Smoking and Tobacco Use

Last Updated 07/28/2021

About smoking and tobacco use

Tobacco smoke contains over 4,000 chemicals, 69 of which are known carcinogens, many more are known toxins. These chemicals are absorbed in the lungs and via the blood travel to virtually every organ, every tissue, and every cell in the human body. Tobacco can affect any part of the body but primarily and most directly affects the lungs and heart.

The four major areas of tobacco’s health effects on the human body involve cancers (and not just lung cancer), non-cancerous respiratory (lung) diseases, diseases of the heart and blood vessels and miscellaneous other effects. Under this miscellaneous category, smoking affects parts of the body not commonly thought of including hearing loss, erectile dysfunction, premature wrinkling of the skin, earlier menopause and more menstrual difficulties, and sleep/ wake abnormalities, to name just a few.

Key facts about tobacco
  • Tobacco use leads to disease and disability and harms nearly every organ and every cell of the body.
  • Tobacco remains the leading cause of preventable disease, disability, and death in the United States.
  • In 2019, 14.0% of all adults (34.1 million people) currently smoked cigarettes: 15.3% of men, 12.7% of women.
  • Each day, about 1,600 youth try their first cigarette.
  • Most adult cigarette smokers want to quit smoking.
  • In 2015, nearly 7 in 10 (68.0%) adult cigarette smokers wanted to stop smoking.
  • In 2018, more than half (55.1%) adult cigarette smokers had made a quit attempt in the past year.
  • In 2018, 7 out of every 100 (7.5%) people who tried to quit succeeded.

Smoking and cancer

While most people are aware that smoking causes lung cancer, most smokers do not know that tobacco increases the risk of a tremendous variety of cancers including colon, liver, cervix, brain, esophagus, throat, kidney and even penile cancer in men, to name just a few.

  • Smoking can cause cancer almost anywhere in your body:1,2
  • Bladder
  • Blood (acute myeloid leukemia)
  • Cervix
  • Colon and rectum (colorectal)
  • Esophagus
  • Kidney and ureter
  • Larynx
  • Liver
  • Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)
  • Pancreas
  • Stomach
  • Trachea, bronchus, and lungs
  • Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors.1
  • If nobody smoked, one of every three cancer deaths in the United States would not happen.1,2

Smoking and respiratory disease

Smoking affects the lungs in other ways in addition to causing lung cancer. Chronic obstructive pulmonary disease (COPD) is the single largest non-cancer lung disease caused by smoking and, of course, these risks are greater for fire fighters who are exposed to smoke and chemicals as a matter of routine and who must maintain normal lung function to do their job safely. COPD includes emphysema, chronic bronchitis, asthma (asthma is also referred to as reactive airways disease) and several less-common diseases. Further, many if not all lung diseases are made worse by tobacco smoke exposure.

  • Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs that deliver oxygen to your blood.1,2
  • Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis.1,2
  • Cigarette smoking causes most cases of lung cancer.1,2
  • tobacco smoke can trigger an asthma attack or make an attack worse.1,2
  • Smokers are 12 to 13 times (1200% to 1300%) more likely to die from COPD than nonsmokers.1

Smoking and cardiovascular disease

As dramatic as the effects of lung disease and cancer are, the greatest impact on morbidity (illness) and mortality  (death) is tobacco caused cardiovascular disease. This includes heart and blood vessel disease such as atherosclerosis (hardening of the arteries), myocardial ischemia (poor blood flow and low oxygen to the heart muscle), myocardial infarctions (heart attacks), hypertension (high blood pressure) and peripheral vascular disease (poor blood flow and low oxygen to the peripheral tissues such as the legs, feet, hands and fingers).

