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People have many questions about tobacco that can sometimes be
hard to answer. They might have questions about cigarettes, cigars,
spit and other types of smokeless tobacco, other tobacco products,
nicotine, addiction, or 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;
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. Cigarettes are the only legal product whose advertised and
intended use -- smoking -- is known to harm the body and cause cancer.
Some people try to make their smoking habit safer by smoking
fewer cigarettes, but most smokers find that hard to do. 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 people think that switching from high-tar and
high-nicotine cigarettes to those with low tar and nicotine makes
smoking safer, but this is not true. When people switch to brands with
lower tar and nicotine, they often end up smoking more cigarettes, or
more of each cigarette, to get the same nicotine dose as before.
Smokers have been led to believe that "light" cigarettes are a
lower health risk and are a good option to quitting. This is not true.
A low-tar cigarette can be just as harmful as a high-tar cigarette
because a person often takes deeper puffs, puffs more often, or smokes
them to a shorter butt length. Studies have not found that the risk of
lung cancer is any lower in smokers of "light" or low-tar cigarettes.
Although hand-rolled cigarettes are reported to be a cheaper
and healthier way to smoke, they are not safer than commercial brands.
In fact, life-long smokers of hand-rolled cigarettes have been found to
have an increased risk of cancers of the larynx (voice box), esophagus
(tube that connects the mouth to the stomach), mouth, and pharynx
(throat) when compared with smokers of machine-made cigarettes.
Newer kinds of cigarettes are 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 the tobacco itself, including tar and carbon monoxide.
Herbal cigarettes, even though they do not contain tobacco,
also 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 than those
without menthol?
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
decreases 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 of all cigarettes sold in the US are flavored
with menthol. These cigarettes are most popular among African-American
smokers.
Recent 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 trying to
quit to improve their chances of quitting smoking.
Is cigarette smoking really addictive?
Yes. The nicotine in cigarette smoke causes an addiction to
smoking. 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
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 to see if there are other
chemicals in tobacco that help promote addiction. 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 a
person's breathing muscles. 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.
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 begin to smoke?
Most people begin smoking as teens, usually because of
curiosity and peer pressure. People with friends and/or parents who
smoke are more likely to start smoking than those who don't.
The tobacco industry's ads, price breaks, and other promotions
for its products are another 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 appear in 3 out of 4
box office hit movies. One-third of the movies that show cigarettes are
youth-rated films. And studies show that young people who see smoking
in movies are more likely to start smoking.
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.
Almost 90% of adult smokers first smoked at or before age 19.
How many people smoke cigarettes?
Cigarette smoking has decreased among adults in the United
States from about 42% of the population in 1965 to about 21% in 2008
(the latest year for which numbers are available). It is estimated that
about 46 million adults currently smoke cigarettes. About 23% of men
and 18% of women were smokers in 2008. Education seems linked to
smoking rates, with lower smoking rates in groups with higher levels of
education.
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 2007 nearly 1 in 3 male
high school students (30%) and more than 1 in 5 female high school
students (21%) used some type of tobacco in the month before they were
surveyed. About 1 in 5 students (20%) were considered current cigarette
smokers. Half of these students (about 50%) reported they had tried to
quit smoking during the past year. Cigar smoking was also common among
high school students (about 14%).
Also, about 19% of middle school students used some form of
tobacco, with cigarettes (6%) being the most common.
Tobacco use is higher among male students for all products
except cigarettes, where the numbers for boys and girls are now about
the same.
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
high-risk sexual behaviors.
What in cigarette smoke is harmful?
Cigarette smoke is a complex mixture of chemicals produced by
the burning of tobacco and its additives. The smoke contains tar, which
is made up of more than 4,000 chemicals, including over 60 known to
cause cancer. Some of these substances cause heart and lung diseases,
and all of them can be deadly. You might be surprised to know some of
the chemicals found in cigarette smoke include:
- Cyanide
- Benzene
- Formaldehyde
- Methanol (wood alcohol)
- Acetylene (the fuel used in welding torches)
- Ammonia
Cigarette smoke also contains the poison gases nitrogen oxide
and carbon monoxide. The active ingredient that produces the effect
people are looking for is nicotine, an addictive drug.
The tobacco leaves used in making cigarettes contain
radioactive materials; the amount depends on the soil the plants were
grown in and fertilizers used. But this means that cigarette smoke
contains small amounts of radioactive material too, which smokers bring
into their lungs as they inhale. These radioactive particles build up
in the lungs, and over time can mean a big dose of radiation. This may
be another key factor in smokers getting lung cancer.
Does smoking cause cancer?
