Tobacco, Nicotine, & E-Cigarettes

Street names: Chew, Dip, Snuff

What are tobacco, nicotine, and e-cigarette products?

 stubbed out 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: Waterpipe, Narghile, 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 serious harm to the body. For example, tar causes lung cancer and other serious diseases that affect breathing, and carbon monoxide can cause heart problems.

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, 30 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 on Smoking and Health, 2014 [accessed 2015 Oct 9]. or http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.... [accessed 2015 Oct 9].

2. 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 2015 Oct 9].

 

How are tobacco and nicotine products used?

Tobacco and nicotine products come in many forms. People either smoke, chew, 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: Hookah tobacco comes in many flavors, and the pipe is typically passed around in groups.
      • recent study found that a typical hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide as smoking a cigarette
  • 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 battery-operated devices that deliver nicotine and flavorings without burning tobacco. 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.

How do tobacco and nicotine affect the brain?

Like other drugs, 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.

A typical smoker will take 10 puffs on a cigarette over the period of about 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 pack (25 cigarettes) daily gets 250 “hits” of nicotine each day.

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.

What are the other effects of tobacco and nicotine?

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.

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 58 million Americans are regularly exposed to secondhand smoke and more than 41,000 nonsmokers die from diseases caused by secondhand smoke exposure.3

The chart lists the health problems people are at risk for when smoking or chewing tobacco or as a result of exposure to secondhand smoke.

Increased Risk of Health Problems

Health Effect

Smoking tobacco

Secondhand Smoke

Smokeless tobacco

Cancer

Cancers: Cigarette smoking 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 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.4

 

Cancers: 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.

 

Lung Problems 

Breathing problems: Bronchitis (swelling of the air passages to the lungs), emphysema (damage to the lungs), and pneumonia have been linked with smoking.

Lowered lung capacity: People who smoke can’t exercise or play sports for as long as they once did.

Breathing problems: Secondhand smoke causes breathing problems in people who do not smoke, like coughing, phlegm, and lungs not working as well as they should.

 

Heart Disease / Stroke

Heart disease and stroke: 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).

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.5

Heart disease and stroke: Recent research shows smokeless tobacco may play a role in causing heart disease and stroke.

Other health Problems

Cataracts: People who smoke can get cataracts, which is clouding of the eye that causes blurred vision.

Loss of sense of smell and taste

Aging skin and teeth: After smoking for a long time, people find their skin ages faster and their teeth discolor.

 

Mouth problems: Smokeless tobacco increases the chance of getting cavities, gum disease, and sores in the mouth that can make eating and drinking painful.

Pregnant Women and Children

Pregnant women: 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.

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

Fire-related deaths: Smoking is the leading cause of fire-related deaths—more than 600 deaths each year.6

 

 

3. 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 2015 Oct 9].

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 August 2015. 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 August 2015. 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 August 2015. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/

What about e-cigarettes?

E-cigarettes are fairly new products. They’ve only been around for about a decade. Therefore, researchers are just in the early stage of studying the health effects 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.”

Because they do not burn tobacco, e-cigarettes are not expected to be as harmful to the lungs as other tobacco products.  But since they are so new, we do not know for sure.  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 in any form would increase the risk of other drug use and for addiction.
  • Some research suggests 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. A recent study showed that students who have used e-cigarettes by the time they start 9th grade are more likely than others to start smoking traditional cigarettes and other smoked tobacco products within the next year.7
  • 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.

Are e-cigarettes regulated?

Yes. The U.S. government’s Food and Drug Administration (FDA) announced on May 5, 2016 that the FDA will now restrict how and to whom e-cigarettes, as well as hookah tobacco and cigars, can be sold. This means the FDA will now regulate these types of tobacco products in much the same way they regulate cigarettes:

  • It is now illegal to sell e-cigarettes, hookah tobacco, or cigars in person or online to anyone under age 18;
  • Buyers have to show their photo ID to purchase e-cigarettes, hookah tobacco, or cigars, verifying that they are 18 years or older.
  • These products cannot be sold in vending machines (unless in an adult-only facility).
  • It is illegal to hand out free samples.

FDA regulation also means that the Federal government will now have a lot more information about what is in e-cigarettes, the safety or harms of the ingredients, how they are made, and what risks need to be communicated to the public (for example, on health warnings on the product and in advertisements). They will also be able to stop manufactures from making statements about their products that are not scientifically proven.

