Tobacco, Nicotine, & E-Cigarettes
Cigarettes: Also known as: “smokes,” “cigs,” or “butts”
Smokeless tobacco: Also known as: “chew,” “dip,” “spit tobacco,” “snus,” or “snuff”
Hookah: Also known as: “narghile,” “argileh,” “shisha,” “hubble-bubble,” or “goza”
Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco or created by burning it (as in cigarettes), but nicotine is the ingredient that can lead to addiction. Other chemicals produced by smoking, such as tar, carbon monoxide, acetaldehyde, and nitrosamines, also can cause harm to the body. For example, tar causes lung cancer and other serious diseases that affect breathing. Carbon monoxide causes heart problems, which is one reason why people who smoke are at high risk for heart disease.
Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarettes cause more than 480,000 premature deaths in the United States each year—from smoking or exposure to secondhand smoke—about 1 in every 5 U.S. deaths, or 1,300 deaths every day.1 An additional 16 million people suffer with a serious illness caused by smoking. Thus, for every 1 person who dies from smoking, 33 more suffer from at least 1 serious tobacco-related illness.2
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 of Smoking and Health, 2014 - http://ash.org/wp-content/uploads/2014/01/full-report.pdf [27.2 MB] or http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#toll [access 2014 Dec 22].
2. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Tobacco Use: Targeting the Nation’s Leading Killer—At a Glance 2011. Available at: http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/tobacco_aag_2011_508.pdf [484 KB]
Tobacco and nicotine products come in many forms. People either smoke, chew, or sniff them, or inhale their vapors.
Smoked tobacco products.
- Cigarettes (regular, light, and menthol). No evidence exists that “lite” or menthol cigarettes are safer than regular cigarettes.
- Cigars and pipes.
- Bidis and kreteks (clove cigarettes). Bidis are small, thin, hand-rolled cigarettes primarily imported to the United States from India and other Southeast Asian countries. Kreteks—sometimes referred to as clove cigarettes—contain about 60-80% tobacco and 20-40% ground cloves. Flavored bidis and kreteks are banned in the United States because of the ban on flavored cigarettes.
- Hookahs or water pipes. Practiced for centuries in other countries, smoking hookahs has become popular among teens in the United States. Hookah tobacco comes in many flavors, and the pipe is typically passed around in groups. As with smoking cigarettes, water pipe smoking still delivers the addictive drug nicotine and is at least as toxic as cigarette smoking.
Smokeless tobacco products. The tobacco is not burned with these products:
- Chewing tobacco, which is placed between the cheek and gums.
- Snuff, ground tobacco which can be sniffed if dried or placed between the cheek and gum.
- Dip, moist snuff that is used like chewing tobacco.
- Snus, a small pouch of moist snuff.
- Dissolvable products, including lozenges, orbs, sticks, and strips.
- Electronic cigarettes. Also called e-cigarettes, electronic nicotine delivery systems, or e-cigs, electronic cigarettes are smokeless, battery-operated devices that deliver flavored nicotine to the lungs without burning tobacco (the usual source of nicotine). In most e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The resulting vapor is then inhaled (called “vaping”). See What About E-Cigarettes? to learn more.
Like cocaine, heroin, and marijuana, nicotine increases levels of a neurotransmitter called dopamine. Dopamine is released normally when you experience something pleasurable like good food, your favorite activity, or spending time with people you care about. When a person uses tobacco products, the release of dopamine causes similar effects. This effect wears off quickly, causing people who smoke to get the urge to light up again for more of that good feeling, which can lead to addiction.
Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may enhance the effects of nicotine on the brain.
When smokeless tobacco is used, nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. Even after the tobacco is removed from the mouth, nicotine continues to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for users of smokeless tobacco than for smokers.
When nicotine enters the body, it initially causes the adrenal glands to release a hormone called epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes an increase in blood pressure, heart rate, and breathing.
Most of the harm to the body is not from the nicotine, but from other chemicals contained in tobacco or produced when burning it—including carbon monoxide, tar, formaldehyde, cyanide, and ammonia. Tobacco use harms every organ in the body and can cause many problems. The health effects of smokeless tobacco are somewhat different from those of smoked tobacco. But for both types of tobacco products, the risks are real.
Smoking Tobacco Effects
- Cancer. Tobacco use can be blamed for about one-third of all cancer deaths, including 90% of lung cancer cases. Tobacco use is also linked with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, bladder, and bone marrow (leukemia).
- Lung or respiratory problems. Bronchitis (swelling of the air passages to the lungs), emphysema (damage to the lungs), and pneumonia have been linked with smoking.
