Tobacco, Nicotine, & Vaping (E-Cigarettes)

Street names: Chew, Dip, Snuff

Revised October 2019

What are tobacco, nicotine, and vaping (e-cigarette) products?

broken cigarette sitting alongside an e-cigarette©Shutterstock/CatherineL-Prod

Also known as:

Cigarettes: Butts, Cigs, and Smokes

Smokeless tobacco: Chew, Dip, Snuff, Snus, and Spit Tobacco

Hookah: Goza, Hubble-bubble, Narghile, Shisha, and Waterpipe

Vaping: E-cigarettes, E-cigs, Electronic Cigarettes, JUULing

Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco leaves but nicotine is the one that can lead to addiction. Other chemicals produced by smoking tobacco, 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.

These toxic chemicals can be dangerous. In fact, 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. This represents about 1 in every 5 U.S. deaths, or 1,300 deaths every day. An additional 16 million people suffer with a serious illness caused by smoking. So, for every 1 person who dies from smoking, 30 more suffer from at least 1 serious tobacco-related illness.1

How Tobacco and Nicotine Products Are Used

Tobacco and nicotine products come in many forms. People can smoke, chew, sniff them, or inhale their vapors.

  • Smoked tobacco products.
    • Cigarettes: These are labeled as regular, light, or  menthol, but no evidence exists that “lite” or menthol cigarettes are safer than regular cigarettes.
    • Cigars and pipes: ​Some small cigars are hollowed out to make room for marijuana, known as "blunts," often done to hide the fact that they are smoking marijuana. Either way, they are inhaling toxic chemicals. 
    • 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. A 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. It is typically placed between the cheek and gums.
    • Snuff: Ground tobacco that can be sniffed if dried or placed between the cheek and gums.
    • Dip: Moist snuff that is used like chewing tobacco.
    • Snus: A small pouch of moist snuff.
    • Dissolvable products: These include lozenges, orbs, sticks, and strip.
  • Vaping/electronic cigarettes (also called e-cigarettes, electronic nicotine delivery systems, vaping devices, e-cigs, or JUULing). Vaping products are battery-operated devices that deliver nicotine and flavorings without burning tobacco. In most products, 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 Vaping (E-Cigarettes)? to learn more.

1 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. February 2019. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

What happens in the brain when you use tobacco and nicotine?

Like many other drugs, nicotine increases levels of a neurotransmitter called dopamine. Dopamine is released naturally 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 “feel-good” 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. So, a person who smokes about a pack of 25 cigarettes a day gets 250 “hits” of nicotine.  

Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may increase 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 happens to your body when you use tobacco and nicotine?

Short-Term Effects

When nicotine enters the body, it initially causes the adrenal glands to release a hormone called adrenaline, which stimulates the body and gives it a pleasurable “kick.” But the rush of adrenaline also causes the following:

  • increased blood pressure
  • increased heart rate
  • faster breathing

Long-Term Effects

The nicotine is addictive, and as people keep using tobacco, they are continually exposed to many toxic chemicals found in the tobacco (or produced by burning it). These include carbon monoxide, tar, formaldehyde, cyanide, and ammonia. Tobacco use harms every organ in the body and can cause many serious health problems, listed below.

Smoking Tobacco

  • 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 Problems. Bronchitis (swelling of the air passages to the lungs), emphysema (damage to the lungs), and pneumonia have been linked to smoking. People who smoke can’t exercise or play sports for as long as they once did.
  • Heart disease and stroke. Smoking increases the risk for stroke, heart attack, and other diseases of the blood’s heart and circulation system that can lead to death.
  • Cataracts. People who smoke can get cataracts, which is clouding of the eye that causes blurred vision.
  • Loss of sense of smell and taste. This also includes bad breath.
  • Aging skin and teeth. After smoking for a long time, people find their skin ages faster and their teeth discolor.
  • Risk to unborn baby. Pregnant women who smoke are at increased risk for delivering their baby early, having smaller babies, or suffering a miscarriage, stillbirth, or experiencing other problems with their pregnancy. Smoking by pregnant women also may be associated with learning and behavior problems in children.
  • Fire-related deaths. Smoking is the leading cause of fire-related deaths—more than 600 deaths each year, in some cases caused by people falling asleep with a lit cigarette that causes a house fire.6

Secondhand Smoke

People who do not smoke but live or hang out with smokers are exposed to secondhand smoke—smoke that is exhaled or given off by the burning end of tobacco products. Just like smoking, regularly standing near smokers increases your risk for disease. The Centers for Disease Control and Prevention reports that there is no risk-free level of exposure to secondhand smoke. Each year, an estimated 58 million Americans are regularly exposed to secondhand smoke and more than 42,000 nonsmokers die from diseases caused by secondhand smoke exposure.2 Since the 1964 Surgeon General’s Report, 2.5 million adults who were nonsmokers died because they breathed secondhand smoke. It is unclear what long- term side effects there are from exposure to e-cigarette vapor, but one in four U.S. middle and high school students say they've been exposed to unhealthy secondhand aerosol from e-cigarettes.3 Long-term effects can include: 

  • 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 but were exposed to second hand smoke.4
  • 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.
  • 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
  • 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.        

