Smoking and Tobacco Use

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

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

Resources that can help you quit

Smoking Cessation Workbook

Quitting smoking is a process. Real-life solutions and habit changers, like the ones outlined in this workbook, will help you through that process even if you’re not ready to take that step today.

New Habit Helper

Building new habits means breaking with old ones. This interactive game app, “Smoke Out: Tobacco Pirates,” not only entertains but also helps you learn about breaking the tobacco habit.

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Tobacco game on iphone


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.

As you read more about the medications that are available to you, keep in mind that tobacco treatment specialists have used all of these medications in every possible combination safely and effectively. Tobacco users who have a specific target quit date or those that prefer a reduction to cessation treatment plan can use each one of these medications, individually or in combination. Again, you should discuss medications, combination of medications or treatment plan with your physician or healthcare provider.

  • Chantix® (Varenicline) or Champix® (outside the United States)

    Chantix® is the first new medication approved for the treatment of tobacco addiction in over 10 years and it was specifically designed to simultaneously bind and block the nicotine receptors in the human brain. Chantix® is a prescription medication and must be prescribed by a physician or other licensed health professional. The effect of this tablet medication is to release the same pleasure neurochemical that nicotine stimulates while also preventing nicotine from having the same positive reinforcing effect on the smoker’s brain.  It helps the tobacco user’s brain think it is still smoking.

    Simply stated, the smoker prescribed Chantix® does not get the same pleasure or “high” from their tobacco but also does not miss smoking as much. Research demonstrates that Chantix® allows the smoker to quit with greater ease. After 12 weeks of treatment, 44% of Chantix® users were tobacco free. As with all tobacco treatment medications, smokers who have difficulty establishing a quit date can focus on reducing their tobacco consumption without a specific planned quit date.

    Approved by the FDA in 2006, there have been over 24 million Chantix® users worldwide. The most common side-effects are nausea, abdominal gas, constipation, insomnia and vivid dreams. Rare instances of depression have been reported. Many clinicians believe that this depression is most commonly due to nicotine withdrawal rather than Chantix® use but (uncommonly) it may be drug related. As we discussed previously, no medication is right for everyone. As always, discuss this and all medications with your physician. Your doctor or health care professional should be an integral part of your tobacco treatment plan.

  • Bupropion (Wellbutrin®, Zyban®)

    In 1997, Bupropion, an antidepressant, was the first non-nicotine medication approved for the treatment of tobacco addiction. Years before, Dr. Linda Ferry observed at the Jerry L. Pettis Veterans Administration Hospital in Loma Linda, California that the Bupropion molecule was significantly more effective in helping her smoking military veterans quit. Every smoker, and those of us in the tobacco treatment field, owe Dr. Ferry a debt of gratitude.

    In our experience, Bupropion tablets are particularly effective in smokers, who after stopping, experience depression, dysphoria or sadness. Bupropion is a prescription medication and must be prescribed by a physician or other licensed health professional. After years of using Bupropion, we observed and subsequently demonstrated in a large placebo-controlled multi-center study, that this medication reduces the amount of nicotine the smoker consumes prior to a quit date and even increases the motivation to quit.

    Side-effects include dry-mouth, headache, constipation, light-headedness, and a reported one in 1,000 risk for a seizure. Like every medication, Bupropion is not right for every smoker. Talk to your physician to determine if Bupropion is a wise choice for you.

    Bupropion works well with Chantix® and the nicotine replacement products. However, the correct use of multiple medications can require the assistance of a trained tobacco treatment specialist. Here is a listing of tobacco specialists in your area.

  • Nicotine Nasal Spray

    The Nicotine Nasal Spray delivers clean nicotine to the inside of the tobacco user’s nose. There, the nicotine is rather rapidly absorbed by the nasal mucus membranes (nasal mucosa) and delivered to the brain within 4 to 15 minutes. In fact, other than by smoking a cigarette, this is the fastest way to deliver nicotine to the brain. This makes the Nicotine Nasal Spray an extremely effective tobacco treatment. It can be used repeatedly and on a regular schedule as a “continuous” tobacco cessation medication and/or intermittently as a “rescue” medication for severe tobacco cravings. One spray of nicotine nasal spray to both nostrils delivers approximately the same amount of nicotine as the average smoker can receive from the average cigarette.

