Tobacco

Overview

Tobacco use is the leading cause of premature, preventable death in the United States. Tobacco use causes premature deaths from cancer, heart disease, stroke, lung disease, and other diseases.

As defined by the U.S. Tobacco Control Act, "tobacco product" refers to commercial products made or derived from the tobacco plant or containing nicotine from any source. Tobacco products include cigarettes, cigars, cigarillos, little filtered cigars, pipes, hookahs, nicotine vaping devices, heated tobacco products, smokeless tobacco, and oral nicotine pouches. Tobacco products deliver nicotine, an addictive drug that can lead to nicotine addiction and tobacco use disorder. Nicotine addiction is one of the main reasons so many people who use tobacco products find it difficult to quit. 

Related Terms:

• Cigarettes: combustible cigarettes, menthol cigarettes
• Smokeless tobacco: chewing tobacco, oral tobacco, spit tobacco, dip, chew, snuff, snus
• Vaping devices: e-cigarettes, electronic cigarettes, vaping devices, e-cigs, Electronic Nicotine Delivery Systems (ENDS), e-liquid, e-juice
• Other tobacco products: cigars, cigarillos, little filtered cigars, pipes, hookahs, waterpipes, bidis, kreteks

Harmful Chemicals in Tobacco Products

All tobacco products contain harmful chemicals that cause disease. More than 7,000 chemicals have been identified in cigarette smoke, and at least 69 of these chemicals are known to cause cancer. Cigar smoke also contains carcinogens and is possibly more toxic than cigarette smoke. For every gram of tobacco smoked, there is more cancer-causing tar in cigars than in cigarettes. Even if cigar smoke is not inhaled, high levels of nicotine can still be absorbed into the body. A single cigar can potentially provide as much nicotine as a pack of cigarettes. Using nicotine vaping products exposes the person to harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents.

Though scientists are still learning about the long-term effects of nicotine vaping on health, there are short-term health effects, such as nicotine addiction and adverse respiratory symptoms.  Smokeless tobacco (e.g., snuff, dip and chew) is also harmful and contains at least 28 chemicals that have been found to cause cancer.

Health Effects of Tobacco Use

Nicotine Addiction and Tobacco Use Disorder

Nicotine is highly addictive and can make it very difficult for a person to quit using tobacco products once they start. Nicotine is a stimulant drug. After entering the blood (via the lungs or mouth), nicotine stimulates the release of adrenaline (also called epinephrine) in your body. Adrenaline stimulates the central nervous system and increases blood pressure, breathing, and heart rate.

As with most addictive substances, nicotine activates the brain's reward circuits and increases levels of a chemical messenger called dopamine, which reinforces rewarding behaviors. Nicotine's interaction with the reward circuit motivates some people to use nicotine repeatedly, despite risks to their health and well-being, a feature of nicotine addiction.

When a person tries to cut back or quit, the lack of nicotine causes withdrawal symptoms. These may include:

• Strong urges to use nicotine (cravings)
• Feeling irritable, restless, jumpy, and tired
• Trouble concentrating
• Feeling depressed or nervous
• Trouble sleeping
• Headaches

For most people, the worst symptoms last a few days to a few weeks. Most symptoms can go away in about four weeks. In some people, nicotine withdrawal can persist for months.

Cancer

Tobacco use, primarily smoking, is the leading preventable cause of cancer and of death from cancer. People who use tobacco products or who are regularly around secondhand smoke have an increased risk of cancer because tobacco products and secondhand smoke have many chemicals that damage DNA.

Cigarette smoking causes many types of cancer, including cancer of the lung, larynx (voice box), mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia. Cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking and secondhand smoke exposure causes most lung cancer deaths.

Using other tobacco products such as cigars or pipes also increases the risk for lung cancer. Cigar smoking causes cancer of the oral cavity, larynx, esophagus, lung, and pancreas. People who use smokeless tobacco have increased risks of cancers of the mouth, esophagus, and pancreas. 

Heart Disease and Stroke

The chemicals in tobacco smoke harm blood vessels and damage the heart. Tobacco smoke contributes to inflammation, which may cause more plaque buildup in the arteries. It also damages blood vessel walls, making them stiff and less elastic, which narrows the blood vessels. Smoking disturbs normal heart rhythms, increases in blood pressure and heart rate, lowers HDL ("good") cholesterol, raises LDL ("bad") cholesterol, and thickens the blood.

