk following cessation can be measured in different ways.

A common measure is relative risk, where the likelihood of developing or dying of disease in a population of former smokers is compared to either current or never smokers. At a population level, relative risk represents the fraction of disease attributable to smoking. However this measure is influenced by the rates of disease in the reference population, which should be taken into account when examining the influence of cessation on disease risk.

Another measure is absolute risk, where the actual rates of disease in former smokers are compared to those of current or never smokers. Rates can be directly compared, or the excess rate of disease caused by smoking in smokers can be calculated as can the excess disease rate in former smokers. Another measure is cumulative risk of disease, which enables the cumulative risk for those who quit at different ages to be compared to that of continuing smokers.

A more complete discussion of changes in risk following cessation can be found in a handbook published in 2007 by the International Agency for Research in Cancer.3 i In general, the risk of disease is lower in former smokers than in otherwise similar current smokers. Smoking results in both acute and chronic changes to the body and progression towards disease. Cessation results in reversal of acute changes and slowing of disease progression and provides the potential for damage reversal.3

Many harmful effects of smoking are arrested or begin to decline as soon as a person stops smoking.1,2 Many disease risks in former smokers continue to decrease with prolonged abstinence, compared to continued smoking. The risk for some health effects decreases more rapidly than for others, and improvement may continue for years after quitting. Some disease risks return to the level of never smokers after a long period of abstinence, but others do not, even after 20 years of abstinence.3

The extent of damage to health and risk for smoking-related disease is related to how much the person has smoked and for how long.3 For some health effects, for example inflammation of the lung, the reversal process is not yet well understood.3

However, while some damage may be irreversible or less reversible, there are substantial benefits to be gained from quitting at any age, regardless of smoking history.1,2 Benefits accrue to persons both with and without smoking-related disease.1

7.1.1 Health problems that may be temporarily exacerbated by quitting

While there is no question of the overall long-term benefits of cessation, quitting is associated with a number of bothersome short-term problems such as mouth ulcers and cold symptoms, weight gain and constipation.9

Mouth ulcers and colds

There is evidence that smokers and users of smokeless tobacco are less likely to develop aphthous stomatitis (common mouth ulcers). Individuals commonly report a short-term increase in mouth ulcers and cold symptoms on quitting smoking.10

Depression

Many smokers appear to have an increase in depressed mood and associated negative affect as part of nicotine withdrawal, but for the majority of people who quit this is temporary.11,12 Smokers with a history of depression tend to report higher levels of nicotine dependence and experience more severe and prolonged withdrawal episodes, including greater negative mood.13–16 Among smokers with a history of depression, around 30% who stop smoking will develop a new episode of major depression. The risk remains high for at least six months.17,18

7.1.2 Quitting and weight gain

While smoking cessation usually results in some level of weight gain, there is disagreement about the extent and how long it lasts.

Smokers' average weight is about 3 to 4 kg less than that of non-smokers.12,19 Smoking appears to attenuate weight gain over time, in part due to increasing metabolic rate.19,20 The difference in weight between smokers and non-smokers is more marked in older long-term smokers while the average weight of younger smokers is similar.20–23 The weight difference, however, is further complicated by the finding that despite their lower weight and body mass index (BMI), smokers have a greater waist-to-hip ratio than non-smokers. Increased waist circumference is a stronger predictor of cardiovascular disease than BMI.24

When smokers quit, the majority experience some weight gain.1 Estimates of weight gain associated with cessation vary depending on the sample, study design and follow-up period.25 Most excess weight gain occurs in the first year after cessation, after which the rate of weight gain slows.19,21,26–30 One study found that increase in body weight may continue for longer.31 Estimates of the mean weight gain in people continuously abstinent for a year are about 5 to 6 kg.2730 Individual experience of weight change after quitting is quite broad, ranging from weight loss to a minority gaining over 10 kg.21,28,3035Increase in waist circumference per kilogram gained is smaller in people who quit than in continuing smokers, indicating that recent ex-smokers gain less visceral fat.33,36

Limited research suggests that some of the weight gained during the first few years after quitting may be lost with continued abstinence,37, 38 however more research is needed to resolve this issue.39 Large cross-sectional studies show that long-term former smokers have a mean waist-to-hip ratio and a mean BMI similar to or approaching that of people who have never smoked.24,32,35,40

Reasons for the association between smoking cessation and weight gain are not fully understood. Predictors of weight gain include younger age, lower socio-economic status and heavier smoking, with some influence of underlying genetic factors.26 Weight gain after smoking cessation is related to a transient increase in food intake41 and to changes in metabolic rate.42 There is some evidence that smoking and obesity are independently associated with specific food cravings and mood states.43

The health benefits of smoking cessation far outweigh the health risk from extra body weight, unless the weight gain is extraordinarily large.1 Despite this, fear of weight gain is a significant factor in discouraging quitting and provoking relapse in smokers. 26,44-52

(See Chapter 3, Section 3.29 for further information on the health effects of smoking in conjunction with and compared with those associated with obesity, and Section 7.8.3 for further information on managing weight gain.)

