Adriani W, Spijker S, Deroche-Gamonet V, Laviola G, Le Moal M, Smit AB, Piazza PV. Evidence for enhanced neurobehavioral vulnerability to nicotine during peri-adolescence in rats. Journal of Neuroscience. 2003;23(11):4712–6. [PubMed: 12805310]
Alesci NL, Forster JL, Blaine T. Smoking visibility, perceived acceptability, and frequency in various locations among youth and adults. Preventive Medicine. 2003;36(3):272–81. [PubMed: 12634018]
Anderson G. Chronic Care: Making the Case for Ongoing Care. Princeton (NJ): Robert Wood Johnson Foundation; 2010. [accessed: November 30, 2011]. < http://www.rwjf.org/files/research/50968chronic.care.chartbook.pdf>.
Bonnie RJ, Stratton K, Wallace RB, editors. Ending the Tobacco Problem: A Blueprint for the Nation. Washington: National Academies Press; 2007.
Cochrane Collaboration. Home page. 2010. [accessed: November 30, 2010]. < http://www.cochrane.org/>.
Community Preventive Services Task Force. First Annual Report to Congress and to Agencies Related to the Work of the Task Force. Community Preventive Services Task Force. 2011. [accessed: January 9, 2012]. < http://www.thecommunityguide.org/library/ARC2011/congress-report-full.pdf>.
Dalton MA, Beach ML, Adachi-Mejia AM, Longacre MR, Matzkin AL, Sargent JD, Heatherton TF, Titus-Ernstoff L. Early exposure to movie smoking predicts established smoking by older teens and young adults. Pediatrics. 2009;123(4):e551–e558. [PMC free article: PMC2758519] [PubMed: 19336346]
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ (British Medical Journal) 2004;32:1519. [PMC free article: PMC437139] [PubMed: 15213107] [Cross Ref]
Fagerström K. The epidemiology of smoking: health consequences and benefits of cessation. Drugs. 2002;62(Suppl 2):1–9. [PubMed: 12109931]
Family Smoking Prevention and Tobacco Control Act, Public Law 111-31, 123 U.S. Statutes at Large 1776 (2009)
Grimshaw G, Stanton A. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews. 2006;(4):CD003289. [PubMed: 17054164] [Cross Ref]
Kessler DA. Nicotine addiction in young people. New England Journal of Medicine. 1995;333(3):186–9. [PubMed: 7791824]
Lovato C, Linn G, Stead LF, Best A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database of Systematic Reviews. 2003;(4):CD003439. [PubMed: 14583977] [Cross Ref]
Lovato C, Watts A, Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database of Systematic Reviews. 2011;(10):CD003439. [PubMed: 21975739] [Cross Ref]
Lynch BS, Bonnie RJ, editors. Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths. Washington: National Academies Press; 1994. [PubMed: 25144107]
National Association of Attorneys General. Master Settlement Agreement. 1998. [accessed: June 9, 2011]. < http://www.naag.org/back-pages/naag/tobacco/msa/msa-pdf/MSA%20with%20Sig%20Pages%20and%20Exhibits.pdf/file_view>.
National Cancer Institute. Changing Adolescent Smoking Prevalence. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 2001. Smoking and Tobacco Control Monograph No. 14. NIH Publication. No. 02-5086.
National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Bethesda (MD): U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2008. Tobacco Control Monograph No. 19. NIH Publication No. 07-6242.
National Research Council. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington: National Academy Press; 1986. [PubMed: 25032469]
Office of the Surgeon General Reports of the Surgeon General, U.S. Public Health Service. 2010. [accessed: November 30, 2010]. < http://www.surgeongeneral.gov/library/reports/index.html>.
Perry CL, Eriksen M, Giovino G. Tobacco use: a pediatric epidemic [editorial] Tobacco Control. 1994;3(2):97–8.
Peto R, Lopez AD. Future worldwide health effects of current smoking patterns. In: Koop CE, Pearson CE, Schwarz MR, editors. Critical Issues in Global Health. San Francisco: Wiley (Jossey-Bass); 2001. pp. 154–61.
Reddy KS, Perry CL, Stigler MH, Arora M. Differences in tobacco use among young people in urban India by sex, socioeconomic status, age, and school grade: assessment of baseline survey data. Lancet. 2006;367(9510):589–94. [PubMed: 16488802]
Schochet TL, Kelley AE, Landry CF. Differential expression of arc mRNA and other plasticity-related genes induced by nicotine in adolescent rat forebrain. Neuroscience. 2005;135(1):285–97. [PMC free article: PMC1599838] [PubMed: 16084664]
Sowden AJ. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews. 1998;(4):CD001006. [PubMed: 10796581] [Cross Ref]
Sowden AJ, Stead LF. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews. 2003;(1):CD001291. [PubMed: 12535406] [Cross Ref]
Stead LF, Lancaster T. Interventions for preventing tobacco sales to minors. Cochrane Database of Systematic Reviews. 2005;(1):CD001497. [PubMed: 15674880] [Cross Ref]
Steinberg L. Risk taking in adolescence: what changes, and why? Annals of the New York Academy of Sciences. 2004;1021:51–8. [PubMed: 15251873]
Task Force on Community Preventive Services. Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine. 2001;20(2 Suppl):S10–S15. [PubMed: 11173214]
Task Force on Community Preventive Services. Tobacco. In: Zaza S, Briss PA, Harris KW, editors. The Guide to Preventive Services: What Works to Promote Health? New York: Oxford University Press; 2005. pp. 3–79. < http://www.thecommunityguide.org/tobacco/Tobacco.pdf>.
