Quit smoking, and the earlier the better

Cost

Free, and it saves money: a pack a day costs about 20–30 CNY, and quitting keeps that money. The hard part is getting through withdrawal, which usually takes a few weeks to a few months.

What you get

A U.S. study that followed a group of people (observational: it records what happens and does not assign people to groups) found that people who still smoked had a life expectancy more than 10 years shorter than people who never smoked. Quitting before 40 removes about 90% of the added risk of death from continuing to smoke. Quitting at 25–34 gains about 10 years of life, at 35–44 about 9 years, and at 45–54 about 6 years (the original reports years of life). A similar Chinese study found that in the 2010s, urban men who smoked had 1.65 times the risk of death of non-smokers (RR 1.65), and rural men 1.22 times. After 10 years of having quit on one's own, this smoking-related part of the risk nearly disappears. The same holds after a fracture. Pooling 19 observational studies, people who smoked had about 2.3 times the odds of a fracture failing to heal (the bone not knitting) compared with non-smokers (OR 2.32, 95% CI 1.76–3.06, the plausible range, adjusted for other factors). The rate was also higher for broken shin bones (tibia) and open fractures. In a Swedish randomized trial, of 50 people who joined a 6-week quit-smoking program after emergency fracture surgery, 20% had at least one complication after surgery. Of the 55 who did not join, 38% did. For planned surgery, you can start quitting 4 to 8 weeks before the operation, with weekly coaching and nicotine replacement. This lowers complications after surgery by about 58% (RR 0.42, 95% CI 0.27–0.65, 2 trials, 210 people).

Notes

Other people's smoke kills too: in 2004 about 603,000 (60.3万) people worldwide died from secondhand smoke, about 1% of all deaths that year. Even if you don't smoke, stay away from other people's smoke, and especially keep it away from children. The specific ways to quit are in the next four items: §2.3 (quit-smoking medicines), §2.4 (set a quit day), §2.5 (go to a quit-smoking clinic) and §2.6 (e-cigarettes). The number on bones that fail to heal comes from observational studies, and people who smoke may differ from non-smokers in other ways that cannot all be removed from the numbers. The trial of quitting after a fracture had only 105 people, and when the authors recalculated it as an odds ratio, the difference was no longer significant (OR 2.51, 95% CI 0.96–6.9).

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Jha P et al. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. NEJM. https://doi.org/10.1056/NEJMsa1211128
2. Chen Z et al. (2015). Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. https://doi.org/10.1016/S0140-6736(15)00340-2
3. Oberg M et al. (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. https://doi.org/10.1016/S0140-6736(10)61388-8 (the two second-hand smoke figures)
4. Scolaro JA et al. (2014). Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.M.00081
5. Nåsell H et al. (2010). Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.I.00627
6. Thomsen T et al. (2014). Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002294.pub4 (the fracture and surgery figures)

Translated from the Chinese original. Original book, section 2, tip 1. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer