People have many questions about tobacco that can sometimes be hard to answer. There are all sorts of questions about cigarettes, cigars, spit and other types of smokeless tobacco, other tobacco products, nicotine, addiction, and quitting. Many of these questions are answered here.

We also answer some questions about how smoking and tobacco can affect a person’s health, including the heart, circulation, and lungs. We discuss its effect on unborn babies and how it affects the risk of cancer and other diseases.

Is there a safe way to smoke cigarettes?

No. All cigarettes damage the human body. Any smoking is dangerous.

Some people try to make their smoking habit safer by smoking fewer cigarettes, which most smokers find quite hard to do. Sadly, research has found that even smoking as few as 1 to 4 cigarettes a day can lead to serious health outcomes, including an increased risk of heart disease and a greater chance of dying at a younger age.

Some smokers believe that “light” cigarettes are a lower health risk. This is not true. Studies have not found that the risk of serious health effects is lower in smokers of “light” or low-tar cigarettes. Because of this, the US Food and Drug Administration (FDA) has banned use of the terms “light,” “mild,” and “low” in any cigarette sales unless the FDA specifically allows it – and so far, they haven’t.

Hand-rolled cigarettes are thought by some people to be a cheaper and healthier way to smoke, but they are not safer than commercial brands. In fact, life-long smokers of hand-rolled cigarettes have been found to have a higher risk of cancers of the larynx (voice box), esophagus (swallowing tube), mouth, and pharynx (throat) when compared with smokers of machine-made cigarettes.

Some cigarettes are now being sold as “all natural.” They are marketed as having no chemicals or additives and rolled with 100% cotton filters. There is no proof they are healthier or safer than other cigarettes, nor is there good reason to think they would be. Smoke from these cigarettes, like the smoke from all cigarettes, contains many agents that cause cancer (carcinogens) and toxins that come from burning the tobacco itself, including tar and carbon monoxide.

Even though herbal cigarettes do not contain tobacco, they give off tar and carbon monoxide and are dangerous to your health. The bottom line is there’s no such thing as a safe smoke.

Are menthol cigarettes safer?

Menthol cigarettes are not safer than any other brand. In fact, they may even be more dangerous. The added menthol produces a cooling sensation in the throat when the smoke is inhaled. It also lessens the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer.

About one-fourth (25%) of all cigarettes sold in the United States are flavored with menthol. These cigarettes are most popular among children, African-Americans, Hispanics, and smokers in other minority groups.

Studies have shown that people who smoke menthol cigarettes are less likely to try to quit and are less likely to succeed when they do try. At least one researcher proposed that menthol smokers might want to switch to non-menthol cigarettes before they quit to improve their chances of quitting smoking.

Most people don’t know that many cigarette brands that are not advertised as having menthol often have a bit of menthol added. Even amounts of menthol that are too small to taste can make a cigarette seem smoother and less harsh. These small amounts of menthol can ease the path for new smokers.

Is cigarette smoking really addictive?

Yes. The nicotine in cigarette smoke can cause addiction. Nicotine is an addictive drug just like heroin and cocaine:

• When taken in small amounts, nicotine creates pleasant feelings that make the smoker want to smoke more. It acts on the chemistry of the brain and central nervous system, affecting the smoker’s mood. Nicotine works very much like other addicting drugs, by flooding the brain’s reward circuits with dopamine (a chemical messenger). Nicotine also gives you a little bit of an adrenaline rush – not enough to notice, but enough to speed up your heart and raise your blood pressure.
• Nicotine reaches the brain within seconds after taking a puff, but its effects start to wear off within a few minutes. This is what most often leads the smoker to get another cigarette. If the smoker doesn’t smoke again soon, withdrawal symptoms kick in and get worse over time.
• The typical smoker takes about 10 puffs from each cigarette. A person smoking a pack per day gets about 200 “hits” of nicotine each day.
• Smokers usually become dependent on nicotine and suffer physical and emotional (mental or psychological) withdrawal symptoms when they stop smoking. These symptoms include irritability, nervousness, headaches, and trouble sleeping. The true marker for addiction, though, is that people still smoke even though they know smoking is bad for them – affecting their lives, their health, and their families in unhealthy ways. Most people who smoke want to quit.

