Harmfull of

cigarettes.

People have many questions about tobacco that can sometimes be hard to answer. They include questions about tobacco, including cigarettes, cigars, spit and other types of smokeless tobacco, and other tobacco products; nicotine; addiction; and quitting. Many of those questions are answered here. Here we also talk about how smoking and tobacco can affect a person's health, including the heart, circulation, and lungs, its effect on unborn babies, and how it affects the development of cancer and other diseases.

Is there a safe way to smoke cigarettes?

No. All cigarettes can damage the human body. Any smoking is dangerous. Cigarettes are the only legal product whose advertised and intended use -- smoking -- is harmful to the body and causes cancer.

Although some people try to make their smoking habit safer by smoking fewer cigarettes, most smokers find that hard to do. Research has found that even smoking as few as 1 to 4 cigarettes a day can lead to serious health outcomes, including an increased risk of heart disease and a higher risk of dying at a younger age.

Some people think that switching from high-tar and high-nicotine cigarettes to those with low tar and nicotine makes smoking safer, but this is not true. When people switch to brands with lower tar and nicotine, they often end up smoking more cigarettes, or more of each cigarette, to get the same nicotine dose as before.

Smokers have been led to believe that "light" cigarettes have a lower health risk and are a good option to quitting. This is not true. A low-tar cigarette can be just as harmful as a high-tar cigarette because a person often takes deeper puffs, puffs more often, or smokes them to a shorter butt length. Studies have not found that the risk of lung cancer is any lower in smokers of "light" or low-tar cigarettes.

Hand-rolled cigarettes, while reported to be a cheaper and healthier way to smoke, are not safer than commercial brands. In fact, lifelong smokers of hand-rolled cigarettes have been found to have an increased risk of cancers of the larynx (voice box), esophagus (tube that connects the mouth to the stomach), mouth, and pharynx (throat) when compared with smokers of manufactured cigarettes.

"All natural" cigarettes are marketed as having no chemicals or additives and rolled with 100% cotton filters. There is no proof they are healthier or safer than other cigarettes, nor is there good reason to think they would be. Smoke from these cigarettes, like the smoke from all cigarettes, contains many carcinogens (agents that cause cancer) and toxins that come from the tobacco itself, including tar and carbon monoxide.

Herbal cigarettes, even though they do not contain tobacco, also give off tar and carbon monoxide and are dangerous to your health. The bottom line is there's no such thing as a safe smoke.

Is cigarette smoking really addictive?

Yes. The nicotine in cigarette smoke causes an addiction to smoking. Nicotine is an addictive drug (just like heroin and cocaine) for 3 main reasons.

• When taken in small amounts, nicotine creates pleasant feelings that make the smoker want to smoke more. 
• Smokers usually become dependent on nicotine and suffer physical and emotional (psychological) withdrawal symptoms when they stop smoking. These symptoms include nervousness, headaches, and trouble sleeping. 
• Because nicotine affects the chemistry of the brain and central nervous system, it can affect the mood and nature of the smoker.

What does nicotine do?

In large doses nicotine is a poison and can kill by stopping a person's breathing muscles. Smokers usually take in small amounts that the body can quickly break down and get rid of. The first dose of nicotine makes a person to feel awake and alert, while later doses produce a calm, relaxed feeling.

Nicotine can make new smokers, and regular smokers who get too much of it, feel dizzy or sick to their stomachs. The resting heart rate for young smokers increases 2 to 3 beats per minute. Nicotine also lowers skin temperature and reduces blood flow in the legs and feet. It may play a role in increasing smokers' risk of heart disease and stroke.

Many people mistakenly think that nicotine is the substance in tobacco that causes cancer. This belief may cause some people to avoid using nicotine replacement therapy when trying to quit. Although nicotine is what gets (and keeps) people addicted to tobacco, other substances in tobacco are responsible for its cancer-causing effects. There is some early evidence from lab-based studies that nicotine may help existing tumors to grow, but whether these results apply to people is not yet known and more research is needed.

Why do people begin to smoke?