7.1.3 Immediate improvements in wellbeing and functioning

Upon cessation, the nicotine and carbon monoxide levels in the body decline rapidly. Nicotine levels drop to very low levels within a few hours, and the main metabolites of nicotine are largely eliminated within a week.1,3,53 After 24 hours the level of carbon monoxide in the blood has decreased substantially.1 After a year blood pressure returns to normal levels (this means it generally stabilises at whatever the person's new blood pressure is) and small airway function improves, with further improvements after six months.54 After two months, improvements can be seen in blood viscosity, blood flow to the limbs and blood levels of high-density cholesterol.1,55 Within six months the immune system improves greatly. Within a few months the cilia in the lungs and airways improve at sweeping mucus and debris from the lungs (as long as irreversible damage has not taken place).56 Lung function improves and the presence and severity of respiratory symptoms reduces.9 Symptoms of chronic bronchitis, such as chronic cough, mucus production and wheeze, decrease rapidly, and lung function in asthmatic patients improves within a few months after stopping smoking.3,57,58 Rates of respiratory infections such as bronchitis and pneumonia also decrease, compared to continued smoking.1

7.1.4 Short to medium-term reductions in health risks following quitting

7.1.4.1 Problems during pregnancy

It is extremely dangerous for a woman to smoke during pregnancy. (Refer to Chapter 3, Section 3.7 for a more detailed discussion of health effects, and Section 7.11 for a more detailed discussion of interventions aimed at pregnant women and their partners.) The US Surgeon General has stated that 'smoking is probably the most important modifiable cause of poor pregnancy outcome among women in the United States'.1 Stopping smoking before or during pregnancy is important and has benefits for both the baby and the mother.59 Encouraging women to quit before they become pregnant or early in pregnancy is important because the critical period may be quite early.20 Although the effect of cutting down on the numerous health risks to the foetus is not well studied,59 there is no solid evidence that cutting down significantly reduces the risks to the foetus.3,60

Women who stop smoking either before becoming pregnant or in the first three to four months of pregnancy have infants with a similar birthweight to those infants born to women who have never smoked.1,61 Women who stop smoking any time up to the 30th week of pregnancy have infants with higher birthweights than those who smoke throughout pregnancy. Reducing the number of cigarettes smoked, instead of quitting completely, does not appear to benefit the birthweight of the foetus.1 Low birthweight infants have a higher risk of illness, death and developing diseases in childhood and adulthood.1,2 Women who quit smoking before or during pregnancy reduce their risk of pregnancy complications, including preterm premature rupture of membranes and preterm delivery (birth at less than 37 weeks gestation).1,20 Smoking cessation reduces the risk of infant death.62

7.1.4.2 Diseases for which the risk quickly declines

Heart disease

Smoking cessation reduces the risk of cardiovascular disease and death for male and female smokers of all ages with or without heart disease.4 There are immediate and long-term benefits.63 After one year the increased risk halves and after 15 years the rate is similar to that of a non-smoker.1 Quitting helps to improve peripheral vascular tone64 and to prevent atherosclerosis (the narrowing and hardening of the arteries due to build-up of plaque on the artery walls) advancing to heart disease and stroke.2,3,65 Smoking is a known risk factor for sudden cardiac death (SCD),2 and quitting smoking results in a significant reduction in SCD risk.66

Stroke

There is a marked reduction in risk within two to five years of quitting.3 After 15 years the risk of stroke is the same as a non-smoker.1

Oral health

Stopping smoking can reduce the risk of oral diseases associated with smoking including cancer, and improve the health of the mouth, gums and teeth.2,67–69 Stopping smoking reduces the risk of leukoplakia, and after one to five years about half of leukoplakia disappears.70 Cessation reduces the risk of developing periodontitis, slows down the progress of existing disease, and quite quickly improves wound healing.2,67,71–73 Following cessation, gum colour gradually returns to normal68 and so-called 'smoker's palate' can disappear.67,68 Stopping smoking improves the success rate of dental implants.69 Smoking cessation may be associated with relatively rapid improvement in periodontal health in young adults.73

