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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, 1.1 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 

443,000 premature deaths in the United 

States each year—about 1 in every 5 U.S. 

deaths2—and an additional 8.6 million 

people suffer with a serious illness caused by 

smoking.3 Thus, for every one person who 

dies from smoking, 20 more suffer from at 

least one serious tobacco-related illness.3

The harmful effects of smoking extend far 

beyond the smoker. Exposure to secondhand 

smoke can cause serious diseases and 

death. Each year, an estimated 126 

million Americans are regularly exposed to 

secondhand smoke and almost 50 thousand 

nonsmokers die from diseases caused by 

secondhand smoke exposure.4 

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, long-term brain changes 

Cigarettes and Other Tobacco Products
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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.5 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 irritability, attention difficulties, 

sleep disturbances, increased appetite, and 

powerful cravings for tobacco. Treatments 

can help smokers manage these symptoms 

and improve the likelihood of successfully 

quitting.

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. Smokeless 

tobacco (such as chewing tobacco and 

snuff) also increases the risk of cancer, 

especially oral cancers. 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.1,2 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. 

Carbon monoxide increases the chance of 

cardiovascular diseases. Tar exposes the 

user to an increased risk of lung cancer, 

emphysema, and bronchial disorders. 

Pregnant women who smoke cigarettes run 

an increased risk of miscarriage, stillborn 

or premature infants, or infants with low 

birthweight.2 Maternal smoking may also 

be associated with learning and behavioral 

problems in children. Smoking more than 

one 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.6

While we often think of medical 

consequences that result from direct use of 

tobacco products, passive or secondary 

smoke also increases the risk for many 
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diseases. Secondhand smoke, also known 

as environmental tobacco smoke, consists 

of exhaled smoke and smoke given off 

by the burning end of tobacco products. 

Nonsmokers exposed to secondhand 

smoke at home or work increase their 

risk of developing heart disease by 25 

to 30 percent 7 and lung cancer by 20 

to 30 percent.2 In addition, secondhand 

smoke causes respiratory problems, such 

as coughing, overproduction of phlegm, 

and reduced lung function and respiratory 

infections, including pneumonia and 

bronchitis, in both adults and children. In 

fact, each year about 150,000 – 300,000 

children younger than 18 months old 

experience respiratory tract infections 

caused by secondhand smoke.4 Children 

exposed to secondhand smoking are at 

an increased risk for sudden infant death 

syndrome, ear problems, and severe 

asthma. Furthermore, children who grow up 

with parents who smoke are more likely to 

become smokers, thus placing themselves 

(and their future families) at risk for the same 

health problems as their parents when they 

become adults. 

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.8

Are There Effective 

Treatments for Tobacco 

Addiction?

Tobacco addiction is a chronic disease 

that often requires multiple attempts to 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; but 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’ (HHS) national toll-free quitline, 

800-QUIT-NOW, 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 
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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. Current FDA-approved NRT 

products include nicotine chewing gum, the 

nicotine transdermal patch, nasal sprays, 

inhalers, and lozenges.

Other Medications

Bupropion and varenicline are two FDA-approved 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 smoking cessation therapies. One promising 

intervention is a vaccine called NicVax that 

works by targeting nicotine in the bloodstream, blocking its access to the brain and 

thereby preventing its reinforcing effects. 

Preliminary trials of this vaccine have yielded promising results, with vaccinated smokers achieving higher quit rates and longer 

term abstinence compared to smokers given 

placebo. NicVax is now being evaluated in 

Phase III clinical trials; successful completion 

will bring NicVax closer to final approval by 

the FDA.

How Widespread Is 

Tobacco Use?

Monitoring the Future Survey†

Current smoking rates among 8th- and 

12th-grade students reached an all-time low 

in 2009. According to the Monitoring the 

Future survey, 6.5 percent of 8th-graders 

and 20.1 percent of 12th-graders reported 

they had used cigarettes in the past month. 

Current smoking also decreased among 

10th-graders, to about 13 percent in 2009. 

Although unacceptably high numbers of 

youth continue to smoke, these numbers 

represent a significant decrease from peak 

smoking rates (21 percent in 8th-graders, 

30 percent in 10th-graders, and 36 percent 

in 12th-graders) that were 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 believed there was a “great” health 
Updated August 2010 Page 5 of 6 

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; for example, the percentage of 12th-graders reporting disapproval 

of smoking one or more packs of cigarettes 

per day increased from 68.8 percent in 

1998 to 81.8 percent in 2009. During the 

same period, the percentage of 8th-graders 

who said it was “very easy” or “fairly easy” 

to obtain cigarettes declined from 73.6 percent in 1998 to 55.3 percent in 2009. 

Current use of smokeless tobacco remained 

steady among 8th-graders and 12th-graders 

in 2009 (3.7 percent and 8.4 percent, 

respectively); however, current smokeless 

tobacco use among 10th-grade students 

increased significantly from 5.0 percent in 

2008 to 6.5 percent in 2009. 

National Survey on Drug Use and 

Health (NSDUH)††

In 2008, 28.4 percent of the U.S. population age 12 and older (approximately 70.9 

million people) used a tobacco product 

at least once in the month prior to being 

interviewed. This figure includes 2.8 million 

young people aged 12 to 17 (11.4 percent of this age group). In addition, almost 

60 million Americans (23.9 percent of the 

population) were current cigarette smokers; 

13.1 million smoked cigars; almost 8.7 million used smokeless tobacco; and nearly 1.9 

million smoked tobacco in pipes.

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.

Data Sources

† These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National 

Institutes of Health, Department of Health and Human Services, 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.

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

12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health 

and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 

877–643–2644.

References

1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 

Office on Smoking and Health, Department of Health and Human Services. The Health Consequences of Smoking: 

What It Means to You, 2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/00_pdfs/

SGR2004_Whatitmeanstoyou.pdf.
Updated August 2010 Page 6 of 6

2 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, 

Office on Smoking and Health, Department of Health and Human Services. Smoking and Tobacco Use—Fact Sheet: 

Health Effects of Cigarette Smoking. Updated January 2008. Available at: http://www.cdc.gov/tobacco/data_

statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm.

3 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, 

Office on Smoking and Health, Department of Health and Human Services. Tobacco Use: Targeting the Nation’s 

Leading Killer—At a Glance 2009. Available at: http://www.cdc.gov/chronicdisease/resources/publications/aag/

pdf/tobacco.pdf). 

4 Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, 

Office on Smoking and Health, Department of Health and Human Services. Smoking & Tobacco Use, Fast Facts. 

Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#toll. Accessed 

7/22/2010.

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

Neuropsychopharmacology 30:705–712, 2005.

6 Buka SL, Shenassa ED, Niaura R. Elevated risk of tobacco dependence among offspring of mothers who smoked 

during pregnancy: A 30-year prospective study. Am J Psychiatry 160:1978–1984, 2003.

7 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 

Office on Smoking and Health, Department of Health and Human Services, 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/#heart.

8 Office of the Surgeon General, Office of Public Health and Science, Office of the Secretary, Public Health Service, 

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

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