People have many questions about tobacco that can sometimes be hard to answer. They include questions about tobacco (including cigarettes, cigars, spit and other types of smokeless tobacco, and other tobacco products), nicotine, addiction, and quitting. Many of these questions are answered here. We also answer some questions about how smoking and tobacco can affect a person's health, including the heart, circulation, and lungs; its effect on unborn babies; and how it affects the development of cancer and other diseases.

Is there a safe way to smoke cigarettes?

No. All cigarettes can damage the human body. Any smoking is dangerous. Cigarettes are the only legal product whose advertised and intended use -- smoking -- is known to harm the body and cause cancer.

Although some people try to make their smoking habit safer by smoking fewer cigarettes, most smokers find that hard to do. Research has found that even smoking as few as 1 to 4 cigarettes a day can lead to serious health outcomes, including an increased risk of heart disease and a greater chance of dying at a younger age.

Some people think that switching from high-tar and high-nicotine cigarettes to those with low tar and nicotine makes smoking safer, but this is not true. When people switch to brands with lower tar and nicotine, they often end up smoking more cigarettes, or more of each cigarette, to get the same nicotine dose as before.

Smokers have been led to believe that "light" cigarettes have a lower health risk and are a good option to quitting. This is not true. A low-tar cigarette can be just as harmful as a high-tar cigarette because a person often takes deeper puffs, puffs more often, or smokes them to a shorter butt length. Studies have not found that the risk of lung cancer is any lower in smokers of "light" or low-tar cigarettes.

Hand-rolled cigarettes, while reported to be a cheaper and healthier way to smoke, are not safer than commercial brands. In fact, lifelong smokers of hand-rolled cigarettes have been found to have increased risk of cancers of the larynx (voice box), esophagus (tube that connects the mouth to the stomach), mouth, and pharynx (throat) when compared with smokers of machine-made cigarettes.

Newer kinds of cigarettes are being sold as "all natural." They are marketed as having no chemicals or additives and rolled with 100% cotton filters. There is no proof they are healthier or safer than other cigarettes, nor is there good reason to think they would be. Smoke from these cigarettes, like the smoke from all cigarettes, contains many agents that cause cancer (carcinogens) and toxins that come from the tobacco itself, including tar and carbon monoxide.

Herbal cigarettes, even though they do not contain tobacco, also give off tar and carbon monoxide and are dangerous to your health. The bottom line is there's no such thing as a safe smoke.

Are menthol cigarettes safer than those without menthol?

Menthol cigarettes are not safer than any other brand. In fact, they may even be more dangerous. About one-fourth of all cigarettes sold in the United States are flavored with menthol. These cigarettes are especially popular among African Americans. The added menthol produces a cooling sensation in the throat when the smoke is inhaled. It also decreases the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer.

Recent studies have shown that people who smoke menthol cigarettes are less likely to try to quit and are less likely to succeed when they do try. At least one researcher proposed that menthol smokers might want to switch to non-menthol cigarettes before trying to quit to improve their chances of quitting smoking.

Is cigarette smoking really addictive?

Yes. The nicotine in cigarette smoke causes an addiction to smoking. Nicotine is an addictive drug just like heroin and cocaine:

• When taken in small amounts, nicotine creates pleasant feelings that make the smoker want to smoke more. It acts on the chemistry of the brain and central nervous system, affecting the smoker's mood. Nicotine works very much like other addicting drugs, by flooding the brain's reward circuits with dopamine (a chemical messenger). Nicotine also gives you a little bit of adrenaline -- not enough to notice, but enough to speed up your heart and raise your blood pressure.

• Nicotine reaches the brain within seconds after taking a puff, but its effects start to wear off within a few minutes. This often leads the smoker to get another cigarette. If the smoker doesn't smoke again soon, withdrawal symptoms kick in and get worse over time.

• The typical smoker takes about 10 puffs from each cigarette. A person smoking a pack per day gets about 200 "hits" of nicotine each day.

• Smokers usually become dependent on nicotine and suffer physical and emotional (psychological) withdrawal symptoms when they stop smoking. These symptoms include irritability, nervousness, headaches, and trouble sleeping. The true marker for addiction, though, is that people still smoke even though they know smoking is bad for them -- affecting their lives, their health, and their families in unhealthy ways. Most people who smoke want to quit.

Researchers are also looking to see if there are other chemicals in tobacco that help promote addiction. In the brains of animals, tobacco smoke causes chemical changes that are not fully explained by the effects of nicotine.

What does nicotine do?

