A R e p o r t o f t h e S u r g e o n G e n e r a l

How Tobacco Smoke Causes Disease

 . . . w h a t i t m e a n s t o

SGR_CS4.indd 1 11/29/10 
Regina M. Benjamin, MD, MBA

Surgeon General

SGR_CS4.indd 2 11/29/10 

About the 2010 Surgeon General’s Report

The 2010 Surgeon General’s report contains important new 

information about how tobacco smoke causes disease. The report 

makes it clear why we must protect others from tobacco smoke, 

especially children and pregnant women. It also helps explain why 

it is so important to quit smoking ... and why now is the time to quit.

This Report of the Surgeon General on how tobacco smoke causes 

disease includes the contributions of 64 health experts. The full 

report is more than 700 pages long. It is written for a scientific 

audience. This summary has a message for everyone. Please share 

it with your family, friends, and coworkers.

Smoking cigarettes can kill you. This report is important because it 

reveals new scientific findings about how deadly cigarettes are and 

how quickly they can damage your body. This new research also 

suggests that tobacco companies have altered cigarettes to make 

them more addictive. Cigarettes are deadly.

The Surgeon General is America’s doctor.

The President appoints the Surgeon General as the highestranking health leader to protect the health of all Americans. The 

Surgeon General uses the best scientific information available to 

promote health, to reduce risk for illness and injury, and to make 

the nation healthier.

To read the full report and its related materials, go to 

www.surgeongeneral.gov 
In this Booklet ...

2

4

6

8

10

12

14

15

16

Poison

Tobacco smoke is a deadly mix of more than 7,000 chemicals.

Addiction

Nicotine is powerfully addictive.

Cancer

Smoking can start your body on a path toward cancer.

Circulatory

Smoking causes immediate damage to your arteries.

Respiratory

Smoking damages your lungs.

Children

Smoking harms reproduction and your children’s health.

Diabetes

Smoking makes diabetes harder to control.

Families

Secondhand smoke causes immediate harm to nonsmokers. 

Quit

Now is the time to quit smoking.

SGR_CS4.indd 3 11/29/10 
poison

2 A Report of the Surgeon General

Tobacco smoke is a deadly mix of more than 7,000 chemicals.

New research reveals 

why the poisons in 

tobacco smoke are so 

deadly. Your doctor 

can help you quit.

Tobacco smoke 

is a toxic mix 

of more than 

7,000 chemicals. Many 

are poisons. When these 

chemicals get deep into your body’s tissues, they 

cause damage. Your body must fight to heal the 

damage each time you smoke. Over time, the 

damage can lead to disease.

The chemicals in tobacco smoke reach your 

lungs quickly when you inhale. What this new 

report shows is that these same poisonous chemicals 

reach every organ in your body. They go quickly 

from your lungs into your blood. Then the 

blood flows through your arteries. It carries the 

chemicals to tissues in all parts of your body. 

Your lungs, blood vessels, and other delicate 

tissues become inflamed and damaged when 

you smoke.

Smoking keeps your body under attack.

If you spilled drain cleaner on your skin, it 

would hurt and become inflamed. If you did this 

many times a day, your skin would not have a 

chance to heal. It would stay red, irritated, and 

inflamed. The organs in your body also have 

a lining of cells similar to skin. Chemicals in 

tobacco smoke cause inflammation and damage 

to these cells. When you keep smoking, the 

damage cannot heal. 

Smoking makes your immune system work 

overtime. Your body makes white blood cells 
to respond to injuries, infections, and even 

cancers. Blood tests show that your white 

blood cell numbers stay high when you 

smoke. High numbers mean that your body 

is constantly fighting against the damage 

caused by tobacco smoke. This constant 

stress disrupts how your body works. New 

research shows that stress can lead to disease 

in almost any part of your body.

Damage	is	

immediate.

The poisons in smoke 

pose a danger right 

away. Sudden blood 

clots, heart attacks, 

and strokes can be 

triggered by tobacco 

smoke. Poisons in 

tobacco smoke disrupt 

the way your body 

heals itself. Even 

smoking a cigarette 

now and then is 

enough to hurt you. 

