What are the health effects of smoking?

There's no way around it; smoking is bad for your health. It harms nearly every organ of the body, some that you would not expect. Cigarette smoking causes nearly one in five deaths in the United States. It can also cause many other cancers and health problems. These include

• Cancers, including lung and oral cancers
• Lung diseases, such as COPD (chronic obstructive pulmonary disease)
• Damage to and thickening of blood vessels, which causes high blood pressure
• Blood clots and stroke
• Vision problems, such as cataracts and macular degeneration (AMD)

Women who smoke while pregnant have a greater chance of certain pregnancy problems. Their babies are also at higher risk of dying of sudden infant death syndrome (SIDS).

Smoking also causes addiction to nicotine, a stimulant drug that is in tobacco. Nicotine addiction makes it much harder for people to quit smoking.

What are the health risks of secondhand smoke?

Your smoke is also bad for other people - they breathe in your smoke secondhand and can get many of the same problems as smokers do. This includes heart disease and lung cancer. Children exposed to secondhand smoke have a higher risk of ear infections, colds, pneumonia, bronchitis, and more severe asthma. Mothers who breathe secondhand smoke while pregnant are more likely to have preterm labor and babies with low birth weight.

Are other forms of tobacco also dangerous?

Besides cigarettes, there are several other forms of tobacco. Some people smoke tobacco in cigars and water pipes (hookahs). These forms of tobacco also contain harmful chemicals and nicotine. Some cigars contain as much tobacco as an entire pack of cigarettes.

E-cigarettes often look like cigarettes, but they work differently. They are battery-operated smoking devices. Using an e-cigarette is called vaping. Not much is known about the health risks of using them. We do know they contain nicotine, the same addictive substance in tobacco cigarettes. E-cigarettes also expose non-smokers to secondhand aerosols (rather than secondhand smoke), which contain harmful chemicals.

Smokeless tobacco, such as chewing tobacco and snuff, is also bad for your health. Smokeless tobacco can cause certain cancers, including oral cancer. It also increases your risk of getting heart disease, gum disease, and oral lesions.

Why should I quit?

Remember, there is no safe level of tobacco use. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers and premature death. Quitting smoking can reduce your risk of health problems. The earlier you quit, the greater the benefit. Some immediate benefits of quitting include

• Lower heart rate and blood pressure
• Less carbon monoxide in the blood (carbon monoxide reduces the blood's ability to carry oxygen)
• Better circulation
• Less coughing and wheezing

Smoking leads to disease and disability and harms nearly every organ of the body. More than 16 million Americans are living with a disease caused by smoking. For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis.

Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year. Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.

What is Cancer?

Cancer refers to diseases in which abnormal cells divide out of control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems, which help the body get rid of toxins.

There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start—for example, lung cancer begins in the lung and laryngeal cancer begins in the larynx (voice box).

Symptoms can include:

• A thickening or lump in any part of the body
• Weight loss or gain with no known reason
• A sore that does not heal
• Hoarseness or a cough that does not go away
• A hard time swallowing
• Discomfort after eating
• Changes in bowel or bladder habits
• Unusual bleeding or discharge
• Feeling weak or very tired

How Is Smoking Related to Cancer?

Smoking can cause cancer and then block your body from fighting it:

• Poisons in cigarette smoke can weaken the body’s immune system, making it harder to kill cancer cells. When this happens, cancer cells keep growing without being stopped.
• Poisons in tobacco smoke can damage or change a cell’s DNA. DNA is the cell’s “instruction manual” that controls a cell’s normal growth and function. When DNA is damaged, a cell can begin growing out of control and create a cancer tumor.

Doctors have known for years that smoking causes most lung cancers. It’s still true today, when nearly 9 out of 10 lung cancers are caused by smoking cigarettes. In fact, smokers have a greater risk for lung cancer today than they did in 1964, even though they smoke fewer cigarettes. One reason may be changes in how cigarettes are made and what chemicals they contain.

Treatments are getting better for lung cancer, but it still kills more men and women than any other type of cancer. In the United States, more than 7,300 nonsmokers die each year from lung cancer caused by secondhand smoke. Secondhand smoke is the combination of smoke from the burning end of a cigarette and the smoke breathed out by smokers.

Smoking can cause cancer almost anywhere in your body, including the:

• Blood (acute myeloid leukemia)
• Bladder
• Cervix
• Colon and rectum
• Esophagus
• Kidney and renal pelvis
• Larynx
• Liver
• Lungs
• Mouth and throat
• Pancreas
• Stomach
• Trachea, lung. and bronchus

Men with prostate cancer who smoke may be more likely to die from these diseases than nonsmokers.

Smokeless tobacco, such as chewing tobacco, also causes cancer, including cancers of the:

• Esophagus
• Mouth and throat
• Pancreas

How Can Smoking-Related Cancers Be Prevented?

• Quitting smoking lowers the risks for cancers of the lung, mouth, throat, esophagus, and larynx.
  • Within 5 years of quitting, your chance of getting cancer of the mouth, throat, esophagus, and bladder is cut in half.
  • Ten years after you quit smoking, your risk of dying from lung cancer drops by half.

  If nobody smoked, one of every three cancer deaths in the United States would not happen.

