Guardians of the Public's Health

Wisdom from Dr. Joel Nitzkin, a past President of AAPHP and Past Chair of the Tobacco Control Task Force. Please note this is not a policy of AAPHP nor is this meant to be medical advice.  This is one person's opinion.

New:  Dr.  Nitzkin's July 23, 2017 Science-based E-cigarette Policy Document  ASAMEcigRecom20170723FinalWithLinks.pdf

Guidance to Smokers and Their Physicians

Cigarette smoking kills about 400,000 American smokers each year and about 40,000 non-smokers from exposure to environmental tobacco smoke. As such, cigarette smoking continues to be the #1 preventable cause of death in the USA.

Smokers smoke for the feel-good effects of the nicotine, often not realizing the addictive nature of this product and the manner in which they can loose the ability to feel good without it.

The nicotine, itself, other than being highly addictive, is relatively innocuous in terms of increasing the risk of potentially fatal cancer, heart and lung disease. In smokers, these diseases are caused by other chemicals in the smoke, not the nicotine.

What is a smoker to do?

The best option, from both physical and mental health perspectives, for most people, is to quit "Cold Turkey."  Just quit and bear the discomfort of nicotine withdrawal over a two to four week period. You can do it if you try.  Also -- you can learn more about how best to do this from the web site and other internet resources promoting cold turkey quitting.

For some smokers who have tried quitting "Cold Turkey" and failed, there are a number of prescription and non-prescription nicotine replacement (gum, patches, inhalers) and other medications that might help. Be warned, however, that some of these carry serious side effects, and none eliminate all the discomfort of quitting "Cold Turkey."  At best, they lessen the severity of withdrawal and reduce the duration of such discomfort. For more information on this set of options, go to, call 1 800 QUIT NOW (1 800 784 8669).

There is yet another series of options for those who have tried to quit, and failed, and for those who cannot bear the thought of discontinuing nicotine, but would like to eliminate most of the excess risk of cancer, lung and heart disease.  Recent research has shown, in the United States and Scandinavia, that there are a number of smoke-free options that can reduce the risk of tobacco-related cancer, lung and heart disease by 98% or better, while satisfying the urge to smoke. These products include snus (a kind of snuff), other snuff products, and chewing tobacco. E-cigarettes and dissolvable tobacco products (sticks, strips and orbs) promise even larger reductions in risk, but they are too new on the market for research to have documented such benefits. For additional information you can check out the tobacco page on our AAPHP web site at, the and web sites.

Other combustible products, including cigars, pipes and water pipes (charcoal is burned to heat tobacco), are intermediate in risk between cigarettes and the smoke-free options, but not low enough in risk to be recommended as alternatives to cigarettes.

For yet additional information on all these options, please feel free contact Dr. Nitzkin  at

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