7.1.5 Medium to long-term health benefits of quitting

Successful cessation appears to stop the progressive increase in the use of health services associated with continued smoking within a few years.74

Specific long-term health benefits include:

  • Lung cancer. Quitting is beneficial for lung cancer risk.75 Quitting at age 30 reduces the risk of lung cancer by several times compared to a lifetime smoker. Even quitting at 50 more than halves the risk over the next 25 years compared to continued smoking.76 The absolute annual risk of developing or dying from lung cancer does not decrease, but by stopping smoking the much greater increase in risk that would result from continuing to smoke is avoided.3
  • Chronic obstructive pulmonary disease (COPD). Smoking cessation remains the only proven strategy for reducing the disease-causing processes leading to COPD.4 Cessation reduces decline in lung function.77 In smokers without COPD, stopping smoking improves lung function by about 5% within a few months of cessation. The accelerated decline in lung function in smokers stops within five years of smoking cessation, returning to the far slower rates of decline that naturally occur with ageing.1, 3 Existing emphysematous damage to lung tissue caused by smoking is permanent1 however cessation slows the progression of COPD.9 Symptoms of COPD will be less likely in the short and long term.1 In people diagnosed with COPD, stopping smoking reduces the rate of lung function decline, and decreases the risk of hospitalisation for COPD.3,56,78
  • Other cancers. Smoking cessation is the only proven strategy for reducing the disease-causing processes leading to cancer.4 The risks of cancers of the mouth, throat, larynx, oesophagus, stomach, bladder, kidneys, pancreas and cervix are reduced after quitting compared to continued smoking, and continue to decrease over time.1,3 The risk of pancreatic, oral and cervical cancers quite quickly become similar to people who have never smoked, but the risks for the other cancers remain higher than never-smokers even after 15 to 20 years.1,3
  • Peripheral vascular disease. Quitting slows down the build-up of plaque on artery walls, so that the risk of the disease is substantially reduced. For those who already have the disease, amputations are less likely.1,79
  • Blindness. Cataract development and macular degeneration risks and progression are reduced.2,53
  • Male erectile dysfunction is reduced when smokers quit.2,53
  • Female fertility. Missed and painful periods are reduced after quitting, as is the risk of delayed conception and early menopause.20,80 The higher risk of heart disease and stroke among women smokers who use the contraceptive pill is reduced.81

Overall health and quality of life improve, with some evidence that heavier smokers report greater improvement in quality of life after quitting and report being happier now than when they were smoking.1,2,82–85

7.1.6 Cutting down: are there health benefits?

Cutting down the number of cigarettes smoked each day is a common strategy used by smokers to reduce harm, to move towards quitting, or to save money.86–89 However, research shows no noticeable improvement in health outcomes or lifespan among smokers who are able to cut down on a long-term basis.4, 9092,This is largely because smokers primarily seek a consistent level of nicotine. Those who cut down therefore tend to smoke the remaining cigarettes harder by taking more and larger puffs, and holding each puff longer. Thus they do not reduce their intake of toxins as much as the reduction in the number of cigarettes suggests.87,93

7.1.7 Other benefits of quitting

There are other benefits of quitting smoking. Financial savings for a pack-a-day smoker are about $5000 per year (2012 prices).94 Smokers who quit reduce their likelihood of financial stress and are likely to enhance their material wellbeing.95 As more public and private places become smokefree, ex-smokers avoid the inconvenience of having to find somewhere to smoke. Quitting avoids further smoking-related damage to skin, and slows the development of wrinkles.96 Life insurance is often cheaper,97 the risk of smoking-related fires is reduced98, 99 and people who quit have fewer sick days.2

7.1.8 Population beliefs about the benefits of quitting

There are limited data on population beliefs of the benefits of smoking cessation. There is a strong belief among smokers that stopping smoking will improve their health.100,101 Evidence from Victorian surveys show that smokers mention saving money (57%), feeling healthier (55%) and breathing and fitness (31%) as particular advantages of quitting.102 Quitting protects the health of pets and smokers do perceive this as a benefit of quitting.103

 

iSee IARC (2007). IARC Handbooks of Cancer Prevention, Tobacco Control, Vol. 11: Reversal of Risk after Quitting Smoking. Lyon, France.