    While the nasal spray can be irritating and can result in sneezing, runny nose, tearing eyes and less seldom an occasional bloody nose, these effects are usually minor and transient, easing or disappearing entirely after the nasal passages are acclimated to the spray. The ability to tolerate the nasal spray’s side effect is quite dependent on the technique used in the application.

    For best results, first direct the spray towards the sides of each nostril, rather than the center, and allow the sprayed fluid to coat the inside of the nostril rather than straight up into the sinus. Hold your breath while spraying and after administration continue to breathe through your mouth for a few minutes and avoid sniffing the solution deep into the nose.

    Nicotine Nasal Spray is a prescription medication. Talk to your doctor, healthcare professional, and tobacco treatment specialist to help determine if the nicotine nasal spray is right for you.

  • Nicotine Inhaler

    The nicotine inhaler is also a prescription medication. It consists of a nicotine gel cartridge, which is placed in a plastic tube vaguely resembling a cigarette. The nicotine gel releases a nicotine vapor, which is absorbed in the mouth’s oral mucous member. Each puff delivers approximately one-tenth the amount of nicotine delivered in a cigarette puff.

    For some smokers, the cigarette shape and the use of the nicotine inhaler also helps in reducing tobacco cravings by simulating the hand to mouth ritual of smoking. Some users may experience a sore throat, nasal irritation, cough, heartburn, stomach upset, hiccups or nausea. The most common side effects being mild mouth or throat irritation and cough. These side effects are usually minor, do not occur for most users, and can be eliminated or minimized by correct use.

    The nicotine inhaler, which is actually a puffer, should be puffed similar to a cigar so that the nicotine vapor is deposited onto the mouth’s lining. Nicotine is absorbed by the mouth’s lining rather than the lung so the most effective use of the nicotine inhaler is a series of shallow puffs. This also minimizes or eliminates side effects by avoiding inhaling the vapor into the back of the throat where it can irritate the vocal cords and the airways leading into the lungs.

    The inhaler cartridges are designed to deliver the most nicotine at roughly four puffs per minute for 20 to 30 minutes and then discarding the cartridge. Most smokers puff each cartridge too infrequently and use, on average, between one and two cartridges per day. This is far too little to receive an adequate amount of therapeutic nicotine. For use as a “continuous” tobacco cessation medication, the FDA recommends using anywhere from 6 to 16 cartridges each day. The nicotine inhaler is also suitable for use as a “rescue” medication for severe tobacco cravings. Like all medications, correct use is essential for the desired therapeutic effect and increased quit rates.

  • Nicotine Polacrilex Gum

    In the United States, nicotine polacrilex gum was the first tobacco cessation medication ever approved by the FDA.  The gum is an over-the-counter medication that does not require a physician’s prescription and delivers nicotine in a resin matrix directly to the lining of the mouth, similar to the nicotine inhaler.

    Nicotine gum is not like regular chewing gum. Chewed like ordinary gum, nicotine gum will not work very well. It is important to chew the nicotine gum very slowly until you notice a peppery taste or slight tingling sensation (usually after about 15 chews, but can vary individual to individual) in your mouth. Then “park” the gum between your cheek and gums (below your teeth line) until the peppery or tingling sensation disappears, then keep repeating these steps. One piece of gum that is chewed correctly can be used for about 30 minutes. Chewing incorrectly can increase unpleasant side effects such as heartburn. Do not eat or drink immediately before you use the gum.

    Although the gum is available in 2 and 4 milligram strength, the consistency and flavors have improved significantly over the last two decades and is now available in mint, orange, cinnamon, fruit and other flavors.

    Begin by chewing at least one piece every 1-2 hours. Side effects include mouth irritation, hiccups, nausea, and on rare, occasion jaw pain. The nicotine gum is contraindicated in smokers with TMJ (temporal mandible joint) syndrome or significant dental work or numerous missing teeth.

    Like all FDA-approved medications, nicotine gum also significantly increases quit rates. It can be used frequently as a “continuous” tobacco cessation medication and/or intermittently as a “rescue” medication for severe tobacco cravings.

  • Nicotine Polacrilex Lozenges

    Nicotine polacrilex lozenges are an over-the-counter medication that does not require a physician’s prescription. Similar to the nicotine polacrilex gum, the nicotine polacrilex lozenge releases nicotine directly through the lining of the mouth, temporarily relieving craving and nicotine withdrawal symptoms. It is recommended to use one to two lozenges each hour and at least nine lozenges per day, but many smokers may need much more than this minimum.