  • Smoking causes stroke and coronary heart disease, which are some of the leading causes of death in the United States.1,3
  • Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.1
  • Smoking damages blood vessels and can make them thicken and narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form in your blood.1,2
  • A stroke occurs when:
    • A clot blocks the blood flow to part of your brain;
    • A blood vessel in or around your brain bursts.1,2
  • Blockages caused by smoking can also reduce blood flow to your legs and skin.1,2

Smoking and other health risks

Smoking harms nearly every organ of the body and affects a person’s overall health.1,2

  • Smoking can make it harder for a woman to become pregnant. It can also affect your baby’s health before and after birth. Smoking increases risks for:1,2,4
    • Preterm (early or premature) delivery
    • Stillbirth (death of the baby before birth)
    • Low birth weight
    • Sudden infant death syndrome (known as SIDS or crib death)
    • Ectopic pregnancy (when a fertilized egg grows outside the uterus)
    • Orofacial clefts in infants
  • Smoking can also affect men’s sperm, which can reduce fertility and also increase risks for birth defects and miscarriage.2
  • Smoking can affect bone health.1,4

Women past childbearing years who smoke have weaker bones than women who never smoked. This is called osteopenia or osteoporosis.  They are also at greater risk for broken bones.

  • Smoking affects the health of your teeth and gums and can cause tooth loss.1
  • Smoking can increase your risk for cataracts (clouding of the eye’s lens that makes it hard for you to see). It can also cause age-related macular degeneration (AMD). AMD is damage to a small spot near the center of the retina, the part of the eye needed for central vision.1
  • Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers.1,2
  • Smoking causes general adverse effects on the body, including inflammation and decreased immune function.1
  • Smoking is a cause of rheumatoid arthritis.1

About smokeless tobacco

Smokeless tobacco includes products such as chewing (spit) tobacco, moist snuff, snus (a “spitless,” moist powder tobacco, often in a pouch), and other tobacco-containing products that are not smoked. Many people assume that smokeless tobacco is healthier than smoking cigarettes, but that is not the case. In fact, there are over 30 chemicals and carcinogens in smokeless tobacco that are known to cause cancer.

Tobacco guide

Smokeless Tobacco Facts


  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2017 Apr 20].
  2. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2017 Apr 20].
  3. Centers for Disease Control and Prevention. QuickStats: Number of Deaths from 10 Leading Causes—National Vital Statistics System, United States, 2010. Morbidity and Mortality Weekly Report 2013:62(08);155. [accessed 2017 Apr 20].
  4. U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 [accessed 2017 Apr 20].

About e-cigarettes

People may use e-cigarettes for many reasons. Studies show that many people try e-cigarettes as a quitting cigarettes aid.  Other users may be curious. They may also enjoy the flavor or the taste. Some people believe that e-cigarettes are less harmful than other tobacco products. e-Cigarettes are now the most commonly used tobacco products among young people. In 2014, more young people smoked e-cigarettes than traditional cigarettes.

e-Cigarettes are sometimes marketed as tools to help people quit smoking.  However, to date the evidence that e-cigarettes actually do help smokers quit is controversial. 

Key facts about e-cigarettes

Electronic cigarettes, or e-cigarettes, are products that enable users to breathe in, or smoke, vapor. The vapor contains nicotine, flavorings, and other substances. These products are commonly referred to as:

  • E-cigarettes
  • E-cigs
  • Cigalikes
  • E-hookahs
  • Mods
  • Vape pens
  • Vapes
  • Tank systems
  • Pods
  • Puff Bars

What is the debate about e-cigarettes?

E-cigarette vapor may be less toxic than cigarette smoking, but this is controversial too. However, e-cigarettes are not  approved by the US Food and Drug Administration (FDA) to help people quit smoking.  There is simply not enough evidence to prove that e-cigarettes can help people quit smoking. To date, no long-term safety studies of e-cigarette use have been completed.

How smoking e-cigarettes affects your body

e-Cigarette vapor is not harmless. It can contain harmful substances, including nicotine and cancer-causing chemicals. Being exposed to nicotine at a young age can cause addiction and can harm the growing brain. e-Cigarettes should not be used indoors or around children. Drinking e-cigarette liquids can cause sickness and possibly death.