Recent news and research

For recent news items and research on this topic, click here (Last updated April 2016)    

References

1. US Department of Health and Human Services. The health benefits of smoking cessation: a report of the Surgeon General. Atlanta, Georgia: Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/pre_1994/index.htm

2. US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm

3. International Agency for Research on Cancer. Reversal of risk after quitting smoking. IARC handbooks of cancer prevention, tobacco control, Vol. 11. Lyon, France: IARC, 2007. Available from: http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=76&codcch=22

4. US Department of Health and Human Services. How smoking causes diseases: a report of the Surgeon General:. Atlanta, Georgia: US Dept. of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Available from: www.surgeongeneral.gov/library/tobaccosmoke/Cached

5. Doll R and Hill AB. The mortality of doctors in relation to their smoking habits: a preliminary report. British Medical Journal 1954;1(4877):1451–5. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2085438&blobtype=pdf

6. Doll R, Peto R, Wheatly L, Gray R and Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ (Clinical Research Ed.) 1994;309(6959):901–11. Available from: http://www.bmj.com/cgi/content/full/309/6959/901

7. Doll R, Peto R, Boreham J and Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ (Clinical Research Ed.) 2004;328(7455):1519. Available from: http://www.bmj.com/cgi/content/abstract/328/7455/1519

8. Taylor DH, Hasselblad V, Henley SJ, Thun MJ and Sloan FA. Benefits of smoking cessation for longevity. American Journal of Public Health 2002;92(6):990–6. Available from: http://www.ajph.org/cgi/content/full/92/6/990

9. Gratziou C. Respiratory, cardiovascular and other physiological consequences of smoking cessation. Current Medical Research and Opinion 2009;25(2):535–45. Available from: http://www.informapharmascience.com/doi/abs/10.1185/03007990802707642

10. Ussher M, West R, Steptoe A and McEwen A. Increase in common cold symptoms and mouth ulcers following smoking cessation. Tobacco Control 2003;12:86-8. Available from: http://tc.bmjjournals.com/cgi/content/abstract/12/1/86

11. Hughes J. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine & Tobacco Research 2007;9(3):315–27. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/14622200701188919

12. Royal College of Physicians of London. Nicotine addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians of London, 2000. Available from: http://bookshop.rcplondon.ac.uk/details.aspx?e=131

13. Breslau N, Kilbey MM and Andreski P. DSM-III-R nicotine dependence in young adults: prevalence, correlates and associated psychiatric disorders. Addiction 1994;89(6):743-54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8069175

14. Breslau N. Psychiatric comorbidity of smoking and nicotine dependence. Behavioural Genetics 1995;25(2):95-101. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7733862

15. Kahler CW, Brown RA, Strong DR, Lloyd-Richardson EE and Niaura R. History of major depressive disorder among smokers in cessation treatment: associations with dysfunctional attitudes and coping. Addictive Behaviors 2003;28(6):1033-47. Available from: http://www.ncbi.nlm.nih.gov/12834649

16. Wilhelm K, Richmond R and Wodak A. Clinical aspects of nicotine dependence and depression. Medicine Today 2004;3:40–6.

17. Glassman AH, Covey LS, Stetner F and Rivelli S. Smoking cessation and the course of major depression: a follow-up study. Lancet 2001;357(9272):1929-32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11425414

18. Killen JD, Fortmann SP, Schatzberg A, Hayward C and Varady A. Onset of major depression during treatment for nicotine dependence. Addictive Behaviors 2003;28(3):461-70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12628619

19. Perkins K. Weight gain following smoking cessation. Journal of Consulting and Clinical Psychology 1993;61(5):768–77.

20. US Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm

21. Klesges RC, Ward KD, Ray JW, Cutter G, Jacobs DR, Jr. and Wagenknecht LE. The prospective relationships between smoking and weight in a young, biracial cohort: the Coronary Artery Risk Development in Young Adults Study. Journal of Consulting Clinical Psychology 1998;66(6):987-93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9874912

22. Akbartabartoori M, Lean ME and Hankey CR. Relationships between cigarette smoking, body size and body shape. International Journal of Obesity 2005;29(2):236-43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15505632

23. O'Loughlin J, Karp I, Henderson M and Gray-Donald K. Does cigarette use influence adiposity or height in adolescence? Annals of Epidemiology 2008;18(5):395-402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18346909

