Tobacco use is the leading preventable cause of disease, disability, and death in the United States. 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 1 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.

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 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

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 birthweight2. 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 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.2In 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 years8.

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. 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) has established a national toll free quitline, 800 QUIT NOW, to serve as an access point for any smoker seeking information and assistance in quitting. NIDA is also supporting research to expand the availability of behavioral therapies by developing interventions using alternative delivery formats, such as web , computer , PDA or text based modalities, all of which may benefit hard to reach populations and increase access to treatment options for millions of smokers.

Nicotine Replacement Treatments

Nicotine replacement therapies (NRTs) were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. Current FDA approved NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges. 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.

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 type of intervention in development is a nicotine vaccine, which would induce a strong immune response to nicotine in the bloodstream, blocking its access to the brain and thereby preventing its reinforcing effects.

How Widespread Is Tobacco Use? Monitoring the Future Survey

Current smoking rates among 8th , 10th , and 12th grade students reached an all time low in 2012. According to the Monitorin
g the Future survey, 4.9 percent of 8th graders, 10.8 percent of 10th graders, and 17.1 percent of 12th graders reported they had used cigarettes in the past month. 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 37 percent in 12th graders) that were reached in the late 1990s.

The use of hookahs has also remained steady at high levels since its inclusion in the survey in 2010 past year use was reported by 18.3% of high school seniors. Meanwhile, past year use of small cigars has declined since 2010 yet remains high with 19.9% of 12th graders reporting past year use. Current use of smokeless tobacco remained steady among all grades in 2012 2.8 percent of 8th graders, 6.4 percent of 10th graders, and 7.9 percent of 12th graders reported past month use.

National Survey on Drug Use and Health (NSDUH)

In 2011, 26.5 percent of the U.S. population age 12 and older (approximately 68.2 million people) used a tobacco product at least once in the month prior to being interviewed. This figure includes 2.5 million young people aged 12 to 17 (10 percent of this age group). In addition, almost 56.8 million Americans (22.1 percent of the population) were current cigarette smokers 12.9 million smoked cigars more than 8.2 million used smokeless tobacco and over 2.1 million smoked tobacco in pipes.

Other Information Sources

For additional information on tobacco abuse and addiction, please visit our Nicotine information page.

For more information on how to quit smoking, please visit

Data Sources

These data are from the 2012 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 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 (PDF, 1.1 MB).

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

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 (PDF, 3.5 MB).

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 #toll. Accessed 7/22/2010.

5 Cao J, Belluzzi JD, Loughlin SE, Keyler DE, Pentel PR and Leslie FM. Acetaldehyde, a major constituent of tobacco smoke, enhances behavioral, endocrine and neuronal resonses to nicotine in adolescent and adult rats. Neuropsychopharmacology 32 2025 35, 2007.

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 /#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 (PDF, 1.2 MB)

E-cigarettes — the pros and cons of electronic cigarettes

What made you decide to try the e cigarette? After reading this article, share your comments and read what others have to say.

You can smoke them virtually anywhere. Many say they will help you quit smoking, a plus for people with COPD who often struggle with smoking cessation. Others are skeptical and afraid to try them. The FDA would like to regulate them as medical products. The e cigarette industry feels that the FDA has no substantiated reason to do so. There’s a lot of talk going on about e cigarettes, so before making a decision to use them, learn the facts about their pros and cons.

What are E Cigarettes?

Electronic cigarettes, or e cigarettes for short, are battery powered devices filled with liquid nicotine (a highly addictive chemical) that is dissolved in a solution of water and propylene glycol. Many of them look like real cigarettes, with a white cylindrical tube, brown filter, and red glowing tip. Others come in less conspicuous, darker colors.

How Do They Work?

Often termed «vaping,» when you take a puff on the end of the e cigarette tube, a battery heats up the nicotine, which creates a vapor that is then inhaled into the lungs. The end result is a sensation of smoke in the mouth and lungs without really smoking.

The Upside to E Cigarettes

Unlike tobacco products, there are no current laws in effect prohibiting the use of e cigarettes in public places. Case in point, I work in a hospital and a fellow nurse smokes them right there in the nursing station.

Here’s what current research says about the positive aspects of this product

• In a study of 40 tobacco dependent smokers, researchers concluded that smoking e cigarettes alleviated the desire to smoke (after abstaining from smoking overnight), was well tolerated, and pharmacologically more like a Nicorette inhaler than tobacco.
• Another study of 50 smokers who wanted to reduce the health risks associated with smoking, but not quit completely, concluded that the Eclipse brand of e cigarettes dramatically decreased the consumption of cigarettes without causing withdrawal symptoms. In addition, when participants smoked Eclipse, the nicotine concentrations in their blood remained fairly stable and their desire to quit altogether remained intact. However, the study concluded that because the Eclipse increased carbon monoxide concentrations in the blood, it may not be a safer choice of cigarette. On the other hand, it caused few, significant adverse events.
• In a case study series, the e cigarette was found to help three study participants who all had a documented history of repeated failed attempts at smoking cessation using professional smoking cessation assistance methods quit smoking and remain abstinent for at least 6 months.
• During an online survey conducted in 2010, researchers polled visitors of websites and discussion forums dedicated to the use of the e cigarette and smoking cessation. Of the 3,587 participants, 70% were former smokers, 61% were men, and the median age was 41 years. On average, participants used the e cigarette for approximately 3 months, drew 120 puffs/day, and used 5 cartridges/day. Almost all of them used cartridges that contained nicotine. Ninety six percent said that the e cigarette helped them quit smoking, while 92% said that it made them smoke less. A majority of the participants said the e cigarette helped them fight cravings, cope with withdrawal symptoms, and avoid relapsing on cigarettes.

The Downside of E Cigarettes

If you are a savvy consumer, both positive and negative aspects of the the product you are considering should be scrutinized before you purchase it. The e cigarette is no exception. Take a look at what some of the research says about the negative aspects of the e cigarette

• A 2010 research paper published in Tobacco Control suggests that the e cigarette lacks important regulatory factors, such as essential health warnings, proper labeling, clear instructions on how to use them, and safe disposal methods. The authors of the study also found that some of the e cigarette cartridges leaked, which could cause toxic exposure to nicotine.
• A study published in the December 2011 issue of CHEST found that the e cigarette caused acute pulmonary effects after smoking it for only five minutes, although study authors pointed out that these effects may not be of clinical significance. During the study, 40 healthy non smokers (30 experimental/10 control) were asked to smoke the e cigarette ad lib for five minutes. The experimental group used the e cigarette with the nicotine cartridge in place, while the control group smoked it with the nicotine cartridge removed.

  After five minutes, lung function was assessed using a variety of tests. Results showed that smoking the device for just five minutes caused an increase in impedance, peripheral airway flow resistance, and oxidative stress in the lungs of healthy smokers (smokers who are not diagnosed with lung disease or chronic health conditions.) They also pointed out that the study only measured results from smoking the e cigarette for five minutes because the average consumer is likely to smoke the e cigarette many times a day, this might increase the risks. However, the authors suggested that it is possible that if the e cigarette were used as a short term bridge to smoking cessation, the benefits might outweigh the risks.

• On their website, the FDA states that states that «E cigarettes may contain ingredients that are known to be toxic to humans, and may contain other ingredients that may not be safe.» They also suggest that because e cigarette manufacturers are not required to submit clinical study data to them, the public has no way of knowing «whether e cigarettes are safe for their intended use, what types or concentrations of potentially harmful chemicals are found in these products, or how much nicotine they are inhaling when they use these products.» The FDA is also concerned that the marketing efforts of e cigarettes may increase addiction to nicotine, especially in young people, encouraging them to experiment with real tobacco products.

The Best Way To Quit Smoking

How you choose to quit smoking is a matter of personal choice. The best method is the one that works for you. With this in mind, doing whatever it takes to be successful and safe is how many people ultimately approach it.

Consult your health care provider about different stop smoking aids, including nicotine replacement therapy, quit smoking medications such as Clonidine and Wellbutrin, quit smoking support groups, and educational materials.

If you decide to try the e cigarette, be sure to discuss this with your doctor and do your homework. Understand the pros, cons, and safety concerns, and then make an informed decision. The most important thing to remember is, no matter how you do it, you are making the best decision of your life when you finally decide to quit smoking, especially if you have COPD.

If you’re interested in purchasing an e cigarette starter kit, compare prices here.

Sources

Etter JF, Bullen C. Electronic cigarette users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011 Nov 106(11) 2017 28. Epub 2011 Jul 27.

Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery randomised cross over trial. Tob Control. 2010 Apr 19(2) 98 103.

Caponnetto P, Polosa R, Russo C, Leotta C, Campagna D. J. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses a case series. Med Case Reports. 2011 Dec 20 5(1) 585.

Evangelopoulou, Gregory N. Connolly and Panagiotis K. Behrakis Constantine I. Vardavas, Nektarios Anagnostopoulos, Marios Kougias, Vassiliki. Acute pulmonary effects of using an e cigarette impact on respiratory flow resistance, impedance and exha
led nitric oxide. Chest Prepublished online December 22, 2011.

Fagerstrom KO, Hughes JR, Rasmussen T, Callas PW. Randomized trial investigating effect of a novel nicotine delivery device (Eclipse) and a nicotine oral inhaler on smoking behavior, nicotine and carbon monoxide exposure, and motivation to quit. Tob Control. 2000 Sep 9(3) 327 33.

Fagerstrom KO, Hughes JR, Callas PW. Long term effects of the Eclipse cigarette substitute and the nicotine inhaler in smokers not interested in quitting. Nicotine Tob Res. 2002 4 Suppl 2 S141 5.

Food and Drug Administration News and Events Public Health Focus. Accessed 1/24/2011.

Anna Trtchounian and Prue Talbot. Electronic nicotine delivery systems is there a need for regulation? Tob Control published online December 7, 2010.