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Nicotine Tob Res. 2016 Aug;18(8):1684-96. doi: 10.1093/ntr/ntw016. Epub 2016 Jan 17.

Exploring Issues of Comorbid Conditions in People Who Smoke.

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Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC;
Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT;
Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ;
Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX;
Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA;
Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI;
Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Department of Cancer Prevention and Control, Yale Cancer Center, New Haven, CT; Tobacco Treatment Service, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT; Tobacco Treatment and Lung Cancer Screening Programs, Hollings Cancer Center, Charleston, SC.
Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC; Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC


Smoking affects comorbid disease outcomes, and patients with comorbid conditions may have unique characteristics that are important to consider when treating tobacco use. However, addressing tobacco in patients being treated for comorbid conditions is not a consistent practice. Recognizing the need for a "call-to-action" to address tobacco use in people with comorbid conditions, the Tobacco Treatment Network within the Society for Research on Nicotine and Tobacco (SRNT) convened a Comorbidities Workgroup to explore the relationship between smoking and comorbid disease to identify common themes including: the harms associated with continued tobacco use, the frequency of comorbid disease and tobacco use, the potential effect of comorbid disease on the ability to quit tobacco use, the association between tobacco use and suboptimal disease-specific treatment response, and evidence regarding potential approaches to improve addressing tobacco use in patients with comorbid disease. Five candidate conditions (psychiatric, cancer, cardiovascular, pulmonary, and human immunodeficiency virus infected patients) were explored. Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Optimal strategies for addressing tobacco use within each comorbid disease are also not well defined. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction research should consider comorbid conditions as an important construct to explore.


This article explores how physical and psychiatric conditions may interact in the treatment of tobacco dependence, and discusses the need for smoking cessation as a critical component of comorbid condition management. Five common comorbid domains-psychiatric, cancer, pulmonary, cardiovascular, and human immunodeficiency virus (HIV)-are highlighted to illustrate how these different conditions might interact with smoking with respect to prevalence and harm, motivation to quit, and cessation treatment utilization and success.

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