• Skip to main content
  • Skip to FDA Search
  • Skip to in this section menu
  • Skip to footer links

U.S. flag

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

U.S. Food and Drug Administration

Health Effects of Tobacco Use

Tobacco use has serious effects on the health of users. In fact, tobacco use remains the leading preventable cause of disease and death in the United States, 1 leading to more than 480,000 deaths each year. 

Different tobacco products, however, pose varying levels of health risk to users. Combustible products that burn tobacco, like a cigarette, are the most harmful to a user’s health, while noncombustible products, such as e-cigarettes, may be less harmful. However, no tobacco product is considered safe. 

Health Effects of Smoking 

Cigarettes are responsible for the vast majority of all tobacco-related disease and death in the U.S. Smokers are exposed to a toxic mix of over 7,000 chemicals when they inhale cigarette smoke, 2 the consequences of which can threaten their health in many ways. 

  Order Free Print Version   |   Download Infographic

Health Effects of Smoking Infographic

If you or a loved one are among the 34 million U.S. adults who smoke cigarettes in this country 9 and want to quit , there are resources to help you on your journey to living a smoke-free life .

COVID-19 and Smoking

Am I at risk for serious complications from COVID-19 if I smoke cigarettes?

Subscribe to CTP Email Newsletters

Stay up to date on tobacco product news and announcements from FDA’s Center for Tobacco Products (CTP) by subscribing to our email newsletters.

Yes. Data show that when compared to never smokers, cigarette smoking increases the risk of more severe illness from COVID-19, which could result in hospitalization, the need for intensive care, or even death. Smoking cigarettes can cause inflammation and cell damage throughout the body, and can weaken your immune system, making it less able to fight off disease.

There’s never been a better time to quit smoking. If you need resources to help you quit smoking, the FDA has supportive tips and tools to help you get closer to quitting for good .

If I vape tobacco or nicotine am I at risk for complications from COVID-19?

E-cigarette use can expose the lungs to toxic chemicals, but whether those exposures increase the risk of COVID-19 or the severity of COVID-19 outcomes is not known. However, many e-cigarette users are current or former smokers, and cigarette smoking increases the risk of respiratory infections, including pneumonia.

In the Health Effects of Tobacco Use Section

Nicotine Is Why Tobacco Products Are Addictive

Q&A with CTP’s New Director of the Office of Regulations

Keep Your Air Clear: How Tobacco Can Harm Your Lungs

Q&A with CTP’s New Director of the Office of Regulations

How Smoking Affects Heart Health

Woman using laptop in library

What It’s Like to Quit Smoking

Woman using laptop in library

Quitting Smoking and Other Tobacco Public Health Resources

Man looking at phone

Subscribe to CTPConnect

Get regular updates on the health effects of tobacco, public health educational resources, and highlights on current tobacco issues and regulations.

Health Effects of Cigarette Smoking

Smoking and death, smoking and increased health risks, smoking and cardiovascular disease, smoking and respiratory disease, smoking and cancer, smoking and other health risks, quitting and reduced risks.

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. 1,2

Quitting smoking lowers your risk for smoking-related diseases and can add years to your life. 1,2

Cigarette smoking is the leading cause of preventable death in the United States. 1

Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer. 1

Smokers are at greater risk for diseases that affect the heart and blood vessels (cardiovascular disease). 1,2

Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs. 1,2

Smoking can cause cancer almost anywhere in your body: 1,2

Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors. 1

If nobody smoked, one of every three cancer deaths in the United States would not happen. 1,2

Smoking harms nearly every organ of the body and affects a person’s overall health. 1,2

To receive email updates about Smoking & Tobacco Use, enter your email address:


Exit Notification / Disclaimer Policy

CDC.gov Privacy Settings

We take your privacy seriously. You can review and change the way we collect information below.

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.

Cookies used to make website functionality more relevant to you. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests.

Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data.

Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. These cookies may also be used for advertising purposes by these third parties.

Thank you for taking the time to confirm your preferences. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page.

Essay On Harmful Effects of Tobacco

Essay On Harmful Effects of Tobacco Chewing, Have you ever heard of tobacco smoking? Of course, yes. It is the most common thing to see people smoking tobacco cigarettes. It is not good to smoke, but people still are addicted to smoking. Today, we would be going to talk about tobacco like what is it, what are its effects, etc. So, start reading:

essay on harmful effects of tobacco

Essay on Tobacco

What is tobacco.

essay on harmful effects of tobacco

It is the most common name of some plants in the genus Nicotine belonging to the family Solanaceae. There are more than 70 species of tobacco, which are known in the world. But N. tabacum is the chief commercial crop. The more powerful variant N. Rustica is also utilized in some countries.

We have seen the use of tobacco cigarettes and other addictive products like pipes, cigars, and shishas. In these products, dried tobacco leaves are used for smoking. Tobacco is also being used as chewing the Tobacco, snuff, snus, and dipping Tobacco.

What does Tobacco contain?

Tobacco has the highly addictive stimulant alkaloid nicotine and many other harmful alkaloids. If we talk about the history of Tobacco, it has been used in America for many years, with some cultivation sites located in Mexico. People in the USA tribes grow and use Tobacco in a traditional way.

Historically, people belonging to the Northeast Woodlands cultures have brought Tobacco in pouches in the form of a readily accepted trade item. People used Tobacco smoking both ceremonially and socially like when they had to seal a peace treaty or any kind of trade agreement.

There are several native cultures, where Tobacco is considered a gift from the Creator, with the tobacco smoking in ceremonies carrying one’s prayers and thoughts to the creator.

What’s about Tobacco smoking?

Tobacco smoking is the method of burning Tobacco and consuming the smoke, which is developed throughout the process of smoking. The smoke produced through the use of Tobacco may be inhaled as is performed with cigarettes.

Some people like to release it from the mouth, as is generally performed with cigars and pipes. Tobacco was introduced to Eurasia by European colonists in the late 17 th century, where it followed common trade ways.

The practice encountered disparagement from its first import to the Western world forwards but surrounded itself in a certain section of many societies before becoming spread in the entire world upon the introduction of automated cigarette-rolling apparatus.

Smoking is the most common way of consuming Tobacco. The agricultural product is often combined with additives and then combusted. As a result, the smoke is then inhaled and the active substances are absorbed via the alveoli in the oral mucosa or lungs.

Several substances in cigarette smoking activate chemical reactions in nerve endings that increase alertness, heart rate, and reaction time. Endorphins and dopamine are released that give a sense of pleasure to humans.

Also Read: Nasha Mukti Par Essay in English

As of 2008-2010, Tobacco is consumed by about 49 percent of men and 11 percent of women having an age of 15 years or older in middle income and low-income nations such as India, Bangladesh, Mexico, China, Egypt, Philippines, Russia, Ukraine, Vietnam, and many others. People in these countries almost use Tobacco in the form of smoking.

Tobacco Essay in English

Health effects of tobacco.

Most people are addicted to Tobacco smoking. Today, the government has put many initiatives to control the use of Tobacco in smoking products. But still, people who are addicted have a hard time quitting smoking.

This is why it is important to understand the risk effects of Tobacco on health if anyone of us is an avid smoker. Using Tobacco for a long time can boost your risk for many health-related issues in human beings.

Tobacco is a plant and its leaves are chewed, smoked, or sniffed to feel a variety of effects. Due to the presence of the chemical substance known as nicotine, it is known to be an addictive substance.

Apart from nicotine, Tobacco smoking contains a number of other chemicals, which are 7000 in number and at least 70 of which are a reason for occurring cancer and other health problems. Tobacco, which is not burned is known as smokeless Tobacco.

There are around 30 chemicals in smokeless Tobacco that can develop cancer in humans, which also includes nicotine.

Health problems caused by smoking or smokeless Tobacco are mentioned below:

Heart and blood vessel problems:

There are some other poor effects of Tobacco on the health of a human being. These are:

Health effects of secondhand smoke

If someone is living around the smoke of others known as secondhand smoke, then he/she is having a higher risk for lung cancer, heart attack, heart disease, sudden and severe reactions (eye, throat, nose, and lower respiratory tract).

How to quit Tobacco smoking?

Like any form of addiction, quitting Tobacco is not an easy task, particularly if you are doing it on an individual basis. You can seek assistance from friends, family members, and coworkers.

We can engage in therapy sessions in a healthcare center. There are hospitals, community centers, health departments, and work sites, which can help us quit smoking.

This is an Essay On Harmful Effects of Tobacco Chewing, from this entire article, we cover information regarding essay on tobacco in English, anti tobacco essay in English. If found anything missing let us know by commenting below. For more info kindly visit us at wikiliv.com

Share this:

Leave a comment cancel reply.

Save my name, email, and website in this browser for the next time I comment.

Home — Essay Samples — Nursing & Health — Tobacco — Tobacco and Its Negative Effect on People

tobacco use effects essay

The Negative Effects of Tobacco on Health, The Environment, and The Younger Generation

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

The Negative Effects of Tobacco on Health, The Environment, and The Younger Generation Essay

Remember: This is just a sample from a fellow student.

Related Essays

Look at that guy smoking, he gets his own spot to stand dedicated just for his kind. He must be a really rich person as only rich people can afford to smoke. And, hey, look how great they look from smoking. All those wrinkles [...]

Vape has become one of the most popular means of smoking nowadays. People find that vaping is better than smoking cigarettes. Vape has many characteristics those attract people to take it instead of cigarettes. As people are [...]

There are many people who know that smoking cigarette is not good for their body. Cigarette holds many chemical substances such as cadmium, butane, acetic acid, methane, ammonia, arsenic, methanol, nicotine, hexamine, stearic [...]

For years there has been conflicting research whether smoking should be banned or not and it is a significant issue today. Many people have given up smoking while others still continue to smoke. Smoking is the inhalation and [...]

Tobacco use has become a popular pastime in our country. While there are many justified uses for which people elect to smoke or chew it, the health risks outweigh all benefits that people may experience. This research assignment [...]

Stop smoking it can cost you your life! What is smoking? How can something small cause so much harm to the world? Smoking is an addictive drug that can cause death or cancer it has caused, More than 10 times as many U.S. [...]

Tobacco smoking is the practice of smoking tobacco and inhaling tobacco smoke (which includes some of the gaseous phases and other substances). A general explanation may include simple intake of tobacco smoke into the mouth, and [...]

  The human body is incredibly fragile. Countless things in the world can change how well the body functions. One such thing is cigarettes. At some point, the population has learned about the dangerous effects of [...]

When most people think of addiction, they think of potheads and alcoholics. Although those are the most common types of addiction, there are also more bizarre things like sex addicts and gambling. In a sense, every person has a [...]