Cancer Screening

Screening for Cervical and Colorectal Cancers

Research shows that screening for cervical and colorectal cancers, as recommended, helps prevent these diseases. Screening for cervical and colorectal cancers helps find these diseases at an early, and often highly treatable, stage. CDC offers free or low-cost cervical cancer screening nationwide.

Health care reform through the Affordable Care Act increases access to cervical and colorectal cancer screening through expanded insurance coverage and eliminating cost-sharing. In addition, CDC’s Screen for Life: National Colorectal Cancer Action Campaign informs people aged 50 years and older about the importance of having regular colorectal cancer screening tests.

Screening for Lung Cancer

People who have smoked for many years may consider screening for lung cancer a type of scan called low-dose computed tomography (LDCT). Talk to your doctor about lung cancer screening and the possible benefits and risks. Lung cancer screening is not a substitute for quitting smoking.

The U.S. Preventive Services Task Force recommends yearly screening for lung cancer with low-dose computed tomography for adults who are:

• 50 to 80 years of age and
• have a 20 pack-year smoking history (meaning they have smoked at least one pack of cigarettes per day for at least 20 years) and
• currently smoke, or have quit within the past 15 years

The Task Force recommends that screening stop once a person has not smoked for 15 years or if they develop a health problem that makes them unable or unwilling to have surgery if lung cancer is found.

How Is Cancer Treated?

The treatment for cancer depends on the type of cancer and the stage of the disease (how severe the cancer is and whether it has spread). Doctors may also consider the patient’s age and general health. Often, the goal of treatment is to cure the cancer. In other cases, the goal is to control the disease or to reduce symptoms for as long as possible. The treatment plan for a person may change over time.

Most treatment plans include surgery, radiation therapy, or chemotherapy. Other plans involve biological therapy (a treatment that helps your immune system fight cancer).

Some cancers respond best to a single type of treatment. Other cancers may respond best to a combination of treatments.

For patients who get very high doses of chemotherapy or radiation therapy, a stem cell transplant, also known as a bone marrow transplant, may be recommended by their doctor. This is because high-dose therapies destroy both cancer cells and normal blood cells.

Quitting smoking improves the outlook (the prognosis) for people with cancer. People who continue to smoke after diagnosis raise their risk for future cancers and death. They are more likely to die from cancer than nonsmokers and are more likely to develop a second (new) tobacco-related cancer.

Colorectal Cancer and Ostomies

An ostomy (or stoma) is a surgical opening made to the body that allows waste to be eliminated from the body. Ostomies are used in treatment or management of cancer or other diseases. Ostomies are needed when the body’s normal opening is closed or altered as part of cancer treatment. An ostomy pouch is located around the opening to collect waste for removal. Ostomies are usually done during the first stages of surgical treatment to remove cancer. For colorectal cancer patients, a colostomy (surgical openings from the bowel or colon to the abdomen) can be a lifesaving surgery. An ostomy can be temporary or permanent. Temporary ostomies are used while the affected area of the body heals. Permanent ostomies are used when cancer has resulted in the removal of the entire colon or the end of it.

Many of the health problems caused by tobacco use are well known. Cigarette smoking causes heart disease, lung and esophageal cancer, and chronic lung disease. Additionally, several research studies have identified smoking as a risk factor for osteoporosis and bone fracture. According to the Centers for Disease Control and Prevention, more than 16 million Americans are living with a disease caused by smoking.

Facts about osteoporosis

Osteoporosis is a condition in which bones weaken and are more likely to fracture. Fractures from osteoporosis can result in pain and disability. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass.

In addition to smoking, risk factors for developing osteoporosis include:

• Thinness or small frame.
• Family history of the disease.
• Being postmenopausal and particularly having had early menopause.
• Abnormal absence of menstrual periods (amenorrhea).
• Prolonged use of certain medications, such as those used to treat lupus, asthma, thyroid deficiencies, and seizures.
• Low calcium intake.
• Lack of physical activity.
• Excessive alcohol intake.

Osteoporosis can often be prevented. It is known as a “silent” disease because, if undetected, bone loss can progress for many years without symptoms until a fracture occurs. It has been called a childhood disease with old age consequences because building healthy bones in youth can help prevent osteoporosis and fractures later in life. However, it is never too late to adopt new habits for healthy bones.

Smoking and osteoporosis

Cigarette smoking was first identified as a risk factor for osteoporosis decades ago. Studies have shown a direct relationship between tobacco use and decreased bone density. Analyzing the impact of cigarette smoking on bone health is complicated. It is hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among people who smoke. For example, in many cases people who smoke are thinner than nonsmokers, tend to drink more alcohol, may be less physically active, and have poor diets. Women who smoke also tend to have an earlier menopause than nonsmokers. These factors place many people who smoke at an increased risk for osteoporosis apart from their tobacco use.

In addition, studies on the effects of smoking suggest that smoking increases the risk of having a fracture. As well, smoking has been shown to have a negative impact on bone healing after fracture.

Osteoporosis management strategies

Start by quitting: The best thing smokers can do to protect their bones is to quit smoking. Smoking cessation, even later in life, may help limit smoking-related bone loss. Many resources are available to help you stop smoking, some of which are listed at the end of this fact sheet.