Sitting in a smoky bar 

raises your odds of a 

heart attack.

Smoking	longer	

means	more	

damage.

The more years you 

smoke, the more 

you hurt your body. 

Scientists now know that your disease risk 

surges even higher after you have smoked 

for about 20 years. But research shows that if 

you quit by age 30, your health could become 

almost as good as a nonsmoker’s. At any age, 

the sooner you quit, the sooner your body can 

begin to heal. 

How Tobacco Smoke Causes Disease: What It Means to You 3

poison

Tobacco 

smoke 

contains a 

deadly mix 

of more	

than	7,000	

chemicals. 

Hundreds 

are toxic. 

About 70 

can cause 

cancer. 

Here are 

some of the 

chemicals.
addiction

4 A Report of the Surgeon General

N

Nicotine is powerfully addictive.

Addiction to nicotine 

changes the chemical 

balance in your brain. 

icotine is a 

highly addictive 

drug. Addiction 

keeps people smoking even when they want 

to quit. Breaking addiction is harder for some 

people than others. Many people need more 

than one try in order to quit. 

Scientists now know more about why the brain 

craves nicotine. Like heroin or cocaine, nicotine 

changes the way your brain works and causes 

you to crave more and more nicotine. These 

powerful cravings make it hard for you to think 

about anything else. Smoking can cause both 

physical and mental addiction.

Cigarettes	are	designed	for	addiction.

Cigarette makers have long known that nicotine 

addiction helps sell their products. Cigarettes 

today deliver more nicotine and deliver it 

quicker than ever before. The additives and 

chemicals that tobacco companies put in 

cigarettes may have helped make them more 

addictive. Once inhaled, nicotine races from 

your lungs to your heart and brain. 

You might have thought that “filtered,” “lowtar,” or “light” cigarettes were less dangerous 

than others. But research shows that these 

cigarettes are every bit as addictive and are no 

safer than other cigarettes. Misleading labels are 

no longer allowed.
5

Teens	are	more	sensitive	to	nicotine.

Each day, about 4,000 teens smoke a cigarette 

for the first time. That’s nearly 1.5 million 

youth per year. It’s as many people as the entire 

population of a city like Philadelphia.

Many teens who try cigarettes don’t know how 

easy it is to become addicted. Nicotine addiction 

is so powerful that every day about 1,000 teens 

become daily smokers. Why is this important? 

Because most current smokers became addicted 

as teenagers.

You	can	beat	addiction	to	tobacco.

Smokers who quit go through withdrawal. 

The first days are the most uncomfortable. The 

physical symptoms of nicotine addiction end 

about 3 weeks after you quit smoking. But you 

may still have an urge to smoke when you wake 

up, drink coffee, or are out with friends. It takes 

longer to break these patterns. But you can beat 

the mental addiction, too. 

addiction

Call 1-800-QUIT-NOW for free advice and 

support. Experienced counselors will help you 

make a quit plan that works for you. People 

who get coaching are more likely to succeed 

than those who try to quit smoking on their 

own. Many other groups also offer booklets, 

programs, and advice to help smokers quit. 

Talk to your doctor about quitting, and see the 

quit page at the back of this booklet. 

If you’ve already tried other ways, ask your doctor 

about nicotine replacements or new medicines to 

help you quit. They help you control the cravings 

of nicotine withdrawal. 

Your most important step to better health is to 

quit smoking. It’s up to you. Now is the time.

How Tobacco Smoke Causes Disease: What It Means to You

...what it means toYOU

If you quit a pack-a-day habit, you will 

save about $2,000 per year by not buying 

cigarettes. That would buy a family 

vacation or down payment on a car. 

You can beat addiction to nicotine. 

More than half of all adults who ever 

smoked have quit. So can you.
cancer

6 A Report of the Surgeon General

Smoking can start your body on a path toward cancer.