Find Free Essays

We provide you with original essay samples, perfect formatting and styling

Cite this Essay

To export a reference to this article please select a referencing style below:

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!


Are you interested in getting a customized paper?

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

We can help you get a better grade and deliver your task on time!

tobacco use effects essay


The Effects of Smoking Tobacco Essay

Tobacco, Alcohol And Tobacco Use And Its Effects On The Human Body

Firstly, tobacco usage is highly dangerous for ones health. “Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general”(“ Health Effects of Cigarette Smoking”). Tobacco when used releases a chemical called nicotine that raises blood pressure, increases blood flow through the heart and temporarily provides a slight high feeling. However, this comes with many dangers, as it is very harmful to the human body. Cigarette smoking is the most common way to use tobacco. Cigarettes are very dangerous because tobacco smoke puts many poisons into ones mouth, throat, and lungs – as well as pollutes the air around the smoker making it not just bad for the smoker but also everyone else that is around them. Smokers are at high risk for heart disease, stroke, lung cancer and chronic bronchitis. According to the CDC, smoking tobacco causes over 480,000 human deaths per year in the US alone. Other forms of consuming tobacco like dipping are at a higher risk for developing mouth and throat cancer. Tobacco can

The Dangers Of Smoking

Cigarettes are one of the most common habits that people do nowadays but in recent years has slowly been decreasing In the US. “There are approximately one billion smokers in the world today” (Saha, Sibu). It is at the same time one of the main causes for lung cancer. Many if not everyone that smokes know that it can be harmful to you and your body. It can be a very dangerous habit to take up but at the same time the person smoking is not the only one that is in danger. “It is estimated that approximately 1.1 billion people smoke worldwide. From these numbers 900 million are from men and the other 200 million are women” (Saha, Sibu). Everyday people smoke cigarettes around their friends, family and children and it causes more harm than they know it. Smoking can not only cause you cancer but can also give cancer to the ones around you.

The Real Cost

According to “The Action of Smoking and Health,” every six seconds someone loses their life as a result of a tobacco related disease. It’s hard to realize how damaging cigarette smoking’s effect can be until you experience it first hand. It is almost certain that every one knows someone who is currently a smoker or was a smoker at some point in their life. For years smoking was the seen as the “cool” thing to do, it was how to “fit in.” There was no real emphasis placed on the dangers of this particular habit, and as a result, it became a world wide trend. In the past, technology and medicine were not nearly advanced enough to be able to determine just how harmful tobacco usage is. However, as we have made medical and

Health Risks of Tobacco Use Today Essay

More and more health risks caused by tobacco are being discovered every day. Some risks are that you can get blood clots and aneurysms in the brain, blood clots in the legs, coronary artery disease, high blood pressure, poor blood supply to the legs, decreased ability to taste and smell, harm to sperm, loss of sight due to an increased risk of macular degeneration, tooth and gum diseases, wrinkling of the skin, and many more. (Zieve)

Effects Of Smoking On The United States

World-wide efforts have increased to alarm people of the danger in consuming tobacco products, both first hand and second hand. In recent years, reports have proven a decline in smoking. However, there are still millions of people that smoke in the United State of America. As a result, the effect of smoking has become a major health risk. According to the Centers for Disease Control and Prevention (CDC), tobacco use is the leading preventable cause of death, disease, and disability in the US.

Banning Smoking Due to the Serious and Fatal Side Effects Essay

Millions of people are smokers in the United States. “In 2011, an estimated 19.0% (43.8) million United States adults were current cigarette smokers” (“Cigarette Smoking in the”). This number does not include all the underage smokers that are unaccounted. Cigarette smoking has very serious and fatal side effects. Some of these side effects include asthma, cancer, diabetes, heart disease and stroke, COPD, and Buerger’s disease. Tobacco use is a preventable death sentence. Smokers are not only harming themselves but the people around them breathing the second-hand smoke. “Each year, about 46,000 nonsmokers in the United States die from heart disease caused by second-hand smoke” (“Cigarette Smoking in the”). This number is

DARE: Drug Resistance Education

One thing we learned about is tobacco and how it affects people, in the U.S. there are more than 400,000 tobacco related deaths. That is a lot of people. Chewing tobacco can cause mouth cancer, tooth loss, and many other health problems. Smoking is often linked to tobacco. There are 200 known chemicals in cigarette smoke, which leads into secondhand smoke. You don’t have to be a smoker to be killed by a cigarette, there are over 50,000 deaths per year due to secondhand smoke. Smoking also causes heart

Tobacco And Its Effects On Society

Tobacco will ruin the person’s inner system and will have serious conditions to the body. “According to ASH, Action on Smoking and & Health, 100 million people died from tobacco-related diseases in the 20th century. Without action taken, 1 billion people could die this century from tobacco-related diseases.” Tobacco gives so many harms to human organs that will take them forward to death. People do not realize or care about how much diseases they get until they found it out. They should check their health and do something before it is too late or else they will be one of the 1 billion. 100 million is not a small number, it is actually a serious number that people should be worry about. They should

Attention All Smokers Research Paper

Attention all smokers. Here is some important information that you need to hear. With smoking, one can receive serious medical conditions or even death. Smoking is no laughing matter, it can lead to severe health complications. The smallest consequences for smoking are bad breath, yellow teeth, and smelling bad. In a few years, one may encounter more serious health problems. He or she may have a significantly greater chance of getting lung cancer, heart disease, and breathing difficulties such as emphysema. If one develops luge cancer, she or he has to go through painful treatment, which may or may not cure them. Lung cancer is a serious matter, people should attempt to avoid this horrible disease. While smoking, one can

Smoking Persuasive Research Paper

Yet, we have lighted up a few wicked, malicious, and rigorous impacts on individuals' own health, notwithstanding to how it may affect other surrounding, where are the consequences may be even more dangerous, malignant, and frightful, since that, secondhand smokers also liable to cancer, heart disease, breathing problems, colds and flu, and other more

Quit Tobacco

There are many effects in smoking tobacco of any kind. The U.S. Department of Health and Human Services has stated, “There is no such thing as a safe cigarette” (HHS, 2016). There are many factors in the affects of tobacco use. Take me for example, I use to smoke and I quit so many times I lost count. But I came to the realization that if I did not quit, I would be sick for the rest of my life. I made the final decision to quit because I had so many problems with sinus infections, allergies, bronchitis and the beginning stages of asthma caused by smoking.

Smoking Promotion Role

The harmful effects of smoking are well known. Smoking increases the chances of chronic disease’s for example Lung Cancer, with 90% of these cases being caused by smoking (Cancer Research UK 2009). Responsible for 5200 lives per year, the huge financial burden on the National

A Single Case Study Using Cognitive Behavioral Techniques to Quit Smoking

Cigarette smoking is a leading public health issue worldwide and has a negative impact on the health of millions of individuals each year (American Cancer Society, 2007). The health related effects from cigarette smoking include cancer, hypertension, stroke, and cardiovascular disease. Moreover, cigarette smoking is an addictive behavior (American Psychological Association [APA], 2000). Millions of people attempt to quit smoking and fail (American Cancer Society, 2007).

Smoking in Public Buildings Should Be Banned

Smoking causes health problems for everyone around the world, not just people near smokers. Most people know that smoking can cause countless health problems; a group of scientists conducted a study showing the effects of secondhand smoke in nonsmokers. The scientists knew in 2004 that, on a worldwide scale, the health concerns created by exposure to tobacco smoke for nonsmokers were not well known. They tested people and found the effects from worldwide exposure in children and adults, and these statistics have probably risen in the past ten years (Öberg, Jaakkola, Woodward, Peruga, Prüss-Ustün). They found that “Worldwide, 40% of children, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke in 2004. This exposure was estimated to have caused 379,000 deaths from ischaemic heart disease,”- also known as

The Effects Of Tobacco Smoking

Although free of nicotine, marijuana smoke certainly pollutes the lungs. And since tobacco smoking has been linked to respiratory injury, cancer, emphysema, heart disease, complications of pregnancy, low birth weight, and other ills, it makes sense to worry whether smoking marijuana might prove equally harmful (Mack and Joy). Marijuana joints have been shown to deliver at least four times as much tar to the lungs as tobacco cigarettes of equivalent weight. This difference is due to the lack of filters on joints and because marijuana smokers typically inhale a larger volume of smoke and take it more deeply into the lungs than tobacco smokers do. Marijuana smokers also tend to hold smoke in for a time before exhaling, exposing the lungs to even greater levels of cancer-causing agents. Clinical studies suggest that people who smoke marijuana are more likely to develop respiratory illnesses than are nonsmokers. A survey of outpatient medical visits at a large health maintenance organization (HMO) found that marijuana users were more likely to seek help for respiratory illnesses than people who smoked tobacco (Mack and Joy). While cannabis is harmful to the brain and lungs of the user, it is also harmful to the ones around the user. It has been shown that the effects of using cannabis are similar to those of alcohol and benzodiazepines and include slowing of reaction time, motor incoordination, specific defects in short-term memory, difficulty in concentration and particular

Related Topics


tobacco use effects essay

Cause And Effects Essay: The Effects Of Smoking Tobacco

Cigarette smoking in nevada.

Smoking tobacco is a huge problem in not only Nevada but all states, and is one of the leading preventable causes of death in the U.S. Cigarette smoking not only affects the lungs as most people would expect, but it harms every organ in a person’s body. Smoking immensely reduces a person’s health and can cause various diseases. In the United States, the risk of dying from smoking tobacco has dramatically increased in the last 50 years. The list of health risks that people can acquire when they decide to start smoking is incredibly long, and includes illnesses such as heart disease and lung cancer. A shocking fact about smoking tobacco is that if nobody were to smoke in the United States, one of every three cancer deaths would not happen. It

Smoking: Leading Cause Of Preventable Death

Smoking is the leading cause of preventable death in the United States. Teens should not be tempted to smoke because it is addictive and causes multiple health problems. Adolescents all over the world are exposed to this drug every day.

Persuasive Essay On Vaping

Over the recent years, vaping has dramatically grown into a multi million dollar industrie. Vaping has became one of the most popular things to do these past and probably future years. People everywhere are buying one because they think that it 's fun and cool. Vaping has became a very popular way to get a buzz discreetly it is also a big disturbance in schools.Vaping is benefiting more people than smoking is because Vaping is better for the environment , people are switching to e-cigs for benefits, and Vaping helps people with mental health issues.

