22% of the Spanish population is a daily smoker. Men are more smokers. In Spain, women between 15-25 years of age smoke as much or more than men. Every smoker should be assessed for: physical dependence on nicotine (Fagerström test), social and psychological dependence (Glover Nilsson test), degree of motivation to quit (Richmond test), probabilities of success of therapies (Henri-Mondor and Michael-Fiore test) and the evolutionary stage of behavioral change (Prochaska and DiClementi). Anti-smoking advice is very cost-effective and should always be given. Smoking is an enhancer of cardiovascular risk because it is a pathogen for the development of arteriosclerosis and is associated with ischemic heart disease, stroke and peripheral artery disease. Smoking increases the risk of chronic pulmonary diseases (COPD) and is related to cancers of the lung, female genitalia, larynx, oropharynx, bladder, mouth, esophagus, liver and biliary tract, and stomach, among others. In smoking cessation, it is important the involvement and multidisciplinary collaboration of doctors, nurses, psychologists, etc. is needed. We have effective pharmacological treatments for smoking cessation. Combined treatments are recommended when the smoker’s dependence is high. For individuals who are unable to quit smoking, a strategy based on tobacco harm management with a total switch to smokeless products could be a less dangerous alternative for their health than continuing to smoke.
