Also known as:
Cigarettes: Butts, Cigs, and Smokes
Smokeless tobacco: Chew, Dip, Snuff, Snus, and Spit Tobacco
Hookah: Goza, Hubble-bubble, Narghile, Shisha, and Waterpipe
Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco leaves or created by burning them (as in cigarettes), but nicotine is the ingredient that can lead to addiction. Other chemicals produced by smoking, such as tar, carbon monoxide, acetaldehyde, and nitrosamines, also can cause serious harm to the body. For example, tar causes lung cancer and other serious diseases that affect breathing, and carbon monoxide can cause heart problems.
Teens who are considering smoking for social reasons should keep this in mind: Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarettes cause more than 480,000 premature deaths in the United States each year—from smoking or exposure to secondhand smoke—about 1 in every 5 U.S. deaths, or 1,300 deaths every day. An additional 16 million people suffer with a serious illness caused by smoking. So, for every 1 person who dies from smoking, 30 more suffer from at least 1 serious tobacco-related illness.1
How Tobacco and Nicotine Products Are Used
Tobacco and nicotine products come in many forms. People can smoke, chew, sniff them, or inhale their vapors.
1 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
Like other drugs, nicotine increases levels of a neurotransmitter called dopamine. Dopamine is released normally when you experience something pleasurable like good food, your favorite activity, or spending time with people you care about. When a person uses tobacco products, the release of dopamine causes similar effects. This effect wears off quickly, causing people who smoke to get the urge to light up again for more of that good feeling, which can lead to addiction.
A typical smoker will take 10 puffs on a cigarette over the period of about 5 minutes that the cigarette is lit. So, a person who smokes about 1 pack (25 cigarettes) daily gets 250 “hits” of nicotine each day.
Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may increase the effects of nicotine on the brain.
When smokeless tobacco is used, nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. Even after the tobacco is removed from the mouth, nicotine continues to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for users of smokeless tobacco than for smokers.
When nicotine enters the body, it initially causes the adrenal glands to release a hormone called adrenaline. The rush of adrenaline stimulates the body and causes an increase in blood pressure, heart rate, and breathing.
Most of the harm to the body is not from the nicotine, but from other chemicals in tobacco or those produced when burning it—including carbon monoxide, tar, formaldehyde, cyanide, and ammonia. Tobacco use harms every organ in the body and can cause many problems. The health effects of smokeless tobacco are somewhat different from those of smoked tobacco, but both can cause cancer.
People who do not smoke but live or hang out with smokers are exposed to secondhand smoke—exhaled smoke as well as smoke given off by the burning end of tobacco products. Just like smoking, this also increases the risk for many diseases. Each year, an estimated 58 million Americans are regularly exposed to secondhand smoke and more than 42,000 nonsmokers die from diseases caused by secondhand smoke exposure.2 One in four U.S. middle and high school students say they’ve been exposed to unhealthy secondhand aerosol from e-cigarettes.3
The chart below lists the health problems people are at risk for when smoking or chewing tobacco or as a result of exposure to secondhand smoke.
|Increased Risk of Health Problems|
|Health Effect||Smoking tobacco||Secondhand Smoke||Smokeless tobacco|
|Cancer||Cancers: Cigarette smoking can be blamed for about one-third of all cancer deaths, including 90% of lung cancer cases. Tobacco use is also linked with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, bladder, and bone marrow (leukemia).||Lung cancer: People exposed to secondhand smoke increase their risk for lung cancer by 20% to 30%. About 7,300 lung cancer deaths occur per year among people who do not smoke.4
|Cancers: Close to 30 chemicals in smokeless tobacco have been found to cause cancer. People who use smokeless tobacco are at increased risk for oral cancer (cancers of the mouth, lip, tongue, and pharynx) as well as esophageal and pancreatic cancers.
|Lung Problems||Breathing problems: Bronchitis (swelling of the air passages to the lungs), emphysema (damage to the lungs), and pneumonia have been linked with smoking.