Eat a well-balanced diet rich in calcium and vitamin D: Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that you get adequate amounts of calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily.

Vitamin D plays an important role in calcium absorption and bone health. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people, especially those who are older, may need vitamin D supplements to achieve the recommended intake of 600 to 800 IU (International Units) each day.

Exercise for your bone health: Like muscle, bone is living tissue that responds to exercise by becoming stronger. Weight-bearing and resistance exercises are the best exercises for bone. Examples include of weight-bearing exercises include walking, climbing stairs, and dancing. Resistance exercises – such as lifting weights – can also make bones stronger.

Avoid excessive use of alcohol: Chronic alcohol use has been linked to an increase in fractures of the hip, spine, and wrist. Drinking too much alcohol interferes with the balance of calcium in the body. It also affects the production of hormones, which have a protective effect on bone, and of vitamins, which we need to absorb calcium. Excessive alcohol consumption also can lead to more falls and related fractures.

Talk to your doctor about a bone density test: A bone mineral density (BMD) test measures bone density at various sites of the body. This painless test can detect osteoporosis before a fracture occurs and can predict one’s chances of fracturing in the future. If you currently or used to smoke, you may want to ask your health care provider whether you are a candidate for a BMD test, which can help determine whether medication should be considered.

See if medication is an option for you: There is no cure for osteoporosis. However, several medications are available to prevent and treat the disease in postmenopausal women and in men. Your doctor can help you decide whether medication might be right for you.

Smoking affects the entire body, increasing the risk of many life-threatening diseases—including lung cancer, emphysema, and heart disease. Smoking also contributes to many cancers and diseases of the digestive system. Estimates show that about one-fifth of all adults smoke, and each year at least 443,000 Americans die from diseases caused by cigarette smoking.

What is the digestive system?

The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine—which includes the colon and rectum—and anus. Food enters the mouth and passes to the anus through the hollow organs of the GI tract. The liver, pancreas, and gallbladder are the solid organs of the digestive system. The digestive system helps the body digest food, which includes breaking food down into nutrients the body needs. Nutrients are substances the body uses for energy, growth, and cell repair.

Does smoking increase the risk of cancers of the digestive system?

Smoking has been found to increase the risk of cancers of the

• mouth
• esophagus
• stomach
• pancreas

Research suggests that smoking may also increase the risk of cancers of the

• liver
• colon
• rectum

What are the other harmful effects of smoking on the digestive system?

Smoking contributes to many common disorders of the digestive system, such as heartburn and gastroesophageal reflux disease (GERD), peptic ulcers, and some liver diseases. Smoking increases the risk of Crohn’s disease, colon polyps, and pancreatitis, and it may increase the risk of gallstones.

How does smoking affect heartburn and GERD?

Smoking increases the risk of heartburn and GERD. Heartburn is a painful, burning feeling in the chest caused by reflux, or stomach contents flowing back into the esophagus—the organ that connects the mouth to the stomach. Smoking weakens the lower esophageal sphincter, the muscle between the esophagus and stomach that keeps stomach contents from flowing back into the esophagus. The stomach is naturally protected from the acids it makes to help break down food. However, the esophagus is not protected from the acids. When the lower esophageal sphincter weakens, stomach contents may reflux into the esophagus, causing heartburn and possibly damaging the lining of the esophagus.

GERD is persistent reflux that occurs more than twice a week. Chronic, or long lasting, GERD can lead to serious health problems such as bleeding ulcers in the esophagus, narrowing of the esophagus that causes food to get stuck, and changes in esophageal cells that can lead to cancer.

How does smoking affect peptic ulcers?

Smoking increases the risk of peptic ulcers. Peptic ulcers are sores on the inside lining of the stomach or duodenum, the first part of the small intestine. The two most common causes of peptic ulcers are infection with a bacterium called Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen.

Researchers are studying how smoking contributes to peptic ulcers. Studies suggest that smoking increases the risk of H. pylori infection, slows the healing of peptic ulcers, and increases the likelihood that peptic ulcers will recur. The stomach and duodenum contain acids, enzymes, and other substances that help digest food. However, these substances may also harm the lining of these organs. Smoking has not been shown to increase acid production. However, smoking does increase the production of other substances that may harm the lining, such as pepsin, an enzyme made in the stomach that breaks down proteins. Smoking also decreases factors that protect or heal the lining, including

• blood flow to the lining
• secretion of mucus, a clear liquid that protects the lining from acid
• production of sodium bicarbonate—a saltlike substance that neutralizes acid—by the pancreas

The increase in substances that may harm the lining and decrease in factors that protect or heal the lining may lead to peptic ulcers.

How does smoking affect liver disease?

Smoking may worsen some liver diseases, including

• primary biliary cirrhosis, a chronic liver disease that slowly destroys the bile ducts in the liver
• nonalcoholic fatty liver disease (NAFLD), a condition in which fat builds up in the liver

Researchers are still studying how smoking affects primary biliary cirrhosis, NAFLD, and other liver diseases.

Liver diseases may progress to cirrhosis, a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue then replaces healthy liver tissue, partially blocking the flow of blood through the liver and impairing liver functions.