Yes. Tobacco use accounts for at least 30% of all cancer
deaths in the United States. Smoking causes about 87% of lung cancer
deaths. Smoking also causes cancers of the larynx (voice box), mouth,
pharynx (throat), esophagus (swallowing tube), and bladder. It also has
been linked to the development of cancers of the pancreas, cervix,
kidney, and stomach and some types of leukemia. Cigars, pipes, and spit
and other types of smokeless tobacco all cause cancers, too. There is
no safe way to use tobacco.
How does cigarette smoke affect the lungs?
Damage to the lungs begins early in smokers, and cigarette
smokers have a lower level of lung function than non-smokers. This
continues to worsen as long as the person smokes. Cigarette smoking
causes many lung diseases that can be nearly as bad as lung cancer.
Chronic bronchitis and emphysema are 2 types of chronic obstructive
pulmonary disease that can make it hard to breathe and can cause
serious health problems -- even death.
Chronic bronchitis
Chronic bronchitis is a disease where the airways make too
much mucus, forcing the smoker to cough it out. It is a common problem
for smokers. The lungs start to make large amounts of mucus, and do it
more often. The airways become inflamed (swollen) and the cough becomes
chronic. It doesn't get better or go away. Airways get blocked by scars
and mucus. This can lead to bad lung infections.
Emphysema
Cigarette smoking is also the major cause of emphysema, a
disease that slowly destroys a person's ability to breathe. Oxygen gets
into the blood by moving across a large surface area in the lungs.
Normally, thousands of tiny sacs make up this surface. In emphysema,
the walls between the sacs break down and create larger but fewer sacs.
This decreases the lung surface area, which lowers the amount of oxygen
reaching the blood. Over time, the lung surface area can become so
small that a person with emphysema must gasp for breath.
Shortness of breath (especially when lying down), a mild cough
that doesn't go away (which is often dismissed as "smoker's cough"),
feeling tired, and sometimes weight loss are early signs of emphysema.
People with emphysema are at risk for many other problems linked to
weak lung function, including pneumonia. In later stages of the
disease, patients can only breathe comfortably with the help of an
oxygen tube under the nose. Emphysema cannot be reversed, but it can be
slowed down, especially if the person stops smoking.
Chronic obstructive pulmonary disease
More than 10 million people in the US suffer from chronic
obstructive pulmonary disease (COPD), the name used to describe both
chronic bronchitis and emphysema. COPD is the fourth leading cause of
death in America. More women die from COPD than men. Smoking is the
main risk factor for COPD. More than 75% of COPD deaths are caused by
smoking. The late stage of chronic lung disease is one of the most
miserable of all medical problems. It makes the person feel as if they
are gasping for breath all the time. They feel as if they are drowning.
Why do smokers have "smoker's cough?"
Cigarette smoke has chemicals and particles that irritate the
airways and lungs. When a smoker inhales these substances, the body
tries to protect itself by making mucus and coughing. The early morning
smoker's cough happens for many reasons. Normally, tiny hair-like
formations (called cilia) beat outward and sweep harmful material out
of the lungs. But cigarette smoke slows the sweeping action, so some of
the poisons in the smoke stay in the lungs and mucus stays in the
airways. While a smoker sleeps, some cilia recover and begin working
again. After waking up, the smoker coughs because the lungs are trying
to clear away the irritants and mucus that built up the day before. The
cilia will completely stop working after they have been exposed to
smoke for a long time. Then the smoker's lungs are even more exposed
and prone to infection and irritation.
If you smoke but don't inhale, is there any
danger?
Yes. Wherever smoke touches living cells, it does harm. Even
if smokers don't inhale, they are breathing secondhand smoke and are
still at risk for lung cancer. Pipe and cigar smokers, who often
don’t inhale, are at an increased risk for lip, mouth,
tongue, and some other cancers, too.
Does cigarette smoking affect your heart?
Yes. Smoking cigarettes increases the risk of heart disease,
which is the number one cause of death in the US. Smoking, high blood
pressure, high cholesterol, physical inactivity, obesity, and diabetes
are all risk factors for heart disease, but cigarette smoking is the
biggest risk factor for sudden death from a heart attack.
A smoker who has a heart attack is more likely to die within
an hour of the heart attack than a non-smoker. Cigarette smoke can harm
the heart at very low levels, even when the amount is too low to cause
lung disease.
How does smoking affect pregnant women and
their babies?
Pregnant women who smoke risk the health and lives of their
unborn babies. Smoking during pregnancy is linked with a greater chance
of miscarriage, premature delivery, stillbirth, infant death, low
birth-weight, and sudden infant death syndrome (SIDS). Up to 5% of
infant deaths could be prevented if pregnant women did not smoke.