Every cigarette 

increases the risk 

for cancer. S

moking today 

can cost you in 

the future. Once 

tobacco has damaged 

cells, they can grow uncontrollably as cancer. 

Because cells are tiny, years sometimes pass 

before you find a lump or your doctor sees a 

tumor on a scan. 

DNA	damage	leads	to	cancer.

DNA is the cell’s “instruction manual.” It 

controls a cell’s normal growth and function. 

When DNA is damaged, a cell can begin 

growing out of control and create a cancer 

tumor. This happens because poisons in 

tobacco smoke can destroy or change the cell’s 

instructions. The next cigarette you smoke 

might damage your DNA in a way that leads to 

cancer. 

Normally, your immune system helps to protect 

you from cancer. It sends out tumor fighters 

to attack and kill cancer cells. However, new 

research shows that the poisons in cigarette 

smoke weaken the tumor fighters. When this 

happens, cells keep growing without being 

stopped. For this reason, smoking can cause cancer 

and then block your body from fighting it.

Breathing tobacco smoke when you already 

have cancer is especially dangerous. New 

research shows that tobacco smoke helps tumors 

grow. It can undo the benefits of chemotherapy. 

Being smoke-free will help your body heal. 
cancer

How Tobacco Smoke Causes Disease: What It Means to You 7

Smoking can cause cancer almost 

anywhere in your body.

Here are some of the 

cancers that researchers 

know smoking causes.

mouth, nose, 

and throat

larynx

trachea

esophagus

lungs

stomach

pancreas

kidneys and 

ureters

bladder

cervix

bone marrow 

and blood

Doctors have known for years that smoking 

causes most lung cancers. Nearly 9 out of 10 men 

who die from lung cancer smoke. About 3,000 

nonsmokers die each year from lung cancer 

caused by secondhand smoke. 

Ten years after you quit smoking, your risk for 

dying from lung cancer drops by half. And 

there are benefits of quitting at ANY age. 

Quitting smoking saves lives.

... what it means toYOU

Within 5 years of quitting, your 

chance of cancer of the mouth, 

throat, esophagus, and bladder is 

cut in half. If nobody smoked, 

1 of every 3 cancer deaths in the 

United States 

would not 

happen.

Chemicals in tobacco smoke can start cells throughout 

your body on a path toward cancer. For example, here’s 

how smoking causes dangerous bladder cancer.

Repeated irritation 

by cancer-causing 

chemicals stresses 

cells in your 

bladder...

...sometimes 

causing a 

tumor to 

begin...

...and to 

grow out of 

control 

as cancer.
circulatory

8 A Report of the Surgeon General

Smoking causes immediate damage to your arteries.

Smoking can cause

 • aneurysms, which are 

bulging blood vessels that 

can burst and cause death

• stroke, which is sudden 

death of brain cells caused 

by blood clots or bleeding

• heart attack and damage to 

your arteries

Smoking increases 

the danger of heart 

attack and stroke. Breathing tobacco 

smoke can 

change your 

blood chemistry. This 

damages blood vessels. Almost immediately, cells 

that line your body’s blood vessels react to the poisons 

in tobacco smoke. Your heart rate and blood 

pressure go up. Your blood vessels thicken and 

grow narrower.

Smoking	alters	your	blood	chemistry.

When you get a cut, blood cells called platelets 

stick together to form a clot. This helps stop 

the cut from bleeding. However, blood clots 

cause trouble when they form inside your body. 

Chemical changes caused by smoking make 

blood too sticky. Deadly clots form that can 

block blood flow to your heart, brain, or legs. 

Breathing tobacco smoke causes other changes 

in your blood. Your triglyceride level rises, 

and your “good cholesterol” level falls. The 

chemicals in tobacco smoke also prevent your 

body from repairing damaged places in the 

lining of your arteries. Clots are more likely to 

form in a damaged artery.

Smoking	leads	to	heart	attack	and	stroke.

Smoking is one cause of dangerous plaque 

buildup inside your arteries. Plaque is made 

of cholesterol and scar tissue. It clogs and 

narrows your arteries. This can trigger chest 

pain, weakness, heart attack, or stroke. Plaque 

can rupture and cause clots that block arteries. 