The liver is the largest organ in the digestive system. The liver carries out many functions, such as making important blood proteins and bile, changing food into energy, and filtering alcohol and poisons from the blood. Research has shown that smoking harms the liver’s ability to process medications, alcohol, and other toxins and remove them from the body. In some cases, smoking may affect the dose of medication needed to treat an illness.

How does smoking affect Crohn’s disease?

Current and former smokers have a higher risk of developing Crohn’s disease than people who have never smoked.

Crohn’s disease is an inflammatory bowel disease that causes irritation in the GI tract. The disease, which typically causes pain and diarrhea, most often affects the lower part of the small intestine; however, it can occur anywhere in the GI tract. The severity of symptoms varies from person to person, and the symptoms come and go. Crohn’s disease may lead to complications such as blockages of the intestine and ulcers that tunnel through the affected area into surrounding tissues. Medications may control symptoms. However, many people with Crohn’s disease require surgery to remove the affected portion of the intestine.

Among people with Crohn’s disease, people who smoke are more likely to

• have more severe symptoms, more frequent symptoms, and more complications
• need more medications to control their symptoms
• require surgery
• have symptoms recur after surgery

The effects of smoking are more pronounced in women with Crohn’s disease than in men with the disease.

Researchers are studying why smoking increases the risk of Crohn’s disease and makes the disease worse. Some researchers believe smoking might lower the intestines’ defenses, decrease blood flow to the intestines, or cause immune system changes that result in inflammation. In people who inherit genes that make them susceptible to developing Crohn’s disease, smoking may affect how some of these genes work.

How does smoking affect colon polyps?

People who smoke are more likely to develop colon polyps. Colon polyps are growths on the inside surface of the colon or rectum. Some polyps are benign, or noncancerous, while some are cancerous or may become cancerous.

Among people who develop colon polyps, those who smoke have polyps that are larger, more numerous, and more likely to recur.

How does smoking affect pancreatitis?

Smoking increases the risk of developing pancreatitis. Pancreatitis is inflammation of the pancreas, which is located behind the stomach and close to the duodenum. The pancreas secretes digestive enzymes that usually do not become active until they reach the small intestine. When the pancreas is inflamed, the digestive enzymes attack the tissues of the pancreas.

How does smoking affect gallstones?

Some studies have shown that smoking may increase the risk of developing gallstones. However, research results are not consistent and more study is needed.

Gallstones are small, hard particles that develop in the gallbladder, the organ that stores bile made by the liver. Gallstones can move into the ducts that carry digestive enzymes from the gallbladder, liver, and pancreas to the duodenum, causing inflammation, infection, and abdominal pain.

Can the damage to the digestive system from smoking be reversed?

Quitting smoking can reverse some of the effects of smoking on the digestive system. For example, the balance between factors that harm and protect the stomach and duodenum lining returns to normal within a few hours of a person quitting smoking. The effects of smoking on how the liver handles medications also disappear when a person stops smoking. However, people who stop smoking continue to have a higher risk of some digestive diseases, such as colon polyps and pancreatitis, than people who have never smoked.

Quitting smoking can improve the symptoms of some digestive diseases or keep them from getting worse. For example, people with Crohn’s disease who quit smoking have less severe symptoms than smokers with the disease.

Eating, Diet, and Nutrition

Eating, diet, and nutrition can play a role in causing, preventing, and treating some of the diseases and disorders of the digestive system that are affected by smoking, including heartburn and GERD, liver diseases, Crohn’s disease, colon polyps, pancreatitis, and gallstones. More information about eating, diet, and nutrition and these conditions can be found on the Digestive Diseases A-Z list.

Points to Remember

• Smoking has been found to increase the risk of cancers of the mouth, esophagus, stomach, and pancreas. Research suggests that smoking may also increase the risk of cancers of the liver, colon, and rectum.
• Smoking increases the risk of heartburn and gastroesophageal reflux disease (GERD).
• Smoking increases the risk of peptic ulcers.
• Smoking may worsen some liver diseases, including primary biliary cirrhosis and nonalcoholic fatty liver disease (NAFLD).
• Current and former smokers have a higher risk of developing Crohn’s disease than people who have never smoked.
• People who smoke are more likely to develop colon polyps.
• Smoking increases the risk of developing pancreatitis.
• Some studies have shown that smoking may increase the risk of developing gallstones. However, research results are not consistent and more study is needed.
• Quitting smoking can reverse some of the effects of smoking on the digestive system.

You probably know that cigarette smoking kills you. You probably know that cigarettes contain chemicals—a mix of over 7,000 chemicals, in fact—that can cause diseases including cancer, cardiovascular disease, and COPD. You may not know that other tobacco products, like e-cigarettes, hookah, and smokeless tobacco, contain some of the same chemicals as cigarettes. What are these chemicals, and how might they affect your health?

Nicotine: The Addictive Chemical in Tobacco

Nicotine is a highly addictive chemical found in the tobacco plant itself and is therefore present in all tobacco products. While nicotine is what addicts and keeps people using tobacco products, it is not what makes tobacco use so deadly. Tobacco and tobacco smoke contain thousands of chemicals. This mix of chemicals—not nicotine—is what causes serious disease and death in tobacco users.