24. Canoy D, Wareham N, Luben R, Welch A, Bingham S, Day N, et al. Cigarette smoking and fat distribution in 21 828 British men and women: a population-based study. Obesity Research 2005;13(8):1466-75. Available from: http://www.ncbi.nlm.nih.gov/16129730

25. Eisenberg D and Quinn B. Estimating the effect of smoking cessation on weight gain: an instrumental variable approach. Health Services Research 2006;41(6):2255–66. Available from: http://www3.interscience.wiley.com/journal/118580318/abstract

26. Filozof C, Fernandez Pinilla MC and Fernandez-Cruz A. Smoking cessation and weight gain. Obesity Reviews 2004;5(2):95-103. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15086863

27. Nides M, Rand C, Dolce J, Murray R, O'Hara P, Voelker H, et al. Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the Lung Health Study. Health Psychology 1994;13(4):354-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7957014

28. O'Hara P, Connett JE, Lee WW, Nides M, Murray R and Wise R. Early and late weight gain following smoking cessation in the Lung Health Study. American Journal of Epidemiology 1998;148(9):821-30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9801011

29. Pirie PL, McBride CM, Hellerstedt W, Jeffery RW, Hatsukami D, Allen S, et al. Smoking cessation in women concerned about weight. American Journal of Public Health 1992;82(9):1238-43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1503165

30. Klesges RC, Winders SE, Meyers AW, Eck LH, Ward KD, Hultquist CM, et al. How much weight gain occurs following smoking cessation? A comparison of weight gain using both continuous and point prevalence abstinence. Journal of Consulting and Clinical Psychology 1997;65(2):286–91. Available from: http://psycnet.apa.org/index.cfm?fa=main.landing

31. Suwazono Y, Dochi M, Oishi M, Tanaka K, Morimoto H and Sakata K. Longitudinal effect of smoking cessation on physical and laboratory findings. American Journal of Preventive Medicine 2010;38(2):192–200. Available from: http://www.ajpm-online.net/article/PIIS0749379709007594/fulltext

32. Flegal KM, Troiano RP, Pamuk ER, Kuczmarski RJ and Campbell SM. The influence of smoking cessation on the prevalence of overweight in the United States. New England Journal of Medicine 1995;333(18):1165-70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7565970

33. Pisinger C and Jorgensen T. Waist circumference and weight following smoking cessation in a general population: the Inter99 study. Preventive Medicine 2007;44(4):290-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17222450

34. Swan GE and Carmelli D. Characteristics associated with excessive weight gain after smoking cessation in men. American Journal of Public Health 1995;85(1):73-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7832265

35. Williamson D, Madans J, Anda R, Kleinman J, Giovini G and Byers T. Smoking cessation and severity of weight gain in a national cohort. New England Journal of Medicine 1991;14(11):739–45. Available from: http://content.nejm.org/cgi/content/abstract/324/11/739

36. Lissner L, Bengtsson C, Lapidus L and Bjorkelund C. Smoking initiation and cessation in relation to body fat distribution based on data from a study of Swedish women. American Journal of Public Health 1992;82(2):273-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1739163

37. Chen Y, Horne SL and Dosman JA. The influence of smoking cessation on body weight may be temporary. American Journal of Public Health 1993;83(9):1330-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8363012

38. Kadowaki T, Watanabe M, Okayama A, Hishida K, Okamura T, Miyamatsu N, et al. Continuation of smoking cessation and following weight change after intervention in a healthy population with high smoking prevalence. J Occup Health 2006;48(5):402-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17053308

39. Froom P, Melamed S and Benbassat J. Smoking cessation and weight gain. The Journal of Family Practice 1998;46(6):460-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9638109

40. Munafò M, Tilling K and Ben-Shlomo Y. Smoking status and body mass index: a longitudinal study. Nicotine & Tobacco Research 2009;11(6):765–71. Available from: http://ntr.oxfordjournals.org/cgi/content/full/11/6/765

41. Hudmon KS, Gritz ER, Clayton S and Nisenbaum R. Eating orientation, postcessation weight gain, and continued abstinence among female smokers receiveing an usolicited smoking cessation intervention. Health Psychology 1999;18(1):29–36. Available from: http://psycnet.apa.org/index.cfm?fa=main.landing