    Unlike ordinary lozenges, these are not meant to be chewed or swallowed. Place the lozenge in your mouth and allow the lozenge to dissolve slowly over 20 to 30 minutes while trying to swallow minimally. It is important to minimize swallowing so the dissolved medicine can be absorbed in the mouth. Of course, the lozenges deliver a lower, slower level of nicotine than a cigarette. It is not surprising that side effects are similar to the nicotine polacrilex gum and that it can be used frequently as a “continuous” tobacco cessation medication and/or intermittently as a “rescue” medication for severe tobacco cravings.

  • Nicotine Patches

    In the United States, the nicotine patch is an over-the-counter medication that does not require a physician’s prescription. Nicotine transdermal patches deliver a steady dose of nicotine directly through the skin. It works be entering the blood circulation and slowly entering the brain, easing craving and tobacco withdrawal symptoms and increasing quit rates.

    A constant low dose of nicotine may be all that is needed to eliminate tobacco cravings in light smokers (e.g. five to six cigarettes per day). For those with heavier tobacco use and/or more severe cravings, the other nicotine products (spray, inhaler, gum or lozenge) can be used in addition as “rescue” medications for breakthrough cravings.

    Some suggestions for proper application of the patch:

    1. After a shower or cleaning a non-hairy area of skin with a non-moisturizing soap, let the area dry completely. The upper arm is a good choice for most people, but the patch can be worn on almost any non-hairy area. It is important to avoid using lotions, cream, and skincare products on the area you choose.
    2. Try not to touch the sticky part of the patch while firmly pressing the patch on your skin with the heel of your palm for at least 10 seconds.
    3. Wash your hands after applying or removing a transdermal nicotine patch.
    4. Safely dispose of any foil pouch, wrapping in plastic that protected the patch. Used patches should be folded in half and disposed of safely as well. Make sure these materials are out of reach of children and pets.

    The nicotine patch can be worn for either 16 (removed at bedtime) or 24 hours. If you crave cigarettes when you wake up or feel like you want extra protection from tobacco cravings, wear the patch for 24 hours. Some patients can experience vivid dreams while wearing the patch after bedtime. In actuality, some patients enjoy the vivid colorful dreams. If vivid dreams present a problem, simply remove the patch at bedtime and apply a fresh patch first thing in the morning.

    Some smokers experience skin irritation caused by the adhesive. This can often be effectively treated with over-the-counter cortisone cream. Cortisone cream can be applied after the patch is removed. In more severe instances the area can be pre-treated the night before but, wash off the area of the remaining pre-treatment cortisone cream before applying the patch in the morning. Some patients may prefer one brand to another because of differences, real or perceived in effectiveness, stickiness and/or skin irritation.

Medication Safety

There are hundreds of well-researched studies that prove without question that medications help you quit. However, many people don’t believe that and choose not to use medications or they discontinue these medications too soon and/ or don’t take enough to begin with. This is usually a mistake and sabotages many efforts.

For example, many smokers fear (incorrectly) that nicotine replacement medications are dangerous because they deliver nicotine into the human body.  Actually, nicotine is not the dangerous chemical in tobacco. Nicotine makes and keeps the tobacco user addicted, but nicotine is not what kills. The 4,000 to 9,000 other chemicals are what damage the heart and lungs, increasing the risk for cancers of many organs, while carbon monoxide (the odorless, colorless gas which kills many fire victims) robs the body of oxygen.

The only active ingredient in nicotine replacement medications is nicotine. Each of the five FDA-approved nicotine replacement medications are designed to deliver nicotine slower than a cigarette. Clean and slow nicotine is better than dirty cigarette-delivered nicotine. Nicotine replacement products have been used by millions of smokers for over 3 decades.

Not one smoker is known to have died from a nicotine replacement medication. Conversely, during the past 25 years, over 12 million Americans have been killed as a direct result of their tobacco addiction. That is about 1,200 each day, equaling about 50 smoker deaths each hour.

Every medication for every condition has certain risks associated with its use. The question is always “Do the benefits exceed the risks?” According to some studies, more than half of all smokers will die many years or decades earlier than if they did not smoke. While no medication is right for everyone, every one of the FDA-approved medications is safe and effective. While four of the FDA medications are available only by prescription and the other three are over-the-counter, every smoker is advised to address medications with their physician or healthcare professional.

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 clinician education guide for additional treatment and reference materials.


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.

Smoking Cessation Toolkit Survey

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