Regulation does not mean that e-cigarettes are necessarily safe for all adults to use, or that all of the health claims currently being made in advertisements by manufactures are true. But it does mean that e-cigarettes, hookah tobacco, and cigars now have to follow the same type of rules cigarette manufacturers have been following since 2009.

7Rigotti NA. e-Cigarette use and subsequent tobacco use by adolescents: new evidence about a potential risk of e-cigarettes. JAMA. 2015;314(7):673-674.

Can you get addicted to tobacco or nicotine products?

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. The average 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 continues to seek 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:
    • irritability
    • 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

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 (go back to smoking)—often within a week. Most former smokers have had several failed quit attempts before they finally succeed.

Some people believe e-cigarette products may help smokers lower nicotine cravings while they are trying to quit smoking cigarettes. But, researchers do not yet know whether e-cigarettes may be helpful for people trying to quit. There is also the possibility that they could strengthen the nicotine addiction, which would make quitting more difficult.

8. 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 2015. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm

Can you die if you use tobacco and nicotine?

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 On average, smokers die 10 years earlier than nonsmokers.9  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.

The good news is that people who quit may live longer. A 24-year-old man who quits smoking will, on average, increase his life expectancy (how long he is likely to live) by 5 years.10

8. 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 2015 Oct 9].

9. 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 2015 Oct 9].

 10. U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; 1990. HHS Publication No. 90-8416.

How many teens use tobacco and nicotine?

Smoking and smokeless tobacco use generally start during adolescence. Among people who use tobacco:

  • Each day, nearly 3,200 people younger than 18 years of age smoke their first cigarette.10Teens and e-cigarettes
  • Every day, 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 under the age of 18 - or about 1 in every 13 young people - could die prematurely (too early) from a smoking-related illness.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 490,000 teens ages 12 to 17 are current smokeless tobacco users. Most of them, 85% are boys. That means, for every 100 teens who use smokeless tobacco, 85 of them are boys and 15 of them are girls.14

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th Graders, 10th Graders, and 12th Graders; 2015 (in percent)*

Drug

Time Period

8th Graders

10th Graders

12th Graders

Cigarettes (any use)

Lifetime

13.30

[19.90]

[31.10]

 

Past Month

[3.60]

[6.30]

[11.40]

 

Daily

1.30

3.00

[5.50]

 

1/2-pack+/day

0.40

1.00

2.10

E-cigarettes

Past Month

9.50

14.00

16.20

Smokeless Tobacco

Lifetime

8.60

12.30

13.20

 

Past Month

3.20

4.90

6.10

 

Daily

0.80

1.60

2.90

* Data in brackets indicate statistically significant change from the previous year.

For more statistics on teen drug abuse, see NIDA’s Monitoring the Future study.

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 2015 Oct 9].

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 2015 Oct 9].

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 2015 Oct 9].

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. Results from the 2014 National Survey on Drug Use and Health: Detailed Tables.  Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2015.

 

What do I do if I want to quit using tobacco?

If you or someone you know needs more information or is ready to quit, check out these resources:

Teens

Adults

  • 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.

For More Information on Tobacco, Nicotine, & E-Cigarettes

Drug Facts

NIDA:

Centers for Disease Control and Prevention:

 

Statistics and Trends

NIDA:   

Centers for Disease Control and Prevention

Monitoring the Future (University of Michigan):

Substance Abuse and Mental Health Services Administration:

Blog Posts

Chat Day Transcripts

Infographics

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Teens and E-cigarettes

Published: February 11, 2016
This infographic explores e-cigarette use among teens, including usage rates compared with cigarette use, potential for e-cig use to lead to smoking, and what teens say is in their e-cig, as well as avenues for teens’ exposure to e-cig advertising.
See text description below

Substance Use in Women and Men

Published: January 08, 2016
This infographic shows differences in substance use trends between women and men for marijuana use disorder, abuse of prescription pain medicines, treatment admissions for sleeping aid misuse, and nicotine cessation.
See below for text description

Drug and Alcohol Use in College-Age Adults in 2014

Published: December 21, 2015
The 2014 Monitoring the Future College Students and Adults survey shows trends in alcohol, marijuana, nicotine, and stimulant use in college students and non-college peers.
See text description below

Monitoring the Future 2015 Survey Results

Published: December 16, 2015
NIH’s 2015 Monitoring the Future survey shows long term decline in illicit drug use, prescription opioid abuse, cigarette and alcohol use among the nation’s youth.