Special interest: Smoking cessation

Exposure to tobacco smoke through passive as well as active smoking is associated with an increased risk of infertility and menopause occurring before the age of 50, a large observational study has shown. This is the first study to assess the impact of second-hand smoking on infertility and age of menopause.

Pollution caused by fine particulate matter (PM_2.5) is around ten times higher in homes where people smoke indoors compared with non-smoking homes, a study from Scotland has found. Furthermore, home air pollution from smoking appears to dwarf that from outdoor sources. Approximately 20% of those living in smoking homes in Scotland will inhale a lifetime mass of PM_2.5 greater than the median value predicted for a non-smoker living in a heavily polluted urban setting.

A prospective cohort study from the UK has found no evidence that varenicline or bupropion raise the risk of depression, self harm or suicide.

18% of all deaths in adults aged 35 or over in England are still attributable to smoking. Almost all these premature deaths could be avoided if smokers stopped before their mid-thirties but only a quarter of people who have ever smoked regularly manage to quit by this age. GP advice is one of the most important triggers to a smoker making an attempt to quit. Evidence shows that offering help to all smokers is easier, quicker and likely to be more effective than just advising smokers to stop or asking whether they are interested in quitting.

There are around 10 million smokers in the UK, half of whom will die prematurely, losing many years of life, unless they quit. Smoking is increasingly concentrated in the most disadvantaged sectors of society, and is now the biggest avoidable cause of social inequality in life expectancy in the UK. Preventing smoking depends on reducing the affordability of cigarettes, using the media to educate and promote health, making non-smoking the norm in public and workplaces, preventing advertising and promotion, preventing supply to children, and providing effective support to individuals who want to quit.

A study in the BMJ has found a significant reduction in the incidence of myocardial infarction (MI) since smoke-free legislation was introduced in England on 1 July 2007.There have been many studies including meta-analyses showing that passive smoking increases the risk of coronary heart disease and this risk could be increased by as much as 60%, similar to that seen in light smokers. The mechanism of such effects is thought to be through increases in platelet aggregation and alterations in endothelial function. These effects can occur very rapidly and as such the benefits of reducing smoke exposure could be seen quite early.

The rise in the use of e-cigarettes in England has been associated with an improvement in the success of quit attempts, a study in the BMJ has found.

Offering smokers admitted to hospital behavioural support and pharmacotherapy could help reduce smoking rates significantly, a national audit in England has shown.

Smoking cessation services in England have trebled their impact in helping smokers to give up over the past decade, a study has found. However, a wide variation across local services was noted. The researchers analysed the performance of stop smoking services across England from 2001/02 to 2010/11, asking the questions: How has the performance of the services changed? How well have the services met the needs of different groups including economically disadvantaged smokers? How much local variation has there been in success rates?