When a pregnant woman smokes, she's smoking for 2. The
nicotine, carbon monoxide, and other harmful chemicals enter her
bloodstream, go into the baby's body, and keep it from getting vital
nutrients and oxygen it needs for growth.
Breast-feeding is a good way to feed a new baby, but if the
mother smokes the baby is exposed to nicotine and other poisons in the
smoke through breast milk. Nicotine can cause many unwanted symptoms in
the baby, such as restlessness, a rapid heartbeat, vomiting, shorter
sleep times, or diarrhea.
Some research has also suggested that children whose mothers
smoked while pregnant or who have been exposed to secondhand smoke,
even in small amounts, may be slower learners in school. They may be
shorter and smaller than children of non-smokers. They are also more
likely to smoke when they get older.
What are some of the short- and long-term
effects of smoking cigarettes?
Smoking causes many types of cancer. But cancers account for
only about half of the deaths linked to smoking. Long-term, smoking is
also a major cause of heart disease, aneurysms, bronchitis, emphysema,
and stroke. It also makes pneumonia and asthma worse. Wounds take
longer to heal and the immune system may not work as well in smokers as
in non-smokers.
Smoking also damages the arteries. Because of this, many
vascular surgeons refuse to operate on patients with peripheral artery
disease (poor blood circulation in the arms and legs) unless they stop
smoking. And male smokers have a higher risk of sexual impotence
(erectile dysfunction) the longer they smoke
The truth is that cigarette smokers die younger than
non-smokers. In fact, according to a study done in the late 1990s by
the Centers for Disease Control and Prevention (CDC), smoking shortened
male smokers' lives by 13.2 years and female smokers' lives by 14.5
years. Men and women who smoke are much more likely to die during
middle age (between the ages of 35 and 69) than those who have never
smoked.
Smoking also causes many short-term effects, such as poor lung
function. Because of this, smokers often suffer shortness of breath and
nagging coughs. They often will tire easily during physical activity.
Some other common short-term effects include less ability to smell and
taste, premature aging of the skin, bad breath, and stained teeth
What are the chances that smoking will kill
you?
About half of the people who keep smoking will die because of
it. In the United States, tobacco causes nearly 1 in 5 deaths, killing
about 443,600 Americans each year. Smoking is the single most
preventable cause of death in our society.
Based on current patterns, smoking will kill about 650 million
people alive in the world today. If these patterns continue,
tobacco-caused deaths worldwide are expected to increase from about 5.4
million per year today to about 10 million per year by the 2030s. Most
of these deaths will happen in developing countries.
What are the dangers of environmental
(secondhand) tobacco smoke?
Environmental tobacco smoke (ETS) is also known as secondhand
smoke. Passive smoking (inhaling secondhand smoke) happens when
non-smokers breathe other people’s tobacco smoke. This
includes mainstream smoke
(smoke that is inhaled and then exhaled into the air by smokers) and sidestream smoke
(smoke that comes directly from the burning tobacco in cigarettes). ETS
contains the same harmful chemicals as the smoke that smokers inhale.
There is strong evidence that ETS causes serious damage to
human health. Each year about 3,400 non-smoking adults die of lung
cancer and about 46,000 die of heart disease as a result of breathing
secondhand smoke. It can also affect non-smokers by causing asthma and
other respiratory problems, eye irritation, headaches, nausea, and
dizziness. Children whose parents smoke are more likely to suffer from
asthma, pneumonia, bronchitis, ear infections, coughing, wheezing, and
increased mucus production. Babies of parents who smoke have a greater
chance of dying of sudden infant death syndrome (SIDS). Pregnant women
exposed to ETS are at risk for having a low birth weight baby and may
also be at risk for pre-term delivery and miscarriage.
Can secondhand smoke cause breast cancer?
Research is still being done to find out whether secondhand
smoke may increase the risk of breast cancer. Both mainstream and
secondhand smoke have about 20 chemicals that, in high concentrations,
cause breast cancer in rodents. Chemicals in tobacco smoke reach breast
tissue and are found in breast milk.
Any link between secondhand smoke and breast cancer risk in
human studies is a subject of debate, partly because breast cancer risk
has not been shown to be increased in active smokers. One possible
reason for this is that tobacco smoke may have different effects on
breast cancer risk in smokers and in those who are exposed to
secondhand smoke.