42. Kadota K, Takeshima F, Inoue K, Takamori K, Yoshioka S, Nakayama S, et al. Effects of smoking cessation on gastric emptying in smokers. Journal of Clinical Gastroenterology 2010;44(4):e71–5. Available from: http://journals.lww.com/jcge/pages/articleviewer.aspx?year=2010&issue=04000&article=00001&type=abstract

43. Pepino MY, Finkbeiner S and Mennella JA. Similarities in food cravings and mood states between obese women and women who smoke tobacco. Obesity (Silver Spring) 2009;17(6):1158-63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19247281

44. Shraim M, Parsons A, Aveyard P and Hajek P. Interventions for preventing weight gain after smoking cessation. (Protocol) 2006. [viewed 16 September 2008] ; Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006219/frame.html

45. Pomerleau CS and Saules K. Body image, body satisfaction, and eating patterns in normal-weight and overweight/obese women current smokers and never-smokers. Addictive Behaviors 2007;32(10):2329-34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17320305

46. Pomerleau CS, Zucker AN and Stewart AJ. Characterizing concerns about post-cessation weight gain: results from a national survey of women smokers. Nicotine Tob Res 2001;3(1):51-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11260811

47. Brouwer RJ and Pomerleau CS. "Prequit attrition" among weight-concerned women smokers. Eat Behav 2000;1(2):145-51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15001057

48. Copeland AL, Martin PD, Geiselman PJ, Rash CJ and Kendzor DE. Predictors of pretreatment attrition from smoking cessation among pre- and postmenopausal, weight-concerned women. Eat Behav 2006;7(3):243-51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16843227

49. Alberg AJ, Carter CL and Carpenter MJ. Weight gain as an impediment to cigarette smoking cessation: a lingering problem in need of solutions. Preventive Medicine 2007;44(4):296-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17316778

50. White MA, McKee SA and O'Malley S S. Smoke and mirrors: magnified beliefs that cigarette smoking suppresses weight. Addictive Behaviours 2007;32(10):2200-10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17428615

51. Fiore M, Bailey W, Cohen S and Dorfman S. Smoking cessation clinical practice guideline no. 18. Rockville, Maryland: Agency for Health Care Policy and Research, US Department of Health and Human Services, Public Health Service, 1996.

52. Fiore M, Bailey W and Cohen S, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, Maryland: US Department of Health and Human Services. Public Health Service, 2000. Available from: http://www.surgeongeneral.gov/tobacco/

53. US Department of Health and Human Services. The health consequences of smoking: nicotine addiction. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health, 1988. Available from: http://profiles.nlm.nih.gov/NN/B/B/Z/D/_/nnbbzd.pdf

54. Rodrigo C. The effects of cigarette smoking on anesthesia. Anesthesia Progress 2000;47(4):143-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11432181

55. US Department of Health and Human Services. The health consequences of smoking: cardiovascular disease. A report of the Surgeon General. Rockville, Maryland: Public Health Service, Office on Smoking and Health, 1983. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/previous_sgr.htm

56. US Department of Health and Human Services. The health consequences of smoking: chronic obstructive lung disease. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1984. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/previous_sgr.htm

57. Jang A, Park S, Kim D, Uh S, Kim Y, Whang H, et al. Effects of smoking cessation on airflow obstruction and quality of life in asthmatic smokers. Allergy, Asthma & Immunology Research 2010;2(4):254–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20885910

58. Tonnesen P, Pisinger C, Hvidberg S, Wennike P, Bremann L, Westin A, et al. Effects of smoking cessation and reduction in asthmatics. Nicotine & Tobacco Research 2005;7(1):139–48. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/14622200412331328411

59. Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L and Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Systematic Review 2009(3):CD001055. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19588322

60. Shea AK and Steiner M. Cigarette smoking during pregnancy. Nicotine &Tobacco Research 2008;10(2):267-78. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18236291

61. Lightwood J, Phibbs C and Glantz S. Short term health and economic benefits of smoking cessation: low birthweight. Pediatrics 1999;104(6):1312–20. Available from: http://pediatrics.aappublications.org/cgi/content/full/104/6/1312

62. Johansson A, Dickman P, Kramer M and Cnattingius S. Maternal smoking and infant mortality: does quitting smoking reduce the risk of infant death? Epidemiology 2009;20(4):590–7. Available from: http://journals.lww.com/epidem/pages/articleviewer.aspx?year=2009&issue=07000&article=00019&type=abstract