Lowered lung capacity: People who smoke can’t exercise or play sports for as long as they once did.
|Breathing problems: Secondhand smoke causes breathing problems in people who do not smoke, like coughing, phlegm, and lungs not working as well as they should.|
|Heart Disease / Stroke||Heart disease and stroke: Smoking increases the risk for stroke, heart attack, vascular disease (diseases that affect the circulation of blood through the body), and aneurysm (a balloon-like bulge in an artery that can rupture and cause death).||Heart disease: Secondhand smoke increases the risk for heart disease by 25% to 30%. It is estimated to contribute to as many as 34,000 deaths related to heart disease.5||Heart disease and stroke: Recent research shows smokeless tobacco may play a role in causing heart disease and stroke.|
|Other health Problems||Cataracts: People who smoke can get cataracts, which is clouding of the eye that causes blurred vision.
Loss of sense of smell and taste
Aging skin and teeth: After smoking for a long time, people find their skin ages faster and their teeth discolor.
|Mouth problems: Smokeless tobacco increases the chance of getting cavities, gum disease, and sores in the mouth that can make eating and drinking painful.|
|Pregnant Women and Children||Pregnant women: Pregnant women who smoke are at increased risk for delivering their baby early or suffering a miscarriage, still birth, or experiencing other problems with their pregnancy. Smoking by pregnant women also may be associated with learning and behavior problems in children.||Health problems for children: Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, lung infections, ear problems, and more severe asthma.|
|Accidental Death||Fire-related deaths: Smoking is the leading cause of fire-related deaths—more than 600 deaths each year.6|
2Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
3 Wang TW, Marynak KL, Aguku IT, et al. Secondhand Exposure to Electronic Cigarette Aerosol Among US Youths. JAMA Pediatrics. 2017, e1.
4 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Health Effects of Secondhand Smoke. Atlanta, GA. February 2016. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm.
5 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Health Effects of Secondhand Smoke. Atlanta, GA. February 2016. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm.
6 Centers for Disease Control and Prevention. Smoking and Tobacco Use. Tobacco-Related Mortality. Atlanta, GA. February 2016. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/.
Yes. Tobacco use (both smoked and smokeless) is the leading preventable cause of death in the United States. It is a known cause of cancer. Smoking tobacco also can lead to early death from heart disease, health problems in children, and accidental home and building fires caused by dropped cigarettes. In addition, the nicotine in smokeless tobacco may increase the risk for sudden death from a condition where the heart does not beat properly (ventricular arrhythmias); as a result, the heart pumps little or no blood to the body’s organs.
According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 480,000 premature deaths in the United States each year—about 1 in every 5 U.S. deaths, or 1,300 deaths every day.7 On average, smokers die 10 years earlier than nonsmokers.8 People who smoke are at increased risk of death from cancer, particularly lung cancer, heart disease, lung diseases, and accidental injury from fires started by dropped cigarettes.
The good news is that people who quit may live longer. A 24-year-old man who quits smoking will, on average, increase his life expectancy (how long he is likely to live) by 5 years.9
7 Centers for Disease Control and Prevention. Smoking and Tobacco Use: 2014 Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress. Atlanta, GA. 2014. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm.
8 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
9 Centers for Disease Control and Prevention. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Atlanta, GA. 1990. HHS Publication No. 90-8416.
Yes. It is the nicotine in tobacco that is addictive. Each cigarette contains about 10 milligrams of nicotine. A person inhales only some of the smoke from a cigarette, and not all of each puff is absorbed in the lungs. The average person gets about 1 to 2 milligrams of the drug from each cigarette.
Studies of widely used brands of smokeless tobacco showed that the amount of nicotine per gram of tobacco ranges from 4.4 milligrams to 25.0 milligrams. Holding an average-size dip in your mouth for 30 minutes gives you as much nicotine as smoking 3 cigarettes. A 2-can-a-week snuff dipper gets as much nicotine as a person who smokes 1½ packs a day.
Whether a person smokes tobacco products or uses smokeless tobacco, the amount of nicotine absorbed in the body is enough to make someone addicted. When this happens, the person continues to seek out the tobacco even though he or she understands the harm it causes. Nicotine addiction can cause:
E-cigarettes are fairly new products. They’ve only been around for about ten years, so researchers are in the early stage of studying how they affect your health.
How E-cigarettes Work
E-cigarettes are designed to deliver nicotine without the other chemicals produced by burning tobacco leaves. Puffing on the mouthpiece of the cartridge activates a battery-powered inhalation device (called a vaporizer). The vaporizer heats the liquid inside the cartridge which contains nicotine, flavors, and other chemicals. The heated liquid turns into an aerosol (vapor) which the user inhales—referred to as “vaping.”