Chemicals in Cigarettes: How Do They Get There?

You may believe that cigarettes are so deadly because chemicals are added to them in the manufacturing process. While some chemicals are added during this process, some chemicals in cigarettes—along with nicotine—are found in the tobacco plant itself. As the tobacco plant grows, it absorbs chemicals—like cadmium, lead, and nitrates—from the soil and fertilizer. Cadmium is a carcinogen and is also found in batteries, while lead is a chemical that was once used in house paint. Cadmium and lead are both toxic metals. When the plant is harvested for manufacturing, these chemicals are present in the tobacco leaves.

As the tobacco leaves are cured, dangerous chemicals can form. These chemicals, called tobacco-specific nitrosamines, (TSNAs), remain in the tobacco leaves after the curing process. During manufacturing, ammonia—a chemical found in household cleaning products—along with other chemicals may be added to increase nicotine absorption. Sugar and flavor additives may also be added during this stage to mask the harshness of smoke. These additives form cancer-causing chemicals when they are burned.

Once a cigarette is lit, still more chemicals are formed in the burning process that weren’t present in the growing and manufacturing stages. These chemicals are then inhaled by smokers or those exposed to secondhand smoke. Lastly, dangerous chemicals that are detrimental to human health, wildlife, and water supplies can be released from cigarette butt waste into the environment.

Chemicals in Other Tobacco Products

Hookah

In addition to nicotine, other tobacco products, like hookah, contain some of the same chemicals as cigarettes. Carbon monoxide, metals, and carcinogens can be found in hookah smoke, and hookah users are at risk for some of the same health effects as smokers as a result of these chemicals. Research shows that hookah smokers may absorb even more of the toxic chemicals found in cigarette smoke because of the length of hookah smoking sessions. A typical 1-hour hookah session can produce as much smoke as several packs of cigarettes.

Smokeless Tobacco

Smokeless tobacco, although not combustible, contains a mix of 4,000 chemicals, including as many as 30 or more that are linked to cancer.

These chemicals include heavy metals cadmium, lead, and nickel; as well as arsenic, a chemical used in insecticides; formaldehyde, which is used in embalming fluid; and N-Nitrosonornicotine (NNN), among others. NNN is known to cause cancer in animals and has been linked to an increase in the risk of cancer among humans.

About 1,300 people in the U.S. are diagnosed with oral cancer each year because of smokeless tobacco use. Smokeless tobacco use also causes esophageal and pancreatic cancer.

E-cigarettes

As e-cigarettes have only recently come under FDA’s regulatory authority, their effects on individual and population health are still being studied. Preliminary studies suggest switching completely to e-cigarettes could be less harmful than combustible cigarettes for adults who already have a nicotine addiction. Most e-cigarettes contain nicotine, the same highly addictive chemical in cigarettes that keeps people smoking even when they want to quit. Other chemicals found in cigarette smoke, like formaldehyde, acrolein, and acetaldehyde, are also found in some e-cigarette aerosols. These chemicals can cause irreversible lung damage at certain concentration. E-cigarettes can also contain flavorings such as diacetyl and acetoin. Diacetyl and acetoin are considered safe to eat but inhaling them can be harmful to the lungs. More research is needed to determine the levels at which these chemicals are present in e-cigarette aerosols.

Tobacco-Free: The Best Option for Health

Because all tobacco products contain the addictive chemical nicotine, no tobacco product can be considered safe. Using no tobacco products whatsoever is the best way to safeguard your health. But if you are an adult with an established addiction, cessation will help protect you from the chemicals in tobacco products and tobacco smoke. Quitting smoking is often difficult, and may take multiple attempts, but the longer a smoker is able to stay quit, the more of a chance the body gets to heal from the damage done from chemicals. Nicotine replacement therapies (NRTs) can be effective for cessation and can double your chances of quitting successfully. Although nicotine is an addictive chemical, it does not carry the same risks as some of the other chemicals found in tobacco products. Many FDA-approved NRTs, including gum, patches, and lozenges, are available without a prescription, and may be used in combination with each other. If you are an adult smoker and you are looking to quit, it is a good idea to talk to your doctor about your options.

Some people smoke when they feel stressed. They use smoking as a way to cope. There are many problems with using cigarettes as a way to cope with stress or other unpleasant feelings.

Smoking isn’t a long-term stress reliever. In the time it takes to smoke a cigarette, you could do something else that’s more effective and healthy—like take a short walk or try a relaxation exercise.

Smoking doesn’t solve the problem that’s giving you stress. Your stress will return.

Nicotine addiction causes stress. Cravings for nicotine feel stressful because your body begins to go through withdrawal.

Some smokers find it hard to give up cigarettes as a way to cope with stress. It’s important to find healthy ways to handle stress and take care of yourself without smoking. There are many other ways to cope with stress that don’t involve smoking.

Tobacco products that are labeled or advertised with the terms "light," "low," or "mild" or similar descriptors mislead the public into thinking that these products cause fewer health problems than other cigarettes. However, they still pose a heavy health risk. Research shows that:

• Smokers who use light cigarettes do not reduce their risk for developing smoking-related cancers and other diseases.
• Switching to light cigarettes does not help smokers quit, and may actually decrease the motivation to quit.