Completely blocked arteries can cause 

sudden death.
9

When your arteries are narrowed and blocked 

from smoking, you may have other problems, too. 

Blockages reduce blood flow in your legs and 

skin. Tissue slowly dies. You may develop skin 

ulcers. Eventually, your toes, feet, or legs can be 

so damaged that they must be amputated.

circulatory

Plaque

Clot

How Tobacco Smoke Causes Disease: What It Means to You

Plaque narrows vessels so less blood can flow through. 

When a clot forms in one of these narrow places in an 

artery around the heart, your heart muscle becomes 

starved for the oxygen it needs.

Secondhand	smoke	triggers	heart	attacks.

Tobacco smoke hurts anyone who breathes it. 

When you breathe secondhand smoke, platelets 

in your blood get sticky and may form clots, 

just like in a person who smokes. New research 

shows that even spending time in a smoky room 

could trigger a heart attack. Smoking is not the 

only cause of these problems, but it makes them 

much worse. 

Quitting	can	save	your	life.

If you already have heart or artery disease, you 

have years of life to gain by quitting smoking. 

Your risk for a heart attack drops sharply just 

1 year after you quit smoking. After 2 to 5 years, 

your chance of stroke could fall to about the 

same as a nonsmoker’s. You will feel better and 

can be more active when cigarettes are gone 

from your life.

... what it means toYOU

January 2002 - June 2003 July 2003 - December 2004 

187	heart	attacks

per	100,000 152	heart	attacks

per	100,000

257	heart	attacks

per	100,000

Smoking ban

January 2005 - June 2006

Smoking around others increases 

their risk for heart attack and 

death. By not smoking, you help 

protect your family, friends, and 

coworkers. 

A	public	smoking	ban		

drastically	cut	heart	attacks.

Pueblo, Colorado banned smoking in work 

places and all public areas in July 2003. The 

number of people hospitalized for heart attacks 

dropped 41 percent in 3 years. 
respiratory

10 A Report of the Surgeon General

Smoking damages your lungs.

Even after the age of 

65, quitting tobacco 

can add years to your 

life. You will breathe 

better and feel better.

Every cigarette you 

smoke damages 

your breathing. 

New research shows that 

poisons in tobacco smoke 

harm your body from the 

moment they enter your mouth. They attack the 

inner tissue on the way to your lungs.

Your	body	is	telling	you	not	to	smoke.

The first time you smoke, your lungs may 

feel like they are burning. You may cough 

violently. That’s your body telling you it’s 

being poisoned.

Tiny, brush-like cilia line your airways. They 

sweep out mucus and dirt so your lungs stay 

clear. Over time, smoking damages and destroys 

these brushes. You get “smokers’ cough” because 

your body makes more mucus and the cilia can 

no longer clear your lungs. Other damage is 

happening, too. 

When you quit smoking, you will cough and 

wheeze less. You will cough up less mucus. 

After a few smoke-free months, you will 

breathe easier.

Tobacco	smoke	scars	your	lungs.		

Your lungs should be elastic like a balloon. 

They expand when you breathe in and 

compress when you breathe out. The poisons 

in tobacco smoke inflame the delicate lining of 

your lungs. Years of smoking can damage your 

lungs so much that they no longer stretch and 

exchange air.
respiratory

How Tobacco Smoke Causes Disease: What It Means to You 11

Smoking	causes	lung	disease.

Smoking causes chronic obstructive 

pulmonary disease, or COPD. There is no 

cure. People with COPD slowly die from 

lack of air. COPD includes the diseases 

emphysema and chronic bronchitis. 

• Emphysema causes the walls between the 

air sacs in your lungs to lose their ability 

to stretch and shrink back. The air sacs 

become weaker and wider. Air gets trapped 

in your lungs. You have trouble breathing in 

oxygen and breathing out carbon dioxide. 

If you keep smoking, normal breathing may 

become harder as emphysema develops. 