A report from the California Environmental Protection Agency
(Cal/EPA) in 2005 concluded that the evidence about secondhand smoke
and breast cancer is "consistent with a causal association" in younger
women. This means that the secondhand smoke acts as if it could be a
cause of breast cancer in these women. The 2006 US Surgeon General's
report, The Health
Consequences of Involuntary Exposure to Tobacco Smoke,
concluded that there is "suggestive but not sufficient" evidence of a
link at this point. In 2007, the Cal/EPA did another review and
concluded that "regular ETS exposure is causally related to breast
cancer diagnosed in younger, primarily pre-menopausal women" and that
this link is not likely explained by any other causes. Researchers are
still looking at this, but in any case, women may want to know that
this possible link to breast cancer is yet another reason to avoid
secondhand smoke.
Am I at risk for getting lung cancer from
smoke odors on clothing or from being in a room that still smells of
tobacco smoke?
There are no medical research reports on the cancer-causing
effects of cigarette odors, but research does show that secondhand
smoke can seep into hair, clothing, and other surfaces. Some
researchers call this "thirdhand" smoke. This refers to the toxic
particles that are left in the air after you can no longer see the
smoke. Though unknown, the cancer-causing effects would likely be very
small compared with direct secondhand smoke exposure, such as living in
a household that has a smoker. But this is an active area of tobacco
research.
For more information, see our document called Secondhand Smoke.
What is being done to protect people from
the hazards of smoking?
Tobacco labels
Both the public and private sectors have acted to help
decrease smoking-related deaths and illnesses in this country. Since
1966, the US Surgeon General's health warnings have been required on
all cigarette packages and, since 1987, on all spit or oral tobacco
products. Since 2001, the 7 major cigar manufacturers in the United
States have provided 5 health warnings that rotate on cigar labels.
These labels are much like those on cigarette packages.
Advertising
Congress banned cigarette advertising on TV and radio in 1971
and spit tobacco advertising in 1987. The American Legacy Foundation
and many states have made anti-smoking public service messages that are
featured on television, radio, and billboards. Some tobacco companies
have come up with their own ads, which appear to be anti-smoking but
seem to actually promote a more favorable attitude toward the tobacco
industry.
New laws will affect tobacco marketing
The Family Smoking Prevention and Tobacco Control Act went
into effect in October 2009. This law gives the Food and Drug
Administration (FDA) power to regulate tobacco products in the US. One
of the goals of the law is to restrict the marketing and advertising of
tobacco products. Colorful ads and store displays will no longer be
permitted. Only black and white text ads will be allowed. And starting
in 2010, it will be illegal to place outdoor tobacco ads within 1,000
feet of schools and playgrounds.
Taxes
Taxes on cigarettes have risen in many states in recent years.
They have been shown to discourage young people from starting to smoke
and to encourage smokers to quit. As of late 2009, the federal
cigarette tax is $1.01 per pack. State taxes on tobacco vary from as
low as 7 cents (in South Carolina) to up to $3.46 a pack (in Rhode
Island).
Smoking bans
Laws in all 50 states and the District of Columbia restrict or
do not allow smoking in certain public places. These laws range from
simple restrictions, such as designated areas in government buildings,
to laws that ban smoking in all public places and workplaces. Federal
buildings controlled by the executive branch, including the White
House, are smoke-free. Congressional offices and courthouses are not
required to be smoke-free by this federal ban, but many are smoke-free
for other reasons. A number of other federal agencies also require
smoke-free buildings. Smoking is also banned on all domestic airplane
flights.
According to the US Surgeon General, smoke-free policies that
ban smoking in all indoor areas are the only way to be sure that people
are not exposed to secondhand smoke in workplaces and other public
places.
Are
spit tobacco and snuff safe alternatives to cigarette smoking?
Many terms are used to describe tobacco that is put in the
mouth, such as spit, oral, smokeless, chewing, and snuff tobacco. Using
any kind of spit or smokeless tobacco is a major health risk. It is
less lethal than smoking cigarettes, but less lethal is a far cry from
safe.
The amount of nicotine absorbed is usually more than the
amount delivered by a cigarette. Overall, people who dip or chew get
about the same amount of nicotine as regular smokers. The most harmful
cancer-causing substances in spit tobacco are tobacco-specific
nitrosamines which have been found at levels 100 times higher than the
nitrosamines that are allowed in bacon, beer, and other foods. These
carcinogens cause lung cancer in lab animals, even when injected rather
than inhaled.
The juice from the smokeless tobacco is absorbed directly
through the lining of the mouth. This causes sores and white patches
(called leukoplakia)
that often lead to cancer of the mouth.