Cause And Effect Essay About Vaping

While walking down the sidewalk on a beautiful, sunny day, you walk in front of your favorite bakery which has it’s doors propped open and the gorgeous smells are trolling out of the sweet smelling bakery. You take a deep breathe in and all of a sudden are stopped mid-breathe by the scent of sour skittles. You look to your left and see a guy vaping, and the vapor coming from his device is eliminating the delicious scent of the bakery. Vaping has become a popular product on the market, but some of the effects it has on the body make it a worse choice than smoking. Those who vape are susceptible to bronchitis or severe cough, teary or dry eyes, and lung cancer. These risks that those who vape take are serious conditions, but those who do the vaping aren’t the only ones susceptible to these conditions, those around them are also exposed to secondhand vaping which is just as bad as taking in the vapor directly from

Tobacco Dbq Essay

In the year 1600, tobacco spread all through the United States and in the nations around it. To the people in America, tobacco smoking was taken as a tradition which they all had adopted. By the year 1604, James I the king of England, opposed tobacco smoking, saying that it would cause wild behaviors to the people. By then, tobacco smoking had become a habit for most of the people in England and they begged to be allowed to continue doing it. In the year 1612, tobacco was planted not only to be consumed now but also as a cash crop. Since this year, people have started viewing tobacco as a source of income. After this, tobacco would be grown and in the year 1613, the first ship arrived in London where it took tobacco. The tobacco was sold and

Smoking During Pregnancy Research Paper

Smoking is considered to be the number one cause of adverse outcomes for babies as suggested by the experts. When a woman smokes during pregnancy, that toxic brew gets into their bloodstream, which is the baby 's only source of oxygen as well as nutrients.

Should Cigarettes Be Allowed In Schools

The amount of cigarettes being bought and sold have gone down significantly in the past decade. As it tells us in the article, “Rise Is Seen in Students Who Use E-Cigarettes”, By Sabrina Taver, students seem more interested and more prone to using an E-Cigarette which is a battery powered cigarette, except E-Cigarette deliver nicotine that is vaporized to form an aerosol mist. The makers and developers claim that they are a healthy way of smoking. Yet all this great stuff has been said about the E-cigs, researchers still say that they are vile and the health effects are not yet clear, although they are proven to be less harmful than traditional cigarettes. The Food and Drug Administration still has not yet been able to see if that is true.

Persuasive Essay: Why People Should People Stop Smoking

In many ways, people relieve stress by smoking each day. Most people do not know or do not seem to care about how much damage it does to their body and environment. Despite these definite facts that accompany smoking, cigarettes and cigars have practically a staple in most people 's living conditions and lifestyle. Whether people are planning on smoking, or already longtime smokers, you should definitely not smoke, as it does a lot more damage in return than fix your mental problems. Smoking destroys relationships, the environment, and health, and there are many reasons and facts on why people should put cigarettes out.

Persuasive Speech On Smoking

Firstly those who believe that smoking should be banned say that cigarettes can affect smokers deeply in the long run. “Over 50,000 studies of the health effects of tobacco in dozens of countries have detailed its dangers. Worldwide, tobacco use causes about 90% of lung cancer deaths, 30% of all cancers, 20-25% of coronary heart diseases and stroke deaths, and more than 80% of chronic bronchitis and emphysema”. (Jordan 1).

Why We Should Smoking Be Banned

The topic of banning cigarettes has been a controversial subject for more than a century. More than 1 billion people around the world, but considering that it harms the smoker and everyone around him, should cigarettes be prohibited? Should the right to smoke be taken away?

Argumentative Essay On Second Hand Smoking

Many reports have been issued based on the evidence regarding the devastating health affecs of smoking and the expose of second hand smoke. Unfortunatly, cigarette smoking has reportedly caused about 480,000 deaths anually in the United States with an account of 41,000 deaths due to second hand smoking. It is indicated that America has the greatest heath issues from smoking. Neverless, it has been declining due to the rise on taxes and the promotions to cut down tabacco use advetisement. Smoking can be very addictive but there are many ways to help stop that I’ll get to soon.

Argumentative Essay On Why Tobacco Should Be Banned

Harper, T. (2006). Why the tobacco industry fears point of sale display bans. Tobacco Control, 15 (3), 270-275.

Persuasive Speech: The Dangers Of Cigarette Smoking

As per the latest study conducted by the World Health Organization, one billion people smoke worldwide, which constitute about 20% of the entire world population. Cigarette smoking has numerous health hazards however, lung cancer is the most known to generations. Smoking, at the same time, is also responsible for cardiovascular disease and heart stroke. But accelerated aging continues to remain the most ignored and standard side effect of smoking.

Smoking Informative Speech

Smoking has been a long time habit round the world. However, in the past, smoking cigarette was very popular and known to be a cool recreational drug, and was widely accepted by the community across the world. Today smoking has been less widely accepted and more restricted because of the many health risks that are linked to smoking cigarette. These days, people are well educated and more knowledgeable about the health risks of smoking. Therefore, smoking popularity has been in sharp a decline in the past decade. Smoking cigarette is more than just an addiction; it is one of highest cause of death in the world than any other causes.

Cause And Effect Essay About Smoking

Smoking has become a social habit nowadays. When people around are smoking, the person practically feel like he/she should be doing the same. And this is increasing day by day in our country. Smoking tribulates almost every organ of the body. It is the leading cause of more than 443,00 deaths each year. Secondly smoking approximately result in 3,000 lung cancer deaths of non-smokers which is given off by the end of the burning cigarette and by the smokers exhalation.

More about Cause And Effects Essay: The Effects Of Smoking Tobacco

Related topics.

Warning: The NCBI web site requires JavaScript to function. more...

U.S. flag

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Committee on the Public Health Implications of Raising the Minimum Age for Purchasing Tobacco Products; Board on Population Health and Public Health Practice; Institute of Medicine; Bonnie RJ, Stratton K, Kwan LY, editors. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Washington (DC): National Academies Press (US); 2015 Jul 23.

Cover of Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products

Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products.

4 The Effects of Tobacco Use on Health

The scope of the burden of disease and death that cigarette smoking imposes on the public's health is extensive. Cigarette smoking is the major focus of this chapter because it is the central public health problem, but the topics of secondhand smoke exposure, smoking of other combustible tobacco products, smokeless tobacco, and electronic nicotine delivery systems (ENDS) are also considered. The magnitude of the public health threat posed by cigarette smoking stems from two factors: (1) the prevalence of cigarette smoking is so high, and (2) smoking causes so many deleterious health effects. A policy change that reduces the prevalence of cigarette smoking will result in a commensurate reduction in the population burden of disease and death caused by cigarette smoking. The associations between cigarette smoking and the adverse health effects caused by smoking are dose-dependent ( HHS, 2014 ). Thus, a public health benefit would be realized if a policy change led to reduced exposure to cigarette smoke via means other than reducing the prevalence of smoking. For example, additional reduction in the population burden of smoking-caused disease and death will be generated if the policy also results in delayed initiation of cigarette smoking. The population health benefit from delayed initiation, although potentially large, will be less than the benefit from a commensurate reduction in smoking prevalence because delayed initiation is associated with reduced exposure to cigarette smoking rather than with the complete prevention of the exposure. A decrease in the prevalence of cigarette smoking will have additional downstream benefits by reducing the potential for nonsmokers to be exposed to secondhand tobacco smoke.

Cigarette smoking causes chronic diseases that appear at older ages, such as lung cancer, as well as adverse health effects that occur in the short run. The immediate and short-term adverse health effects of cigarette smoking are less likely to be directly fatal than the long-term health effects. Nevertheless, they are important public health indicators because they lead to suboptimal health status throughout the life course in smokers and because many of the short-term physiologic effects mechanistically contribute to the etiology of smoking-caused diseases that usually do not become clinically apparent until later adulthood.

The short-term adverse health effects caused by cigarette smoking can be observed in smokers immediately or soon after they begin smoking. The health effects of cigarette smoking thus begin at or near the age of initiation of cigarette smoking, which is usually in adolescence. To highlight the immediacy of the adverse impact of smoking on health, this report uses a life-course perspective by considering health effects of smoking according to the various stages of life, which include childhood, adolescence, and young adulthood as well as middle and late adulthood, when most of the chronic disease burden imposed by smoking occurs. A particularly vulnerable time during the life course is pregnancy (for both mother and fetus) and the months following birth (for the infant); for this reason, this stage of life is considered separately. In this report, the term “immediate health effects” refers to effects that occur within days of cigarette smoking, while “long-term health effects” refers to the clinical morbidity and mortality that occur primarily in middle and late adulthood, and the term “intermediate health effects” is used to refer broadly to the health outcomes that occur between the immediate and long-term health effects.

Cigarette smoke contains more than 7,000 chemicals ( HHS, 2010 ). Inhaling cigarette smoke exposes the cigarette smoker to these numerous toxins, which include the various tobacco constituents and the products of pyrolysis. As summarized below, exposure to this complex chemical mixture causes immediate adverse physiologic effects shortly after the exposure occurs ( HHS, 2010 ).

The ultimate harm caused by exposure to the toxic agents in cigarette smoke is determined in large part by the extent of the exposure, and most adult cigarette smokers tend to smoke many cigarettes per day for decades ( HHS, 2014 ). This repeated inhalation of the complex mixture of cigarette smoke toxicants at high daily doses, often sustained over the course of many years, causes a broad spectrum of short-term and long-term health effects that affect most major organ systems (see Tables 4-1 through 4-3 ). In the short run, cigarette smoking causes the smoker to have overall diminished health status as measured by a diverse array of indices, including biomarkers of physiologic disadvantage, lower self-reported health, susceptibility to acute illnesses and respiratory symptoms, and absence from school and work. Among the long-term health effects are smoking-caused diseases that are the major causes of death in middle- and upper-income nations: coronary heart disease, cancer, and chronic obstructive pulmonary disease, or COPD ( HHS, 2014 ).

TABLE 4-1. Immediate Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

Immediate Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

TABLE 4-3. Long-Term Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

Long-Term Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

The net result of the broad spectrum of short-term and long-term deleterious health effects caused by cigarette smoking and the substantial prevalence of smoking is that cigarette smoking is the single most important cause of preventable disease and premature mortality in the United States and in many other high-income nations ( Thun et al., 2012 ). For example, in the United States cigarette smoking is estimated to account for at least 480,000 deaths per year ( HHS, 2014 ). The magnitude of this burden is a direct function of two key facts: (1) cigarette smoking causes an incredibly broad spectrum of short-term and long-term deleterious health effects, and (2) a large proportion of the population is exposed (i.e., the prevalence of smoking is very high).