- Heart disease. Smoking increases the risk for stroke, heart attack, vascular disease (diseases that affect the circulation of blood through the body), and aneurysm (a balloon-like bulge in an artery that can rupture and cause death).
- Cataracts (an eye condition). People who smoke can experience this clouding of the eye, which causes blurred vision.
- Loss of sense of smell and taste.
- Lowered lung capacity. People who smoke can’t exercise or play sports for as long as they once did.
- Aging skin and teeth. After smoking for a long time, people find that their skin ages faster and their teeth discolor or turn brown.
- Harm to the unborn baby of a pregnant woman who smokes. Pregnant women who smoke are at increased risk for delivering their baby early or suffering a miscarriage, still birth, or experiencing other problems with their pregnancy. Smoking by pregnant women also may be associated with learning and behavior problems in children.
For people who do not smoke, secondhand smoke—exposure to exhaled smoke and smoke given off by the burning end of tobacco products—increases the risk for many diseases. Each year, an estimated 88 million Americans are regularly exposed to secondhand smoke and an estimated 41,000 nonsmokers die from diseases caused by secondhand smoke exposure.3
Inhaling secondhand smoke increases a person’s risk for developing:
- Heart disease. Secondhand smoke increases the risk for heart disease by 25% to 30%. It is estimated to contribute to as many as 34,000 deaths related to heart disease.4
- Lung cancer. People exposed to secondhand smoke increase their risk for lung cancer by 20% to 30%. About 7,300 lung cancer deaths occur per year among people who do not smoke.5
- Lung problems. Secondhand smoke causes breathing problems in people who do not smoke, like coughing, phlegm, and lungs not working as well as they should.
- Health problems for children. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, lung infections, ear problems, and more severe asthma.
- Accidental death from fires. Smoking is the leading cause of fire-related deaths—more than 700 deaths each year.6
Smokeless Tobacco Effects
People who use smokeless tobacco products, such as chewing tobacco, snuff, or dip, are at risk for several health problems:
- Tooth decay, gum problems, and mouth sores. Smokeless tobacco increases the chance of getting cavities, gum disease, and sores in the mouth that can make eating and drinking painful.
- Cancer. Close to 30 chemicals in smokeless tobacco have been found to cause cancer. People who use smokeless tobacco are at increased risk for oral cancer (cancers of the mouth, lip, tongue, and pharynx) as well as esophageal and pancreatic cancers.
- Other potential health problems. Recent research shows smokeless tobacco may play a role in causing heart disease and stroke.
3. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Department of Health and Human Services. Smoking & Tobacco Use, Fast Facts. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#toll. Accessed 8/4/2014.
4. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Secondhand Smoke Facts. Updated April 2014. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm
5. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Secondhand Smoke Facts. Updated April 2014. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm
6. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Smoking and Tobacco Use. Tobacco-Related Mortality. Updated February 6, 2014. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/
E-Cigarettes have emerged over the past decade and researchers in the early stage of investigating what the health effects are for people who use these products or who are exposed to the aerosol (vapor) secondhand.
E-Cigarettes are designed to deliver nicotine without the other chemicals produced by burning tobacco leaves. Puffing on the mouthpiece of the cartridge activates a battery-powered inhalation device (called a vaporizer). The vaporizer heats the liquid inside the cartridge which contains nicotine, flavors, and other chemicals. The heated liquid turns into an aerosol (vapor) which the user inhales—referred to as “vaping.”
There are conflicting studies about whether or not e-cigarettes help smokers to quit. For tobacco cigarette smokers, e-cigarettes may be a safer alternative, if the goal is not to quit nicotine all together. However, health experts have raised many questions about the safety of these products, particularly for teens:
- Testing of some e-cigarette products found the aerosol (vapor) to contain known cancer-causing and toxic chemicals, and particles from the vaporizing mechanism that may be harmful. The health effects of repeated exposure to these chemicals are not yet clear.
- There is animal research which shows that nicotine exposure may cause changes in the brain that make other drugs more rewarding. If this is true in humans, as some experts believe, it would mean that using nicotine would increase the risk of other drug use and for addiction.
- There is an established link between e-cigarette use and tobacco cigarette use in teens. Researchers are investigating this relationship. The concern is that e-Cigarette use may serve as a “gateway” or introductory product for youth to try other tobacco products, including regular cigarettes, which are known to cause disease and lead to early death.
- The liquid in e-cigarettes can cause nicotine poisoning if someone drinks, sniffs, or touches it. Recently there has been a surge of poisoning cases in children under age 5. There is also concern for users changing cartridges and for pets.