People who use spit and other types of smokeless tobacco
greatly increase their risk of other cancers including those of the
mouth, throat (pharynx), esophagus (the swallowing tube that connects
the mouth and the stomach), stomach, and pancreas. Other effects of
using spit tobacco include chronic bad breath, stained teeth and
fillings, gum disease, tooth decay, tooth loss, tooth abrasion, and
loss of bone in the jaw. Users may also have problems with high blood
pressure and may be at increased risk for heart disease.
To learn more, please read Smokeless Tobacco and How to Quit.
What is snus? Is it safe?
Snus (sounds like "snoose") is a type of moist snuff first
used in Sweden. It is often flavored with spices or fruit, and is
usually packaged in thin bags much like tea bags. It is also sold
loose, as a moist powder. Like snuff and other spit tobaccos, snus is
held between the gum and mouth tissues where the juice is absorbed into
the body.
Because it is heated during processing, Swedish snus has fewer
tobacco-specific nitrosamines that are known to cause cancer. (See the
previous section, "Are
spit tobacco and snuff safe alternatives to cigarette smoking?")
Snus users in Sweden have lower rates of some types of cancer than
Swedish smokers. Because of this, some people believe snus is "safe."
But snus users have a higher risk of cancer of the pancreas than
non-users. They also get sores or spots in the mouth (lesions) where
the snus is held. It appears that snus users may have mouth cancer more
often than non-users, though more studies need to be done to confirm
this.
Since US tobacco sellers are not required to list what is in
their products, it would be hard to know how the US versions of snus
might compare to the Swedish versions without doing studies here. Since
snus is still new in the US, it is uncertain what other problems it
might cause. Still, snus is not a safe alternative to smoking.
What are the health risks of smoking pipes
or cigars?
Many people view cigar smoking as more civilized and
sophisticated, as well as less dangerous than cigarette smoking. Yet
one large cigar can contain as much tobacco as an entire pack of
cigarettes.
Most of the same cancer-causing substances found in cigarettes
are found in cigars. And most cigars have as much nicotine as several
cigarettes. When cigar smokers inhale, nicotine is absorbed as quickly
as it is with cigarettes. For those who do not inhale, it is absorbed
more slowly through the lining of the mouth. Both inhaled and
non-inhaled nicotine are highly addictive.
Smoking cigars causes cancers of the lung, lip, tongue, mouth,
throat (oral cavity), voice box (larynx), esophagus (swallowing tube),
and probably cancers of the bladder and pancreas. Cigar smokers have a
greater risk of dying from cancer of the mouth, larynx, or esophagus
than non-smokers. The risk of death from lung cancer is not as high as
it is for cigarette smokers, but is still many times higher than the
risk for non-smokers.
Cigar smokers who inhale deeply and smoke several cigars a day
are also at increased risk for heart disease and chronic lung disease.
Pipe smokers have an increased risk of dying from cancers of
the lung, throat, esophagus, larynx, pancreas, and colon and rectum.
They also have an increased risk of dying of heart disease, stroke, and
chronic lung disease. The level of these risks seems to be about the
same as that for cigar smokers.
Smoking cigars or pipes is not a safe alternative to smoking
cigarettes.
To learn more, please see our document called Cigar Smoking.
What about more exotic forms of smoking
tobacco, such as clove cigarettes, bidis, and hookahs?
Many forms of flavored tobacco have become popular in recent
years, especially among younger people. Clove cigarettes (called kreteks), bidis,
and hookahs often appeal to those who want something a little
different. They also give young people another way to experiment with
tobacco. The false image of these products as clean, natural, and safer
than regular cigarettes seems to attract some young people who may
otherwise not start smoking. But these products carry many of the same
risks of cigarettes and other tobacco products, and each has its own
additional problems linked to it.
As of October 2009, new federal laws have banned flavored
cigarettes.It is not illegal to have or smoke them, but it is illegal
to sell them in the US. Tobacco companies are already working around
this by making flavored small cigars as a replacement product.
Clove cigarettes
Clove cigarettes, also called kreteks, are
imported mainly from Indonesia. They contain 60% to 70% tobacco and 30%
to 40% ground cloves, clove oil, and other additives. The chemicals in
cloves have been linked to asthma and other lung diseases.
Users often have the mistaken notion that smoking clove
cigarettes is a safe alternative to smoking tobacco. But this is a
tobacco product with the same health risks as cigarettes. In fact,
kreteks have been shown to deliver more nicotine, carbon monoxide, and
tar than regular cigarettes.
Bidis
Bidis or "beedies" are flavored cigarettes imported mainly
from India. They are hand-rolled in an unprocessed tobacco leaf and
tied with colorful strings on the ends. Their popularity has grown in
recent years in part because they come in many candy-like flavors
(strawberry, vanilla, licorice, and grape), and because they tend to
cost less than regular cigarettes. They often give the smoker a quick
buzz.