In assessing the potential public health impact of enacting a new tobacco policy such as raising the minimum age of legal access to tobacco products (MLA), it is worth keeping in mind that this lengthy catalogue of well-established consequences of cigarette smoking will continue to expand as scientific knowledge advances and more definitive evidence is generated concerning additional health outcomes. Thus, the characterization of the potential impact of a policy change that reduces exposure to cigarette smoke is a conservative estimate of the true public health impact. For example, in addition to the many adverse health outcomes established as causally related to tobacco smoke and summarized in Tables 4-1 , 4-2 , and 4-3 , Tables 4-4 and 4-5 summarize health outcomes for which the evidence summarized in the 2014 Surgeon General's report is currently considered strong enough to be considered suggestive of a causal association but not yet strong enough to be rated as causal. These are outcomes for which the currently existing body of evidence falls short of being definitive, but the association between cigarette smoking and these outcomes remains under active investigation.

TABLE 4-2. Intermediate Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

Intermediate Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

TABLE 4-4. Intermediate Adverse Health Outcomes with Evidence Suggestive of a Causal Association with Cigarette Smoking Based on Surgeon General's Reports.

Intermediate Adverse Health Outcomes with Evidence Suggestive of a Causal Association with Cigarette Smoking Based on Surgeon General's Reports.

TABLE 4-5. Long-Term Adverse Health Outcomes with Evidence Suggestive of a Causal Association with Cigarette Smoking Based on Surgeon General's Reports.

Long-Term Adverse Health Outcomes with Evidence Suggestive of a Causal Association with Cigarette Smoking Based on Surgeon General's Reports.

Tables 4-1 through 4-3 summarize the preclinical health effects and morbidity caused by cigarette smoking, organized according to whether the effects occur in the immediate, intermediate, or long-term time horizon and by the stages of life usually affected by the health outcome.

Immediate Health Effects

Cigarette smoking causes a constellation of subclinical health effects that occur shortly after initiation of smoking. As described below, these immediate adverse health effects include increased oxidative stress; depletion of selected bioavailable antioxidant micronutrients; increased inflammation; impaired immune status; altered lipid profiles; poorer self-rated health status; respiratory symptoms, including coughing, phlegm, wheezing, and dyspnea; and nicotine addiction. Taken in combination, these detrimental effects detract from a smoker's overall health status and lead to what has been referred to as “diminished health status” ( HHS, 2004 ). Physiologic markers of diminished health status include subclinical outcomes such as increased oxidative stress, reduced antioxidant defenses, increased inflammation, impaired immune status, and altered lipid profiles (see Tables 4-1 through 4-3 ). Smoking's impacts on such short-term physiologic outcomes impair the smoker's overall health status, which in turn renders the smoker more susceptible to various adverse health outcomes, such as developing acute illnesses, respiratory symptoms, and a lessened capacity to heal wounds. One downstream marker of the diminished health status induced by cigarette smoking is that smokers are more likely to miss school and work. In short, soon after the initiation of smoking, an array of smoking-induced short-term deleterious health effects sets in motion a lifelong trajectory that leaves persistent smokers highly disadvantaged compared to their counterparts who never smoked. By looking at the immediate and intermediate adverse health effects of cigarette smoking, it is clear that cigarette smoking contributes in important ways to suboptimal health beginning shortly after smoking initiation—long before the chronic diseases that smoking causes at older ages become clinically apparent ( HHS, 2004 ).

Physiologic Markers of Diminished Health Status

Increased oxidative stress.

Cigarette smoke contains free radicals and other oxidants in abundance. A single puff of a cigarette exposes the smoker to more than 10 15 free radicals in the gas phase and additional radicals and oxidants in the tar phase ( Pryor and Stone, 1993 ).

The biological impacts of the oxidative stress induced by cigarette smoking have been extensively documented in humans ( HHS, 2004 ). These include oxidative injury to proteins, DNA, and lipids. Assaying protein carbonyls is one method of measuring oxidative damage to proteins, and protein carbonyl concentrations have been observed to be significantly higher in smokers than in nonsmokers ( Kapaki et al., 2007 ; Marangon et al., 1999 ; Padmavathi et al., 2010 ). One way of quantifying the oxidative damage to DNA is to measure the DNA damage in peripheral white blood cells induced by the hydroxyl radical at the C8 position of guanine, 8-hydroxy-deoxyguanosine (8-OH-dG). Most of the available evidence indicates that current smokers have concentrations of 8-OH-dG in peripheral leukocytes that are at least 20 percent higher than nonsmokers ( HHS, 2004 ). Studies of 8-OH-dG in DNA extracted from urine provide corroborative evidence, with 8-OH-dG concentrations that are 6 to 50 percent higher in smokers than in nonsmokers ( Campos et al., 2011 ; HHS, 2004 ; Lowe et al., 2009 ; Seet et al., 2011 ). Measures of lipid peroxidation include F2-isoprostanes and malondialdehyde (MDA). Many studies have demonstrated that current smokers have substantially higher concentrations of isoprostanes in both plasma and urine than nonsmokers ( Bloomer et al., 2008 ; HHS, 2004 ; Kocyigit et al., 2011 ; Ozguner et al., 2005 ; Seet et al., 2011 ; Taylor et al., 2008 ). The results of several studies indicate that MDA concentrations are 30 percent more abundant in current-versus-nonsmokers, suggesting cigarette smoking directly increases MDA concentrations ( Bloomer et al., 2008 ; Jain et al., 2009 ; Kocyigit et al., 2005 ; Ozguner et al., 2005 ). This is further corroborated by evidence from several studies that have found concentrations of thiobarbituric acid–reactive substances (TBARS) found in MDA range from 6 percent to 118 percent more in smokers than in people who have never smoked ( HHS, 2004 ).

Cigarette smoking clearly generates substantial quantities of oxidative stress, as indicated by a consistent body of evidence indicating that cigarette smoking significantly increases biomarkers of oxidative damage to proteins, DNA, and lipids. Cigarette smokers experience measurable and immediate oxidative damage. This oxidative damage, experienced over long periods of time, is one pathway contributing to smoking-caused disease and death ( HHS, 2010 ).

Depletion of circulating antioxidant micronutrient concentrations

Cigarette smoking exposes the smoker to potential oxidative damage not experienced by the nonsmoker. One direct result of the exposure to oxidative stress is the depletion of the body's defenses against oxidative stress. For example, the antioxidant defense system is partly comprised of antioxidant micronutrients ( Evans and Halliwell, 2001 ). Antioxidant status provides a biomarker of health status because oxidative damage is thought to be centrally involved in the aging process as well as in enhanced susceptibility to a wide range of specific diseases. Evidence from a number of studies firmly establishes that smokers have circulating concentrations of ascorbic acid and provitamin A carotenoids such as a-carotene, b-carotene, and cryptoxanthin that are more than 25 percent lower than nonsmokers ( Alberg, 2002 ). Considered in total, a strong and diverse body of evidence consistently implicates oxidative stress from cigarette smoking in the depletion of antioxidant micronutrients in circulation. Furthermore, the results across studies are consistent with a dose–response relationship, with the amount of smoking being inversely related to the circulating concentrations of vitamin C and provitamin A carotenoids ( HHS, 2004 ).

The immediate effects of cigarette smoking on these concentrations have been examined with measurements of circulating micronutrient concentrations taken before and after a smoker stops smoking. One such study, for example, found substantially increased concentrations of vitamin C and provitamin A carotenoids after 84 hours without a cigarette ( Brown, 1996 ). In another study, the exposure of plasma to the equivalent of six puffs of cigarette smoke completely depleted the ascorbic acid present in the serum ( Eiserich et al., 1995 ). In yet another, measurements taken at baseline and 20 minutes after smoking a cigarette found decreased circulating micronutrient concentrations ( Yeung, 1976 ). Results such as these highlight the immediate impact that smoking a cigarette can have on health status. Cigarette smoking causes depletion of antioxidant micronutrients, leading smokers to have lower circulating concentrations of these antioxidant micronutrients than nonsmokers. The direct immediate result on the smoker's lower concentrations of antioxidant micronutrients such as vitamin C is to reduce the smoker's antioxidant defenses, and thus the smoker's cells throughout the body are more prone to the damaging effects of oxidative stress. Oxidative stress is hypothesized to be associated with premature aging and greater risk of disease ( Laher, 2014 ).

Increased inflammation

The direct pro-oxidant effects of cigarette smoke are further exacerbated by additional endogenous oxidant formation via the smoking-induced inflammatory-immune response ( van der Vaart et al., 2004 ; Yao and Rahman, 2011 ). Another measure of smokers' poorer health is the chronically higher level of inflammatory response experienced by smokers compared to nonsmokers. Chronic inflammation is hypothesized to play a role in the pathogenesis of numerous chronic diseases ( Pawelec et al., 2014 ; Prasad et al., 2012 ).

For example, cigarette smoking is strongly and consistently associated with higher leukocyte concentrations ( HHS, 2004 ); this suggests that smoking induces a sustained, long-term inflammatory response. Compared to nonsmokers, current smokers have been uniformly found, across many studies, to have approximately 20 percent higher leucocyte counts. Furthermore, leucocyte counts increase with a greater degree of smoking, measured either by the number of cigarettes smoked per day or the depth of inhalation ( HHS, 2004 ). Prospective cohort studies that evaluate how changes in smoking status relate to changes in leucocyte counts provide evidence that eliminating cigarette smoking leads to reductions in leucocyte counts ( HHS, 2004 ). Leucocytes are a marker of chronic inflammation, but cigarette smoking is also associated with markers of the acute inflammatory response, such as C-reactive protein ( HHS, 2014 ).

Impaired immune status

The 2014 Surgeon General's report was the first report of the Surgeon General to review thoroughly the contribution of cigarette smoking to impaired immune status. Cigarette smoking was found to adversely impact the two major immune pathways, innate immunity and adaptive immunity. Recognizing the extreme complexity of the immune system, with its built-in compensatory mechanisms, the conclusion of the Surgeon General's report was that the evidence is sufficient to infer that cigarette smoking compromises the immune system and compromises immune homeostasis by diminishing both innate and adaptive immunity ( HHS, 2014 ). The impact of the adverse effects on immune status would be to make smokers more susceptible to disease, which in turn contributes to the etiology of acute infectious and chronic diseases above and beyond the way in which cigarette smoking contributes to acute and chronic inflammation.

