[Tobacco abuse: background and countermeasures]

The extreme extent of world-wide tobacco consumption, mainly in the form of cigarette smoking, is a phenomenon of the 20th century and can be termed a pandemic. Partly due to the massive and uninhibited advertising of the tobacco companies smoking prevalence has dramatically increased until the mid-sixties. Since then thousands of reports on the damaging-effects of smoking have been published which has led to a change in attitude and to a decrease in smoking prevalence at least in industrialised countries. In Switzerland about 25% of the adult population smoke, but the percentage in the age group between 25 to 34 years is significantly higher. Smoking is the most important preventable cause of disease; this has been underlined by recent findings that about 50% of smokers will eventually die from their habit. Regular smokers-usually defined as regularly smoking more than 10-15 cigarettes daily-are nicotine dependent and do not smoke because they want to, but because they have to. Although 60-70% of smokers would like to quit, they fail without help. Nevertheless, smoking cessation is possible: the most important issue is the smoker's own motivation. Psychological counselling and nicotine replacement therapy (NRT) given as either patch, chewing gum, or nasal spray are merely aids to enhance success. With intensive counselling and NRT a maximum success rate of about 30% can be expected assessed 1 year after quit date. In general the use of NRT doubles the success rate of any chosen form of intervention. Cessation of smoking in young people is currently considered the best form of prevention.