Even though bidis contain less tobacco than regular
cigarettes, they deliver higher levels of nicotine (the addictive
chemical in tobacco) and other harmful substances, such as tar,
ammonia, and carbon monoxide. Because they are thinner than regular
cigarettes, they require about 3 times as many puffs per cigarette.
They are also unfiltered.
Bidis seem to have all of the same health risks of regular
cigarettes, if not more. Bidi smokers have much higher risks of heart
attacks, chronic bronchitis, and some cancers than non-smokers.
Hookah (water pipes)
Hookah (or narghile) smoking started in the Middle East. Users
burn flavored tobacco (called shisha)
in a water pipe and inhale the smoke through a long hose. It has
recently become popular among young people, especially around college
campuses. Hookah smoking is usually a social event that allows the
smokers to spend time together and talk as they pass the pipe around.
It is marketed as being a safe alternative to cigarettes because the
percentage of tobacco in the product smoked is low and people think the
water filters out the toxins. These safety claims are false. The water
does not filter out many of the toxins. In fact, hookah smoke contains
more toxins such as nicotine, carbon monoxide, tar, and other hazardous
substances, than cigarette smoke. Several types of cancer have been
linked to hookah smoking. Hookah use is also linked to other unique
risks not linked with cigarette smoking. For example, infectious
diseases can be spread by sharing the pipe or through the way the
tobacco is prepared.
All forms of tobacco are dangerous. Even if the health risks
were smaller for some tobacco products as opposed to others, all
tobacco products contain nicotine, which can lead to increased use and
addiction. Do not think tobacco is safe in any amount or form.
What can I do to help with any damage that
may have been caused by smoking?
If you have used tobacco in any form, now or in the past, tell
your health care provider so he or she can be sure that you get the
right preventive health care. It is well known that tobacco use puts
you at risk for certain health-related illnesses. This means part of
your health care should focus on related screening and preventive
measures to help you stay as healthy as possible. For example, you will
want to be sure that you regularly check the inside of your mouth for
any changes, and have an oral exam by your doctor or dentist if you
find any changes or problems. The American Cancer Society recommends
that periodic check-ups include mouth (oral cavity) exams. By doing
this tobacco users may be able to find oral changes and leukoplakia
(white patches on the mouth membranes) early. This may help prevent
oral cancer.
You should also be aware of any of the following:
- Any change in a cough (for example, you cough up more mucus
than usual)
- A new cough
- Coughing up blood
- Hoarseness
- Trouble breathing
- Wheezing
- Headaches
- Chest pain
- Loss of appetite
- Weight loss
- General fatigue (feeling tired all the time)
- Frequent or repeated respiratory infections
Any of these could be signs of lung cancer or a number of
other lung conditions and you should see a doctor right away. Although
these can be signs of a problem, many people do not notice symptoms of
lung cancers until they are advanced and the cancer has spread to other
parts of the body.
Remember that tobacco users have an increased risk for other
cancers too, depending on the way they use tobacco. You can learn more
about the types of cancer you may be at risk for by reading our
document that discusses the type of tobacco you use (for example, Cigar Smoking).
Other risk factors for these cancers may be more important than your
use of tobacco, but you should know the additional risks that might
apply to you.
If you are concerned about your health because of your tobacco
use, see your health care provider as soon as possible. Taking care of
yourself and getting treatment for small problems will give you the
best chance for treatment success. The best way, though, to take care
of yourself and decrease your risk for life-threatening lung problems
is to quit using tobacco.
How does tobacco use affect the economy?
The tobacco industry is one of the most profitable businesses
in the country, making billions of dollars every year. But the costs of
smoking are far higher than the income from cigarette sales.
- Smoking causes more than $196 billion each year in
health-related costs, including the cost of lost productivity caused by
deaths from smoking.
- Smoking-related medical costs averaged more than $100
billion each year between 2000 and 2004. This translates to $2,247 in
extra medical expenses for each adult smoker per year as of 2004.
- Death-related productivity losses from smoking among
workers cost the US economy almost $97 billion yearly (average for
2000-2004).
- For each pack of cigarettes sold or given away in 2004,
$5.50 was spent on medical care caused by smoking, and $5.32 lost in
productivity, for a total cost to society of $10.82 per pack.
Can quitting really help a lifelong smoker?
Yes. It is never too late to quit using tobacco. The sooner
smokers quit, the more they can reduce their chances of getting cancer
and other diseases. Within minutes of smoking the last cigarette, the
body begins to restore itself.
20 minutes after
quitting
Your heart rate and blood pressure drop.