Most people begin smoking as teens, usually because of curiosity and peer pressure. People with friends and/or parents who smoke are more likely to take up smoking than those who don't.

The tobacco industry's ads and other promotions for its products are another big influence in our society. The tobacco industry spends billions of dollars each year to create and market ads that show smoking as an exciting, glamorous, and healthy adult activity.

Who is most likely to become addicted?

Anyone who starts smoking is at risk of becoming addicted to nicotine. Studies show that cigarette smoking is most likely to become a habit during the teen years. The younger a person is when he or she begins to smoke, the more likely he or she is to develop nicotine addiction. Almost 90% of adult smokers started at or before age 19.

How many people smoke cigarettes?

Among adults in the United States, cigarette smoking has declined from about 42% of the population in 1965 to about 20.9% in 2005 (the latest year for which numbers are available). About 45 million adults currently smoke cigarettes. About 23.9% of men and 18.1% of women were smokers. Education seems to affect smoking rates, as shown by a steady decrease in the smoking rates in groups with a higher level of education.

Is smoking common among young people?

Yes. Tobacco use, including smoking cigarettes, using chew or spit tobacco, and dipping snuff, is common among American youth, according to the most recent government surveys.

Despite declines in recent years, about 1 in 3 male high school students (32%) and 1 in 4 female high school students (25%) used some type of tobacco in 2005. More than 1 in 5 students (23%) were considered current cigarette smokers. Over half of these students (about 55%) reported they had tried to quit smoking during the past year. Cigar smoking was also common among high school students (about 14%).

Also, about 12% of middle school students used some form of tobacco, with cigarettes (8%) being the most common.

Tobacco use is higher among male students for all products except cigarettes, where the numbers for boys and girls are now about the same.

Other problems have been linked to smoking. Studies have shown that students who smoke are more likely to use other drugs, get in fights, carry weapons, attempt suicide, and engage in high-risk sexual behaviors.

What in cigarette smoke is harmful?

Cigarette smoke is a complex mixture of chemicals produced by the burning of tobacco and the additives. The smoke contains tar, which is made up of more than 4,000 chemicals, including over 60 known to cause cancer. Some of these substances cause heart and lung diseases, and all of them can be deadly. You might be surprised to know some of the chemicals found in cigarette smoke. They include:

• cyanide 
• benzene 
• formaldehyde 
• methanol (wood alcohol) 
• acetylene (the fuel used in welding torches) 
• ammonia

Cigarette smoke also contains the poisonous gases nitrogen oxide and carbon monoxide. The active ingredient that produces the effect people are looking for is nicotine, an addictive drug.

Does smoking cause cancer?

Yes. Tobacco use accounts for about one- third of all cancer deaths in the United States. Smoking causes about 87% of lung cancer deaths. Smoking also causes cancers of the larynx (voice box), mouth, pharynx (throat), esophagus (swallowing tube), and bladder, and contributes to the development of cancers of the pancreas, cervix, kidney, and stomach. It is also linked to the development of some types of leukemia. Cigars, pipes, and spit and other types of smokeless tobacco all cause cancers, too. There is no safe way to use tobacco.

How does cigarette smoke affect the lungs?

Damage to the lungs begins early in smokers, and all cigarette smokers have a lower level of lung function than non-smokers. This continues to worsen as long as the person smokes. Cigarette smoking causes many lung diseases that can be just as dangerous as lung cancer.

Chronic Bronchitis

Chronic bronchitis is a disease where the airways produce too much mucus, forcing the smoker to cough it out. It is a common problem for smokers. The lungs start to produce large amounts of mucus more and more of the time. The airways become inflamed (swollen) and the cough becomes chronic -- it doesn't get better or go away. Airways get blocked by scars and mucus. Serious infections can also result.

Emphysema

Cigarette smoking is also the major cause of emphysema -- a disease that slowly destroys a person's ability to breathe. Oxygen reaches the blood by moving across a large surface area in the lungs. Normally, thousands of tiny sacs make up this surface area. With emphysema, the walls between the sacs break down and create larger but fewer sacs. This decreases the lung surface area, which lowers the amount of oxygen reaching the blood. Over time, the lung surface area can become so small that a person with emphysema often must gasp for breath.