Researchers are also looking at other chemicals in tobacco that make it harder to quit. In the brains of animals, tobacco smoke causes chemical changes that are not fully explained by the effects of nicotine.

What does nicotine do?

In large doses nicotine is a poison and can kill by stopping the muscles a person uses to breathe. But smokers usually take in small amounts that the body can quickly break down and get rid of. The first dose of nicotine makes a person to feel awake and alert, while later doses make them feel calm and relaxed.

Nicotine can make new smokers, and regular smokers who get too much of it, feel dizzy or sick to their stomachs. The resting heart rate for young smokers increases 2 to 3 beats per minute. Nicotine also lowers skin temperature and reduces blood flow in the legs and feet. It may play a role in increasing smokers’ risk of heart disease and stroke, but other substances in cigarette smoke likely play a bigger part.

Many people mistakenly think that nicotine is the substance in tobacco that causes cancer. This belief may cause some people to avoid using nicotine replacement therapy when trying to quit. Nicotine is what gets (and keeps) people addicted to tobacco, but other substances in tobacco cause cancer. Some animal studies have shown that nicotine may help existing tumors grow and spread, but whether this happens in people is not yet known and more research is needed.

Why do people start smoking?

Most people begin smoking as teens. Those with friends and/or parents who smoke are more likely to start smoking than those who don’t. Some teens say that they “just wanted to try it,” or they thought it was “cool” to smoke.

The tobacco industry’s ads, price breaks, and other promotions for its products are a big influence in our society. The tobacco industry spends billions of dollars each year to create and market ads that show smoking as exciting, glamorous, and safe.

Despite the fact that cigarette brand product placement in movies was banned by the 1998 Tobacco Master Settlement Agreement, cigarettes appeared in 2 out of 3 box office hit movies in 2005. More than one-third of the movies were youth-rated films. The number of movies with tobacco-related scenes has gone down since 2005. But in 2010, more than 30% of top-grossing movies rated as G, PG, and PG-13 had tobacco scenes. And studies show that young people who see smoking in movies are more likely to start smoking.

TV ads for smoking have been banned for many years, but films that show tobacco brands are much more likely to include smoking scenes as part of their TV trailers. This seems to undercut the intent of the TV ad ban.

Who is most likely to become addicted?

Anyone who starts smoking can become addicted to nicotine. Studies show that cigarette smoking is most likely to become a habit during the teen years. The younger a person is when he or she begins to smoke, the more likely he or she is to become addicted to nicotine. According to the American Lung Association, 68% of adult smokers started smoking regularly at age 18 or younger. And 85% started when they were 21 or younger.

How many people use tobacco?

Cigarette smoking has decreased among adults in the United States from about 42% of the population in 1965 to about 19% in 2010 (the latest year for which numbers are available). It is still the most common form of tobacco use in the US: about 45 million adults currently smoke cigarettes. About 22% of men and 17% of women were smokers in 2010. Education is linked to smoking rates, with lower smoking rates in groups with higher levels of education. More people smoke in the Midwest (22%) and South (21.0%), and fewer smoke in the West (16%).

Tobacco use does not end with cigarettes; other forms of tobacco use are common. In 2010, a survey by the US Substance Abuse and Mental Health Administration found that 8.9 million people used smokeless or spit tobacco. The same survey reported that 13.2 million smoked cigars, and 2.2 million people smoked tobacco in pipes.

Is smoking common among young people?

Yes. Tobacco use, including smoking cigarettes, using chew or spit tobacco, and dipping snuff, is common among American youth, according to the most recent government surveys.

Despite declines in recent years, in 2009 nearly 1 in 3 male high school students (30%) and more than 1 in 5 female high school students (22%) used some type of tobacco in the month before they were surveyed. About 1 in 5 students (20%) were considered current cigarette smokers. More than half of these students (51%) reported they had tried to quit smoking during the past year. Cigar smoking was also common among high school students (about 14%).

Also, about 7% of middle school girls and 10% of middle school boys used some form of tobacco, with cigarettes (about 5%) being the most common.

In both middle school and high school, tobacco use was higher among male students for all products

Other problems have been linked to smoking. Studies have shown that students who smoke are also more likely to use other drugs, get in fights, carry weapons, try to kill themselves, and take part in risky sex.