Smoking increases the risk of developing heart disease or having a stroke. Smoking is also a major risk factor for peripheral artery disease (PAD). Even one or two cigarettes smoked in a day can interfere with PAD treatments.

Lung Disease

Smoking is a leading cause of chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. People who smoke are also at higher risk of developing pneumonia, tuberculosis, and other airway infections.

Health Effects in Pregnancy and Infants

Smoking makes it harder for a woman to get pregnant. Smoking can lead to miscarriage, ectopic pregnancy, premature birth, low birth weight, and having a baby born with a cleft lip and/or cleft palate. Smoking during or after pregnancy also increases an infant's risk of death from sudden infant death syndrome (SIDS).

When a pregnant woman smokes, her fetus gets less oxygen, and nicotine may damage the brain and lungs of the fetus.

Other Health Effects of Tobacco Use

• Diabetes
• Dementia
• Osteoporosis
• Rheumatoid arthritis
• Age-related macular degeneration 
• Cataracts
• Inflammation and impaired immune function
• Erectile dysfunction

It can also cause:

• Yellow stains on teeth and fingers
• Gum disease and bad breath
• Early wrinkling of the skin
• Decreased sense of smell and taste

Secondhand Tobacco Smoke and Nicotine Vaping Aerosols

Exposure to secondhand tobacco smoke is harmful to health. Secondhand tobacco smoke is the combination of the smoke given off by a burning tobacco product and the smoke exhaled by a smoker. Children exposed to secondhand smoke are at increased risk of sudden infant death syndrome, ear infections, colds, pneumonia, and bronchitis. Secondhand smoke exposure can also increase the frequency and severity of asthma symptoms among children who have asthma. Being exposed to secondhand smoke slows the growth of children's lungs and can cause them to cough, wheeze, and feel breathless.

Exposure to secondhand smoke can be measured by testing indoor air for respirable suspended particles or individual chemicals such as nicotine. Exposure can also be evaluated by measuring the level of biomarkers such as cotinine - a byproduct of nicotine metabolism - in a nonsmoker's blood, saliva, or urine.

Nicotine vaping devices produce aerosols containing harmful and potentially harmful substances, including nicotine, heavy metals, volatile organic compounds, and cancer-causing agents. Bystanders are also exposed to the substances in the aerosol.

Preventing Harms of Secondhand Smoke and Nicotine Vaping Aerosols

The only way to fully protect nonsmokers from secondhand smoke and aerosols is to eliminate smoking and vaping in indoor workplaces and public places and by creating smokefree/aerosolfree policies for personal spaces, including multiunit residential housing. Opening windows, using fans and ventilation systems, and restricting smoking to certain rooms does not eliminate exposure to secondhand smoke and aerosols.

Steps you can take to protect yourself and your family include:

• Not allowing smoking or vaping in your home
• Not allowing anyone to smoke or vape in your car, even with the windows down
• Making sure the places where your children are cared for are smoke, aerosol and tobacco free
• Teaching children to avoid secondhand smoke and aerosols
• Seeking out restaurants, bars, and other places that are smokefree and aerosol-free

Federal law prohibits smoking and vaping on airline flights, interstate buses, and most trains. Smoking and vaping are also prohibited in most federal buildings. Many state and local governments have enacted laws prohibiting smoking and vaping in workplaces and public places, including restaurants, bars, schools, hospitals, airports, bus terminals, parks, and beaches.

Youth Tobacco Use

Nicotine is highly addictive and exposure is very harmful to young people. Young people who use tobacco products in any form are uniquely at risk for adverse effects. Nicotine poses unique dangers to youth because their brains are still developing. Brain development continues until about age 25. Using nicotine during adolescence can harm parts of the brain that control attention, learning, mood and impulse control. Adolescents who use nicotine may also be at increased risk for future addiction to other drugs. 

Youth use many different types of tobacco products. Nicotine vaping devices are the most used tobacco product by youth and young adults.

Policies can protect youth. Under U.S. Food and Drug Administration (FDA) regulations, minors can no longer buy tobacco products in stores or online. In December 2019, the federal government updated the age of sale of tobacco products from 18 to 21 years. It is illegal in all states to sell cigarettes and other tobacco products to people younger than age 21. 