Altered lipid profiles

Cigarette smoking causes altered lipid metabolism ( HHS, 2010 ). The alterations in the lipid profile induced by cigarette smoking create a higher risk profile: Compared with nonsmokers, cigarette smokers have significantly higher serum cholesterol, triglyceride, and low-density lipoprotein (LDL) levels and lower high-density lipoprotein (HDL) levels ( Ambrose and Barua, 2004 ). In a meta-analysis of 54 epidemiologic studies, smokers were found to have serum concentrations of cholesterol, triglycerides, and very low density lipoprotein (VLDL) cholesterol that were 3 percent, 9 percent, and 10 percent higher, respectively, and HDL cholesterol concentrations that were 6 percent lower than nonsmokers ( Craig et al., 1989 ). Furthermore, clear dose–response associations were observed, with these associations growing stronger as the number of cigarettes smoked per day increased. The alteration of the lipid profile in the direction of increased cardiovascular disease risk has been extensively documented not only in adults but also in children and adolescents. In a meta-analysis of studies in which study participants ranged from 8 to 19 years of age, adolescents who smoked cigarettes had serum LDL cholesterol and triglyceride concentrations that were significantly higher than in nonsmokers, whereas smokers had lower serum concentrations of HDL cholesterol than nonsmokers ( Craig et al., 1990 ). These differences are likely due to a direct effect of cigarette smoking. In a cohort of middle school students in Germany, those who initiated smoking had significantly lower HDL cholesterol levels than nonsmokers after 2 years of follow-up despite there having been similar baseline levels of HDL cholesterol in the two groups—those who would remain nonsmokers and those who would go on to begin smoking ( Dwyer et al., 1988 ).

Poorer Self-Rated Health Status

The adverse impact of smoking on health status has been directly measured by comparing self-rated health in smokers versus nonsmokers. Studies of varying design have uniformly shown that smokers tend to rate their overall health status lower than nonsmokers do ( HHS, 2004 , 2014 ). The consistent reporting of poorer self-rated health among smokers compared to nonsmokers across numerous dimensions of health status provides direct evidence that smoking impairs the health of cigarette smokers in ways that are perceptible to the smoker even in the absence of clinical disease.

Respiratory Symptoms: Coughing, Phlegm, Wheezing, Dyspnea

The immediate adverse health effects of cigarette smoking are not limited to subclinical measures; they can also result in physical symptoms. In reviewing the evidence separately for children/adolescents and adults, the 2004 Surgeon General's report concluded that cigarette smoking was causally associated with all major respiratory symptoms in both age groups ( HHS, 2004 ). The specific symptoms caused by cigarette smoking are coughing, phlegm, wheezing, and dyspnea. The consistent presence of the causal association across the life course supports the classification of these symptoms as an immediate health effect based on the definition used in this report.

Nicotine Addiction

Another clinical, immediate adverse health effect of cigarette smoking is nicotine addiction. The 2012 Surgeon General's report concluded that cigarette smoking was causally associated with nicotine addiction, beginning in adolescence ( HHS, 2012 ). The onset of nicotine addiction begins soon after smoking initiation.

The importance of nicotine addiction as an immediate adverse health effect cannot be underestimated. Nicotine addiction, via its role in propagating sustained smoking, assumes a role as a central determinant of the entire catalogue of downstream health effects of cigarette smoking. The often long-term, sustained addiction to nicotine is the underlying factor driving the long-term, sustained exposure to the toxins in tobacco smoke that drive the adverse health effects of cigarette smoking.

Finding 4-1: Cigarette smoking is causally associated with a broad spectrum of adverse health effects that begin soon after the onset of regular smoking and that, in total, significantly diminish the health status of the smoker compared to nonsmokers .

Intermediate-Term Effects on Morbidity

The health effects included in the category of “intermediate adverse health effects” consist largely of health outcomes that are not dependent on having smoked a cigarette in the immediate past but rather require a more extensive smoking history for the adverse outcome to become manifest. For example, intermediate adverse health effects are often direct sequellae of some of the immediate health effects of smoking, such as absenteeism and medical care utilization, or else they are diagnoses that are precursors of subsequent, more severe disease endpoints, such as type 2 diabetes and subclinical atherosclerosis. Cigarette smoking cessation diminishes the risk of experiencing these intermediate adverse health effects, but individuals with a past history of cigarette smoking still have greater risks than those who never smoked.


Another indicator of diminished health status is absence from work. Among the many factors that contribute to attendance, health status is clearly a major determinant. Thus, attendance patterns are potential markers of health status ( Alberg et al., 2003 ).

Cigarette smoking is a determinant of absence. A substantial body of evidence on the association in adults between cigarette smoking and absence from work consistently demonstrates that smokers are significantly more likely to have greater workplace absenteeism ( HHS, 2004 ). The likelihood of workplace absence increases with the number of cigarettes smoked per day ( HHS, 2004 ). Furthermore, smoking cessation is associated with reduced absence rates ( HHS, 2004 ). In addition to smokers having more episodes of absence than nonsmokers, smokers tend to stay out longer when they are sick than nonsmokers. Thus, smokers miss more cumulative work time than nonsmokers ( HHS, 2004 ).

A strong and consistent body of evidence demonstrates that cigarette smoking is associated with a greater likelihood of absence from work. This association could be at least partially due to smoking being a marker for other causes of absenteeism, such as mental illness and abuse of other substances. In considering the societal toll of cigarette smoking, attendance is not only a useful marker of diminished health status, but also a marker of other downstream costs. On the individual level, workplace absenteeism can lead to problems on the job and even result in unemployment. At the societal level, absenteeism decreases productivity and is a drain on the economy.

Increased Utilization of Medical Services

Utilization of medical services provides an additional indicator of health status. Despite the complexities inherent in studying the association between cigarette smoking and use of medical services, the evidence reviewed in the 2004 and 2014 Surgeon General's reports yields a clear signal indicating that cigarette smokers generate higher medical care costs and have more inpatients and outpatient visits than those who do not smoke ( HHS, 2004 , 2014 ). Among patients admitted to the hospital, smokers have longer lengths of stay and incur greater expenses per admission than nonsmokers.

Subclinical Atherosclerosis

Atherosclerosis is a cardiovascular disease precursor that begins early in life; it is the underlying pathogenic mechanism that ultimately leads to many cardiovascular disease endpoints. The epidemiologic evidence has been consistent in demonstrating a strong, dose-dependent association between cigarette smoking and subclinical atherosclerosis as measured by carotid intimal–medial thickness. Consequently, cigarette smoking has been established as a cause of atherosclerosis ( HHS, 2004 ). Establishing the link between cigarette smoking and atherosclerosis provides a strong, biologically plausible rationale for the role of cigarette smoking in the pathogenesis of clinical cardiovascular endpoints that occur as a consequence of atherosclerosis.

Impaired Lung Development and Accelerated Decline in Function

In addition to smoking's long-term health effects on the respiratory system from diseases such as lung cancer and COPD, some adverse respiratory effects experienced by adolescent cigarette smokers manifest themselves shortly after smoking initiation. Compared to nonsmokers, adolescents who smoke cigarettes are more likely to experience impaired lung growth, early onset in the decline of lung function, and asthma-related symptoms ( HHS, 2004 ). Among adults who smoke cigarettes, lung function begins to decline at younger ages, and the age-related decline in lung function occurs faster ( HHS, 2004 ).

Increased Susceptibility to Infectious Lung Diseases

Due at least in part to its adverse impact on immune status, cigarette smoking predisposes the smoker to developing acute infectious respiratory illnesses such as pneumonia. Established effects of cigarette smoking on the immune system provide a clear biological basis for the increased likelihood that has been observed among smokers of developing an infection after exposure to microbes that cause respiratory infections and also of developing a clinically apparent disease once infected ( HHS, 2004 ). Further, impaired cilia function in the trachea and bronchi also contributes to the increased risk of respiratory infections in smokers ( Simet et al., 2010 ). Thus, it is no surprise that cigarette smokers have an increased susceptibility to respiratory infections.

Cigarette smoking is causally associated with an increased risk of pneumonia ( HHS, 2004 ). The 2014 Surgeon General's report was the first to review the evidence on the association between cigarette smoking and tuberculosis. A strong statistical association has been observed between cigarette smoking and risk of M. tuberculosis infection and also the risk, once infected, of progressing to tuberculosis disease, but showing a clear causal connection between smoking and risk of tuberculosis has been challenging because cigarette smokers often have a much higher risk profile than nonsmokers for these outcomes because of other social determinants of health. These challenges notwithstanding, the evidence has now coalesced to the point that cigarette smoking is causally associated with tuberculosis disease and tuberculosis mortality ( HHS, 2014 ).

Type 2 diabetes mellitus is a leading underlying cause of mortality from cardiovascular disease, and it also leads to other adverse consequences such as kidney failure and blindness ( HHS, 2014 ). Obesity has long been established as a major risk factor for diabetes, but the association between cigarette smoking and diabetes has only more recently been elucidated. The results of a meta-analysis of 51 prospective cohort studies in the 2014 Surgeon General's report demonstrated that cigarette smokers have a 30–40 percent greater risk of diabetes than nonsmokers and that there is a strong dose–response relationship, with the risk increasing with the number of cigarettes smoked per day ( HHS, 2014 ). In addition to having an increased risk of developing diabetes, evidence also indicates that, among patients with diabetes, cigarette smokers are more likely to suffer cardiovascular complications and to have higher mortality rates. Based on this body of evidence, the 2014 Surgeon General's report concluded that cigarette smoking is a cause of diabetes ( HHS, 2014 ).


A synthesis of the evidence in the 2004 Surgeon General's report revealed a strong, consistent, and dose-dependent relationship between cigarette smoking and the risk of periodontitis. Based on this evidence, cigarette smoking was judged to be causally associated with periodontitis. Approximately one-half of all diagnoses of adult periodontitis are attributable to cigarette smoking ( HHS, 2004 ).

Asthma Exacerbation

The fact that cigarette smoking is causally associated with so many outcomes that are relevant to asthma has long raised suspicions that cigarette smoking is a risk factor for asthma. Examples of these asthma-relevant factors are persistent inflammation, diminished immune status, and the respiratory symptoms of coughing, phlegm, wheezing, and dyspnea. At the present time, the evidence is considered suggestive but not sufficient to infer a causal association between cigarette smoking and the risk of developing asthma in adolescents or adults or between smoking and the risk of asthma exacerbations in adolescents ( HHS, 2014 ). However, the 2014 Surgeon General's report did conclude that cigarette smoking is causally associated with asthma exacerbation in adults ( HHS, 2014 ).

Adverse Surgical Outcomes: Wound Healing and Respiratory Complications

The fact that smoking causes diminished health status by impairing factors such as immune response and lung function provides a strong reason to believe that cigarette smoking could be associated with a worse prognosis after surgical procedures. Based on a large and diverse body of evidence with outcomes that ranged from short- and long-term complications of surgery to survival, the 2004 Surgeon General's report concluded that cigarette smoking is a cause of adverse surgical outcomes ( HHS, 2004 ).

Finding 4-2: Cigarette smoking causes many adverse health effects classified as “intermediate,” which include increased absence from work, the increased use of medical services, subclinical atherosclerosis, impaired lung development and function, an increased risk of lung infections, diabetes, periodontitis, the exacerbation of asthma in adults, subclinical organ injury, and adverse surgical outcomes .

Long-Term Morbidity

Cigarette smoking contributes to a major portion of the population burden of many of the chronic diseases that typically occur in middle and late adulthood, such as cancer, cardiovascular disease, and COPD ( HHS, 2004 ). As noted below, the full scope of long-term morbidity attributable to cigarette smoking also extends to numerous other disease endpoints. Cessation of cigarette smoking diminishes the risk of experiencing these long-term adverse health effects, but a past history of cigarette smoking is still associated with increased risk compared to never having smoked ( HHS, 2014 ).

Cigarette smoking is causally associated with 12 different types of malignancy and is responsible for approximately 30 percent of all cancer deaths in the United States ( ACS, 2007 ; HHS, 2014 ). Cigarette smoking has been known for many years to be a cause of cancers of the lung, oral cavity, larynx, esophagus, bladder, pancreas, kidney, uterine cervix, and stomach, and of acute myeloid leukemia. The conclusions of the 2014 report of the Surgeon General indicate that cigarette smoking is also causally associated with colorectal cancer and liver cancer. Furthermore, cigarette smoking is causally associated with clinical precursors of cancer lesions, such as colorectal adenomatous polyps ( HHS, 2014 ).

Vascular Disease

Cigarette smoking is associated with numerous clinical cardiovascular disease endpoints, including coronary heart disease, stroke, and abdominal aortic aneurism. Coronary heart disease is a leading cause of death in the United States and most high-income countries. Cigarette smoking has been established as a major cause of coronary heart disease for decades. The impact of cigarette smoking is particularly strong among younger age groups, as it causes 40 percent of ischemic heart disease deaths in 35- to 64-year-olds ( HHS, 2004 ).

Cigarette smoking has long been identified as a major cause of cerebrovascular disease. As with coronary heart disease, the impact of cigarette smoking is proportionally larger in relatively younger adults. Among 35- to 64-year-olds, more than 40 percent of all cerebrovascular disease deaths are attributable to cigarette smoking ( HHS, 2004 ).

Cigarette smoking is an established cause of abdominal aortic aneurysm ( HHS, 2004 ). This condition is often fatal and accounts for more than 10,000 deaths per year in the United States.

The process of inhaling cigarette smoke brings the smoker's respiratory system into direct contact with heavy doses of tobacco toxins. Given these profound levels of exposure, it is not surprising that cigarette smoking's deleterious effects on the respiratory system extend well beyond lung cancer. Cigarette smoking is estimated to have caused 7.5 million prevalent cases of COPD in the United States in 2009 ( Rostron et al., 2014 ). More than 138,000 Americans died from COPD in 2010, making it the third leading cause of death in the United States ( Heron, 2013 ). As the predominant cause of COPD, cigarette smoking is responsible for approximately 80 percent of the mortality burden from COPD ( HHS, 2004 ).

Eye Disease: Age-Related Macular Degeneration and Nuclear Cataracts

Cigarette smoking also adversely affects eye health, causing nuclear cataracts ( HHS, 2004 ). The body of evidence linking cigarette smoking with age-related macular degeneration that was accumulated over the past two decades has now been judged to be strong and consistent enough to prove a causal association between the two ( HHS, 2014 ).

Rheumatoid Arthritis

Cigarette smoking also causes joint disease. More than 1 million Americans have been diagnosed with rheumatoid arthritis, a disease linked to immune dysregulation. Enough supportive evidence has been accumulated to indicate a clear link between cigarette smoking and rheumatoid arthritis. The conclusions of the 2014 Surgeon General's report contained the conclusion that a causal association has been established between cigarette smoking and rheumatoid arthritis ( HHS, 2014 ).

Bone Health: Hip Fractures and Bone Density

Cigarette smoking has adverse consequences for bone health. Cigarette smoking is causally associated with hip fractures. In postmenopausal women, a causal association has been established between cigarette smoking and low bone density ( HHS, 2004 ).

Finding 4-3: Cigarette smoking is causally associated with a broad spectrum of adverse long-term health effects which cause suffering, impaired quality of life, and death .

Maternal/Fetal and Infancy Health Effects

Pregnancy represents a particularly vulnerable time of life for both the mother and the developing fetus, and this critical time window extends into the neonatal period and infancy. Because of the unique features of this period of enhanced vulnerability and its critical public health importance, the topic is considered separately. Cigarette smoking is an established cause of a broad spectrum of health effects to the mother, fetus, and infant, including decreased likelihood of becoming pregnant, increased risk of experiencing adverse pregnancy outcomes, and adverse effects on the newborn that can range from organ impairment to congenital malformations to death, as summarized in Table 4-6 . Table 4-6 also includes the immediate physiologic effects of smoking from Table 4-1 to emphasize the point that pregnant women who smoke incur the same short-term adverse health effects incurred by all cigarette smokers. It is estimated that more than 400,000 infants are exposed each year to maternal smoking in utero. Furthermore, recent data indicate that more than 1.2 million births each year in the United States occur among mothers under 25 years of age. In the United States in 2012, 31 percent of all births were to mothers less than 25 years old (1,225,871/3,952,841); of these, 90,095 were to mothers less than 18 years old, 85,310 were to mothers who were 18 years old, and 1,050,466 were to mothers who were 19–24 years old ( Martin et al., 2013 ).

TABLE 4-6. Maternal, Fetal, and Infant Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

Maternal, Fetal, and Infant Adverse Health Outcomes Causally Associated with Cigarette Smoking Based on Surgeon General's Reports.

Decreased Likelihood of Conception

Cigarette smoking is associated with a decreased likelihood of pregnancy because of smoking's adverse effects on the female and the male reproductive systems. Cigarette smoking is causally associated with reduced fertility in women ( HHS, 2004 ). Further, the 2014 Surgeon General's report pointed to a diverse body of research evidence supported by a strong biologic rationale to conclude that cigarette smoking is a cause of erectile dysfunction in men.

Pregnancy Complications

Maternal smoking during pregnancy reduces the likelihood of a full-term gestational period with optimal fetal growth. Cigarette smoking by pregnant women adversely affects pregnancy by making it more likely they will experience ectopic pregnancies, complications of pregnancy such as premature rupture of the membranes, placenta previa, and placental abruption. Furthermore, cigarette smoking in expectant mothers causes preterm delivery and shortened gestation ( HHS, 2004 ).

Outcomes: Childbirth, Infancy, and Survival

Maternal cigarette smoking during pregnancy directly harms the fetus and, later, the infant in several ways ( HHS, 2004 ). Cigarette smoking is causally associated with stunted fetal growth and is an important cause of shortened gestation. In combination, stunted fetal growth and premature delivery are major determinants of low birth weight. Cigarette smoking causes congenital malformations, specifically orofacial clefts. Cigarette smoking is also associated with impaired organ function, specifically reduced lung function ( HHS, 2014 ).

Based on these many severe effects, it is logical to infer that cigarette smoking negatively affects the viability of the fetus and child. Specifically, smoking is causally associated with fetal deaths, or stillbirths; furthermore, among live births smoking is an established cause of overall infant mortality. That is, compared with infants of mothers who do not smoke, infants with mothers who smoke during or after pregnancy experience higher rates of death before reaching 1 year of age. One specific cause of increased mortality of infants whose mothers smoke is sudden infant death syndrome, which is more likely to strike those infants than infants whose mothers do not smoke ( HHS, 2004 ).

After birth, children who are exposed to secondhand smoke (SHS) via parental smoking suffer numerous adverse health effects as a consequence. In infants, symptoms associated with SHS exposure include increased lower respiratory illnesses, otitis media, middle ear effusion, reduced lung function, and the respiratory symptoms of coughing, phlegm, wheezing, and dyspnea ( HHS, 2006 ). In addition to the increased risk of symptoms, infants of smoking mothers are more likely to experience subclinical immediate adverse health effects of cigarette smoke exposure as well. For example, evidence indicates that infant exposure to parental smoking is associated with physiologic markers of diminished health status, such as increased oxidative damage to DNA and lipids. As noted above, 8-OH-dG can be used as a measure of oxidative damage to DNA, and neonatal levels of urinary 8-OH-dG have been found to be significantly associated with exposure to the toxicants from tobacco smoke due to the mother's smoking ( Hong et al., 2001 ). Newborns with mothers who smoked had concentrations of 8-OH-dG that were 333 percent higher than newborns whose mothers did not smoke ( Hong et al., 2001 ).

Finding 4-4: Maternal smoking during pregnancy and secondhand smoke exposure during infancy are causally associated with many adverse health outcomes. This not only leaves exposed infants prone to short- and long-term health risks but also can result in death .

Age of Initiation and Health Outcomes

The following four factors were used to assess the effects that the age of initiation had on an individual's cigarette smoking trajectory and subsequent health effects: (1) nicotine dependence, (2) the number of cigarettes smoked per day (smoking intensity), (3) the likelihood of smoking cessation (or, conversely, the likelihood of remaining a smoker), and (4) health outcomes. These four factors are closely interrelated. Nicotine dependence is associated with smoking intensity ( Hu et al., 2006 ), and both of these measures are in turn associated with the likelihood of remaining a smoker in the long term. The interrelationships among the factors involve both smoking intensity (number of cigarettes per day) and smoking duration (number of years smoked) and hence also the effects of the lifetime cumulative exposure to cigarette smoking. Many of the established deleterious health effects of cigarette smoking are dose-dependent, thus providing a mechanistic explanation for how earlier age of initiation could exert a powerful contribution on smoking-caused health effects that is mediated by leading to increased doses of exposure to cigarette smoke.

In particular, the mechanistic basis for a powerful influence of the age of initiation on smoking-caused adverse health outcomes is grounded in the evidence, reviewed in Chapter 3 , that those who start smoking earlier are more likely to (1) have a greater degree of nicotine dependence ( Breslau and Peterson, 1996 ; Buchmann et al., 2013 ; HHS, 2012 ; Hu et al., 2006 ; Lando et al., 1999 ; Park et al., 2004 ), (2) smoke cigarettes more frequently ( Breslau, 1993 ; Buchmann et al., 2013 ; Chen and Millar, 1998 ; D'Avanzo et al., 1994 ; Escobedo et al., 1993 ; Everett et al., 1999 ; Fernandez et al., 1999 ; Hu et al., 2006 ; Lando et al., 1999 ; Reidpath et al., 2014 ; Taioli and Wynder, 1991 ), and (3) remain smokers for longer periods of time ( Breslau and Peterson, 1996 ; Chen and Millar, 1998 ; D'Avanzo et al., 1994 ; Eisner et al., 2000 ; Everett et al., 1999 ; Khuder et al., 1999 ). These associations all point toward an association between a younger age of initiation and greater exposure to the toxicants in cigarette smoke, which because of well-established dose–response relationships would therefore be expected to lead to higher risk of smoking-caused disease and death. A further negative consequence of starting to smoke at younger ages is that tissues and organ systems that are still in the growth and maturation phase may be particularly vulnerable to the toxicants in smoke, so that even a given exposure dose to cigarette smoke may be more harmful when exposure occurs during childhood and adolescence than during adulthood.

Younger age of initiation has been found to be associated with one short-term health effect in particular: an increased risk of hospital inpatient stay during the previous year ( Lando et al., 1999 ). Concerning long-term health effects, the lung is exquisitely sensitive to the adverse consequences of cigarette smoke because it is directly exposed to inhaled cigarette smoke and is further exposed to harmful smoke toxicants via the circulation of those toxicants in the blood. In a prospective cohort study, a strong association was observed between an earlier age of smoking initiation and an increased risk of respiratory disease ( Kenfield et al., 2008 ). Compared to people who have never smoked, the relative odds (and 95 percent confidence intervals) of contracting respiratory disease were 7.0 (3.9–12.4) for those who started smoking at 26 years old or older; 8.1 (5.5–11.9) for those who started between 22 and 25; 10.2 (9.9–13.2) for smoking initiation between 18 and 21; and 13.4 (9.8–18.2) for those who started smoking at 17 or younger; the age trend is highly statistically significant (a p-value of 0.001). The same study also observed a statistically significant trend for the risk of lung cancer, which was not grouped under respiratory disease ( Kenfield et al., 2008 ); this finding was also observed in another population-based cohort study ( Prizment et al., 2014 ). The strong association between an earlier age of starting to smoke and increased lung cancer risk was summarized in a meta-analysis of 69 studies, which estimated that the summary odds ratio for lung cancer was 10.3 (95 percent confidence interval of 8.0–13.3) for starting to smoke around the age of 14 years; 7.5 (5.9–9.4) for starting to smoke at approximately 18 years; and 3.9 (3.3–4.6) for starting to smoke at age 26 years ( Lee et al., 2012 ). Thus, an earlier age of initiation is strongly associated with an increased risk of respiratory diseases (primarily COPD) and lung cancer.

The evidence for cardiovascular disease has been mixed. The risk of cardiovascular disease increased significantly with younger age of initiation in the ARIC prospective cohort study ( Huxley et al., 2012 ), but the results of the Nurses' Health Study did not find a significant effect ( Kenfield et al., 2008 ). In another study, younger age of initiation was significantly associated with peripheral artery disease ( Planas et al., 2002 ).

Overall, the evidence is consistent in finding that the younger the age of initiation, the greater the risk of nicotine dependence, smoking intensity, and persistent smoking/reduced likelihood of cessation. The associations between a younger age of initiation and these outcomes holds true even after accounting for time from first cigarette to first daily smoking. The findings consistently show a dose–response trend, with younger ages of initiation associated with a higher likelihood of nicotine dependence, greater smoking intensity, and reduced likelihood of cessation. The absence of any apparent age threshold on these associations or any diminution of the associations across the age continuum indicates that any delay in initiation, regardless of the ages affected (e.g., late childhood to early adolescence, early to mid-adolescence, or adolescence to young adulthood) would be expected to have measurable benefits in reducing the lifetime consumption of cigarettes and hence in reducing the risk for smoking-caused disease and death. The adverse consequences of a younger age of initiation appear to manifest at young ages and be sustained over the life course.

Finding 4-5: A younger age of initiation is associated with an increased risk of many adverse health outcomes, such as a hospital inpatient stay in the past year and lifetime risk of respiratory disease, especially chronic obstructive pulmonary disease and lung cancer .

Other Tobacco Products and Sources of Exposure

So far, the discussion has focused specifically on cigarette smoking. SHS exposure and other tobacco products and nicotine delivery devices are discussed below.

Secondhand Smoke Exposure

The health effects of cigarette smoking are not limited to the adverse health effects on the smoker; they also include the health consequences that exposure to SHS has on nonsmokers ( HHS, 2014 ). SHS exposure has now been linked with a host of adverse health effects in addition to the long-established causal associations with lung cancer and heart disease.

As cigarette smokers, parents who smoke cigarettes increase their personal risk for all of the adverse health outcomes described above. If parents smoke in the presence of their children, they also negatively affect the health of their children by exposing them to SHS. The health effects of SHS exposure are not limited to long-term enhanced susceptibility to chronic diseases, but, as in the case of cigarette smoking, they also include immediate and substantial effects that leave SHS-exposed individuals prone to short-term health risks (see Table 4-7 ).

TABLE 4-7. Adverse Health Outcomes Causally Associated with Secondhand Smoke Exposure Based on Surgeon General's Reports.

Adverse Health Outcomes Causally Associated with Secondhand Smoke Exposure Based on Surgeon General's Reports.

Thus, as is the case with cigarette smoking, SHS exposure is associated with diminished health status. Exposure to SHS is associated with increased oxidative damage to DNA and lipids. As noted above, MDA can be used as a measure of lipid peroxidation, and children exposed to SHS have been found to have significantly higher circulating levels of MDA and also significantly lower levels of glutathione peroxidase ( Zalata et al., 2007 ). Concerning antioxidant micronutrients, the evidence for SHS exposure mirrors the evidence for smoking. Compared to nonsmokers not exposed to SHS, nonsmokers exposed to SHS have significantly reduced circulating concentrations of vitamin C and provitamin A carotenoids, indicating that even low-dose cigarette smoke exposures lower circulating antioxidant micronutrient concentrations. Evidence of lowered circulating antioxidant micronutrient concentrations has also been observed in children of smokers ( Wilson et al., 2011 ; Yilmaz et al., 2009 ; Zalata et al., 2007 ). Children whose mothers were smokers had 29 percent and 26 percent lower circulating concentrations of vitamin E and vitamin A, respectively, than children whose mothers did not smoke ( Yilmaz et al., 2009 ).

Nonsmokers exposed to SHS have also been found to have lessened immune status ( HHS, 2010 ). The body of evidence firmly indicates that among nonsmokers, SHS exposure is associated with greater oxidative damage, lower circulating antioxidant micronutrient concentrations, and lessened immune status. Given the consistent body of evidence and the clear biological rationale based on the causal associations seen with cigarette smoking these associations are likely to be rated as causal in the future, but the evidence base has not yet reached the standard for these associations to be judged as causal in the Surgeon General's report.

Consistent with the health effects observed for cigarette smoking, the health effects of SHS exposure also include reduced lung function and the respiratory symptoms of coughing, phlegm, wheezing, and dyspnea. SHS exposure in children causes numerous adverse health effects, including lower respiratory illnesses, otitis media, and middle ear effusion ( HHS, 2006 ).

In adults, SHS exposure is also causally associated with increased risk of long-term chronic diseases, just as in the case of cigarette smoking. These diseases include lung cancer, coronary heart disease, stroke, and inflammatory bowel disease.

As expected, based on the lower-exposure doses of exposure to tobacco toxins that result from secondhand smoke, the health risks of SHS exposure for most health outcomes tend to be less than the risks of cigarette smoking. Nevertheless, the fact that these risks are incurred even at very low doses indicates that there is no safe threshold for exposure to cigarette smoke. The importance of this public health challenge is accentuated by the fact that these health risks are incurred as the result of smoking by others rather by the affected individuals themselves.

Finding 4-6: Secondhand smoke exposure is causally associated with adverse health effects .

It is worth keeping in mind that this lengthy catalogue of well-established consequences of SHS exposure will continue to grow as more definitive evidence coalesces for additional health outcomes. For example, Table 4-8 summarizes health outcomes for which the evidence summarized in the 2014 Surgeon General's report is currently considered strong enough to be considered suggestive of a causal association but not yet strong enough to be rated as causal.

TABLE 4-8. Adverse Health Outcomes with Evidence Suggestive of a Causal Association with Secondhand Smoke Exposure Based on Surgeon General's Reports.

Adverse Health Outcomes with Evidence Suggestive of a Causal Association with Secondhand Smoke Exposure Based on Surgeon General's Reports.

Smoking of Pipes, Cigars, and Other Combustible Tobacco Products

Combustible tobacco products other than cigarettes are also associated with the same sort of chronic disease outcomes associated with cigarette smoking, such as cancer and cardiovascular disease. Pipe and cigar smoke contain similar profiles of harmful toxins to those found in cigarette smoke ( HHS, 2014 ). A key distinction in the health risks is that the doses of toxins delivered to the smoker are often less for pipes and cigars than for cigarettes because pipes and cigars are usually smoked less frequently and the smoke tends to be inhaled less deeply ( HHS, 1998 ). For example, pipe and cigar smoking pose risks for malignancies of the larynx, oral cavity, and esophagus that are similar to the risks associated with smoking cigarettes ( HHS, 1998 ). Pipes and cigars are causally associated with lung cancer, even though the risks are less than observed for cigarette smoking because compared to cigarette smoking pipes and cigars are smoked on average less frequently and the smoke is inhaled less deeply ( Alberg et al., 2013 ). The available evidence indicating that pipe and cigar smoking have similar adverse health effects to cigarette smoking thus supports the conclusion that the impact of a policy change that resulted in lower uptake or delayed initiation of pipes or cigars would have a significant impact on public health but would be expected to be less than a similar reduction in cigarette smoking because of the lower exposure to tobacco toxins due to the manner in which pipes and cigars are smoked.

Another way to smoke tobacco is with a hookah, or waterpipe. From an exposure assessment perspective, the distinctive features of this tobacco smoke delivery system are that the tobacco is sometimes indirectly heated and that the smoke passes through a water column prior to inhalation ( Akl et al., 2010 ). Hookah use is becoming more common throughout the world, including in the United States ( Cobb et al., 2010 ; Jawad et al., 2013 ). In a study comparing the urinary concentrations of the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in cigarette smokers, hookah smokers, and nonsmokers, it was found that hookah smokers had significantly higher NNAL concentrations than nonsmokers but significantly lower concentrations than cigarette smokers ( Radwan et al., 2013 ). In a study in which urine samples were collected from hookah smokers before and after they smoked from the hookah, significant post-smoking increases were noted in the urinary concentrations of nicotine, cotinine, NNAL, and volatile organic compounds ( St. Helen et al., 2014 ). Expired carbon monoxide concentrations ( Jacob et al., 2011 ) and benzene exposure ( Jacob et al., 2013 ) tend to be much higher for hookah smoking than for cigarette smoking. Studies have assessed the association between hookah smoking and selected health outcomes, but there is a paucity of evidence available on this topic, and the body of evidence is generally of low quality ( Akl et al., 2010 ). In a meta-analysis of data from four studies, hookah smoking was significantly associated with an increased lung cancer risk (odds ratio, 2.1; 95 percent confidence interval, 1.3–3.4) ( Akl et al., 2010 ). In this same systematic review, only one study each was identified to assess the association between hookah smoking and cancers of the bladder, esophagus, and nasopharynx, and none of the observed associations were statistically significant ( Akl et al., 2010 ). With respect to pregnancy outcomes, three studies found hookah smoking to be associated with a significantly increased risk of low birth weight (2.1; 1.1–4.2) ( Akl et al., 2010 ). In one study, hookah smoking was found to be associated with a significantly increased risk of respiratory illness (2.3; 1.1–5.1) ( Akl et al., 2010 ). Definitive conclusions on the risks associated with hookah smoking versus cigarette smoking are not possible with the limited quality and quantity of the evidence currently available.