Smokeless Tobacco

The health effects of smokeless tobacco are somewhat different from those of smoked tobacco, but both can cause cancer and other effects: 

  • 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.
  • Heart disease and stroke. Recent research shows smokeless tobacco may play a role in causing heart disease and stroke.
  • Mouth problems. Smokeless tobacco increases the chance of getting cavities, gum disease, and sores in the mouth that can make eating and drinking painful.

2Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. January 2018. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

3 Wang TW, Marynak KL, Aguku IT, et al. Secondhand Exposure to Electronic Cigarette Aerosol Among US Youths. JAMA Pediatrics. 2017, e1. 

4 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Health Effects of Secondhand Smoke. Atlanta, GA. January 2018. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm.

5 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Health Effects of Secondhand Smoke. Atlanta, GA. January 2018. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm.

6 Centers for Disease Control and Prevention. Smoking and Tobacco Use. Tobacco-Related Mortality. Atlanta, GA. January 2018. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/.

Can you die if you use tobacco, nicotine, and vaping (e-cigarette) products?

Reports of Deaths Related to Vaping

The Food and Drug Administration has alerted the public to thousands of reports of serious lung illnesses associated with vaping, including dozens of deaths. They are working with the Centers for Disease Control and Prevention (CDC) to investigate the cause of these illnesses. Many of the suspect products tested by the states or federal health officials have been identified as vaping products containing THC, the main psychotropic ingredient in marijuana. Some of the patients reported a mixture of THC and nicotine; and some reported vaping nicotine alone. No one substance has been identified in all of the samples tested, and it is unclear if the illnesses are related to one single compound. Until more details are known, FDA officials have warned people not to use any vaping products bought on the street, and they warn against modifying any products purchased in stores. They are also asking people and health professionals to report any adverse effects. The CDC has posted an information page for consumers. See Vaping-Related Illnesses and Deaths: What We Know So Far.

Yes. Tobacco use (both smoked and smokeless) is the leading preventable cause of death in the United States. It is a known cause of cancer. Smoking tobacco cigarettes also can lead to early death from heart disease, health problems in children, and accidental home and building 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.7 On average, smokers die 10 years earlier than nonsmokers.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.

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.9

7 Centers for Disease Control and Prevention. Smoking and Tobacco Use: 2014 Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress. Atlanta, GA. 2014. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm.

8 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. February 2019. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

9 Centers for Disease Control and Prevention. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Atlanta, GA. 1990. HHS Publication No. 90-8416.

Are tobacco, nicotine, and vaping (e-cigarette) products addictive?

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 nicotine from each cigarette.

Studies of widely used brands of smokeless tobacco showed that the amount of nicotine per gram of tobacco ranges 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. 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 uncomfortable 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

What about vaping (e-cigarettes)?

Vaping products, also called e-cigarettes, are fairly new products. They’ve only been around for about ten years, so researchers are in the early stage of studying how they affect your health.

How Vaping Products Work

Vaping products 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.”

Various kinds of e-cigarettes

How Vaping Affects the Brain

Nicotine from vaping products activates the brain’s rewards circuits and increases levels of a chemical messenger in the brain called dopamine. Pleasurable feelings caused by nicotine’s interaction with the brain’s reward circuit can cause a person to seek out and use nicotine again and again, despite the risks to their health.

Research so far suggests that nicotine vaping might be less harmful than cigarettes when people who regularly smoke switch to them completely and no longer use tobacco cigarettes. But, because it affects the development of the brain’s reward system, continued e-cigarette use can lead to nicotine addiction. It can also make other drugs, such as cocaine and methamphetamine more pleasurable to a teen’s developing brain.10

It is important to remember that nicotine in any form is a highly addictive drug. Health experts have raised many questions about the safety of these products, particularly for teens:

  • Testing of some vaping 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.
  • Some research suggests that nicotine vaping may serve as a “gateway” or introductory product for youth to try other tobacco products, including regular cigarettes. A study showed that students who have vaped nicotine 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.11 Another study has shown an association between nicotine vaping and progression to smoking actual cigarettes.12 These studies suggest that vaping products may actually encourage cigarette smoking in adolescents.
  • Some research suggests that certain vaping products contain metals like nickel and chromium, possibly coming from the heating of coils.13

Regulation of Vaping Products (E-cigarettes)

The U.S. Food and Drug Administration (FDA) now regulates the sales of vaping products such as e-cigarettes, hookah tobacco, and cigars. Therefore:

  • It is illegal to sell vaping products (e-cigarettes), hookah tobacco, or cigars in person or online to anyone under age 18.
  • Buyers have to show their photo ID to purchase vaping products (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 vaping products, 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 manufacturers from making statements about their products that are not scientifically proven.