Shortness of breath (especially when lying down), a chronic mild cough (which is often dismissed as "smoker's cough"), feeling tired, and sometimes weight loss are early signs of emphysema. 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 the help of an oxygen tube under the nose. Emphysema cannot be reversed, but it can be slowed down -- especially if the person stops smoking.

Chronic Obstructive Pulmonary Disease

More than 7 million current and former smokers suffer from chronic obstructive pulmonary disease (COPD), the name used to describe both chronic bronchitis and emphysema. COPD is the fourth leading cause of death in America. More women die from COPD than men. Smoking is the main risk factor for COPD. About 80% to 90% of COPD deaths are caused by smoking. The late stage of chronic lung disease is one of the most miserable of all medical conditions. It creates a feeling of gasping for breath all the time -- much like the feeling of drowning.

Why do smokers have "smoker's cough?"

Cigarette smoke has chemicals that irritate the air passages and lungs. When a smoker inhales these substances, the body tries to protect itself by making mucus and coughing. The early morning smokers cough happens for many reasons. Normally, tiny hair-like formations (called cilia) beat outward and sweep harmful material out of the lungs. Cigarette smoke slows the sweeping action, so some of the poisons in the smoke stays in the lungs and mucus stays in the airways. While a smoker sleeps, some cilia recover and begin working again. After waking up, the smoker coughs because the lungs are trying to clear away the poisons that built up the previous day. The cilia will completely stop working after they have been exposed to smoke for a long time. Then the smoker's lungs are even more exposed and susceptible than before, especially to bacteria and viruses in the air.

If you smoke but don't inhale, is there any danger?

Yes. Wherever smoke touches living cells, it does harm. Even if smokers don't inhale they are breathing the smoke as secondhand smoke and are still at risk for lung cancer. Pipe and cigar smokers, who often don't inhale, are at an increased risk for lip, mouth, tongue, and some other cancers.

Does cigarette smoking affect your heart?

Yes. Smoking cigarettes increases the risk of heart disease, which is the number one cause of death in the United States. Smoking, high blood pressure, high cholesterol, physical inactivity, obesity, and diabetes are all risk factors for heart disease, but cigarette smoking is the biggest risk factor for sudden death from a heart attack. Smokers who have a heart attack are more likely to die within an hour of the heart attack than non-smokers. Cigarette smoke can harm the heart at very low levels, even when the amount is too low to cause lung disease.

How does smoking affect pregnant women and their babies?

Pregnant women who smoke risk the health and lives of their unborn babies. Smoking during pregnancy is linked with a greater chance of miscarriage, premature delivery, stillbirth, infant death, low birth-weight, and sudden infant death syndrome (SIDS). Up to 5% of infant deaths would be prevented if pregnant women did not smoke.

When a pregnant woman smokes, she's smoking for two. The nicotine, carbon monoxide, and other harmful chemicals enter her bloodstream, pass directly into the baby's body, and keep it from getting vital nutrients and oxygen it needs for growth.

Breast-feeding is a good way to feed a new baby, but if the mother smokes it exposes the baby to nicotine and other poisons in the smoke through breast milk. Nicotine could cause many unwanted symptoms in the baby, such as restlessness, a rapid heartbeat, vomiting, or diarrhea.

Some research has also suggested that children whose mothers smoked while pregnant or who have been exposed to secondhand smoke, even in small amounts, may be slower learners in school. They may be shorter and smaller than children of non-smokers. They are also more likely to smoke when they get older.

What are some of the short- and long-term effects of smoking cigarettes?