In order to better protect the public from misleading claims, the Family Smoking Prevention and Tobacco Control Act prohibits manufacturers from producing and distributing for sale any tobacco products labeled or advertised as "light," "low," or "mild" without a Modified Risk Tobacco Product order from the FDA. Manufacturers must meet rigorous criteria before we can issue an order authorizing the marketing of a modified risk tobacco product. If products are marketed as "light," "low," or "mild" without an MRTP order, FDA considers these claims to be health fraud.

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco.

Cigars differ from cigarettes in that cigarettes are a roll of tobacco wrapped in paper or in a substance that does not contain tobacco.

The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.

The use of flavorings in some cigar brands and the fact that they are commonly sold as a single stick has raised concerns that these products may be especially appealing to youth.

In 2018, among middle and high school students who used cigars in the past 30 days, 43.6% reported using a flavored cigar during that time.

Little cigars are the same size and shape as cigarettes, often include a filter, and are packaged in a similar way, but they are taxed differently than cigarettes. Rather than reduce consumption, cost-conscious smokers might switch from cigarettes to less costly little cigars.

Historically, cigar smoking in the United States has been a behavior of older men, but the industry’s increased marketing of these products to targeted groups in the 1990s increased the prevalence of use among adolescents.

Cigar use is higher among youth who use other tobacco products or other drugs (e.g., alcohol, marijuana, and inhalants) than among youth who do not use these products.

Cigars contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative to cigarettes.

Health Effects

• Regular cigar smoking is associated with an increased risk for cancers of the lung, esophagus, larynx (voice box), and oral cavity (lip, tongue, mouth, throat).
• Cigar smoking is linked to gum disease and tooth loss.
• Heavy cigar smokers and those who inhale deeply may be at increased risk for developing coronary heart disease.
• Heavy cigar smoking increases the risk for lung diseases, such as emphysema and chronic bronchitis.

Current Cigar Use

Adults*

Percentage of U.S. adults who were current cigar smokers^† in 2017:

• 4.9% of all adults
• 8.0% of adult males
• 1.9% of adult females
• 8.0% of African American adults
• 7.0% of American Indian/Alaska Native adults
• 1.3% of Asian American adults
• 3.7% of Hispanic adults
• 4.8% of White adults

High School Students

Percentage of U.S. high school students who were current cigar smokers^† in 2019:

• 7.6% of all students in grades 9–12
• 6.2% of female students in grades 9–12
• 9.0% of male students in grades 9–12

Middle School Students

Percentage of U.S. middle school students who were current cigar smokers^† in 2019:

• 2.3% of all U.S. students in grades 6–8
• 2.0% of female students in grades 6–8
• 2.7% of male students in grades 6–8

Overall

• In 2018, an estimated 12.2 million people in the United States aged 12 years or older (or 4.5%) were current cigar smokers.

*Adults are defined as persons 18 years of age or older.
^†Current cigar use is defined as smoking cigars on 1 or more of the 30 days before participation in a survey about this topic.

Marketing Information

Marketing efforts promote cigars as symbols of a luxury and successful lifestyle. The following strategies can contribute to the increased acceptability of cigar smoking:

• Endorsements by celebrities
• Development of cigar-friendly magazines (e.g., Cigar Aficionado)
• Images of highly visible women smoking cigars
• Product placement in movies

In 2001, the Federal Trade Commission mandated that cigar packaging and advertisements must display one of the following five “SURGEON GENERAL WARNING” text-only labels on a rotating basis:

• Cigar Smoking Can Cause Cancers Of The Mouth And Throat, Even If You Do Not Inhale.
• Cigar Smoking Can Cause Lung Cancer And Heart Disease.
• Tobacco Use Increases The Risk Of Infertility, Stillbirth, And Low Birth Weight.
• Cigars Are Not A Safe Alternative To Cigarettes.
• Tobacco Smoke Increases The Risk Of Lung Cancer And Heart Disease, Even In Nonsmokers.

An electronic cigarette, or e-cigarette, is a handheld electronic device that simulates the feeling of traditional tobacco smoking. Devices can resemble traditional cigarettes, cigars, or pipes, or items like pens or USB sticks. They work by heating a liquid, which typically contains nicotine, to generate an aerosol or vapor that users inhale. Vaping is the commonly used term for the use of e-cigarettes.

Vaping has gained popularity, both in the U.S. and worldwide, particularly among teens and young adults, due to easy availability, targeted marketing, and creative e-liquid flavors. While e-cigarettes are often thought to be safer than tobacco cigarettes, little is known regarding the health effects of their use. Scientists at NIEHS are conducting the E-Cigs and Smoking Study, to develop new biomarkers, or measurable indicators of a normal or abnormal process or condition or disease, of tobacco smoke exposure or e-cigarette use.

Menthol is a substance naturally found in mint plants such as peppermint and spearmint. It gives a cooling sensation. It is often used to relieve minor pain and irritation and prevent infection.

Menthol is added to many products. These include lozenges, syrups, creams and ointments, nasal sprays, powders, and candy. But none of these products are lighted or smoked when used. That makes them different from menthol cigarettes.