Thomas RE, Baker PRA, Lorenzetti D. Family-based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews. 2007;(1):CD004493. [PubMed: 17253511] [Cross Ref]
Thomas RE, Perera R. School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews. 2006;(3):CD001293. [PubMed: 16855966] [Cross Ref]
US Department of Health and Human Services. Preventing Tobacco Use Among Young People A Report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994.
US Department of Health and Human Services. Tobacco Use Among US Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics A Report of the Surgeon General. Atlanta (GA): 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; 1998.
U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington: U.S. Government Printing Office; 2000.
US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta (GA): 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; 2000.
US Department of Health and Human Services. Women and Smoking A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.
US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): 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; 2004.
US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): 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; 2006.
US Department of Health and Human Services. How Tobacco Smoke Causes Disease—The Biology and Behavioral Basis for Tobacco-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): 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. [PubMed: 21452462]
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020. 2011. [accessed: November 1, 2011]. < http://www.healthypeople.gov/2020/default.aspx>.
US Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control; 1964. PHS Publication No. 1103.
Health Risks of Smoking Tobacco
About half of all Americans who keep smoking will die because of the habit. Each year more than 480,000 people in the United States die from illnesses related to tobacco use. This means each year smoking causes about 1 out of 5 deaths in the US.
- Smoking cigarettes kills more Americans than alcohol, car accidents, HIV, guns, and illegal drugs combined.
- Cigarette smokers die younger than non-smokers.
- Smoking shortens male smokers’ lives by about 12 years and female smokers’ lives by about 11 years.
- Smoking not only causes cancer. It can damage nearly every organ in the body, including the lungs, heart, blood vessels, reproductive organs, mouth, skin, eyes, and bones.
How smoking tobacco affects your cancer risk
Smoking accounts for about 30% of all cancer deaths in the United States, including about 80% of all lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women, and is one of the hardest cancers to treat.
Not only does smoking increase the risk for lung cancer, it’s also a risk factor for cancers of the:
Cigarettes, cigars, pipes, and spit and other types of smokeless tobacco all cause cancer. There is no safe way to use tobacco.
Does inhaling affect the risk of cancer?
Yes. Wherever smoke touches living cells, it does harm. Even smokers who don’t inhale are breathing in large amounts of smoke that comes from their mouths and the lit end of the cigarette, cigar, or pipe. They are at risk for lung cancer and other diseases caused by secondhand smoke.
How smoking tobacco damages your lungs
Smoking damages the airways and small air sacs in your lungs. This damage starts early in smokers, and lung function continues to worsen as long as the person smokes. Still, it may take years for the problem to become noticeable enough for lung disease to be diagnosed.
Smoking makes pneumonia and asthma worse. It also causes many other lung diseases that can be nearly as bad as lung cancer.
COPD, or chronic obstructive pulmonary disease, is the name for long-term lung disease which includes both chronic bronchitis and emphysema (discussed below). The risk of COPD goes up the more you smoke and the longer you smoke. It gets worse over time, and there is no cure.
Here are some facts about COPD:
- COPD is the third leading cause of death in the United States.
- Smoking is by far the most common cause of COPD.
- More women die from COPD than men.
Noises in the chest (such as wheezing, rattling, or whistling), shortness of breath during activity, and coughing up mucus (phlegm) are some of the early signs of COPD. Over time, COPD can make it hard to breathe even at rest. The late stage is one of the most miserable of all illnesses. It makes people gasp for breath and feel as if they are drowning.
Chronic bronchitis is a type of COPD. It’s a disease where the airways make too much mucus, forcing the person to cough it out. It’s a common problem for smokers. The airways become inflamed (swollen) and the cough becomes chronic (long-lasting). The symptoms can get better at times, but the cough keeps coming back. Over time, the airways get blocked by scar tissue and mucus, which can lead to bad lung infections (pneumonia).
There’s no cure for chronic bronchitis, but quitting smoking can help keep symptoms under control. Quitting smoking also helps keep the damage from getting worse.
Emphysema is the other type of COPD. It slowly destroys a person’s ability to breathe. Normally, the lungs contain millions of tiny sacs that help oxygen get into the blood. In emphysema, the walls between the sacs break down and create larger but fewer sacs. This lowers the amount of oxygen reaching the blood. Over time, these sacs can break down to the point where a person with emphysema must work very hard to get enough air, even when at rest.
People with emphysema are at risk for many other problems linked to weak lung function, including pneumonia. In later stages of the disease, patients can only breathe comfortably with oxygen.
