Who Is (Still) Smoking?

This chapter explains the origins of the tobacco industry and why smoking is still the leading cause of avoidable morbidity and mortality in the world. The prevalence of smoking is described at various levels, along with near-term projections. The degree to which smoking is concentrated among lower SES groups and other historically disadvantaged groups is also explored. An overview of how tobacco control has sought to reduce the affordability, appeal, acceptability, and accessibility of tobacco is provided, and the efficacy of various cessation interventions (behavioral therapy and pharmacotherapy including NRTs) is discussed. The barriers to smoking cessation are outlined, including the challenge of nicotine dependence, the limits of therapeutic interventions, and the role of risk-understanding, and motivation. The chapter concludes that while tobacco control interventions have all helped some smokers quit, they have not helped all smokers quit. Those “left behind” face unacceptable harms, some of which result from the tobacco control policies that have failed them.