Many smokers think menthol cigarettes are less harmful. There is no evidence that cigarettes, cigars, or smokeless tobacco products that have menthol are safer than other cigarettes.

Like other cigarettes, menthol cigarettes harm nearly every organ in the body. They cause many diseases, including cancer and heart disease. Some research shows that menthol cigarettes may be more addictive than non-menthol cigarettes.

Menthol Marketing

Menthol was first added to cigarettes in the 1920s. In the past, the tobacco industry marketed menthol cigarettes as being healthier and safer. Advertisements emphasized their cool and refreshing taste. The ads often showed nature, coldness, springtime, water, and other refreshing qualities. The tobacco industry also targeted “beginner” smokers, smokers with health concerns, and certain population groups. Many people chose menthol cigarettes because they believed they were safer than non-menthol cigarettes. They are not.

Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon.

Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking.

Hookah is also called narghile, argileh, shisha, hubble-bubble, and goza.

Hookahs vary in size, shape, and style.

A typical modern hookah has a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece.

Hookah smoking is typically done in groups, with the same mouthpiece passed from person to person.

Hookah smoking is NOT a safe alternative to smoking cigarettes.
Tobacco users should quit all tobacco products to reduce health risks.

Hookah Use

• Hookah use began centuries ago in ancient Persia and India.
• Today, hookah cafés are gaining in popularity around the world, including Britain, France, Russia, the Middle East, and the United States.
• In 2018, the Monitoring the Future survey found that—
  • Nearly 1 in every 13 (7.8%) high school students in the United States had used a hookah to smoke tobacco during the previous year.
  • About 1 in every 8 (12.3%) young adults aged 19-30 years had used a hookah to smoke tobacco during the previous year.
• Among 12^th graders, annual hookah use increased from nearly 1 in 6 students (17.1%) in 2010 to about 1 in 4 students (22.9%) in 2014, but since that time has decreased sharply to nearly 1 in 13 students (7.8%) in 2018.
• Monitoring the Future also shows variations in hookah use by region and population density. In 2018, the highest prevalence of use were observed in the Northeast, where 1 in 6 (15.0%) young adults aged 19-30 years had used a hookah to smoke tobacco during the previous year, and in very large cities, where almost 1 in 5 (19.3%) young adults in this age group reported past year use .
• Other small studies of young adults have found high prevalence of hookah use among college students in the United States. These studies show past-year use ranging from 22% to 40%.
• New forms of electronic hookah products, including steam stones and hookah pens, have been introduced.
  • These products are battery powered and turn liquid containing nicotine, flavorings, and other chemicals into an aerosol, which is inhaled.
  • Limited information is currently available on the health risks of electronic tobacco products, including electronic hookahs.

Health Effects

Using a hookah to smoke tobacco poses serious health risks to smokers and others exposed to the smoke from the hookah.

Hookah Smoke and Cancer

• The charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.
• Even after it has passed through water, the smoke from a hookah has high levels of these toxic agents.
• Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.
• Tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers.

Other Health Effects of Hookah Smoke

• Hookah tobacco and smoke contain many toxic agents that can cause clogged arteries and heart disease.
• Infections may be passed to other smokers by sharing a hookah.
• Babies born to women who smoked water pipes every day while pregnant weigh less at birth (at least 3½ ounces less) than babies born to nonsmokers.
• Babies born to hookah smokers are also at increased risk for respiratory diseases.

Hookah Smoking Compared With Cigarette Smoking

• While many hookah smokers may think this practice is less harmful than smoking cigarettes, hookah smoking has many of the same health risks as cigarette smoking.
  • Water pipe smoking delivers nicotine—the same highly addictive drug found in other tobacco products.
  • The tobacco in hookahs is exposed to high heat from burning charcoal, and the smoke is at least as toxic as cigarette smoke.
• Because of the way a hookah is used, smokers may absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do.
  • An hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs.
  • The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), compared with 500–600 ml inhaled when smoking a cigarette.
• Hookah smokers may be at risk for some of the same diseases as cigarette smokers. These include:
  • Oral cancer
  • Lung cancer
  • Stomach cancer
  • Cancer of the esophagus
  • Reduced lung function
  • Decreased fertility

Hookahs and Secondhand Smoke

• Secondhand smoke from hookahs can be a health risk for nonsmokers. It contains smoke from the tobacco as well as smoke from the heat source (e.g., charcoal) used in the hookah.

Nontobacco Hookah Products

• Some sweetened and flavored nontobacco products are sold for use in hookahs.
• Labels and ads for these products often claim that users can enjoy the same taste without the harmful effects of tobacco.
• Studies of tobacco-based shisha and “herbal” shisha show that smoke from both preparations contain carbon monoxide and other toxic agents known to increase the risks for smoking-related cancers, heart disease, and lung disease.

Electronic cigarette fires and explosions in the United States 2009 – 2016

Fires and explosions caused by e-cigarettes are not common, but their consequences can be devastating and life-altering for the victims. The main cause of the fires and explosions is failure of the lithium-ion batteries.

Smoking fire safety messages to share

It is important for smokers to know the steps they can take to keep themselves and their families safe from fire. Put these fire safety messages into your own words when talking to people about smoking and fire safety.

• Smoke outside. Many things in your home can catch on fire if they touch something hot like a cigarette or ashes. It is always safer to smoke outside.
• Put cigarettes out all the way. Do this every time. Don’t walk away from lit cigarettes and other smoking materials. Put water on the ashes and butts to make sure they are really out before you put them in the trash.
• Be alert. Do not smoke after taking medicine that makes you tired. You may not be able to prevent or escape from a fire if you are sleepy or have taken medicine that makes you tired.

• Never smoke around medical oxygen. Medical oxygen can explode if a flame or spark is near. Even if the oxygen is turned off, it can still catch on fire.
• Never smoke in bed. Mattresses and bedding can catch on fire easily. Do not smoke in bed because you might fall asleep with a lit cigarette.
• Put your cigarette out in an ashtray or bucket with sand. Use ashtrays with a wide base so they won’t tip over and start a fire.

Overall mortality among both male and female smokers in the United States is about three times higher than that among similar people who never smoked.

The major causes of excess mortality among smokers are diseases that are related to smoking, including cancer and respiratory and vascular disease.

Smokeless tobacco is a known cause of cancer. In addition, the nicotine in smokeless tobacco may increase the risk for sudden death from a condition where the heart does not beat properly (ventricular arrhythmias).

Tobacco use is the leading preventable cause of death in the United States.

Cigarettes and Death

Cigarette smoking causes about one of every five deaths in the United States each year. Cigarette smoking is estimated to cause the following:

• More than 480,000 deaths annually (including deaths from secondhand smoke)
• 278,544 deaths annually among men (including deaths from secondhand smoke)
• 201,773 deaths annually among women (including deaths from secondhand smoke)

Cigarette smoking causes premature death:

• Life expectancy for smokers is at least 10 years shorter than for nonsmokers.
• Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90%.

Secondhand Smoke and Death

Exposure to secondhand smoke causes an estimated 41,000 deaths each year among adults in the United States:

• Secondhand smoke causes 7,333 annual deaths from lung cancer.
• Secondhand smoke causes 33,951 annual deaths from heart disease.

Increased Risk for Death Among Men

• Men who smoke increase their risk of dying from bronchitis and emphysema by 17 times; from cancer of the trachea, lung, and bronchus by more than 23 times.
• Smoking increases the risk of dying from coronary heart disease among middle-aged men by almost four times.

Increased Risk for Death Among Women

• Women who smoke increase their risk of dying from bronchitis and emphysema by 12 times; from cancer of the trachea, lung, and bronchus by more than 12 times.
• Between 1960 and 1990, deaths from lung cancer among women increased by more than 500%.
• In 1987, lung cancer surpassed breast cancer to become the leading cause of cancer death among U.S. women.
• In 2000, 67,600 women died from lung cancer.
• During 2010–2014, almost 282,000 women (56,359 women each year) will die from lung cancer.
• Smoking increases the risk of dying from coronary heart disease among middle-aged women by almost five times.

Death from Specific Diseases

The following table lists the estimated number of smokers aged 35 years and older who die each year from smoking-related diseases.

Tobacco-Related Health Fraud

All tobacco products are harmful to your health, despite what they taste, smell, or look like. Claiming less harm or reduced risk of disease from using tobacco products can mislead consumers to think that these products are safe to use. FDA considers these kinds of unauthorized claims to be health fraud.

Explicit or implied claims of reduced harm or the risk of tobacco-related disease can only be made after scientific evidence to support those claims has been submitted to FDA, and FDA has issued an order permitting their marketing use. These requirements were put in place so that American tobacco consumers are not misled about the harms of tobacco products. See Modified Risk Orders for a list of tobacco products that have met the requirements permitting them to make claims of reduced risk or harm to users and nonusers.

What is Tobacco-Related Health Fraud?

False or misleading claims in the promotion, labeling, advertising, distribution or sale of tobacco products, including suggestions that a tobacco product is safer, less harmful, contains a reduced level or is free of a harmful substance, or presents a lower risk of tobacco-related disease compared to other tobacco products.

Examples of Tobacco-Related Health Fraud

FDA has issued a number of warning letters for illegally marketing tobacco products and using claims or descriptions that may mislead consumers by suggesting reduced harm or risk in using a tobacco product. The letters cited several, specific examples of tobacco-related health fraud including:

• Marketing, advertising or promotional claims that suggest the product is safer, healthier or less risky to use, like:
  • “Safe Smoke Filter”
  • “Less Toxic”
• Labels, internet sites, or other promotions that describe a tobacco product as “Light,” “Low,” or “Mild”
• Letters, presentations, or other actions directed to consumers indicating FDA approval or authorization is assured or imminent.

Health Fraud Example 1

Health Fraud Example 2

Report Violations

If you see tobacco retailers market or promote their products as “light,” “low,” “mild” or somehow safer to consume, please report it immediately to:

• CTPcompliance@fda.hhs.gov or 1-877-287-1373 Option 3
• Report a Potential Tobacco Violation

Appropriate enforcement actions will be pursued to protect public health once violations are verified.

Detailed information related to any unexpected tobacco- or e-cigarette-related health or product issues can also be reported to the FDA via the online Safety Reporting Portal.