With emphysema, lung tissue is destroyed, 

making it very hard to get enough oxygen.

• Chronic bronchitis is the swelling of the 

lining of your bronchial tubes. When this 

happens, you have less air flow to and from 

your lungs. You cough up heavy mucus with 

chronic bronchitis.

Pneumonia and respiratory problems are far 

more common in smokers. For people with 

asthma, even breathing someone else’s smoke 

can trigger a severe attack. Your airways become 

inflamed and tight. It’s hard to breathe.

... what it means toYOU 

If you quit smoking, you will 

breathe better. You will cough 

less than people who continue to 

smoke. You’ll be surprised how 

much easier it is to be active.

COPD caused by smoking makes you weak from lack 

of oxygen. Eventually, you may have to live on oxygen 

from a tank.
children

12 A Report of the Surgeon General

Smoking harms reproduction and your children’s health.

Pregnant women 

who smoke are 

more likely to have 

babies who die 

from sudden infant 

death syndrome, 

or SIDS. If you are 

pregnant, smoking 

is dangerous. 

Breathing 

secondhand smoke 

is dangerous, too.

S

moking or 

breathing 

secondhand smoke 

can make it harder for 

you to become a parent. 

Research shows that 

tobacco smoke decreases 

your chances of having a 

healthy baby.

Smoking	hurts	people	hoping	to	become	

parents.

Smoking reduces a woman’s chance of getting 

pregnant. Chemicals in smoke interfere 

with the functioning of the tubes that your 

eggs travel through to reach the womb. This 

might decrease fertility or lead to pregnancy 

complications. 

Researchers have also found that smoking 

might damage the DNA in men’s sperm. This 

DNA damage might decrease fertility, cause 

birth defects, or lead to miscarriage. 
13

Smoking hurts unborn babies.

Smoking during pregnancy increases the 

risk of pregnancy complications, premature 

delivery, low birth weight infants, stillbirth, 

and sudden infant death syndrome (SIDS). 

Premature delivery is when a baby is born too 

early. Low birth weight is when a baby weighs 

less than 5 1/2 pounds. Babies born too early 

or too small are not as healthy. Babies whose 

mothers smoke are about 3 times more likely to 

die from SIDS (crib death). 

Tobacco smoke damages the tissues of an 

unborn baby’s growing brain and lungs. When 

a pregnant woman smokes, there could also be 

problems with the growth of the placenta (the 

organ that feeds the baby). Problems with the 

placenta could lead to miscarriage, premature 

delivery, or low birth weight. Smoking can 

even make the placenta detach from the womb 

too early. If this happens, you will miscarry or 

deliver your baby too early.

Tobacco smoke hurts babies and children.

Mothers know it is important to quit smoking 

while they are pregnant. But starting to smoke 

again after your baby is born is also dangerous. 

Babies who breathe secondhand smoke are 

more likely to die from SIDS.

Babies and children who breathe secondhand 

smoke have other health problems. Their lungs 

don’t work as well. Over half of all children in 

the United States breathe secondhand smoke 

at home, in cars, or in public places. More 

than 300,000 children suffer each year from 

infections caused by tobacco smoke, including 

bronchitis, pneumonia, and ear infections. They 

wheeze and cough more often. 

For children who have asthma, breathing 

secondhand smoke can trigger an attack. The 

attack can be severe enough to send a child to 

the hospital. Sometimes an asthma attack is so 

severe that a child dies.

children

One in every five babies born to mothers who smoke 

has low birth weight. Low birth weight is a leading 

cause of infant death.

How Tobacco Smoke Causes Disease: What It Means to You
A Report of the Surgeon General

diabetes

14

Smoking makes diabetes harder to control.

New science 

shows that people 

with diabetes are 

especially affected by 

tobacco smoke. 

We now know 

that poisons 

in tobacco 

smoke affect your blood 

sugar. Smoking even 

increases your chance of 

having type 2 diabetes. People with diabetes who 

smoke need more insulin than those who don’t 

smoke. They are also more likely to have serious 

health problems from diabetes.

Smokers with diabetes have higher risks for 

serious complications, including

• heart and kidney disease

• amputation 

• retinopathy (eye disease causing blindness) 

• peripheral neuropathy (nerve damage). Such 

damage short circuits your body’s electrical 

system. It causes numbness, pain, weakness, 

and poor coordination. People with diabetes 

who smoke are three times more likely to 

have this nerve damage. 

Not smoking can make diabetes easier to control. 

You can even recover from surgery faster. 

... what it means toYOU

The health benefits for people with 

diabetes who stop smoking begin 

immediately. Diabetics who quit 

smoking have better control over 

their blood sugar levels.
How Tobacco Smoke Causes Disease: What It Means to You

families

15

Secondhand smoke causes immediate harm to nonsmokers.

Protect your family from secondhand 

smoke. Secondhand smoke causes 

immediate harm to nonsmokers who 

breathe it. If you are a nonsmoker, you can do 

some important things to protect yourself and 

your family. 

• Do not allow anyone to smoke anywhere in or 

near your home. Some of the smoke stays in 

your house even if you only allow smoking 

near an open window.

• Do not allow anyone to smoke in your car, 

even with the window down. No amount of 

smoke is safe.

• Make sure your children’s day care centers 

and schools are tobacco-free. A tobaccofree campus policy prohibits any tobacco 

use or advertising on school property by 

anyone at any time. This includes offcampus school events. 

• If your state still allows smoking in public 

areas, look for restaurants and other places 

that do not allow smoking. “No-smoking 

sections” do not protect you and your family 

from secondhand smoke.

• Teach your children to stay away from 

secondhand smoke. Be a good role model by 

not smoking. Allowing someone to 

smoke in only one room 

does not protect nonsmokers. 

Smoke from halls and stairs 

gets inside, too.
QUIT

16

Now is the time to quit smoking.

The new research in this report shows the 

scientific reasons to quit smoking. But people 

who quit do it for their own personal reasons.

What are yours?

• I want more years with my family and 

friends.

• I want to be around to share birthdays with 

my kids.

• I want fewer sick days and lost wages.

• I want to be at my daughter’s wedding.

• I want to know my grandkids. 

• I want more energy. 

• I want to breathe easier.

• I want to enjoy the smell and taste of food.

• I want to be a better role model.

• My pet needs me.

• I am tired of standing outside in the cold. 

• I want to spend my money on something 

besides cigarettes.

• I want to live to enjoy retirement.

When you are ready, here are some ways to begin.

• Talk to your doctor. Consider nicotine 

replacement therapy or medication. 

• Find a support program. Social support 

helps when you are trying to quit.

• Focus on eating right and being active.

• Don’t get discouraged. Quitting often takes 

several tries before you succeed.

... what it means toYOU

Now	is	the	time	to	quit	smoking.	No	

one	can	make	you	quit,	and	no	one	

can	do	it	for	you.	Even	if	you	have	

smoked	for	many	years,	you	CAN	quit.	

For	more	information,	go	to		

www.smokefree.gov		

or	call	1-800-QUIT-NOW.
Suggested citation:

U.S. Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke 

Causes Disease: What It Means to You. U.S. Department of Health and Human Services, Centers for Disease 

Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on 

Smoking and Health, 2010. 
For	more	information	

You can read the full Report of the Surgeon General on how tobacco smoke causes 

disease at this Web site: www.surgeongeneral.gov

For more information on the dangers of tobacco smoke, talk to your doctor, nurse, 

pharmacist, or other health care professional. 

More facts and advice are available from the 

Centers for Disease Control and Prevention at www.cdc.gov/tobacco

Toll free: 1-800-CDC-INFO (1-800-232-4636) 

In English and en Español, 24 hours/day, 7 days/week 

Text telephone for hearing impaired: 1-888-232-6348 

Other helpful information is available at www.smokefree.gov 

To access a telephone quitline serving your area, call 

1-800-QUIT-NOW (1-800-784-8669).