In large doses nicotine is a poison and can kill by stopping a person's breathing muscles. Smokers usually take in small amounts that the body can quickly break down and get rid of. The first dose of nicotine makes a person to feel awake and alert, while later doses produce a calm, relaxed feeling.

Nicotine can make new smokers, and regular smokers who get too much of it, feel dizzy or sick to their stomachs. The resting heart rate for young smokers increases 2 to 3 beats per minute. Nicotine also lowers skin temperature and reduces blood flow in the legs and feet. It may play a role in increasing smokers' risk of heart disease and stroke.

Many people mistakenly think that nicotine is the substance in tobacco that causes cancer. This belief may cause some people to avoid using nicotine replacement therapy when trying to quit. Although nicotine is what gets (and keeps) people addicted to tobacco, other substances in tobacco are responsible for its cancer-causing effects. There is some early evidence from lab-based studies that nicotine may help existing tumors grow, but whether these results apply to people is not yet known and more research is needed.

Why do people begin to smoke?

Most people begin smoking as teens, usually because of curiosity and peer pressure. People with friends and/or parents who smoke are more likely to take up smoking than those who don't.

The tobacco industry's ads, price breaks, and other promotions for its products are another big influence in our society. The tobacco industry spends billions of dollars each year to create and market ads that show smoking as an exciting, glamorous, and healthy adult activity. Despite the fact that cigarette brand product placement in movies was banned by the 1998 Tobacco Master Settlement Agreement, cigarettes appear in 3 out of 4 box office hit movies. And an actual cigarette brand can be identified in 1 in 3 movies. Studies show that young people who see smoking in movies are more likely to start smoking.

Who is most likely to become addicted?

Anyone who starts smoking is at risk of becoming addicted to nicotine. Studies show that cigarette smoking is most likely to become a habit during the teen years. The younger a person is when he or she begins to smoke, the more likely he or she is to become addicted to nicotine. Almost 90% of adult smokers first smoked at or before age 19.

How many people smoke cigarettes?

Among adults in the United States, cigarette smoking has gone down from about 42% of the population in 1965 to about 20% in 2007 (the latest year for which numbers are available). Still, more than 43 million adults smoked cigarettes in 2007. About 22% of men and 17% of women were smokers. Education seems linked to smoking rates, with lower smoking rates in groups with higher levels of education.

Is smoking common among young people?

Yes. Tobacco use, including smoking cigarettes, using chew or spit tobacco, and dipping snuff, is common among American youth, according to the most recent government surveys.

Despite declines in recent years, in 2006 nearly 1 in 3 male high school students (30%) and more than 1 in 5 female high school students (21%) used some type of tobacco in the month before they were surveyed. About 1 in 5 students (20%) were considered current cigarette smokers. Half of these students (about 50%) reported they had tried to quit smoking during the past year. Cigar smoking was also common among high school students (about 14%).

Also, about 19% of middle school students used some form of tobacco, with cigarettes (6%) being the most common.

Tobacco use is higher among male students for all products except cigarettes, where the numbers for boys and girls are now about the same.

Other problems have been linked to smoking. Studies have shown that students who smoke are also more likely to use other drugs, get in fights, carry weapons, try to kill themselves, and take part in high-risk sexual behaviors.

What in cigarette smoke is harmful?

Cigarette smoke is a complex mixture of chemicals produced by the burning of tobacco and its additives. The smoke contains tar, which is made up of more than 4,000 chemicals, including over 60 known to cause cancer. Some of these substances cause heart and lung diseases, and all of them can be deadly. You might be surprised to know some of the chemicals found in cigarette smoke include:

• cyanide
• benzene
• formaldehyde
• methanol (wood alcohol)
• acetylene (the fuel used in welding torches)
• ammonia

Cigarette smoke also contains the poison gases nitrogen oxide and carbon monoxide. The active ingredient that produces the effect people are looking for is nicotine, an addictive drug.

Does smoking cause cancer?

Yes. Tobacco use accounts for at least 30% of all cancer deaths in the United States. Smoking causes about 87% of lung cancer deaths. Smoking also causes cancers of the larynx (voice box), mouth, pharynx (throat), esophagus (swallowing tube), and bladder. It also has been linked to the development of cancers of the pancreas, cervix, kidney, and stomach and some types of leukemia. Cigars, pipes, and spit and other types of smokeless tobacco all cause cancers, too. There is no safe way to use tobacco.

How does cigarette smoke affect the lungs?

Damage to the lungs begins early in smokers, and cigarette smokers have a lower level of lung function than non-smokers. This continues to worsen as long as the person smokes. Cigarette smoking causes many lung diseases that can be just as dangerous as lung cancer. Chronic bronchitis and emphysema are 2 types of chronic obstructive pulmonary disease that can make it hard to breathe and can cause serious health problems -- even death.