63. Kawachi I, Colditz G, Stampfer M, Willett W, Mason J, Rosner B, et al. Smoking cessation and time course of decreased risks of coronary heart disease in middle aged-women. Archives of Internal Medicine 1994;154(2):169–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8285812

64. Roux A, Motreff P, Perriot J, Pereira B, Lusson J, Duale C, et al. Early improvement in peripheral vascular tone following smoking cessation using nicotine replacement therapy: aortic wave reflection analysis. Cardiology 2010;117(1):37–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20881393

65. US Department of Health and Education and Welfare. Smoking and health: a report of the Surgeon General. DHEW Publication no (PHS) 79-50066. Atlanta: US Department of Health, Education and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health, 1979. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/previous_sgr.htm

66. Goldenberg I, Jonas M, Tenenbaum A, Boyko V, Matetzky S, Shotan A, et al. Current smoking, smoking cessation, and the risk of sudden cardiac death in patients with coronary artery disease. Archives of Internal Medicine 2003;163(19):2301-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14581249

67. Christen AG. The impact of tobacco use and cessation on oral and dental diseases and conditions. The American Journal of Medicine 1992;93(1A):25S-31S. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1497000

68. Mirbod SM and Ahing SI. Tobacco-associated lesions of the oral cavity: Part II. Malignant lesions. Journal of the Canadian Dental Association 2000;66(6):308-11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10927896

69. Sham AS, Cheung LK, Jin LJ and Corbet EF. The effects of tobacco use on oral health. Hong Kong Medical Journal 2003;9(4):271-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12904615

70. Banoczy J, Gintner Z and Dombi C. Effect of smoking on the development of oral leukoplakia. Fogorvosi szemle 2001;94(3):91-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11480242

71. Johnson GK and Slach NA. Impact of tobacco use on periodontal status. Journal of Dental Education 2001;65(4):313-21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11336116

72. Moller AM, Villebro N, Pedersen T and Tonnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. The Lancet 2002;359(9301):114–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11809253

73. Hodge P and Binnie V. Smoking cessation and periodontal health--a missed opportunity? Evidence-Based Dentistry 2009;10(1):18–19. Available from: http://www.nature.com/ebd/journal/v10/n1/full/6400632a.html

74. Wagner E, Curry S, Grothaus L, Saunders K and McBride C. The impact of smoking and quitting on health care use. Archives of Internal Medicine 1995;155(16):1789–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7654113

75. Huxley R, Jamrozik K, Lam T, Barzi F, Ansary-Moghaddam A, Jiang C, et al. Impact of smoking and smoking cessation on lung cancer mortality in the Asia-Pacific region. American Journal of Epidemiology 2007;165(11):1280–6. Available from: http://aje.oxfordjournals.org/cgi/content/full/165/11/1280

76. Peto R, Darby S, Deo H, Silcocks P, Whitley E and Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of statistics with two case-control studies. BMJ (Clinical Research Ed.) 2000;321(7257):323–9. Available from: http://www.bmj.com/cgi/reprint/321/7257/323

77. Pelkonen M, Notkola I, Tukiainen H, Tervahauta M, Tuomilehto J and Nissinen A. Smoking cessation, decline in pulmonary function and total mortality: a 30 year follow up study among the Finnish cohorts of the Seven Countries Study. Thorax 2001;56(9):703–7. Available from: http://thorax.bmj.com/cgi/content/full/56/9/703

78. Au D, Bryson C, Chien J, Sun H, Udris E, Evans L, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. Journal of General Internal Medicine 2009;24(4):457–63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19194768

79. Gey D, Lesho E and Manngold J. Management of peripheral arterial disease. American Family Physician 2004;69:525-32.

80. Mishra G, Dobson A and Schofield M. Cigarette smoking, menstrual symptoms and miscarriage among young women. Australian & New Zealand Journal of Public Health 2000;24(4):413-20.