The U.S. government’s Food and Drug Administration (FDA) may start to regulate how e-cigarettes are made and sold. Currently, they only regulate e-cigarettes that have a therapeutic benefit, but at this time no products qualify. If the FDA moves to regulate all e-cigarettes, this will likely result in there being rules on safety, advertising, and warning labels, similar to those that currently govern tobacco cigarettes and other tobacco products. For now, e-cigarettes are not guaranteed to be safe. Consumers should not assume that the health claims made in advertisements by manufactures are scientifically proven.
Yes. It is the nicotine in tobacco that is addictive. Each cigarette contains about 10 milligrams of nicotine. A person inhales only some of the smoke from a cigarette, and not all of each puff is absorbed in the lungs. Therefore, a person gets about 1 to 2 milligrams of the drug from each cigarette.
Studies of widely used brands of smokeless tobacco showed that the amount of nicotine per gram of tobacco ranged from 4.4 milligrams to 25.0 milligrams. Holding an average-size dip in your mouth for 30 minutes gives you as much nicotine as smoking 3 cigarettes. A 2-can-a-week snuff dipper gets as much nicotine as a person who smokes 1½ packs a day.
Whether a person smokes tobacco products or uses smokeless tobacco, the amount of nicotine absorbed in the body is enough to make someone addicted. When this happens, the person compulsively seeks out the tobacco even though he or she understands the harm it causes. Nicotine addiction can cause:
- Tolerance. Over the course of a day, someone who uses tobacco products develops tolerance—more nicotine is required to produce the same initial effects. Some of this tolerance is lost overnight. In fact, people who smoke often report that the first cigarette of the day is the strongest or the “best.”
Withdrawal. When people quit using tobacco products, they usually experience withdrawal symptoms, which often drive them back to tobacco use. Nicotine withdrawal symptoms include:
- Problems with thinking and paying attention
- Sleep problems
- Increased appetite
- Craving, which may last 6 months or longer, and can be a major stumbling block to quitting
Treatments can help people who use tobacco products manage these symptoms and improve the likelihood of successfully quitting. For now, smokers who want to quit have other good options with proven effectiveness. Find out more at teen.smokefree.gov and cdc.gov/tobacco/campaign/tips/quit-smoking.
Most people (nearly 70%) who smoke want to quit.7 Most who try to quit on their own relapse—often within a week. However, most former smokers have had several failed quit attempts before they succeed.
7. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Smoking and Tobacco use: Fast Facts. Updated April 2014. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
Yes. Tobacco use (both smoked and smokeless tobacco use) is the leading preventable cause of death in the United States. It is a known cause of human cancer. Smoking tobacco also can lead to early death from heart disease, health problems in children, and accidental fires caused by dropped cigarettes. 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); as a result, the heart pumps little or no blood to the body's organs.
According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 480,000 premature deaths in the United States each year—about 1 in every 5 U.S. deaths, or 1,300 deaths every day.8 People who smoke are at increased risk of death from cancer, particularly lung cancer, heart disease, lung diseases, and accidental injury from fires started by dropped cigarettes.
8. 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 2014 Feb 6].
Smoking and smokeless tobacco use generally start during adolescence. Among people who use tobacco:
- More than 3,200 people younger than 18 years of age smoke their first cigarette.10
- An estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers.11
- If smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 years of age could die prematurely (too early) from a smoking-related illness. This is about 1 in every 13 Americans age 17 years or younger who are alive today.12
- Most smokeless tobacco users will also smoke cigarettes at some time in their lives.13
- Using smokeless tobacco remains a mostly male behavior. About 15% of high school boys use smokeless tobacco.14
10. 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 2014 Apr 24].
11. 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 2014 Apr 24].
12. 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 2014 Apr 24].
13. U.S. Department of Health and Human Services. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings [PDF - 3.2 MB]. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2014.
14. U.S. Department of Health and Human Services. Tobacco: Facts and Figures. BeTobaccoFree.gov, http://betobaccofree.hhs.gov/about-tobacco/facts-figures/#who-smokeless.
If you or someone you know needs more information or is ready to quit, check out these resources:
For Quit Help:
- Call 1-800-QUIT-NOW (1-800-784-8669), a national toll-free number that can help people get the information they need to quit smoking.
- Visit SmokeFree.gov.
For More Information
Visit the Centers for Disease Control and Prevention.
- Commonly Abused Drugs Chart
- DrugFacts: Cigarettes and Other Tobacco Products.
- Mind Over Matter Teaching Guide and Series: Tobacco Addiction
- Research Report Series: Tobacco/Nicotine
Centers for Disease Control and Prevention:
Statistics and Trends
Monitoring the Future (University of Michigan):
Substance Abuse and Mental Health Services Administration: