July 2006 Page 1 of 5

Through the use of cigarettes, cigars,

and chewing tobacco, nicotine is one of

the most heavily used addictive drugs in

the United States. In 2004, 29.2 percent

of the U.S. population 12 and older—

70.3 million people—used tobacco at

least once in the month prior to being

interviewed.* This figure includes 3.6

million young people age 12 to 17.

Young adults aged 18 to 25 reported

the highest rate of current use of any

tobacco products (44.6 percent) in

2004. 

Findings for high school youth indicate

that 25.9 percent of 8th-graders, 38.9

percent of 10th-graders, and 50.0 percent of 12th-graders had ever smoked

cigarettes when asked in 2005.** These

figures were lower for all three grades

from 2004 data, and for 8th-graders

and 12th-graders, the decreases were

statistically significant. 

Statistics from the Centers for Disease

Control and Prevention indicate that

tobacco use remains the leading preventable cause of death in the United

States, causing approximately 440,000

premature deaths each year and resulting in an annual cost of more than 

$75 billion in direct medical costs attributable to smoking. (See www.cdc.gov/

tobacco/issue.htm.) Over the past four

decades, cigarette smoking has caused

an estimated 12 million deaths, including 4.1 million deaths from cancer, 5.5

million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases, and 94,000 infant deaths

related to mothers smoking during pregnancy. (See www.cdc.gov/nccdphp/

publications/aag/osh.htm.)

Secondhand smoke, also known as environmental tobacco smoke, is a mixture

of the smoke given off by the burning

end of tobacco products (sidestream

smoke) and the mainstream smoke

exhaled by smokers. It is a complex mixture containing many chemicals (including formaldehyde, cyanide, carbon

monoxide, ammonia, and nicotine),

many of which are known carcinogens.

Nonsmokers exposed to secondhand

smoke at home or work increase their

risk of developing heart disease by 25

to 30 percent and lung cancer by 20 to

30 percent. In addition, secondhand

smoke causes respiratory problems in

nonsmokers such as coughing, phlegm,

and reduced lung function. Children

exposed to secondhand smoke are at an

increased risk for sudden infant death

syndrome, acute respiratory infections,

ear problems, and more severe asthma.

Cigarettes and Other 

Tobacco Products 
July 2006 Page 2 of 5

Health Hazards ———

Since 1964, 28 Surgeon General’s

reports on smoking and health have 

concluded that tobacco use is the single

most avoidable cause of disease, disability, and death in the United States. 

In 1988, the Surgeon General concluded that cigarettes and other forms of

tobacco, such as cigars, pipe tobacco,

and chewing tobacco, are addictive and

that nicotine is the drug in tobacco that

causes addiction. Nicotine provides an

almost immediate “kick” because it causes a discharge of epinephrine from the

adrenal cortex. This stimulates the central nervous system and endocrine

glands, which causes a sudden release

of glucose. Stimulation is then followed

by depression and fatigue, leading the

user to seek more nicotine. 

Nicotine is absorbed readily from 

tobacco smoke in the lungs, and it does

not matter whether the tobacco smoke 

is from cigarettes, cigars, or pipes.

Nicotine also is absorbed readily when

tobacco is chewed. With regular use of

tobacco, levels of nicotine accumulate in

the body during the day and persist

overnight. Thus, daily smokers or chewers are exposed to the effects of nicotine

for 24 hours each day. Adolescents who

chew tobacco are more likely than

nonusers to eventually become cigarette

smokers.

Addiction to nicotine results in withdrawal symptoms when a person tries to stop

smoking. For example, a study found

that when chronic smokers were

deprived of cigarettes for 24 hours, 

they had increased anger, hostility, and

aggression, and loss of social cooperation. Persons suffering from withdrawal

also take longer to regain emotional

equilibrium following stress. During 

periods of abstinence and/or craving,

smokers have shown impairment across

a wide range of psychomotor and 

cognitive functions, such as language

comprehension.

Women who smoke generally have 

earlier menopause. Pregnant women

who smoke cigarettes run an increased

risk of having stillborn or premature

infants or infants with low birth weight.

Children of women who smoked while

pregnant have an increased risk for

developing conduct disorders. National

studies of mothers and daughters have

also found that maternal smoking during

pregnancy increased the probability that

female children would smoke and would

persist in smoking.

In addition to nicotine, cigarette smoke

is primarily composed of a dozen gases

(mainly carbon monoxide) and tar. The

tar in a cigarette, which varies from

about 15 mg for a regular cigarette to 

7 mg in a low-tar cigarette, exposes the

user to an increased risk of lung cancer,

emphysema, and bronchial disorders.

The carbon monoxide in tobacco smoke

increases the chance of cardiovascular
July 2006 Page 3 of 5

diseases. The Environmental Protection

Agency has concluded that secondhand

smoke causes lung cancer in adults and

greatly increases the risk of respiratory

illnesses in children and sudden infant

death.

Promising Research ———

Research has shown that nicotine, like

cocaine, heroin, and marijuana, increases the level of the neurotransmitter

dopamine, which affects the brain pathways that control reward and pleasure.

Scientists have pinpointed a particular

molecule [the beta 2 (b2)] subunit of the

nicotine cholinergic receptor as a critical

component in nicotine addiction. Mice

that lack this subunit fail to self-administer nicotine, implying that without the b2

subunit, the mice do not experience the

positive reinforcing properties of nicotine. This finding identifies a potential

site for targeting the development of

nicotine addiction medications. 

Other research found that individuals

have greater resistance to nicotine

addiction if they have a genetic variant

that decreases the function of the

enzyme CYP2A6. The decrease in

CYP2A6 slows the breakdown of nicotine and protects individuals against

nicotine addiction. Understanding the

role of this enzyme in nicotine addiction

gives a new target for developing more

effective medications to help people stop

smoking. Medications might be developed that can inhibit the function of

CYP2A6, thus providing a new

approach to preventing and treating

nicotine addiction.

Another study found dramatic changes

in the brain’s pleasure circuits during

withdrawal from chronic tobacco use.

These changes are comparable in magnitude and duration to similar changes

observed during withdrawal from other

abused drugs such as cocaine, opiates,

amphetamines, and alcohol. Scientists

found significant decreases in the sensitivity of the brains of laboratory rats to

pleasurable stimulation after nicotine

administration was abruptly stopped.

These changes lasted several days and

may correspond to the anxiety and

depression experienced by humans for

several days after quitting smoking “cold

turkey.” The results of this research may

help in the development of better treatments for the withdrawal symptoms that

may interfere with individuals’ attempts

to quit.

Treatment ———

Some individuals simply are able to stop

smoking. For others, studies have shown

that pharmacological treatment combined

with behavioral treatment, including psychological support and skills training to

overcome high-risk situations, results in

some of the highest long-term abstinence

rates. Generally, rates of relapse for

smoking cessation are highest in the first

few weeks and months and diminish considerably after about 3 months.
July 2006 Page 4 of 5

Behavioral economic studies find that

alternative rewards and reinforcers can

reduce cigarette use. One study found

that the greatest reductions in cigarette

use were achieved when smoking cost

was increased in combination with the

presence of alternative recreational

activities.

Nicotine chewing gum is one medication approved by the Food and Drug

Administration (FDA) for the treatment of

nicotine dependence. Nicotine in this

form acts as a nicotine replacement to

help smokers quit smoking. The success

rates for smoking cessation treatment

with nicotine chewing gum vary considerably across studies, but evidence 

suggests that it is a safe means of facilitating smoking cessation if chewed

according to instructions and restricted

to patients who are under medical 

supervision.

Another approach to smoking cessation

is the nicotine transdermal patch, a skin

patch that delivers a relatively constant

amount of nicotine to the person wearing it. A research team at NIDA’s

Intramural Research Program studied the

safety, mechanism of action, and abuse

liability of the patch that was consequently approved by FDA. Both nicotine

gum and the nicotine patch, as well as

other nicotine replacements such as

sprays and inhalers, are used to help

people fully quit smoking by reducing

withdrawal symptoms and preventing

relapse while undergoing behavioral

treatment.

Another tool in treating tobacco addiction is a medication that goes by the

trade name Zyban. This is not a nicotine

replacement, as are the gum and patch.

Rather, this works on other areas of the

brain, and its effectiveness is in helping

to make nicotine craving, or thoughts

about cigarette use, more controllable in

people who are trying to quit.

Extent of Use ———

Monitoring the Future (MTF)

Survey 

Despite the demonstrated health risks

associated with cigarette smoking,

young Americans continue to smoke.

However, 30-day*** smoking rates

among high school students have

declined from peaks reached in 1996

for 8th-graders (21.0 percent) and 10thgraders (30.4 percent) and in 1976 for

12th-graders (38.8 percent). In 2005,

30-day rates had dropped to 9.3 percent for 8th-graders, 14.9 percent for

10th-graders, and 23.2 percent for

12th-graders. 

The decrease in smoking rates among

young Americans corresponds to several

years in which increased proportions of

teens said they believe there is a “great”

health risk associated with cigarette

smoking and expressed disapproval of

smoking one or more packs of cigarettes

a day. Students’ personal disapproval of

smoking has risen for some years. In

2005, for example, the percentage of
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12th-graders disapproving of smoking

one or more packs of cigarettes per day

increased significantly, from 76.2 percent in 2004 to 79.8 percent in 2005. 

Other Information

Sources ———

For additional information on tobacco

abuse and addiction, please visit

www.smoking.drugabuse.gov.

For more information on how to 

quit smoking, please visit

www.cdc.gov/tobacco.

* NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age

12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from the National Clearinghouse for Alcohol and Drug Information at

800-729-6686.

** These data are from the 2005 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social

Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and

10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

*** “Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to use at least once during

the year preceding an individual’s response to the survey. “30-day” refers to use at least once during the 30 days preceding an individual’s response to the survey.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.