Chronic bronchitis

Chronic bronchitis is a disease where the airways produce too much mucus, forcing the smoker to cough it out. It is a common problem for smokers. The lungs start to produce large amounts of mucus, and do it more often. The airways become inflamed (swollen) and the cough becomes chronic -- it doesn't get better or go away. Airways get blocked by scars and mucus. Serious infections can also result.

Emphysema

Cigarette smoking is also the major cause of emphysema -- a disease that slowly destroys a person's ability to breathe. Oxygen gets into the blood by moving across a large surface area in the lungs. Normally, thousands of tiny sacs make up this surface area. With emphysema, the walls between the sacs break down and create larger but fewer sacs. This decreases the lung surface area, which lowers the amount of oxygen reaching the blood. Over time, the lung surface area can become so small that a person with emphysema often must gasp for breath.

Shortness of breath (especially when lying down), a mild cough that doesn't go away (which is often dismissed as "smoker's cough"), feeling tired, and sometimes weight loss are early signs of emphysema. People with emphysema are at risk for many other problems linked to weak lung function, including pneumonia. In later stages of the disease, patients can only breathe comfortably with the help of an oxygen tube under the nose. Emphysema cannot be reversed, but it can be slowed down -- especially if the person stops smoking.

Chronic obstructive pulmonary disease

More than 7 million current and former smokers suffer from chronic obstructive pulmonary disease (COPD), the name used to describe both chronic bronchitis and emphysema. COPD is the fourth leading cause of death in America. More women die from COPD than men. Smoking is the main risk factor for COPD. More than 75% of COPD deaths are caused by smoking. The late stage of chronic lung disease is one of the most miserable of all medical problems. It creates a feeling of gasping for breath all the time -- much like the feeling of drowning.

Why do smokers have "smoker's cough?"

Cigarette smoke has chemicals that irritate the air passages and lungs. When a smoker inhales these substances, the body tries to protect itself by making mucus and coughing. The early morning smoker's cough happens for many reasons. Normally, tiny hair-like formations (called cilia) beat outward and sweep harmful material out of the lungs. Cigarette smoke slows the sweeping action, so some of the poisons in the smoke stay in the lungs and mucus stays in the airways. While a smoker sleeps, some cilia recover and begin working again. After waking up, the smoker coughs because the lungs are trying to clear away the irritants and mucus that built up the day before. The cilia will completely stop working after they have been exposed to smoke for a long time. Then the smoker's lungs are even more exposed and prone to infection and irritation.

If you smoke but don't inhale, is there any danger?

Yes. Wherever smoke touches living cells, it does harm. Even if smokers don't inhale they are breathing the secondhand smoke and are still at risk for lung cancer. Pipe and cigar smokers, who often don’t inhale, are at an increased risk for lip, mouth, tongue, and some other cancers.

Does cigarette smoking affect your heart?

Yes. Smoking cigarettes increases the risk of heart disease, which is the number one cause of death in the United States. Smoking, high blood pressure, high cholesterol, physical inactivity, obesity, and diabetes are all risk factors for heart disease, but cigarette smoking is the biggest risk factor for sudden death from a heart attack.

A smoker who has a heart attack is more likely to die within an hour of the heart attack than a non-smoker. Cigarette smoke can harm the heart at very low levels, even when the amount is too low to cause lung disease.

How does smoking affect pregnant women and their babies?

Pregnant women who smoke risk the health and lives of their unborn babies. Smoking during pregnancy is linked with a greater chance of miscarriage, premature delivery, stillbirth, infant death, low birth-weight, and sudden infant death syndrome (SIDS). Up to 5% of infant deaths could be prevented if pregnant women did not smoke.

When a pregnant woman smokes, she's smoking for 2. The nicotine, carbon monoxide, and other harmful chemicals enter her bloodstream, pass directly into the baby's body, and keep it from getting vital nutrients and oxygen it needs for growth.

Breast-feeding is a good way to feed a new baby, but if the mother smokes it exposes the baby to nicotine and other poisons in the smoke through breast milk. Nicotine can cause many unwanted symptoms in the baby, such as restlessness, a rapid heartbeat, vomiting, shorter sleep times, or diarrhea.

Some research has also suggested that children whose mothers smoked while pregnant or who have been exposed to secondhand smoke, even in small amounts, may be slower learners in school. They may be shorter and smaller than children of non-smokers. They are also more likely to smoke when they get older.

What are some of the short- and long-term effects of smoking cigarettes?

Smoking causes many types of cancer, which may not develop for years. But cancers account for only about half of the deaths linked to smoking. Long-term, smoking is also a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke. It also makes pneumonia and asthma worse. Wounds take longer to heal and the immune system may not work as well in smokers as in non-smokers.

Smoking also damages the arteries. Because of this, many vascular surgeons refuse to operate on patients with peripheral artery disease (poor blood circulation in the arms and legs) unless they stop smoking. And male smokers have a higher risk of sexual impotence (erectile dysfunction) the longer they smoke

The truth is that cigarette smokers die younger than non-smokers. In fact, according to a study done in the late 1990s by the Centers for Disease Control and Prevention (CDC), smoking shortened male smokers' lives by 13.2 years and female smokers' lives by 14.5 years. Men and women who smoke are much more likely to die during middle age (between the ages of 35 and 69) than those who have never smoked.

Smoking also causes many short-term effects, such as poor lung function. Because of this, smokers often suffer shortness of breath and nagging coughs. They often will tire easily during physical activity. Some other common short-term effects include less ability to smell and taste, premature aging of the skin, bad breath, and stained teeth

What are the chances that smoking will kill you?

About half of all the people who keep smoking will die because of it. In the United States, tobacco causes nearly 1 in 5 deaths, killing about 443,000 Americans each year. Smoking is the single most preventable cause of death in our society.

Based on current patterns, smoking will kill about 650 million people alive in the world today. If these patterns continue, tobacco-caused deaths worldwide are expected to increase from about 5 million per year today to about 10 million per year by the 2030s. Most of these deaths will happen in developing countries.

What are the dangers of environmental (secondhand) tobacco smoke?

Environmental tobacco smoke (ETS) is also known as secondhand smoke. Passive smoking (inhaling secondhand smoke) happens when non-smokers breathe other people’s tobacco smoke. This includes mainstream smoke (smoke that is inhaled and then exhaled into the air by smokers) and sidestream smoke (smoke that comes directly from the burning tobacco in cigarettes). ETS contains the same harmful chemicals as the smoke that smokers inhale. In fact, because sidestream smoke is formed at lower temperatures, it has even larger amounts of some toxic and cancer-causing substances than mainstream smoke.

There is strong evidence that ETS causes serious damage to human health. Each year about 49,400 non-smoking adults die of lung cancer or heart disease as a result of breathing secondhand smoke. It can also affect non-smokers by causing asthma and other respiratory problems, eye irritation, headaches, nausea, and dizziness. Children whose parents smoke are more likely to suffer from asthma, pneumonia, bronchitis, ear infections, coughing, wheezing, and increased mucus production. Babies of parents who smoke have a greater chance of dying of sudden infant death syndrome (SIDS). Pregnant women exposed to ETS are at risk for having a low birth weight baby and may also be at risk for pre-term delivery and miscarriage.

Can secondhand smoke cause breast cancer?

Research is still being done to find out whether secondhand smoke may increase the risk of breast cancer. Both mainstream and secondhand smoke have about 20 chemicals that, in high concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast tissue and are found in breast milk.

Any link between secondhand smoke and breast cancer risk in human studies is a subject of debate, partly because breast cancer risk has not been shown to be increased in active smokers. One possible reason for this is that tobacco smoke may have different effects on breast cancer risk in smokers and in those who are exposed to secondhand smoke.

A report from the California Environmental Protection Agency in 2005 concluded that the evidence about secondhand smoke and breast cancer is "consistent with a causal association" in younger women. This means that the secondhand smoke acts like it could be a cause of breast cancer in these women. The 2006 US Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, concluded that there is "suggestive but not sufficient" evidence of a link at this point. In any case, women may want to know that this possible link to breast cancer is yet another reason to avoid secondhand smoke.

Am I at risk for getting lung cancer from smoke odors on clothing or from being in a room that still smells of tobacco smoke?

There are no medical research reports on the cancer-causing effects of cigarette odors, but research does show that secondhand smoke can seep into hair, clothing, and other surfaces. The unknown cancer-causing effects would probably be very small compared with direct secondhand smoke exposure, such as living in a household that has a smoker.

What is being done to protect people from the hazards of smoking?

Tobacco labels

Both the public and private sectors have acted to help decrease smoking-related deaths and illnesses in this country. Since 1966, the US Surgeon General's health warnings have been required on all cigarette packages and, since 1987, on all spit or oral tobacco products. Since 2001, the 7 major cigar manufacturers in the United States have provided 5 health warnings that rotate on cigar labels. These labels are much like those on cigarette packages.

Advertising

Congress banned cigarette advertising on TV and radio in 1971 and spit tobacco advertising in 1987. The American Legacy Foundation and many states have made anti-smoking public service messages that are featured on television, radio, and billboards. Some tobacco companies have come up with their own ads, which appear to be anti-smoking but seem to actually promote a more favorable attitude toward the tobacco industry.

Taxes

Taxes on cigarettes have risen in many states in recent years. They have been shown to discourage young people from starting to smoke and to encourage smokers to quit. State taxes on tobacco vary from as low as 7 cents (in South Carolina) to up to $2.58 a pack (in New Jersey).

Smoking bans

Laws in all 50 states and the District of Columbia restrict or do not allow smoking in certain public places. These laws range from simple restrictions, such as designated areas in government buildings, to laws that ban smoking in all public places and workplaces. Federal buildings controlled by the executive branch, including the White House, are smoke-free. Congressional offices and courthouses are not required to be smoke-free by this Federal ban, but many are smoke-free for other reasons. A number of other Federal agencies also require smoke-free buildings. Smoking is also banned on all domestic airplane flights.

Are spit tobacco and snuff safe alternatives to cigarette smoking?

Many terms are used to describe tobacco that is put in the mouth, such as spit, oral, smokeless, chewing, and snuff tobacco. Using any kind of spit or smokeless tobacco is a major health risk. It is a less lethal substitute for smoking cigarettes, but less lethal is a far cry from safe.

The amount of nicotine absorbed is usually more than the amount delivered by a cigarette. Overall, people who dip or chew get about the same amount of nicotine as regular smokers. The most harmful cancer-causing substances in spit tobacco are tobacco-specific nitrosamines which have been found at levels 100 times higher than the nitrosamines that are allowed in bacon, beer, and other foods. These carcinogens cause lung cancer in experimental animals, even when injected rather than inhaled.

The juice from the smokeless tobacco is absorbed directly through the lining of the mouth. This causes sores and white patches (called leukoplakia) that often lead to cancer of the mouth.

People who use spit and other types of smokeless tobacco greatly increase their risk of other cancers including those of the throat (pharynx). Other effects of spit tobacco use include chronic bad breath, stained teeth and fillings, gum disease, tooth decay, tooth loss, tooth abrasion, and loss of bone in the jaw. Users may also have problems with high blood pressure and may be at increased risk for heart disease.

What is snus? Is it safe?

Snus (sounds like "snoose") is a type of moist snuff first used in Sweden. It is often flavored with spices or fruit, and is usually packaged in thin bags much like tea bags. It is also sold loose, as a moist powder. Like snuff and other spit tobaccos, snus is held between the gum and mouth tissues where the juice is absorbed into the body.

Because it is heated during processing, Swedish snus has fewer tobacco-specific nitrosamines (see the previous section, "Are spit tobacco and snuff safe alternatives to cigarette smoking?") that are known to cause cancer. Snus users in Sweden have lower rates of several types of cancer than Swedish smokers. Because of this, some people believe snus is "safe." But snus users have a higher risk of cancer of the pancreas than non-users. They also get sores or spots in the mouth (lesions) where the snus is held. It appears that snus users may have mouth cancer more often than non-users, though more study needs to be done to confirm this.

Since US tobacco sellers are not required to list what is in their products, it would be hard to know how the US versions of snus might compare to the Swedish versions without doing studies here. Since snus has just been introduced in the US, it is uncertain what other problems it might cause. But, snus is not a safe alternative to smoking.

What are the health risks of smoking pipes or cigars?

Many people view cigar smoking as more "civilized" and "sophisticated," as well as less dangerous than cigarette smoking. Yet a single large cigar can contain as much tobacco as an entire pack of cigarettes.

Most of the same cancer-causing substances found in cigarettes are found in cigars. And most cigars have as much nicotine as several cigarettes. When cigar smokers inhale, nicotine is absorbed as quickly as it is with cigarettes. For those who do not inhale, it is absorbed more slowly through the lining of the mouth. Both inhaled and non-inhaled nicotine are highly addictive.

Smoking cigars causes cancers of the lung, lip, tongue, mouth, throat (oral cavity), voice box (larynx), swallowing tube (esophagus), and probably cancers of the bladder and pancreas. Cigar smokers have a greater risk of dying from cancer of the mouth, larynx, or esophagus than non-smokers. The risk of death from lung cancer is not as high as it is for cigarette smokers, but is still many times higher than the risk for non-smokers.

Cigar smokers who inhale deeply and smoke several cigars a day are also at increased risk for heart disease and chronic lung disease.

Pipe smokers have an increased risk of dying from cancers of the lung, throat, esophagus, larynx, pancreas, and colon and rectum. They also have an increased risk of dying of heart disease, stroke, and chronic lung disease. The level of these risks seems to be about the same as that for cigar smokers.

Smoking cigars or pipes is not a safe alternative to smoking cigarettes.

What about more "exotic" forms of smoking tobacco, such as clove cigarettes, bidis, and hookahs?

Many forms of flavored tobacco have become popular in recent years, especially among younger people. Clove cigarettes (kreteks), bidis, and, more recently, hookahs, often appeal to those who want something a little different. They also give young people another way to experiment with tobacco. The false image of these products as clean, natural, and safer than regular cigarettes seems to attract some young people who may otherwise not start smoking. But these products carry many of the same risks of cigarettes and other tobacco products, and each has its own additional problems linked to it.

Clove cigarettes

Clove cigarettes, also called kreteks, are imported mainly from Indonesia and contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. The chemicals in cloves have been linked to asthma and other lung diseases.

Users often have the mistaken notion that smoking clove cigarettes is a safe alternative to smoking tobacco. But this is a tobacco product with the same health risks as cigarettes. In fact, kreteks have been shown to deliver more nicotine, carbon monoxide, and tar than regular cigarettes.

Bidis

Bidis or "beedies" are flavored cigarettes imported mainly from India. They are hand-rolled in an unprocessed tobacco leaf and tied with colorful strings on the ends. Their popularity has grown in recent years in part because they come in many candy-like flavors (like strawberry, vanilla, and grape), they usually cost less than regular cigarettes, and they often give the smoker a quick buzz.

Even though bidis contain less tobacco than regular cigarettes, they deliver higher levels of nicotine (the addictive chemical in tobacco) and other harmful substances such as tar and carbon monoxide. Because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette. They are also unfiltered. Bidis seem to have all of the same health risks of regular cigarettes, if not more. Bidi smokers have much higher risks of heart attacks, chronic bronchitis, and some cancers than non-smokers.

Hookah

Hookah (or narghile) smoking started in the Middle East. Users burn flavored tobacco (called shisha) in a water pipe and inhale the smoke through a long hose. It has recently become popular among young people, especially around college campuses. Hookah smoking is usually a social event that allows the smokers to spend time together and talk as they pass the pipe around. It is marketed as being a safe alternative to cigarettes because the percentage of tobacco in the product smoked is low and people think the water filters out the toxins. These safety claims are false. The water does not filter out many of the toxins. In fact, hookah smoke contains more toxins such as nicotine, carbon monoxide, tar, and other hazardous substances, than cigarette smoke. Several types of cancer have been linked to hookah smoking. Hookah use is also linked to other unique risks not linked with cigarette smoking. For example, infectious diseases can be spread by sharing the pipe or through the way the tobacco is prepared.

All forms of tobacco are dangerous. Even if the health risks were smaller for some tobacco products as opposed to others, all tobacco products contain nicotine, which can lead to increased use and addiction. Do not think tobacco is safe in any amount or form.

What can I do to help with any damage that may have been caused by smoking?

If you have used tobacco in any form, now or in the past, tell your health care provider so he or she can be sure that you get the right preventive health care. It is well known that tobacco use puts you at risk for certain health-related illnesses. This means part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. For example, you will want to be sure that you regularly check the inside of your mouth for any changes, and have an oral exam by your doctor or dentist if you find any changes or problems. The American Cancer Society recommends that periodic check-ups include mouth (oral cavity) exams. By doing this tobacco users may be able to find oral changes and leukoplakia (white patches on the mouth membranes) early. This may help prevent oral cancer.

You should also be aware of any of the following:

• any change in a cough (for example, you cough up more mucus than usual)
• a new cough
• coughing up blood
• hoarseness
• trouble breathing
• wheezing
• headaches
• chest pain
• loss of appetite
• weight loss
• general fatigue (feeling tired all the time)
• frequent or repeated respiratory infections

Any of these could be signs of lung cancer or a number of other lung conditions and you should report any symptom to your doctor right away. Although these can be signs of a problem, many people do not notice symptoms of lung cancers until they are advanced and the cancer has spread to other parts of the body.

Remember that tobacco users have an increased risk for other cancers too, depending on the way they use tobacco. You can learn more about the types of cancer you may be at risk for by reading our document that discusses the type of tobacco you use (for example, Cigar Smoking). Other risk factors for these cancers may be more important than your use of tobacco, but you should know the additional risks that might apply to you.

If you have any health concerns because of your tobacco use, please see your health care provider as soon as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for treatment success. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit using tobacco.

How does tobacco use affect the economy?

