Smokers today tend to smoke fewer cigarettes than in the past4. However, smoking fewer cigarettes does not necessarily translate into reduced harms; biochemical indices of smoking intensity have not shown commensurate declines5. Thus, even those who reduce their smoking significantly (e.g., by 50% from 15 cpd or more: 5), experience rates of myocardial infarction and COPD5 closer to those of heavy smokers than quitters. Over 30% of cases of cancer, 90% of COPD, and 30% of cardiovascular morbidity in the US is attributed to tobacco use6. Tobacco use also delays wound healing, alters clearance rates of drugs7 (e.g., beta blockers, psychiatric drugs), and reduces cancer treatment effectiveness.