How E-cigarettes Affect the Brain
E-cigarettes may be less harmful than regular tobacco cigarettes because users do not inhale burning smoke, which has cancer causing and other harmful ingredients. But we don’t yet have enough research to show potential harmful effects of the vaping mist. Also, recent research shows that many teens start smoking regular cigarettes soon after being introduced to nicotine through electronic vaporizers. It is important to remember that nicotine in any form is a highly addictive drug. Health experts have raised many questions about the safety of these products, particularly for teens:
Regulation of E-cigarettes
Yes. The U.S. Food and Drug Administration (FDA) announced in 2016 that the FDA will now regulate the sales of e-cigarettes, hookah tobacco, and cigars. Therefore:
FDA regulation also means that the Federal government will now have a lot more information about what is in e-cigarettes, the safety or harms of the ingredients, how they are made, and what risks need to be communicated to the public (for example, on health warnings on the product and in advertisements). They will also be able to stop manufacturers from making statements about their products that are not scientifically proven.
Regulation does not mean that e-cigarettes are necessarily safe for all adults to use, or that all of the health claims currently being made in advertisements by manufactures are true. But it does mean that e-cigarettes, hookah tobacco, and cigars now have to follow the same type of rules as cigarette manufacturers.
10 Rigotti NA. e-Cigarette use and subsequent tobacco use by adolescents: new evidence about a potential risk of e-cigarettes. JAMA. 2015;314(7):673-674.
11 Schober W, Szendrei K, Matzen W, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. International Journal of Hygiene and Environmental Health. 2014; 217:628-637.
12 Hess CA, Olmedo P, Goessler W, Cohen E, Rule AM. E-cigarettes as a source of toxic and potentially carcinogenic metals. Environmental Research. 2017;152:221-221.
Smoking and smokeless tobacco use generally start during the teen years. Among people who use tobacco:
A survey of teens in the United States shows cigarette smoking is on the decline. That could be in part due to the introduction of e-cigarettes. Teens today are more likely to smoke an e-cigarette than a regular cigarette.19
Below is a chart showing the percentage of teens who use tobacco and nicotine products:
Swipe left or right to scroll.
|Drug||Time Period||8th Graders||10th Graders||12th Graders|
|Cigarettes (any use)||Lifetime||9.40||15.90||26.60|
* Data in brackets indicate statistically significant change from the previous year.
For more statistics on teen drug abuse, see NIDA’s Monitoring the Future study.
13 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
14 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
15 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
16 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Smokeless Tobacco Use in the United States. Atlanta, GA. July 2016. Available at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/use_us/.
17 Leventhal AM, Stone MD, Andrabi N. Association of e-Cigarette Vaping and Progression to Heavier Patterns of Cigarette Smoking. JAMA. 2016; 316(18):1918-1920.
18 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Smokeless Tobacco Use in the United States. Atlanta, GA. July 2016. Available at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/use_us/.
19 Miech RA, Schulenberg JE, Johnston LD, et al. National adolescent drug trends in 2017: Findings released [Press release]. Ann Arbor, MI. December 2017. Retrieved from http://www.monitoringthefuture.org/.
Treatments can help people who use tobacco products manage these symptoms and improve the likelihood of successfully quitting. For now, teen and young adult smokers who want to quit have good options for help. Find out more at SmokeFree and Tips From Former Smokers.
Nearly 70% of people who smoke want to quit.20 Most who try to quit on their own relapse (go back to smoking)—often within a week. Most former smokers have had several failed quit attempts before they finally succeed.
Some people believe e-cigarette products may help smokers lower nicotine cravings while they are trying to quit smoking cigarettes. However, several research studies show that using electronic devices to help quit cigarette smoking does not usually work in the long term, and might actually discourage people from quitting21. One recent study showed that only nine percent of people using e-vaporizers to quit smoking cigarettes had actually stopped smoking a year later22.
If you or someone you know needs more information or is ready to quit, check out these resources:
20 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. December 2015. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
21 Kulik MC, Lisha NE, Glantz SA. E-cigarettes Associated With Depressed Smoking Cessation: A Cross-sectional Study of 28 European Union Countries. Am J Prev Med. 2018;54(4):603-609. doi:10.1016/j.amepre.2017.12.017
22Weaver SR, Huang J, Pechacek TF, Heath JW, Ashley DL, Eriksen MP. Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016. PLOS ONE. 2018;13(7):e0198047. doi:10.1371/journal.pone.0198047