Little evidence on the health effects of newer combustible tobacco products has been generated. In attempting to estimate risks, it is important to account for the specific product features. For example, the 2014 Surgeon General's report points out that when considering the emergence of small cigarette-like cigars, the health risks may more closely parallel those of cigarettes than of the traditional cigar because of the way that small cigarette-like cigars are used ( HHS, 2014 ). This line of reasoning emphasizes that the health risks of tobacco use are directly linked to doses of exposure to disease-causing toxins, which is a function not only of the tobacco product but also of the frequency and duration of and the manner in which the product is smoked, when factors such as depth of inhalation are accounted for. This concept is also critical to thinking about the health risks of dual use or poly-use of combustible tobacco products and ENDS, an exposure pattern that will likely increase in the future but for which data on health risks are needed.

Finding 4-7: Smoking of combustible tobacco products other than cigarettes, such as pipes and cigars, is causally associated with a broad spectrum of adverse health effects .

Smokeless Tobacco Products

The marketplace for smokeless tobacco products has diversified considerably in recent years. In addition to the traditional smokeless tobacco products of chewing tobacco and snuff, a number of new products have been introduced, such as snus and dissolvable tobacco products.

The 1986 Surgeon General's report examined the evidence concerning smokeless tobacco and concluded that it was a cause of cancer of the oral cavity. Smokeless tobacco use can also lead to oral leukoplakia, gingival recession, and nicotine addiction. A 2007 monograph of the International Agency for Research on Cancer (IARC) that focused on smokeless tobacco concluded that smokeless tobacco is a Group 1 carcinogen, meaning that it is a human carcinogen ( IARC, 2007 ). The IARC review of the evidence led to the conclusion, “Smokeless tobacco causes cancers of the oral cavity and pancreas” ( IARC, 2007 , p. 370). Smokeless tobacco may also be linked to an increased risk of esophageal cancer ( IARC, 2012 ).

These earlier reviews of the evidence concerning the health effects of smokeless tobacco use were primarily based on evidence related to traditional smokeless tobacco products and did not take into account the newer products. A more recent review of the epidemiologic evidence for Swedish-type snus, a moist snuff, suggests that the use of snus may be less harmful than cigarette smoking ( Lee, 2011 ). How the health risks of Swedish-type snus differ from the more traditional smokeless tobacco products has yet to be precisely characterized; furthermore, direct epidemiologic evidence is not yet available on the health effects of the Swedish-type snus products presently marketed in the United States.

Finding 4-8: The use of smokeless tobacco products is causally associated with oral cancer .

The marketplace for tobacco products and devices that deliver nicotine has recently expanded in response to the smoking bans that have increasingly limited the locations where traditional cigarette smoking is allowed ( Jawad et al., 2013 ; Kamerow, 2013 ; Popova and Ling, 2013 ; Schuster et al., 2013 ). Electronic nicotine delivery systems, or ENDS, have experienced a rapid upsurge in use and are now marketed by the major U.S. tobacco companies ( Dockrell et al., 2013 ; Kamerow, 2013 ; Li et al., 2013 ; Popova and Ling, 2013 ).

Monitoring this expansion in products and how the products are used is important to tobacco control. An ENDS product that decreases the delivery of tobacco toxins would ostensibly also reduce the risk of developing smoking-caused disease if current cigarette smokers were to switch from cigarettes to exclusive use of the ENDS. On the other hand, the risk of smoking-caused disease could be increased if the ENDS maintained nicotine addiction and its users continued to smoke cigarettes and to use multiple products that deliver nicotine. Furthermore, these alternative products, particularly those that involve flavorings attractive to adolescents, may serve as a gateway for adolescents to initiate smoking and thus start on a path that eventually leads to tobacco addiction. Currently there is a paucity of data on issues such as these; along with the direct adverse health effects associated with use of these alternative products, these remain important lines of inquiry for future research. Definitive evidence on the long-term health effects of ENDS products will not be available for many years because any long-term health effects associated with these products will take decades to emerge. Furthermore, generating the needed evidence base will be complicated by the facts that there are so many different ENDS products and the products and their contents are evolving.

Cigarette smoking contributes significantly to the population burden of many of the leading causes of chronic disease deaths that typically occur in middle and late adulthood, such as cancer, cardiovascular disease, and COPD ( HHS, 2004 ).

The combined death toll linked to cigarette smoking is staggering. Cigarette smoking is estimated to account for approximately 480,000 deaths per year in the United States ( HHS, 2014 ). In 2010 the four leading causes of death in the United States were heart disease (597,700 deaths), cancer (574,700 deaths), chronic lower respiratory diseases (138,100 deaths), and stroke and cerebrovascular disease (129,500) ( Heron, 2013 ). Cigarette smoking is a major cause of all four of these diseases. Furthermore, smoking is also a cause of the seventh (diabetes, 69,000 deaths) and eighth (influenza/pneumonia, 50,100 deaths) leading causes of death ( Heron, 2013 ).

As a cause of 12 different types of malignancy, cigarette smoking is responsible for 163,700 cancer deaths per year in the United States ( HHS, 2014 ; NCHS, 2013 ). Most of this mortality burden (130,700 deaths) is due to lung cancer, but cigarette smoking also caused 36,000 deaths from other malignancies ( HHS, 2014 ).

Cardiovascular Disease

Cigarette smoking is estimated to cause 160,600 cardiovascular disease deaths per year in the United States ( HHS, 2014 ). The majority of the smoking-caused cardiovascular deaths (99,300 deaths) are due to coronary heart disease, but smoking also causes 25,500 deaths from other forms of heart disease. Furthermore, cigarette smoking causes 15,300 deaths from cerebrovascular disease and 11,500 deaths from other forms of vascular disease.

Type 2 diabetes mellitus is a leading underlying cause of mortality from cardiovascular disease, and it also leads to other adverse consequences such as kidney failure and blindness ( HHS, 2014 ). It is the seventh leading cause of death in the United States ( Heron, 2013 ). Cigarette smoking is estimated to cause 9,000 deaths from type 2 diabetes per year in the United States ( HHS, 2014 ).

More than 138,000 Americans died from COPD in 2010 ( Heron, 2013 ), making it the third leading cause of death in the United States. Cigarette smoking is the predominant cause of COPD. Estimates indicate that 100,600 COPD deaths per year in the United States are attributable to cigarette smoking ( HHS, 2014 ).

Cigarette smoking is causally associated with an increased risk of pneumonia ( HHS, 2004 ) and tuberculosis mortality ( HHS, 2014 ). Cigarette smoking is estimated to cause 12,500 deaths from these infectious diseases per year.

Due to its causal associations with coronary heart disease and lung cancer, secondhand smoke exposure is estimated to cause more than 41,300 deaths per year in the United States ( HHS, 2014 ). The majority of these (almost 34,000 deaths) are due to coronary heart disease, while more than 7,000 deaths per year are from lung cancer ( HHS, 2014 ). Furthermore, parental smoking is estimated to cause approximately 600 deaths per year from prenatal conditions and 400 deaths per year from sudden infant death syndrome ( HHS, 2014 ).

Finding 4-9: Tobacco use is causally associated with premature mortality from a variety of causes, such as lung infections, chronic obstructive pulmonary disease, coronary heart disease, and a variety of cancers .

In this Page

Related information.

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers


Health Effects of Smoking and Tobacco Essays

How tobacco addiction affects the quality of care, popular essay topics.

Home / Essay Samples / Health / Medicine / Tobacco Use

Tobacco Use Essay Examples

There exists a trap in today’s society which has claimed many lives. Lives which are now altered to suit its use and need while also gifting their host their arbitrary title of smoker or tobacco addict. Although many use it to alleviates stress or pain,...

A strategic plan is meant to present a clear picture of where a community wants in the future, what it aspires to accomplish, the methods it will apply to succeed, as well as the measures it will use to monitor progress. This particular strategic plan...

Smoking is a very harmful habit that people get in to, it affects your whole body but especially your lungs. It is one of the biggest causes of preventable deaths and on average 1 in 2 smokers will die from a smoking related disease. Smoking...

A lot of people smoke for it makes them calm when they had a very tiring or sad day. How sure are you? That smoking relieves your stress. That it comforts and helps you to cope up with the pain and problems you have experienced...

Smoking is seems something usual and even natural nowadays. Cigarette manufacturers have moved to a new level and begun to produce products that seem to cause less harm to health or have no negative consequences at all. Nevertheless, this is only a lie imposed on...

Tobacco use, an unhealthy diet, limited exercise, and stress contribute to cardiovascular problems. In order to grasp how detrimental these can be, it is important to understand what they affect. The cardiovascular system is one of the twelve systems in the human body. It contains...

Smoking behavior may not be so fixed or stable among energetic adults as is regularly anticipated. In continuous examination data, upwards of one fifth of smokers point by point starting smoking after the age of 18 a liberal addition over chronicled guidelines. To be sure,...

Tobacco smoking remains a significant preventable cause of ill health and premature death worldwide despite a decline in prevalence in recent years. In the history of human civilization, the cigarette is the deadliest thing. About six million people are killed every year by tobacco. Tobacco...

Currently in Canada, there are about 4. 6 million Canadians who smoke which makes up about 15% of the population, which is significantly lower than previous years, like 1965 when a record 50% of Canadians smoked. Due to the fact that trend of smoking has...

Tobacco use kills nearly six million people worldwide each year. Sadly, of the more than 6 million tobacco-related deaths which are caused every year across the world, one-sixth happen in our country – India alone. Though the ill-effects of tobacco addiction are well-known, its consumption...

Trying to find an excellent essay sample but no results?

Don’t waste your time and get a professional writer to help!

You may also like

Similar Topics

samplius.com uses cookies to offer you the best service possible.By continuing we’ll assume you board with our cookie policy .--> -->