Youth Nicotine Vaping

Nicotine vaping devices, such as e-cigarettes, are battery-operated devices that people use to inhale an aerosol that typically contains nicotine, flavorings, and other chemicals. 

The easy availability of vaping devices, alluring advertisements, various e-liquid flavors, and the belief that they are safer than cigarettes have helped make them appealing to teens. Vaping devices are easy to hide from teachers and parents because they do not leave behind the smell of tobacco cigarettes and often look like flash drives and everyday objects like small, rectangular earbud holders. Some research shows that some teens do not even realize that vaping cartridges contain nicotine and assume the pods contain only flavoring. Evidence suggests that vaping nicotine might serve as an introductory tobacco product for adolescents who then go on to use other tobacco products, including cigarettes, which are known to cause disease and premature death.

How and Why to Quit Tobacco Use

Health Benefits of Quitting Smoking 

Quitting smoking has health benefits at any age, no matter how long or how much you’ve smoked. Quitting smoking reduces the risk of cancer and many other diseases, such as heart disease and COPD. It is never too late to quit and the immediate and long-term health benefits of quitting are substantial:

• Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal.
• Within a few hours, the level of carbon monoxide in the blood begins to decline.
• Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as often.
• Within several months of quitting, people can expect substantial improvements in lung function.
• Within a few years of quitting, people will have lower risks of cancer, heart disease, and other chronic diseases than if they continued to smoke.

People who quit smoking before age 40 reduce their chance of dying prematurely from smoking-related diseases by about 90%, and those who quit by ages 45-54 reduce their chance by about two-thirds. Those who quit between ages 25 and 34 live about 10 years longer; those who quit between ages 35 and 44 live about nine years longer; those who quit between ages 45 and 54 live about six years longer; and those who quit between ages 55 and 64 live about four years longer.

Quitting smoking improves the prognosis of people with cancer. For people with some cancers, quitting smoking at the time of diagnosis may reduce the risk of dying by 30-40%. Quitting also helps improve the body's ability to heal and respond to therapy and lowers the risk of pneumonia and respiratory failure.

For people with chronic obstructive pulmonary disease, quitting smoking slows the progression of the disease. Patients who quit smoking see a reduction in symptoms within three months of being smokefree.

Other Benefits of Quitting Smoking

Remind yourself of the benefits of quitting that extend beyond your health:

• More money saved
• Clothes, hair, breath, and home will smell better
• Yellow stains on teeth and fingers will fade
• More energy
• Setting a good example for children and family
• Making your home smokefree protects your family from secondhand smoke.

Preparing to Quit

Setting a quit date and planning improves your chances of success. Helpful preparation steps include:

• Writing down your reasons for quitting and your triggers
• Planning how you will respond to urges to smoke
• Talking to your healthcare provider about using a nicotine patch or other medicines
• Not letting people smoke in your home
• Reviewing past attempts to quit and thinking about what worked and what didn’t
• Once you quit, not smoking - not even a puff - as one cigarette can cause you to start smoking again

Managing Urges

You can take several steps to manage urges to smoke:

• Distract yourself: Talk to someone, go for a walk, or get busy with a task.
• Change your routine.
• Keep your hands busy with arts and crafts, gardening, or a project around the house.
• Drink water when you feel the urge to smoke.
• Try deep breathing: Take a slow, deep breath in, hold it to a count of five, and release it.
• Reduce stress by listening to music, doing yoga, or connecting with supportive people in your life. 
• Avoid alcohol and caffeine, as they can trigger nicotine cravings and make quitting more difficult.

Quit Smoking Counseling 

Quit smoking counseling is proven to increase the chances of quitting successfully. Counseling can help you make a plan to quit and teach you strategies to help you get through the tough moments. People who have even a short counseling session with a healthcare professional are more likely to quit smoking. The Lung Health Study found that people who smoke heavily who received counseling from a doctor, took part in group sessions with other people who smoke, and used nicotine gum were more likely to quit smoking and had a lower risk of lung cancer, other cancers, heart disease, and respiratory disease. The more counseling a person receives, the better their chances of quitting. 

Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) is approved by the U.S. FDA to help adults quit smoking cigarettes. NRT delivers measured doses of nicotine into the body, which helps relieve cravings and withdrawal symptoms. Strong and consistent evidence shows that NRT can help people quit smoking cigarettes. NRT comes in several different forms:

• Nicotine gum
• Nicotine patches
• Nicotine nasal spray
• Nicotine inhalers
• Nicotine lozenges

Women who are pregnant or breastfeeding and people under the age of 18 should talk with a doctor before using NRT.

Non-Nicotine Medicines for Quitting Smoking

Other medicines that do not contain nicotine are used to help people quit smoking. The U.S. FDA has approved bupropion (also called Zyban) and varenicline for use by adults to help them quit smoking. These medicines reduce nicotine craving and withdrawal symptoms. Strong and consistent evidence shows that these medicines can help people quit smoking cigarettes successfully. Before starting either medicine, talk to your doctor about the important health benefits of quitting smoking and the possible side effects of these medicines.

Handling Return to Use

If you have a lapse back to smoking after you've quit, try not to get discouraged and give up. Ask yourself what caused you to do it and make a plan to avoid or handle that situation in the future. Most people who smoke need a few tries to quit before finally being successful.

Quitting Nicotine Vaping

Scientists are studying the best ways to help people quit nicotine vaping. Quitting vaping is likely similar to quitting smoking because both involve nicotine addiction and quitting may lead to nicotine withdrawal symptoms. Many of the same proven strategies used to quit smoking can be used to help people to quit vaping. 

About Nicotine Vaping and Quitting Smoking

Nicotine vaping devices are not approved by the U.S. FDA as a safe or effective quit smoking aid. If you are using nicotine vaping devices to help you quit smoking, it is important to also make a plan to quit vaping. Use of any tobacco product, including nicotine vaping devices, carries health risks. Using nicotine vaping devices and cigarettes together may result in greater exposure to toxins and worse respiratory health outcomes than using either product alone. Quitting the use of all tobacco products is the best way to protect your health.

There are many proven treatments to help people quit smoking, including counseling and FDA-approved quit smoking medications. 

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on tobacco products.

Find Treatment

Find treatment for substance use disorders at FindTreatment.gov or call 1-800-662-HELP (4357), or TTY: 1-800-487-4889.

Community Support

Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

Here are some additional resources:

• Smokefree.gov provides access to free information and resources, including a Create My Quit Plan tool, smartphone apps, and text message programs.
• The Virtual Office of the Surgeon General provides guidelines to quit smoking.
• Guide to Reducing Vaping Among Youth and Young Adults
• Know the Risks: E-cigarettes and Young People is based on the U.S. Surgeon General’s Report on e-cigarette use among youth and young adults. It includes a parent tip sheet, healthcare provider conversation card, and FAQs.
• Safety Reporting Portal is available to report adverse effects of vaping products.
• Resources from the U.S. Centers for Disease Control and Prevention (CDC)
  • Information on vaping and lung disease.
  • Tips From Former Smokers campaign with real stories from people affected by smoking
• The U.S. Environmental Protection Agency (EPA) has information on the health risks of secondhand smoke and aerosols.

Talking to someone can help:

• National Cancer Institute (NCI) Resources:
  • Call the NCI Smoking Quitline: 1-877-44U-QUIT (1-877-448-7848) for individualized counseling, printed information, and referrals to other sources
  • NCI LiveHelp online chat is a confidential online text chat with an NCI smoking cessation counselor, Monday through Friday, 9:00 a.m. to 9:00 p.m. E.T. LiveHelp also is available in Spanish.
• State quit lines: Call1-800-QUIT-NOW (1-800-784-8669) to be connected directly to your state’s quitline. For support in Spanish, call 1-855-DÉJELO-YA. Hours of operation and services vary from state to state. 
• SAMHSA treatment help: 1-800-662-HELP (4357)

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

Many institutes of the NIH support research to better understand tobacco use and its adverse health effects. Here are a few examples of NIH-supported research efforts: 

• The Population Assessment of Tobacco and Health Study (PATH) is a national longitudinal study of tobacco use and how it affects the health of people in the United States, led by NIH and the FDA.
• The Tobacco Regulatory Science Program (TRSP) is an NIH/FDA collaboration.
• NIH supports research on understanding the determinants of tobacco use and targets for prevention of tobacco products.
• NIH supports research on novel approaches for smoking cessation.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.