The tobacco industry is one of the most profitable businesses in the country, making billions of dollars every year. But the costs of smoking are far higher than the income from cigarette sales.

• Smoking causes more than $193 billion each year in health-related costs, including the cost of lost productivity caused by deaths from smoking.

• Smoking-related medical costs averaged more than $97 billion each year between 2000 and 2004. This translates to $2,197 in extra medical expenses for each adult smoker per year as of 2004.

• Death-related productivity losses from smoking among workers cost the US economy more than $96 billion yearly (average for 2000-2004).

• For each pack of cigarettes sold or given away in 2004, $5.34 was spent on medical care caused by smoking, and $5.28 lost in productivity, for a total cost to society of $10.62 per pack.

Can quitting really help a lifelong smoker?

Yes. It is never too late to quit using tobacco. The sooner smokers quit, the more they can reduce their chances of getting cancer and other diseases. Within minutes of smoking the last cigarette, the body begins to restore itself.

20 minutes after quitting
Your heart rate and blood pressure drop.

12 hours after quitting
The carbon monoxide level in your blood drops to normal.

2 weeks to 3 months after quitting
Your circulation improves and your lung function increases.

1 to 9 months after quitting
Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.

1 year after quitting
The excess risk of coronary heart disease is half that of a smoker's.

5 years after quitting
Your stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting.

10 years after quitting
The lung cancer death rate is about half that of a person who is still smoking. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.

15 years after quitting
The risk of coronary heart disease is that of a non-smoker's.

Are there some benefits of quitting that I'll notice right away?

Kicking the tobacco habit offers some rewards that you'll notice right away and some that will show up more slowly over time. These benefits can improve your day-to-day life a lot.

• Food will taste better.
• Your sense of smell returns to normal.
• Your breath, hair, and clothes smell better.
• Your teeth and fingernails stop yellowing.
• Ordinary activities leave you less out of breath (for example, climbing a flight of stairs or doing light housework).

Quitting also helps stop the damaging effects of tobacco on how you look, including premature wrinkling of your skin and gum disease.

Suppose I smoke for a while and then quit?

Smoking begins to cause damage right away and is highly addictive. Some studies have found nicotine to be as addictive as heroin, cocaine, or alcohol. It’s the most common form of drug addiction in the United States. It’s much better to never start smoking cigarettes -- and become addicted to nicotine -- than it is to smoke with the thought of quitting later. Like alcohol, heroin, and cocaine, nicotine creates a tolerance in the body and promotes psychological dependence. This makes it much harder to quit, but with the right support it can be done.

When an ex-smoker smokes a cigarette, even years after quitting, the body reacts in the same way as it did when the person was smoking, which can cause the person to want to smoke again. Don't think you can smoke for a short while and quit when you want to; it's seldom that easy.

How do people quit smoking?

Quitting smoking is not easy, and some people try many times before succeeding. There are many ways to quit smoking. For example, some have been successful by stopping "cold turkey," by taking part in the Great American Smokeout^®, or by using other methods.

There's no single best way to quit. Quitting for good may mean using many methods, including step-by-step manuals, self-help classes, counseling, toll-free telephone-based counseling programs, and/or using nicotine replacement therapies or other medicines (see next questions). Smokers may also need to make changes in their daily routine to help them break their smoking habits. Some may find long-term support such as Nicotine Anonymous to be helpful. To improve your chances of success, try to use 2 or more of these methods to help you quit.

What are nicotine replacement therapies?

Nicotine replacement therapies (NRTs) are medicines that help decrease or stop a smoker's withdrawal symptoms by giving controlled doses of nicotine without the other harmful chemicals of cigarette smoke. NRTs are sold as patches, gums, inhalers, nasal sprays, or lozenges. The Food and Drug Administration (FDA) has approved all of these products to help people quit smoking. Patches, gums, and lozenges are available over the counter, but you will need a prescription for inhalers and nasal sprays.

These products work by helping smokers control their physical responses as they quit. For best results, smokers should use NRTs along with behavioral change programs that are designed to help smokers break their psychological (mental) dependence on cigarettes. For more information on such programs, call the American Cancer Society at 1-800-ACS-2345 (1-800-227-2345).

Not everyone can use nicotine replacement therapy. People with certain medical conditions and pregnant women should use it only with a doctor's supervision. It is always a good idea to get your doctor's input and support when you decide to quit smoking.

The best time to start NRT is when you begin to try to quit. Many smokers ask if it is possible to start using nicotine replacement while they are still smoking. There is some research on smokers using NRT while still smoking, but the results are still not clear enough to say for certain if this might pose a danger to your health. The most important thing is to make sure that you are not overdosing on nicotine, which can affect your heart and blood circulation. It is safest to be under a doctor's care if you wish to try smoking and using NRT while you are tapering off cigarette smoking.

