September 2008 Page 1 of 5

Tobacco use is the leading preventable

cause of disease, disability, and death

in the United States. Between 1964 and

2004, cigarette smoking 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.1

According to the Centers for Disease

Control and Prevention (CDC), cigarette

smoking results in more than 400,000

premature deaths each year—about 1 

in every 5 U.S. deaths.2

How Does Tobacco Affect 

the Brain?

Cigarettes and other forms of tobacco,

including cigars, pipe tobacco, snuff,

and chewing tobacco, contain the

addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when

a tobacco product is chewed, inhaled,

or smoked. A typical smoker will take

10 puffs on a cigarette over a period of

5 minutes that the cigarette is lit. Thus, a

person who smokes about 11

⁄2 packs (30

cigarettes) daily gets 300 “hits” of nicotine each day.

Upon entering the bloodstream, nicotine

immediately stimulates the adrenal

glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates

the central nervous system and increases

blood pressure, respiration, and heart

rate. Glucose is released into the blood

while nicotine suppresses insulin output

from the pancreas, which means that

smokers have chronically elevated blood

sugar levels. 

Like cocaine, heroin, and marijuana,

nicotine increases levels of the neurotransmitter dopamine, which affects the

brain pathways that control reward and

pleasure. For many tobacco users, longterm brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug

seeking and use, even in the face of

negative consequences. Studies suggest

that additional compounds in tobacco

smoke, such as acetaldehyde, may

enhance nicotine’s effects on the brain.3

A number of studies indicate that adolescents are especially vulnerable to these

effects and may be more likely than adults

to develop an addiction to tobacco.

When an addicted user tries to quit, he

or she experiences withdrawal symptoms

including powerful cravings for tobacco,

irritability, difficulty paying attention,

sleep disturbances, and increased

appetite. Treatments can help smokers

manage these symptoms and improve

the likelihood of successfully quitting.

Cigarettes and Other Tobacco Products
September 2008 Page 2 of 5

What Other Adverse 

Effects Does Tobacco 

Have on Health?

Cigarette smoking accounts for about

one-third of all cancers, including 90

percent of lung cancer cases. In addition

to cancer, smoking causes lung diseases

such as chronic bronchitis and emphysema, and increases the risk of heart 

disease, including stroke, heart attack,

vascular disease, and aneurysm.

Smoking has also been linked to

leukemia, cataracts, and pneumonia.

On average, adults who smoke die 

14 years earlier than nonsmokers.2

Although nicotine is addictive and can

be toxic if ingested in high doses, it

does not cause cancer; other chemicals

are responsible for most of the severe

health consequences of tobacco use.

Tobacco smoke is a complex mixture of

chemicals such as carbon monoxide, tar,

formaldehyde, cyanide, and ammonia—

many of which are known carcinogens.

Tar exposes the user to an increased 

risk of lung cancer, emphysema, and

bronchial disorders. Carbon monoxide

increases the chance of cardiovascular

diseases. Smokeless tobacco (such as

chewing tobacco and snuff) also increases

the risk of cancer, especially oral cancers.

Pregnant women who smoke cigarettes

run an increased risk of miscarriage,

stillborn or premature infants, or infants

with low birthweight. Maternal smoking

may also be associated with learning

and behavioral problems in children.

Smoking more than a pack of cigarettes

per day during pregnancy nearly doubles the risk that the affected child will

become addicted to tobacco if that child

starts smoking. 

Secondhand smoke, also known as environmental tobacco smoke, consists of

exhaled smoke and smoke given off by

the burning end of tobacco products.

According to CDC, approximately

38,000 deaths per year can be attributed

to secondhand smoke.2 Nonsmokers

exposed to secondhand smoke at home

or work increase their risk of developing

heart disease by 25 to 30 percent 4 and

lung cancer by 20 to 30 percent.2 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.

Although quitting can be difficult, the

health benefits of smoking cessation are

immediate and substantial, including

reduced risk for cancers, heart disease,

and stroke. A 35-year old man who

quits smoking will, on average, increase

his life expectancy by 5 years.5

Are There Effective

Treatments for Tobacco

Addiction?

Tobacco addiction is a chronic disease

that often requires multiple attempts to
September 2008 Page 3 of 5

quit. Although some smokers are able to

quit without help, many others need

assistance. Generally, rates of relapse

for smoking cessation are highest in the

first few weeks and months and diminish

considerably after about 3 months. Both

behavioral interventions (counseling) and

medication can help smokers quit; the

combination of medication with counseling is more effective than either alone. 

Behavioral Treatments

Behavioral treatments employ a variety

of methods to assist smokers in quitting,

ranging from self-help materials to individual counseling. These interventions

teach individuals to recognize high-risk

situations and develop coping strategies

to deal with them. The U.S. Department

of Health and Human Services’ (DHHS)

national toll-free quitline, 800-QUITNOW, is an access point for any 

smoker seeking information and assistance in quitting. 

Nicotine Replacement Treatments

Nicotine replacement therapies (NRTs),

such as nicotine gum and the nicotine

patch, were the first pharmacological

treatments approved by the Food and

Drug Administration (FDA) for use in

smoking cessation therapy. NRTs deliver

a controlled dose of nicotine to a smoker

in order to relieve withdrawal symptoms

during the smoking cessation process.

They are most successful when used in

combination with behavioral treatments.

FDA-approved NRT products include

nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers,

and lozenges. 

Other Medications

Bupropion and varenicline are two FDAapproved non-nicotine medications that

effectively increase rates of long-term

abstinence from smoking. Bupropion, a

medication that goes by the trade name

Zyban, was approved by the FDA in

1997 for use in smoking cessation.

Varenicline tartrate (trade name: Chantix)

targets nicotine receptors in the brain,

easing withdrawal symptoms and blocking the effects of nicotine if people

resume smoking. 

Current Treatment Research

Scientists are currently pursuing many

other avenues of research to develop

new tobacco cessation therapies. One

promising intervention is a vaccine that

targets nicotine, blocking the drug’s

access to the brain and preventing 

its reinforcing effects. Preliminary 

trials of this vaccine have yielded 

promising results.

How Widespread is 

Tobacco Use?

Monitoring the Future Survey

Current smoking rates among high

school students reached an all-time low

in 2007. According to the Monitoring

the Future survey, 7.1 percent of 8thgraders, 14 percent of 10th-graders,
September 2008 Page 4 of 5

and 21.6 percent of 12th-graders reported that they had used cigarettes in the

previous month.6 Although unacceptably

high numbers of youth continue to

smoke, these numbers represent a significant decrease from peaks reached in the

late 1990s. 

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

per day. Students’ personal disapproval

of smoking has risen for some years: In

the past 10 years, for example, the percentage of 12th-graders disapproving of

smoking one or more packs of cigarettes

per day increased significantly, from

67.1 percent in 1997 to 80.7 percent in

2007. During the same period, the number of 8th-graders who said it was “very

easy” or “fairly easy” to get cigarettes

declined from 76 percent in 1997 to

55.6 percent in 2007.

Current use of smokeless tobacco among

high school students also reached an alltime low in 2007: 3.2 percent of 8thgraders, 6.1 percent of 10th-graders,

and 6.6 percent of 12th-graders reported that they had used smokeless tobacco

in the previous month. 

National Survey on Drug Use 

and Health (NSDUH)7

In 2006, 29.6 percent of the U.S. population 12 and older—72.9 million people—used a tobacco product at least

once in the month prior to being interviewed. This figure includes 3.3 million

young people aged 12 to 17 (12.9 percent of this age group). In addition,

61.6 million Americans (25 percent of

the population) were current cigarette

smokers; 13.7 million smoked cigars;

8.2 million used smokeless tobacco; and

2.3 million smoked tobacco in pipes. 

Between 2002 and 2006, past-month

cigarette use among persons 12 or older

decreased from 26 percent to 25 percent. Cigarette use in the past month

among 12- to 17-year-olds declined 

from 13 percent in 2002 to 10.4 

percent in 2006. 

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.smokefree.gov.
September 2008 Page 5 of 5

1 Centers for Disease Control and Prevention. The Health Consequences of Smoking: What it Means to You. Atlanta,

GA: CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,

2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/00_pdfs/

SGR2004_Whatitmeanstoyou.pdf.

2 Centers for Disease Control and Prevention. Smoking and Tobacco Use—Fact Sheet: Tobacco-Related Mortality.

Updated September 2006. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/

health_effects/tobacco_related_mortality.htm.

3 Belluzzi JD, Wang R, and Leslie FM. Acetaldehyde enhances acquisition of nicotine self-administration in adolescent

rats. Neuropsychopharmacology 30:705–712, 2005.

4 Centers for Disease Control and Prevention. Smoking and Tobacco Use—Fact Sheet: Secondhand Smoke Causes

Heart Disease. Updated May 2007. Available at: http://www.cdc.gov/tobacco/data_statistics/

fact_sheets/secondhand_smoke/health_effects/heartdisease.htm.

5 U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon

General. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and

Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990.

Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T/.

6 These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

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

The study has tracked 12th-graders’ illicit drug abuse and related attitudes since 1975; in 1991, 8th- and 10thgraders were added to the study. The latest data are online at www.drugabuse.gov.

7 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 NIDA at 877-643-2644.

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.