Right now, researchers do not know the long-term health effects of smoking e-cigarettes. They also do not know what amounts are harmful. Health care providers recommend that people who use e-cigarettes set a date to quit. Smoking traditional cigarettes while vaping e-cigarettes can be even more harmful.  Smoking e-cigarettes, even at lower levels, increases health risks over time.

e-Cigarettes Q&A

Tobacco Addiction

First, it is important to realize that the addiction to tobacco is extremely powerful. Smoking is the fastest, most powerful way to deliver nicotine to the human brain. After a puff, nicotine reaches the brain in only seven seconds. There it affects the brain like a shotgun blast, changing the brain’s chemistry increasing the sensation of pleasure, altering mood, decreasing appetite, and enhancing performance. Other parts of the brain learn “that was really good, let’s do that again soon.” Studies show that for most people, tobacco addiction occurs after a remarkably few number of cigarettes.

Measuring your addiction

Karl Fagerström, a renowned Swedish tobacco addiction researcher over 20 years ago, designed a simple six question test to measure the severity of a smoker’s nicotine addiction. The Fagerström Test for Nicotine Dependence has also been adapted for smokeless oral tobacco as well.

Fagerström Test for Nicotine Dependence

How many cigarettes per day do you usually smoke?

0 – 10 or less
1 – 11 to 20
2 – 21 to 31
3 – 31 or more

How soon after you wake up do you smoke your first?

0 – Within 5 minutes
1 – 6 -30 minutes
2 – 30-60 minutes
3 – More than 61 minutes

Do you find it difficult to not smoke in no smoking areas?

1 – Yes
0 – No

Which cigarette would you most hate to give up?

1 –The first one
0 – Any other one

Do you smoke more frequently in the first hours waking up than during the rest of the day?

1 – Yes
0 – No

Do you smoke if you are ill?

1 – Yes
0 – No

Scoring: 0-1 very low, 2-3 low, 5-7 moderate, 7-8 high, 9-10 very high

There are other ways to determine how severe your level of nicotine addiction is.  For example, has a doctor told you that your health is being damaged by your smoking and yet, you continue to smoke? Do you have a heart or lung condition?

For most illnesses, smoking contributes to continued deteriorating health. If despite knowing this you continue to smoke, then your addiction is severe. These are additional signs that you a severely addicted to nicotine:

  • Do you wake at night and smoke?
  • Are you avoiding family members, friends or events because smoking is difficult or forbidden?
  • Does your workplace prohibit smoking and you are willing to risk termination by continuing to smoke?

Quitting tobacco use

While every smoker knows tobacco kills, most are not aware of new methods, new medications and the combinations of medications available to help smokers (and other tobacco users) quit. If you are a smoker, odds are you have tried multiple times to quit and chances are great that you wish you were successful. Some reports show that the average smoker makes between six to nine serious attempts until they enjoy success and that over 70% of all smokers, want to quit.

Indeed, if the negative effects of tobacco abstinence such as “missing not smoking” could be eliminated, the percentage of smokers wanting to quit would climb dramatically. Indeed, it is now possible to help smokers quit with virtually no pain and little, if any, discomfort.

Quitting and reduced risks
  • Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.2
  • Within 2 to 5 years after quitting smoking, your risk for stroke may reduce to about that of a nonsmoker’s.2
  • If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.2
  • Ten years after you quit smoking, your risk for dying from lung cancer drops by half.2

Benefits of stopping smoking

  • 20 minutes: Heart rate will begin to drop back toward a normal level.
  • 2 hours: Heart rate and blood pressure will be close to normal levels again. Circulation improves, and fingers and toes tips may start to feel warm. Nicotine withdrawal symptoms usually start about 2 hours after last cigarette (intense cravings, anxiety, tension, frustration, drowsiness or trouble sleeping, and/or increased appetite).
  • 12 hours: Carbon monoxide decreases to lower levels. The amount of oxygen increases to normal levels.
  • 24 hours: Risk for coronary artery disease begins to reduce. Risk for heart attack declines.
  • 48 hours: Your nerve endings begin to regrow, and your senses of smell and taste begin to return to normal—withdrawal symptoms peak.
  • 2-3 weeks: You can exercise with ease, and withdrawal symptoms start to subside.
  • 1-9 months: Cilia begin to repair and protect lungs from infections; coughing and shortness of breath will decrease, and withdrawal symptoms go away within 9 months.
  • 1 year: Risk for heart disease drops to half that of a smoker.
  • 5-15 years: Risk for stroke is same as nonsmoker
  • 10 years: Risk for dying from lung cancer and other types of cancer will drop to half that of a smoker.
  • 15 years: Risk for heart disease will be the same level as that of a nonsmoker.

