Intended for healthcare professionals


Tobacco dependence should be recognised as a lethal non-communicable disease

BMJ 2019; 365 doi: (Published 21 May 2019) Cite this as: BMJ 2019;365:l2204
  1. Dan Xiao, professor1 2,
  2. Chen Wang, professor12
  1. 1WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Tobacco Medicine and Tobacco Cessation Centre, Centre of Respiratory Medicine, China–Japan Friendship Hospital, Beijing, China
  2. 2Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
  1. Correspondence to: C Wang wangchen{at}

Reframing would extend the scope of tobacco control

Tobacco use is one of the main risk factors for non-communicable diseases, which are a major health threat globally. Despite worldwide efforts at tobacco control over several decades, the prevalence of smoking is still high: 22% of people aged 15 and older are smokers.1 In 2007 there were 1.1 billion smokers worldwide, and this number had not changed by 2015.2 China had an estimated 316 million smokers in 2015.3 Unless these smokers stop, one in two is likely to die from tobacco related illnesses.4

Despite the efforts of healthcare professionals and the political will demonstrated by interventions such as smoking bans in public places, tobacco taxes, and pictorial warnings of serious harm on cigarette packaging,2 most smokers have not been able to quit for good because of nicotine dependence.25 Nicotine physically alters the smoker’s brain, making quitting difficult.5

Dependence is overlooked

The American Psychiatric Association and the World Health Organization have …

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