For more information, see our document, Guide to Quitting Smoking.

Are there other medicines or vaccines to help smokers quit?

Yes. Some medicines that don't have nicotine have already been approved to help quit smoking.

Bupropion (Zyban^® or Wellbutrin^®) was first used as an anti-depressant, and later approved by the FDA to help people quit smoking. This medicine does not contain nicotine and you will need a prescription for it. It affects chemicals in the brain that are related to nicotine craving. It can be used alone or together with nicotine replacement. Unlike nicotine replacement, you start taking it 1 or 2 weeks before you stop smoking. Newer medicines may help smokers (or former smokers) by stopping them from getting physical pleasure from smoking. The medicines seem to work by stopping nicotine from stimulating the brain, either by blocking the brain receptors that nicotine normally attaches to, or keeping it from reaching the brain altogether (as in the case of the vaccines).

One such medicine, varenicline (Chantix^®), is FDA-approved for help with quitting. Varenicline is a pill taken twice a day, starting at least a week before your quit date. Once in the body, it attaches to nicotine receptors in the brain, reducing the pleasurable effects of smoking and helping to reduce nicotine withdrawal symptoms. Many studies have shown varenicline can more than double the chances of quitting smoking. Since varenicline is a newer drug, research has not been done to find out if it is safe to use along with nicotine replacement products. But the company that makes varenicline noted that people who used the drug along with NRT had more side effects such as nausea and headaches.

For people who have not been able to quit smoking using NRT, bupropion, or varenicline, or who can't use these drugs, some doctors prescribe older medicines that have been approved by the FDA for uses other than quitting smoking. Nortriptyline is generally used to treat depression and clonidine is used to treat high blood pressure. Both of these drugs have restrictions on who can safely use them. People taking them need medical monitoring because of rare but serious side effects. But studies have shown that they can make it easier for some people to quit smoking, even though they have not been approved by the FDA for that purpose.

Other medicines still being studied include rimonabant, which is also a pill, and vaccines that are given as a series of injections. Early tests of these new treatments have been promising. They seem to be safe, and may help some smokers quit or stay quit. But larger studies are needed to show these treatments are effective before the FDA can approve them for use. Many large studies of these treatments are now under way. If they prove effective, one or more of these drugs could be approved within the next few years.

It is not likely that any one of these drugs will work in every person. That is why using different quitting aids at the same time is still the best way to increase your chances of success. For more information on quitting and medicines that can be used, see Guide to Quitting Smoking.

Where can I go for help?

It is hard to stop smoking, but you can do it! More than 47 million Americans have quit smoking for good, and now there are more former smokers than current smokers in the US. Many organizations offer information, counseling, and other services on how to quit, as well as information on where to go for help. Other good resources for finding help include your doctor, dentist, local hospital, or employer.

If you want to quit smoking and need help, contact one of the following organizations: 

American Cancer Society
Toll-free number: 1-800-ACS-2345 (1-800-227-2345)
Web site: www.cancer.org

American Heart Association
Toll-free number: 1-800-AHA-USA-1 (1-800-242-8721)
Web site: www.americanheart.org

American Lung Association
Toll-free number: 1-800-LUNG-USA (1-800-548-8252)
Web site: www.lungusa.org

National Cancer Institute
Toll-free number: 1-877-448-7848 (smoking cessation help)
1-800-4-CANCER (1-800-422-6237) for cancer information
Web site: www.cancer.gov

Centers for Disease Control and Prevention
Toll-free number: 1-800-CDC-INFO (1-800-232-4636)
Web site: www.cdc.gov/tobacco/quit_smoking/index.htm

Smokefree.gov
(Info on state phone-based quitting programs)
Toll-free number: 1-800-QUITNOW (1-800-784-8669)
Web site: www.smokefree.gov

More information from your American Cancer Society

The following information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345 (1-800-227-2345).

• Child and Teen Tobacco Use (also available in Spanish)

• Cigar Smoking (also available in Spanish)

• Cigarette Smoking (also available in Spanish)

• Double Your Chances of Quitting Smoking

• Guide to Quitting Smoking (also available in Spanish)

• Helping a Smoker Quit: Dos and Don'ts

• Quitting Smoking -- Help for Cravings and Tough Situations (also available in Spanish)

• Secondhand Smoke (also available in Spanish)

• Women and Smoking (also available in Spanish)

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or visit www.cancer.org.

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Last Medical Review: 10/16/2008
Last Revised: 11/14/2008