Questions to ask your healthcare provider

The following are questions you can ask your provider about quitting:

  • What types of medicines can help me stop smoking?
  • What will help besides medications?
  • If I have tried to quit is the past, is it worth trying again? (Most smokers try several times before they successfully quit.)
  • Do all people gain weight when they stop smoking?
  • What can I do to maintain a healthy weight while trying to quit smoking?

Resources that can help you quit

Apps and games

Tobacco game on iphone

Kick the habit for good

Play “Smoke Out: Tobacco Pirates,” our interactive game, to help you quit.

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Most tobacco users know tobacco in any form is harmful to their health, but they may be overwhelmed at the thought of quitting. The good news is that there are new ways to help you kick the habit for good, including medications. The best part? You don’t even have to stop using tobacco to start on a doctor prescribed treatment.

If you’re thinking about quitting, you can always start on a medication and see how you do. Many tobacco users find that medication helps them cut down even before they are ready to quit. Even more so, many users say medications even increase their motivation to quit. It’s a win-win. You can find more information about quit-smoking products here.

U.S. Federal and State Programs

The National Network of Tobacco Cessation Quitlines is a state/federal partnership that provides tobacco users in every state with access to the tools and resources they need to quit smoking; ensuring the highest level of assistance to tobacco users who want to quit. The toll-free number 1-800 QUIT NOW (1-800-784-8669) serves as a single point of access to all state-based programs. Callers can also access additional, language-specific quitline services via 1-855-DÉJELO-YA for service in Spanish (1-855-335-3569), 1-800-838-8917 for service in Mandarin or Cantonese, 1-800-556-5564 for service in Korean, and 1-800-778-8440 for service in Vietnamese.

The federal government website,, is maintained by the Tobacco Control Research Branch of the National Cancer Institute (NCI) and provides choices that best fit the needs of tobacco users. The site provides assistance in the form of:

  • An online step-by-step cessation guide;
  • Local and state telephone quitlines;
  • NCI’s national telephone quitline and instant messaging service; and
  • Publications, which may be downloaded, printed, or ordered

Get the facts about tobacco: Myths BUSTED


I have smoked for 20 years and stopping now will not really help me.


No matter how long you have smoked cigarettes, everyone benefits regardless of their age. Within a year, your risk of heart attack is reduced and your lung function declines at a slower rate. If you quit smoking at the age of 30, 40, 50, or even 60, your life expectancy is increased by 10, 9, 6, and 3 years respectively.


Everyone who quits smoking gains significant amount of weight, and I am
not willing to add all those extra pounds.


About 10% of men and 13% of women gain significant weight. Talk to your doctor about ways to minimize weight gain while quitting.


I tried to quit and started smoking again. Therefore, I am unable to quit


Smoking is one of the hardest addictions to give up (even harder than street drugs). Most smokers fail the first time they try to quit; and lifetime nonsmokers try several times before they are finally successful.


My smoking is only hurting myself. I have the right to decide when and
where I smoke.


Secondhand smoke (also known as “ETS” or environmental tobacco smoke) is toxic. It increases risk of lung cancer by 20 to 30% and causes 34,000 premature deaths from heart disease and 8,000 deaths from stroke each year. It also increases your risk of bronchitis and lung infections and worsens the health of everyone around you.


I tried the nicotine patch and was unsuccessful, so it seems like I just cannot quit.