Smoking causes many types of cancer, which may not develop for years. But cancers account for only about half of the deaths linked to smoking. Long-term, smoking is also a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke, and it makes pneumonia and asthma worse. Wounds take longer to heal and the immune system may be less effective in smokers than in non-smokers. Smoking also damages the arteries. Because of this, many vascular surgeons refuse to operate on patients with peripheral artery disease (poor blood circulation in the arms and legs) unless they stop smoking. And male smokers have a higher risk of sexual impotence (erectile dysfunction) the longer they smoke

The truth is that cigarette smokers die younger than non-smokers. In fact, according to a study from the Centers for Disease Control and Prevention (CDC) done in the late 1990s, smoking shortened male smokers' lives by 13.2 years and female smokers' lives by 14.5 years. Men and women who smoke are much more likely to die during middle age (between the ages of 35 and 69) than those who have never smoked.

Smoking also causes many short-term effects, such as poor lung function. Because of this, smokers often suffer shortness of breath and nagging coughs. They often will tire easily during physical activity. Some other common short-term effects include less ability to smell and taste, premature aging of the skin, bad breath, and stained teeth

What are the chances that smoking will kill you?

About half of all the people who continue to smoke will die because of the habit. In the United States, tobacco causes nearly 1 in 5 deaths, killing about 440,000 Americans each year. Smoking is the single most preventable cause of death in our society.

Based on current patterns, smoking will kill about 650 million people alive in the world today. If these patterns continue, tobacco-caused deaths worldwide are expected to increase from about 5 million per year today to about 10 million per year by the 2030s. Most of these deaths will happen in developing countries.

What are the dangers of environmental tobacco smoke?

Environmental tobacco smoke (ETS), also known as passive smoking or secondhand smoke, occurs when non-smokers breathe in other people's tobacco smoke. This includes mainstream smoke (smoke that is inhaled and then exhaled into the air by smokers) and sidestream smoke (smoke that comes directly from the burning tobacco in cigarettes). ETS contains the same harmful chemicals as the smoke that smokers inhale. In fact, because sidestream smoke is formed at lower temperatures, it has even larger amounts of some toxic and cancer-causing substances than mainstream smoke.

There is strong evidence that ETS causes serious damage to human health. ETS causes about 3,000 lung cancer deaths and about 35,000 deaths from heart disease each year in healthy non-smokers who live with smokers. It can also affect non-smokers by causing asthma and other respiratory problems, eye irritation, headaches, nausea, and dizziness. Children whose parents smoke are more likely to suffer from asthma, pneumonia, bronchitis, ear infections, coughing, wheezing, and increased mucus production. Babies of parents who smoke have a greater chance of dying of sudden infant death syndrome (SIDS). Pregnant women exposed to ETS are at risk for having a low birth weight baby and may also be at risk for pre-term delivery and miscarriage.

Breast Cancer

An issue that continues to be an active focus of scientific research is whether secondhand smoke may increase the risk of breast cancer. Both mainstream and secondhand smoke have about 20 chemicals that, in high concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast tissue and are found in breast milk.

The evidence about secondhand smoke and breast cancer risk in human studies is controversial, at least in part because the risk has not been shown to be increased in active smokers. One possible explanation for this is that tobacco smoke may have different effects on breast cancer risk in smokers and in those who are just exposed to smoke.

A report from the California Environmental Protection Agency in 2005 concluded that the evidence regarding secondhand smoke and breast cancer is "consistent with a causal association" in younger, mainly premenopausal women. The 2006 US Surgeon General's report, T he Health Consequences of Involuntary Exposure to Tobacco Smoke , concluded that there is "suggestive but not sufficient" evidence of a link at this point. In any case, women should be told that this possible link to breast cancer is yet another reason to avoid contact with secondhand smoke.

Am I at risk for getting lung cancer from smoke odors on clothing or from being in a room where people have been smoking?

There are no reports in the medical literature of research on the cancer-causing effects of cigarette odors, but the literature shows that secondhand smoke can seep into hair, clothing, and other surfaces. The unknown cancer-causing effects would probably be minimal compared to direct secondhand smoke exposure, such as living in a household that has a smoker.

What is being done to protect people from the hazards of smoking?