Regulation does not mean that vaping products 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 vaping products, hookah tobacco, and cigars now have to follow the same type of rules as cigarette manufacturers.

10 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. E-Cigarette Use Among Youth And Young Adults: A Report of the Surgeon General — Executive Summary.; 2016. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.... Accessed February 21, 2017.

11 Rigotti 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.

12 Chaffee BW, Watkins SL, Glantz SA. Electronic Cigarette Use and Progression From Experimentation to Established Smoking. Pediatrics. March 2018:e20173594. doi:10.1542/peds.2017-3594.

13 Hess CA, Olmedo P, Goessler W, Cohen E, Rule AM. E-cigarettes as a source of  toxic and potentially carcinogenic metals. Environmental Research. 2017;152:221-221.

How many teens use tobacco, nicotine, and vaping (e-cigarette) products?

Smoking and smokeless tobacco use generally start during the teen years. Among people who use tobacco:

  • Each day, nearly 3,200 people younger than 18 years of age smoke their first cigarette.14
  • Every day, an estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers.15
  • 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.16
  • Vaping is the most commonly used form of tobacco among youth in the United States. 
  • Young people who use vaping products or smokeless tobacco may be more likely to also become smokers.17, 18
  • Using smokeless tobacco remains a mostly male behavior. About 490,000 teens ages 12 to 17 are current smokeless tobacco users. For every 100 teens who use smokeless tobacco, 85 of them are boys.19

A survey of teens in the United States shows nicotine vaping is on the rise, raising concerns about the impact of nicotine on brain health and the potential for addiction.20

Monitoring the Future 2018: Teens Using Vaping Devices In Record Numbers
Monitoring the Future 2018: Teens More Likely To Use Marijuana Than Cigarettes

Below is a chart showing the percentage of teens who use tobacco and nicotine products. Brackets indicate a significant change from the previous year, with cigarette smoking generally down and vaping increasing significantly. 

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th Graders, 10th Graders, and 12th Graders; 2018 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Cigarettes (any use) Lifetime 9.10 16.00 [23.80]
Past Month 2.20 4.20 [7.60]
Daily 0.80 1.80 3.60
1/2-pack+/day 0.30 0.70 1.50
Smokeless Tobacco Lifetime 6.40 10.00 10.10
Past Month 2.10 3.90 4.20
Daily 0.30 1.00 1.60
Any Vaping Lifetime [21.50] [36.90] [42.50]
Past Year [17.60] [32.30] [37.30]
Past Month [10.40] [21.70] [26.70]

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

14 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. February 2019. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

15 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. February 2019. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

16 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. February 2019. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

17 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Smokeless Tobacco Use in the United States. Atlanta, GA. August 2018. Available at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/use_us/.

18 Leventhal AM, Stone MD, Andrabi N. Association of e-Cigarette Vaping and Progression to Heavier Patterns of Cigarette Smoking. JAMA. 2016; 316(18):1918-1920.

19 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Smokeless Tobacco Use in the United States. Atlanta, GA. August 2018. Available at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/use_us/.

20 Miech RA, Schulenberg JE, Johnston LD, et al. National adolescent drug trends in 2018: Findings released [Press release]. Ann Arbor, MI. December 2018. Retrieved from http://www.monitoringthefuture.org/.

What do I do if I want to quit using tobacco, nicotine, and vaping (e-cigarette) products?

Teens and young adults who smoke but want to quit have good options for help. If you or someone you know needs more information or is ready to quit, read more about quitting the use of tobacco and nicotine. If you have a friend who smokes, it puts you at higher risk for starting, because your friend is likely to pressure you into trying it. You might decide to step away from the friendship for a while to protect your own health. Even secondhand smoke is bad for your health.

Nearly 70 percent of people who smoke want to quit.21 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. However, several research studies show that using electronic devices to help quit cigarette smoking does not usually work in the long term, and might actually discourage people from quitting.22  One recent study showed that only nine percent of people using e-vaporizers to quit smoking cigarettes had actually stopped smoking a year later.23

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

Teens

Adults

  • 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.

21 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Atlanta, GA. Februrary 2019. Available at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

22 Kulik MC, Lisha NE, Glantz SA. E-cigarettes Associated With Depressed Smoking Cessation: A Cross-sectional Study of 28 European Union Countries. Am J Prev Med. 2018;54(4):603-609. doi:10.1016/j.amepre.2017.12.017

23Weaver SR, Huang J, Pechacek TF, Heath JW, Ashley DL, Eriksen MP. Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016. PLOS ONE. 2018;13(7):e0198047. doi:10.1371/journal.pone.0198047

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