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Tobacco use continues to present
economic and health burden on Americans and remains the leading cause of
preventable mortality and morbidity in the United States. Cigarette smoking and
secondhand smoke exposure resulted in approximate 6.5 million
smoking-associated cancer deaths, 7.8 million cardiovascular deaths and 3.8
million pulmonary disease-related mortality respectively from 1965 through 2014
(1). According to the Centers
for Disease Prevention and Control (CDC), cigarette smoking exerts about $97
billion annual losses in productivity and accounted for 5 million years
of potential life lost among adult smokers from 2005 -2012 (2). However, decades
of population-level interventions have achieved some successes in bending combustible
cigarette smoking trajectory (3).  The CDC
analysis noted a downward trend  in
cigarette smoking prevalence among US adults from 21% in 2005 (45 million
adults) to 15% (37 million adults) in 2015 (4), this still falls short of
Healthy People 2020 objective to reduce cigarette smoking population to less
than 12% (5).

Strategic mass media campaigns,
tax hikes on tobacco industry, expanded smoke-free areas, and access to smoking
cessation services have overall made tobacco use less attractive (3). In
response to sustained negative media advertisements urging tobacco industry to
reduce nicotine dependence, tobacco industry introduced electronic cigarettes
in the mid-2000s as an alternative to combustible cigarette smoking and smoking
cessation aid (6).The authors reviewed and compared the efficacy of electronic
cigarettes with traditional guideline-recommended smoking cessation pharmacotherapy.

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Smoking Cessation Strategies Guideline

Disparities in cigarette smoking
exist in certain populations in the United States (4). By gender, cigarette
smoking is higher among males than females; by age, it is highest among adults
aged 25-44 years and lowest in adults above 65 years; American Indian/Alaska
natives, persons with lower education attainment and those living below the
poverty line are more likely to use tobacco. By region, smoking prevalence is
highest in the Midwest and higher in persons living with disability than
without (4).

Given the addictiveness of
nicotine, it is difficult for smokers to quit. The US Surgeon General’s smoking
cessation guideline last updated in 2008 recommends combination of
pharmacologic and behavior therapy as the most effective approach to smoking
cessation (7). The cornerstone of smoking cessation is pharmacologic
treatment.  Pharmacologic agents include 7
first-line medications (5 nicotine replacement and 2 non-nicotine replacement
therapy) increase the odds of quitting smoking (7). Several authors have
compared the efficacy nicotine replacement therapy (NRT), bupropion and
varenicline. Varenicline is superior to bupropion (9), nicotine patch, gum or
other NRT (inhaler, lozenges, spray and tablets) (8). While nicotine
replacement medications are easily accessible over the counter, varenicline is
available by physician’s prescription. 

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