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Acute myocardial infarction (heart attack) risk declines in only 3-4 years Smokers with CHD Cessation halves risk during 1-13 years of follow-up (Eur Heart J 1999;20:1773) One of every five smokers that quits avoids CHD event during 10 years Smoking cessation and CHD Blood pressure, stroke, renal function Blood pressure increased (independently of body weight) after cessation in several long-term studies 24-hour BP monitoring showed daytime lowering of BP after 1 week of cessation (Hypertension 1999;33:586) Former smokers have decreased carotid artery stenosis compared to current smokers Cessation reduces risk of stroke to non-smoker level after 5 years Drug treatment of hypertension is less effective in smokers Former smokers have less renal function abnormalities than continuing smokers Pulmonary function Lung health study (JAMA 1994;272:1497) Randomised Slower decline in pulmonary function in intervention group Fewer respiratory symptoms CHANGE IN FEV1 BY SMOKING STATUS 2.9 2.8 Sustained quitters 2.7 Continuing smokers Postbronchodilator FEV1 2.6 2.5 2.4 5 Screen 1 2 3 4 Years of follow-up JAMA 1994;272(19):1497-505 depqumch.tc Effects of cessation on reproductive health Women who stop before pregnancy: no adverse effects of smoking on infants Stopping between the 1st prenatal care visit and week 32 prevents deficits in infant birth weight, head circumference and brain:body weight ratio but does not completely prevent deficits in crown-heel length or increased ponderal index (Am J Epidemiol 2000;152:219) Former smokers have the same prevalence of erectile dysfunction (impotence) as non-smokers Postoperative complications Danish study (Lancet 2002;359:114) Randomised Cessation 6-8 weeks before surgery Fewer wound-related complications, reduced cardiovascular complications and secondary surgery Overall complication rate was 18% in the smoking intervention group and 52% in controls Shorter hospital stay Other benefits of cessation Risk of bone loss, hip fracture and periodontal disease minimised by cessation Rheumatoid arthritis risk reduced Cataract risk reduced Aortic aneurysm Peripheral arterial disease Others The central role of smoking cessation in limiting global smoking-attributable mortality over the next 50 years Scenarios for future deaths from tobacco 520 500 Trend 400 300 Cumulative deaths from tobacco (millions) 220 200 70 100 0 1950 1975 2000 2025 2050 Year Source: Peto et al Scenarios: impact of prevention 520 500 500 Trend If smoking uptake halves 400 by 2020 300 Cumulative deaths from tobacco (millions) 220 200 70 100 0 1950 1975 2000 2025 2050 Year Source: Peto et al Scenarios: impact of cessation 520 500 500 Trend If smoking uptake halves 400 by 2020 340 300 Cumulative deaths from tobacco (millions) 220 If adult smoking halves by 2020 200 190 70 100 0 1950 1975 2000 2025 2050 Year Source: Peto et al

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Juul has become so popular that, as of earlier this year, it was reported to account for nearly 75% of the market share in the US e-cigarette market, leaping from about 40% market share in 2017, making it todays best-selling e-cigarette brands in the US