81. Farley T, Meirik O, Chang CL and Poulter N. Combined oral contraceptives, smoking, and cardiovascular risk. Journal of Epidemiology and Community Health 1998;52(12):775-85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10396518

82. Hirdes J and Maxwell C. Smoking cessation and quality of life outcomes among older adults in the Cambell Survey on Well-Being. Canadian Journal of Public Health 1994;85(2):99–102. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8012927

83. Mulder I, Tijhuis M, Smit HA and Kromhout D. Smoking cessation and quality of life: the effect of amount of smoking and time since quitting. Preventive Medicine 2001;33(6):653–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11716663

84. Sales M, Oliveira M, Mattos I, Viana C and Pereira E. The impact of smoking cessation on patient quality of life. Jornal Brasileiro de Pneumologia 2009;35(5):436–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19547852

85. Shahab L and West R. Do ex-smokers report feeling happier following cessation? Evidence from a cross-sectional survey. Nicotine & Tobacco Research 2009;11(5):553-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19351779

86. Australian Bureau of Statistics. 4714.0.55.001 - National Aboriginal and Torres Strait Islander Social Survey, Australia, 2002 Canberra: Australian Bureau of Statistics, 2004. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.0.55.0012002?OpenDocument

87. McNeill A. Harm reduction. Review. BMJ (Clinical Research Ed.) 2004;328(7444):885–7. Available from: http://www.bmj.com/cgi/content/full/328/7444/885

88. McNeill A and White P. Editorial: The case for harm reduction in smoking. Drugs: Education, Prevention and Policy 1998;59:125-27.

89. Piasecki T. Relapse to smoking. Review. Clinical Psychology Review 2006;26(2):196–215. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16352382

90. Tverdal A and Bjartveit K. Health consequences of reduced daily cigarette consumption. Tobacco Control 2006;15(6):472-80. Available from: http://tc.bmj.com/cgi/content/abstract/15/6/472

91. Godtfredsen NS, Holst C, Prescott E, Vestbo J and Osler M. Smoking reduction, smoking cessation, and mortality: a 16-year follow-up of 19 732 men and women from the Copenhagen Centre for Prospective Population Studies. American Journal of Epidemiology 2002;156(11):994–1001. Available from: http://aje.oxfordjournals.org/cgi/content/full/156/11/994

92. Godtfredsen NS, Osler M, Vestbo J, Andersen I and Prescott E. Smoking reduction, smoking cessation, and incidence of fatal and non-fatal myocardial infarction in Denmark 1976-1998: a pooled cohort study. Journal of Epidemiology and Community Health 2003;57(6):412–6. Available from: http://jech.bmj.com/cgi/content/full/57/6/412

93. National Cancer Institute. Risks associated with smoking cigarettes with low machine-measured yield of tar and nicotine. Smoking and Tobacco Control Monograph. Bethesda, MD: U.S. Department of Health and Human Services National Institutes of Health, National Cancer Institute, 2001.

94. NSW Retail Tobacco Traders' Association. The Australian Retail Tobacconist; 83. Cigarette price lists. 1-4. 2010. Catalogue information available from:

95. Siahpush M, Spittal M and Singh GK. Association of smoking cessation with financial stress and material well-being: results from a prospective study of a population-based national survey. American Journal of Public Health 2007;97(12):2281–7. Available from: http://www.ajph.org/cgi/content/abstract/97/12/2281

96. Freiman A, Bird G, Metelitsa A, Barankin B and Lauzon G. Cutaneous effects of smoking. Journal of Cutaneous Medical Surgery 2004;8(6):415-23.

97. Lane B. Age, job and sex hold key to your cost of insurance. The West Australian, (Perth) 1999:Monday 17 May 45

98. Chernichko L, Saunders L and Tough S. Unintentional house fire deaths in Alberta 1985-1990: a population study. Canadian Journal of Public Health 1993;84(5):317–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8269379

99. Chapman S and Balmain A. Reduced-ignition Propensity Cigarettes: A review of policy relevant information. Canberra: Commonwealth Department of Health and Ageing, 2004.

100. US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the US Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Centre for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1989. Available from: http://profiles.nlm.nih.gov/NN/B/B/X/S/

101. Wakefield M, Freeman J and Inglis G. Chapter 5: Changes associated with the National Tobacco Campaign: results of the third and fourth follow-up surveys. In Hassard K, edn. Australia's National Tobacco Campaign: evaluation report vol. 3 Every cigarette is doing you damage. Canberra: Department of Health and Ageing, 2004 Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp

102. Trotter L, Mullins R, Boulter J and Borland R. Key findings of the 1996 and 1997 household surveys. Quit evaluation studies no. 9. Melbourne, Australia: Anti-Cancer Council of Victoria, 1998 1-26. Available from: http://www.quit.org.au/downloads/QE/QE9/QE9Home.html

103. Milberger SM, Davis RM and Holm AL. Pet owners' attitudes and behaviours related to smoking and second-hand smoke: a pilot study. Tobacco Control 2009;18(2):156-8. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/18/2/156

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