including workspaces, restaurants, and bars, there was a 14% reduction in strokes in counties that had not previously had a ban in place.352 A study of New York State did not find a reduction in strokes despite a decrease in risk of MI when it enacted a comprehensive smoking ban in enclosed work- spaces, restaurants, and construction sites.353 Smoking likely contributes to increased stroke risk through both short-term effects on the risk of thrombus generation in ath- erosclerotic arteries and long-term effects related to increased Smoking as little as a single cigarette increases heart rate, mean BP, and cardiac index and decreases arterial dis- Beyond the immediate effects of smoking, both active and passive exposure to cigarette smoke is associated with the development of atherosclerosis.357 In addition to placing indi- viduals at increased risk for both thrombotic and embolic stroke, cigarette smoking approximately triples the risk of cryptogenic stroke among individuals with a low atherosclerotic burden and no evidence of a cardiac source of emboli.358,359 Although the most effective preventive measures are to never smoke and to minimize exposure to environmental tobacco smoke, risk is reduced with smoking cessation. Smoking cessa- tion is associated with a rapid reduction in the risk of stroke and other cardiovascular events to a level that approaches, but does not reach, that of those who never smoked.354,360 362 Although sustained smoking cessation is difficult to achieve, effective behavioral and pharmacological treatments for nicotine dependence are available.363 365 Comprehensive reviews and recommendations for smoking cessation are pro- vided in the 2008 Surgeon General s report,363 the 2008 update from the Public Health Service,366 and the 2009 affirmation of these recommendations from the US Preventive Services Task The combination of counseling and medications is more effective than either therapy alone.367 With regard to specific pharmacotherapy, in a meta-anal- ysis current to January 2012, nicotine replacement therapy, bupropion, and varenicline were all superior to inert control medications, but varenicline was superior to each of the other active interventions in direct comparisons.368 Emerging evi- dence suggests that varenicline may be more cost-effective than nicotine replacement therapy.369 Cigarette Smoking: Summary and Gaps Cigarette smoking increases the risk of ischemic stroke and SAH, but the data on ICH are inconclusive. 