(Effect of smoking on arterial stiffness and pulse pressure
amplification, Mahmud A, Feely J. 2003. Hypertension:41:183.)
12 hours after
quitting
The carbon monoxide level in your blood drops to normal.
(US Surgeon General's
Report, 1988, p. 202)
2 weeks to 3
months after quitting
Your circulation improves and your lung function increases.
(US Surgeon General's
Report, 1990, pp.193, 194,196, 285, 323)
1 to 9 months
after quitting
Coughing and shortness of breath decrease; cilia (tiny hair-like
structures that move mucus out of the lungs) regain normal function in
the lungs, increasing the ability to handle mucus, clean the lungs, and
reduce the risk of infection.
(US Surgeon General's
Report, 1990, pp. 285-287, 304)
1 year after
quitting
The excess risk of coronary heart disease is half that of a smoker's.
(US Surgeon General's
Report, 1990, p. vi)
5 years after
quitting
Your stroke risk is reduced to that of a non-smoker 5 to 15 years after
quitting.
(US Surgeon General's
Report, 1990, p. vi)
10 years after
quitting
The lung cancer death rate is about half that of a person who is still
smoking. The risk of cancer of the mouth, throat, esophagus, bladder,
cervix, and pancreas decreases.
(US Surgeon General's
Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)
15 years after
quitting
The risk of coronary heart disease is that of a non-smoker's.
(US Surgeon General's
Report, 1990, p. vi)
Are there some benefits of quitting that
I'll notice right away?
Kicking the tobacco habit offers some rewards that you'll
notice right away and some that will show up more slowly over time.
These benefits can improve your day-to-day life a lot.
- Food will taste better.
- Your sense of smell returns to normal.
- Your breath, hair, and clothes smell better.
- Your teeth and fingernails stop yellowing.
- Ordinary activities leave you less out of breath (for
example, climbing a flight of stairs or doing light housework).
Quitting also helps stop the damaging effects of tobacco on
how you look, including premature wrinkling of your skin and gum
disease.
Suppose I smoke for a while and then quit?
Smoking begins to cause damage right away and is highly
addictive. Some studies have found nicotine to be as addictive as
heroin, cocaine, or alcohol. It’s the most common form of
drug addiction in the United States. It’s much better to
never start smoking cigarettes -- and become addicted to nicotine --
than it is to smoke with the plan to quit later. Like alcohol, heroin,
and cocaine, nicotine creates a tolerance in the body and promotes
psychological dependence. This makes it much harder to quit, but with
the right support it can be done.
When an ex-smoker smokes a cigarette, even years after
quitting, the body reacts the same way it did when the person was
smoking, which can cause the person to want to smoke again. Don't think
you can smoke for a short while and quit when you want to; it's seldom
that easy.
How do people quit smoking?
Quitting smoking is not easy, and some people try many times
before they are able to quit for good. There are many ways to quit
smoking. For example, some have been able to stop "cold turkey," by
taking part in the Great American Smokeout®,
or by using other
methods.
There's no single best way to quit. Quitting for good may mean
using many methods, including step-by-step manuals, self-help classes,
counseling, toll-free telephone-based counseling programs, and/or using
nicotine replacement therapies or other medicines (see the next
questions). Smokers may also need to make changes in their daily
routine to help them break their smoking habits. Some may find
long-term support such as Nicotine Anonymous helpful. To improve your
chances of success, try to use 2 or more of these methods to help you
quit.
What are nicotine replacement therapies?
Nicotine replacement therapies (NRTs) are medicines that help
decrease or stop a smoker's withdrawal symptoms by giving controlled
doses of nicotine without the other harmful chemicals of cigarette
smoke. NRTs are sold as patches, gums, inhalers, nasal sprays, or
lozenges. The Food and Drug Administration (FDA) has approved all of
these products to help people quit smoking. Patches, gums, and lozenges
are available over the counter, but you need a prescription for
inhalers and nasal sprays.
These products work by helping smokers control their physical
responses as they quit. For best results, smokers should use NRTs along
with behavioral change programs that are designed to help smokers break
their psychological (mental) dependence on cigarettes. For more
information on such programs, call the American Cancer Society at
1-800-227-2345.
Not everyone can use nicotine replacement therapy. People with
certain medical conditions and pregnant women should use it only with a
doctor's supervision. It is always a good idea to get your doctor's
input and support when you decide to quit smoking.
The best time to start NRT is when you begin to try to quit.
Many smokers ask if it is possible to start using nicotine replacement
while they are still smoking. There is some research on smokers using
NRT while still smoking, but the results are still not clear enough to
say for certain if this might pose a danger to your health. The most
important thing is to make sure that you are not overdosing on
nicotine, which can affect your heart and blood circulation. It is
safest to be under a doctor's care if you wish to try smoking and using
NRT while you are tapering off cigarette smoking.