Chances of quitting are better when given two types of nicotine replacement therapies (one like the patch for baseline control and one like nicotine gum, spray, or lozenges for when you get the urge to smoke). There are several oral therapies to help you stop smoking, so talk to your doctor about what is best for you.


I tried to quit so many times and haven’t been able to quit. There is no point in doing it again.


It has long been said that the average smoker takes five to seven times attempts to quit. According to a
recent survey smokers can be expected to make over 30 quit attempts before they succeed! Don’t give up: It is worth the effort to keep on trying.


I am just a “social smoker.” I don’t have to worry about cigarettes
causing me problems


While light smoking may not have the same risk of developing lung cancer, social smokers’ risk of lung cancer is still three to five times greater than that in nonsmokers. A recent study demonstrated that social smokers’ risks of having high blood pressure and high cholesterol was the same as “regular smokers.” Both of these groups had higher risks of heart attack and stroke when compared with nonsmokers. Additionally, light smokers have an increased risk of pneumonia and other lung diseases and have a more difficult time recovering from a respiratory infection.


Smoking bans in public places do nothing to decrease smoking or health. All they accomplish is making smokers feel stigmatized.


Over the years, smoking bans have proven to reduce the frequency of individuals who smoke, how much they smoke, as well as various smoking related diseases in smokers AND nonsmokers. Several different countries have shown a reduction in cardiovascular and respiratory-related hospital admissions after public smoking bans were started.


I heard that Chantix (varenicline) causes people to commit suicide. I would rather die a “slow suicide” by continuing to smoke!


Symptoms of nicotine withdrawal include depression and anxiety, especially in those with a previous diagnosis of those illnesses. In 2009 the FDA placed a special “black box” warning on Chantix that suggested caution be used in prescribing this medicine in those with a history of depression. However, a more recent study did not show an increase in psychiatric events taking varenicline or a different smoking cessation pill compared with nicotine patches or placebo. The FDA removed the “black box” warning based on these results, but recommended that people trying to quit with varenicline be observed for
psychiatric symptoms and told to discontinue the medication if symptoms develop.


I only smoke filtered cigarettes. These are safer and less likely to cause disease.


Cigarettes are designed to appeal to different customers. In 2009, the FDA banned the use of “light” or “low-tar” cigarettes because they gave
smokers’ the idea that they were somehow less harmful, which is not true. There is no evidence that filters have any effect on the deadliness of smoking.
In fact, smoking light or filtered cigarettes encourages smokers to inhale more deeply. This is believed to develop lung cancer in the more distant parts of the lung, and is more difficult to treat.


Some of the medications to help with smoking cessation are worse than smoking! If the nicotine is bad for me, then why would I
want to put it into my body?


Nicotine itself is not known to be particularly bad for you. However, nicotine is the addictive part of the cigarette and what keeps you coming
back for more. The primary cause of health-related problems from cigarettes is the 43 known carcinogens and 400 other toxins. Nicotine replacement is recommended for at least 3 months, but even if you quit smoking and use nicotine replacement therapy for the rest of your life, your health will be better than if you continue to smoke.

Tobacco Mythbusters


Resources for Clinicians

The majority of smokers would like to stop smoking, and each year, about half try to quit permanently. Yet, only about 6% of smokers are able to quit in a given year.1 Most smokers will need to make multiple attempts before they are able to quit permanently, and they will need your guidance. Our toolkit helps you assess your patient’s readiness and willingness to change and begin treatment for tobacco addiction.

Please note that the medications and techniques described in the toolkit are effective for all tobacco products, including vaping with e-cigarettes, smokeless oral tobacco, heat-not-burn products, hookahs, cigars and pipes.

Clinician Interactive Toolkit

For the best experience, interact with the toolkit in landscape view.

Tobacco Dependence Treatment Toolkit

Download our patient education guide for further reference.


1. Centers for Disease Control and Prevention (CDC). Quitting smoking among adults—United States, 2001-2010. MMWR Morb Mortal Wkly Rep. 2011;60(44):1513-1519.

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