Emphysema cannot be cured or reversed, but it can be treated and slowed down if the person stops smoking.
Why do smokers have “smoker’s cough?”
Tobacco smoke has many chemicals and particles that irritate the airways and lungs. When a smoker inhales these substances, the body tries to get rid of them by making mucus and coughing.
The early morning smoker’s cough happens for many reasons. Normally, tiny hair-like structures (called cilia) in the airways help sweep harmful material out of the lungs. But tobacco smoke slows the sweeping action, so some of the particles in the smoke stay in the lungs and mucus stays in the airways. While a smoker sleeps (and doesn’t smoke), some cilia recover and start working again. After waking up, the smoker coughs because the lungs are trying to clear away the irritants and mucus that built up from the day before.
So-called “smoker’s cough” can be an early sign of COPD.
How smoking tobacco affects your heart and blood vessels
Smoking tobacco damages your heart and blood vessels (cardiovascular system), increasing your risk of heart disease and stroke. It’s a major cause of coronary heart disease, which can lead to a heart attack.
Smoking causes high blood pressure, lowers your ability to exercise, and makes your blood more likely to clot. It also decreases HDL (good) cholesterol levels in the blood.
Smoking is a major risk factor for peripheral arterial disease (PAD). In PAD, plaque builds up in the arteries that carry blood to the head, organs, and limbs. This increases your risk of heart disease, heart attack, and stroke.
Smoking can cause or worsen poor blood flow to the arms and legs. (This is called peripheral vascular disease or PVD). This can cause pain in the legs when walking, and may lead to open sores that don’t heal. Surgery to improve the blood flow often fails in people who keep smoking. This is why many doctors who operate on blood vessels (vascular surgeons) won’t do certain operations on patients with PVD unless they stop smoking.
How smoking tobacco can affect your sex life and reproductive system
Tobacco use can damage a woman’s reproductive health. Women who smoke are more likely to have trouble getting pregnant. When they are pregnant they also tend to have problems that can hurt both mother and baby, for instance:
- Smokers are more likely to have an ectopic pregnancy (where the embryo implants outside the uterus), which can threaten the mother’s life.
- Smokers are also more likely to have early membrane ruptures and placentas that separate from the uterus too early.
- Serious bleeding, early delivery (premature birth), and emergency Caesarean section (C-section) may result from these problems.
- Smokers are more likely to have miscarriages, stillbirths, babies with cleft lip or palate, and low birth-weight babies.
- Smoking during pregnancy has also been linked to a higher risk of birth defects and sudden infant death syndrome (SIDS)
Women who smoke tend to be younger at the start of menopause than non-smokers and may have more unpleasant symptoms while going through menopause.
Smoking damages the arteries, and blood flow is a key part of male erections. Male smokers have a higher risk of sexual impotence (erectile dysfunction) the more they smoke and the longer they smoke. At least one study has also linked cigar smoking to sexual impotence in men.
Smoking can also affect sperm (which reduces fertility) and increase the risk for miscarriage and birth defects.
Other ways smoking tobacco affects your health
Not all of the health problems related to smoking result in deaths. Smoking affects a smoker’s health in many ways, harming nearly every organ of the body and causing many diseases. Here are a few examples of other ways smoking tobacco affects your health:
- Increased risk of gum disease and tooth loss.
- Wounds taking longer to heal
- Decreased immune system function
- Increased risk of type 2 diabetes
- Decreased sense of smell and taste
- Premature aging of the skin
- Bad breath and stained teeth
- Increased risk for cataracts (clouding of the lenses of the eyes)
- Lower bone density (thinner bones), which means a higher risk for broken bones, including hip fracture
- Higher risk of developing rheumatoid arthritis
- Increased risk for age-related macular degeneration, which can cause blindness
- Increased risk of peptic ulcers
Many of the health problems linked to smoking can steal away a person’s quality of life long before death. Smoking-related illness can make it harder for a person to breathe, get around, work, or play. Quitting smoking, especially at younger ages, can reduce smoking-related disability.
Kids who smoke have smoking-related health problems
Smoking causes serious health problems in children and teens. The most serious is nicotine addiction, which leads to long-term tobacco use. Over time, smokers then develop the health problems discussed above, and often at younger ages.
Children and teens who smoke regularly tend to have more health problems than kids who don’t, such as:
- Coughing spells
- Shortness of breath, even when not exercising
- Wheezing or gasping
- More frequent headaches
- Increased phlegm (mucus)
- Respiratory illnesses that are worse and happen more often
- Worse cold and flu symptoms
- Reduced physical fitness
- Poor lung growth and function, which increases COPD risk
Tobacco use is linked to other harmful behaviors in teens
Research has shown that teen tobacco users are more likely to use alcohol and illegal drugs than are non-users. Cigarette smokers are also more likely to get into fights, carry weapons, attempt suicide, suffer from mental health problems such as depression, and engage in high-risk sexual behaviors. This doesn’t necessarily mean that tobacco use caused these behaviors, but they’re more common in teens who use tobacco.