For more information, see our Guide to Quitting Smoking.
Are there other medicines or vaccines to
help smokers quit?
Yes. Some medicines that don't have nicotine have already been
approved to help quit smoking.
Bupropion (Wellbutrin®) was
first used as an
anti-depressant, and later approved by the FDA to help people quit
smoking (under the brand name Zyban®).
This medicine does not
contain nicotine and you need a prescription for it. It affects
chemicals in the brain that are related to nicotine craving. It can be
used alone or together with nicotine replacement. Unlike nicotine
replacement, you start taking it 1 or 2 weeks before you stop smoking.
Newer medicines may help smokers (or former smokers) by
stopping them from getting physical pleasure from smoking. The
medicines seem to work by stopping nicotine from stimulating the brain,
either by blocking the brain receptors that nicotine normally attaches
to, or by keeping nicotine from reaching the brain altogether (as in
the case of the vaccines).
One such medicine, varenicline (Chantix®),
is
FDA-approved for help with quitting. Varenicline is a pill taken twice
a day, starting at least a week before your quit date. Once in the
body, it attaches to nicotine receptors in the brain, reducing the
pleasurable effects of smoking and helping to reduce nicotine
withdrawal symptoms. Many studies have shown varenicline can more than
double the chances of quitting smoking. Since varenicline is a newer
drug, research has not been done yet to find out if it is safe to use
along with nicotine replacement products. But the company that makes
varenicline noted that people who used the drug along with NRT had more
side effects such as nausea and headaches.
For people who have not been able to quit smoking using NRT,
bupropion, or varenicline, or who can't use these drugs, some doctors
prescribe older medicines that have been approved by the FDA for uses
other than quitting smoking. For instance, nortriptyline is a drug used
to treat depression and clonidine is used to treat high blood pressure.
Both of these drugs have restrictions on who can safely use them. And
people taking them need medical monitoring because of rare but serious
side effects. But studies have shown that they can make it easier for
some people to quit smoking, even though they have not been approved by
the FDA for that purpose.
Other medicines still being studied include rimonabant, which
is also a pill, and vaccines that are given as a series of shots. Early
tests of these new treatments have been promising. They seem to be
safe, and may help some smokers quit or stay quit. But larger studies
are needed to show these treatments are effective before the FDA can
approve them for use. Many large studies of these treatments are now
under way. If they are shown to work, one or more of these drugs could
be approved within the next few years.
It is not likely that any one of these drugs will work in
every person. That is why using different quitting aids at the same
time is still the best way to increase your chances of success. For
more information on quitting and medicines that can be used, see our
Guide to Quitting Smoking.
Where can I go for help?
It is hard to stop smoking, but you can do it! More than 47
million Americans have quit smoking for good, and now there are more
former smokers than current smokers in the US. Many organizations offer
information, counseling, and other services on how to quit, as well as
information on where to go for help. Other good resources for finding
help include your doctor, dentist, local hospital, or employer.
If you want to quit smoking and need help,
contact one of the following organizations:
American Cancer
Society
Toll-free number: 1-800-227-2345
Web site: www.cancer.org
American Heart
Association
Toll-free number: 1-800-AHA-USA-1 (1-800-242-8721)
Web site: www.americanheart.org
American Lung
Association
Toll-free number: 1-800-LUNG-USA (1-800-586-4872)
Web site: www.lungusa.org
Tobacco cessation program "Freedom from Smoking Online" at
www.ffsonline.org
National Cancer
Institute
Cancer Information Service
Toll-free number: 1-800-4-CANCER (1-800-422-6237) for cancer
information
Toll-free smoking cessation/tobacco line: 1-877-448-7848
Web site: www.cancer.gov
Smoking cessation Web site: www.smokefree.gov
Nicotine
Anonymous
Toll-free number: 1-877-879-6422
Web site: www.nicotine-anonymous.org
Centers for
Disease Control and Prevention
Toll-free number: 1-800-CDC-INFO (1-800-232-4636)
Web site: www.cdc.gov
Tobacco information at www.cdc.gov/tobacco/quit_smoking/index.htm
Additional resources
More information from your American Cancer
Society
The following information may also be helpful to you. These
materials may be ordered from our toll-free number.
No matter who you are, we can help. Contact us anytime, day or
night, for information and support. Call us at 1-800-227-2345 or
visit
www.cancer.org.
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Last Medical Review: 12/28/2009
Last Revised: 12/28/2009
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