638 



3. Behavioral interventions are most effective when they include 

 multiple components (procedures such as aversive smoking, 

 skills training, group support, and self-reward). Inclusion of too 

 many treatment procedures can lead to less successful out- 

 come. 



4. Nicotine replacement can reduce tobacco withdrawal symp- 

 toms and may enhance the efficacy of behavioral treatment. 



Appendix A: Trends in Tobacco Use in the United States 



1. An estimated 32.7 percent of men and 28.3 percent of women 

 smoked cigarettes regularly in 1985. The overall prevalence of 

 smoking in the United States decreased from 36.7 percent in 

 1976 (52.4 million adults) to 30.4 percent in 1985 (51.1 million 

 adults). 



2. In 1985, the mean reported number of cigarettes smoked per 

 day was 21.8 for male smokers and 18.1 for female smokers. 



3. Smoking is more common in lower socioeconomic categories 

 (blue-collar workers or unemployed persons, less educated 

 persons, and lower income groups) than in higher socioeconom- 

 ic categories. For example, the prevalence of smoking in 1985 

 among persons without a high school diploma was 35.4 percent, 

 compared with 16.5 percent among persons with postgraduate 

 college education. 



4. An estimated 18.7 percent of high school seniors reported daily 

 use of cigarettes in 1986. The prevalence of daily use of one or 

 more cigarettes among high school seniors declined between 

 1975 and 1986 by approximately 35 percent. Most of the decline 

 occurred between 1977 and 1981. Since 1976, the smoking 

 prevalence among females has consistently been slightly 

 higher than among males. 



5. The use of cigars and pipes has declined 80 percent since 1964. 



6. Smokeless tobacco use has increcised substantially among 

 young men and has declined among older men since 1975. An 

 estimated 8.2 percent of 17- to 19-year-old men were users of 

 smokeless tobacco products in 1986. 



Appendix B: Toxicity of Nicotine 



1. At high exposure levels, nicotine is a potent and potentially 

 lethal poison. Human poisonings occur primarily as a result of 

 accidental ingestion or skin contact with nicotine<ontaining 

 insecticides or, in children, after ingestion of tobacco or tobacco 

 juices. 



2. Mild nicotine intoxication occurs in first-time smokers, non- 

 smoking workers who harvest tobacco leaves, and people who 



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