Tobacco Labels

Both the public and private sectors have acted to help decrease smoking-related deaths and illnesses in this country. Since 1966, the US Surgeon General's health warnings have been required on all cigarette packages and, since 1987, on all spit or oral tobacco products. Since 2001, the 7 major cigar manufacturers in the United States have provided 5 health warnings that rotate on cigar labels. These labels are much like those on cigarette packages.

Advertising

Congress banned cigarette advertising on TV and radio in 1971 and spit tobacco advertising in 1987. The American Legacy Foundation and many states have made anti-smoking public service messages that are featured on television, radio, and billboards.

Taxes

Taxes on cigarettes have risen in many states in recent years. They have been shown to discourage young people from starting to smoke and to encourage smokers to quit. State taxes on tobacco vary from as low as 7 cents (in South Carolina) to up to $2.58 a pack (in New Jersey).

Smoking Bans

Laws in all 50 states and the District of Columbia restrict or do not allow smoking in certain public places. These laws range from simple restrictions, such as designated areas in government buildings, to laws that ban smoking in all public places and workplaces. Many federal worksites, including the White House, are smoke-free. Smoking is also banned on all domestic airplane flights.

Are menthol cigarettes safer than other brands?

Menthol cigarettes are not safer than any other brand. In fact, they may even be more dangerous. About one-fourth of all cigarettes sold in the United States are flavored with menthol. These cigarettes are especially popular among African Americans. The added menthol produces a cooling sensation in the throat when the smoke is inhaled. It also decreases the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer.

A recent study showed that people who smoke menthol cigarettes are less likely to try to quit and are less likely to be successful when they do try. This study proposed that menthol smokers might want to switch to non-menthol cigarettes before trying to quit in order to improve their chances of quitting smoking.

Are spit tobacco and snuff safe alternatives to cigarette smoking?

There are many terms used to describe tobacco that is put in the mouth , such as spit, oral, smokeless, chewing, and snuff tobacco. The use of any kind of spit or smokeless tobacco is a major health risk. It is a less lethal substitute for smoking cigarettes but, less lethal is a far cry from safe.

The amount of nicotine absorbed is usually more than the amount delivered by a cigarette. Overall, people who dip or chew get about the same amount of nicotine as regular smokers. The most harmful cancer-causing substances in spit tobacco are tobacco-specific nitrosamines which have been found at levels 100 times higher than the nitrosamines that are allowed in bacon, beer, and other foods. These carcinogens cause lung cancer in experimental animals, even when injected, not inhaled.

The juice from the smokeless tobacco is absorbed directly through the lining of the mouth. This causes sores and white patches (called leukoplakia) that often lead to cancer of the mouth.

People who use spit and other types of smokeless tobacco greatly increase their risk of other cancers including those of the pharynx (throat). Other effects of spit tobacco use include chronic bad breath, stained teeth and fillings, gum disease, tooth decay, tooth loss, tooth abrasion, and loss of bone in the jaw. Users may also have problems with high blood pressure and may be at increased risk for heart disease.

What is snus? Is it safe?

Snus (sounds like "snoose") is a type of moist snuff first used in Sweden. It is often flavored with spices or fruit, and is usually packaged in thin bags much like tea bags. It is also sold loose, as a moist powder. Like snuff and other spit tobaccos, snus is held between the gum and mouth tissues where the juice is absorbed into the body.

Because it is heated during processing, Swedish snus has fewer tobacco-specific nitrosamines (see previous question) that are known to cause cancer. Snus users in Sweden have lower rates of several types of cancer than Swedish smokers. Because of this, some people believe snus is "safe." However, snus users have a higher risk of cancer of the pancreas than non-users. They also get sores or spots in the mouth (lesions) where the snus is held. It appears that snus users may have mouth cancer more often than non-users, though more study needs to be done to confirm this.

Since US tobacco sellers are not required to list what is in their products, it would be hard to know how the US versions of snus might compare to the Swedish versions without doing studies here. Since snus has just been introduced, it is uncertain what other problems it might cause.but, snus is not a safe alternative to smoking.