Why do people smoke – reasons cigarettes are hard to quit

Exactly why do people smoke? It was a question I sought the answer to for several years when I first began writing stop smoking articles.

Eventually, I came across “Why People Smoke Cigarettes”, a statement on cigarette smoking developed from testimony delivered before the U.S. Congress by William Pollin, M.D., Director of the National Institute on Drug Abuse on March 16, 1982 (DHHS, 1983).

The statement, based upon robust scientific knowledge, conveys a profound level of understanding of why people smoke and the reasons cigarettes are hard to quit from the viewpoint of smoking as a drug dependency.

This article summarises the key points as the document is no longer freely available.


Bearing in mind that the statement was written in 1982, the following facts help put the scale of cigarette smoking in America, at that time, into context.

“Four drugs stand out among all drugs and substances of abuse”

  • Fewer than 500,000 persons used heroin
  • Alcohol affected 10 million problem drinkers and their families
  • Marijuana was the most widely used illicit drug and
  • Tobacco, in the form of cigarettes was smoked by 56 million Americans

Smoking is more than just a “nasty” habit (Mark Twain), “it is, in fact, the most widespread example of drug dependence in our country”.

“All drugs that produce dependence have at least these four characteristics in common”

  • Psychoactive (affecting the chemistry of the brain and nervous system).
  • By definition, they create dependence and lead to compulsive use
  • When one gives up the drug abruptly, one may experience physiological and psychological distress
  • There is a strong tendency among former users to relapse, sometimes months or even years after quitting.

The Role of Nicotine

The most important role of nicotine is its action on the brain and nervous system in helping to create dependence.

  • Nicotine reinforces and strengthens the desire to smoke and causes users to keep on smoking.
  • Cigarette smokers absorb nicotine more quickly than pipe and cigar smokers or those who chew tobacco or use snuff because most cigarette smokers inhale.
  • Inhalation is the fastest and most efficient way of getting nicotine to the brain.
  • Nicotine acts through specialized cell formations located in the human brain and muscle tissues. These receptors have the capacity to recognize and react to nicotine when it is present in the body.
  • Nicotine and the opium derivatives are the only other drugs of dependence for which specialized receptors of this kind have been identitied and studied in detail.
  • When the receptors signal the presence of nicotine, a wide range of physical reactions occur. Changes occur in heart rate and skin temperature, blood pressure rises, peripheral blood circulation slows, changes occur in brain waves, and hormones affecting the central nervous system are released.

This articles continues in Part Two Why People Smoke Cigarettes which considers ‘the way people Smoke’, ‘what happens when a person tries to quit smoking’ and ‘lessons learned in the treatment of other dependencies that can be applied to cigarette smoking’.


U.S. Dept. of Health and Human Services, Public Health Service (DHHS). Why people smoke cigarettes. U.S. Dept. of Health and Human Services, Public Health Service. DHHS Publication No. (PHS) 83 50195, 1983.


  • Effects of Second Hand Smoke
  • Second Hand Smoke Statistics
  • Which Stars Smoke Cigarettes

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Smoking and pregnancy – wikipedia, the free encyclopedia

It is important to examine these effects because smoking before, during and after pregnancy is not an unusual behavior among the general population and can have detrimental health impacts, especially among both mother and child as a result. It is reported that roughly 20% of pregnant women smoke at some point during the three months.

Smoking during pregnancy edit

In the United States today, approximately 10% of women smoke during pregnancy. Of women who smoked during the last 3 months of pregnancy, 52% reported smoking 5 or less cigarettes per day, 27% reported smoking 6 to 10 cigarettes per day, and 21% reported smoking 11 or more cigarettes per day. In the United States, women whose pregnancies were unintended are 30% more likely to smoke during pregnancy than those whose pregnancies were intended. 4

Effects on ongoing pregnancy edit

Smoking during pregnancy can lead to a plethora of health risks to both the mother and the fetus.

Women who smoke during pregnancy are about twice as likely to experience the following pregnancy complications 5

  • premature rupture of membranes, which means that the amniotic sac will rupture prematurely, and will induce labour before the baby is fully developed. Although this complication has a good prognosis (in Western countries), it causes severe economic stress as the premature child may have to stay in the hospital to gain health and strength to be able to sustain life on their own.
  • placental abruption, wherein there is premature separation of the placenta from the attachment site. The fetus can be put in distress, and can even die. The mother can lose blood and can have a haemorrhage she may need a blood transfusion.
  • placenta previa, where in the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix. 6 Having placenta previa is an economic stress as well because it requires having a caesarean section delivery, which is more expensive and requires a longer recovery period in the hospital. There can also be complications, such as maternal hemorrhage.

Premature birth edit

Some studies show that the probability of premature birth is roughly 50% higher for women who smoke during pregnancy going from around 8% to 11%. 7

Implications for the umbilical cord edit

Smoking can also impair the general development of the placenta, which is problematic because it reduces blood flow to the fetus. When the placenta does not develop fully, the umbilical cord which transfers oxygen and nutrients from the mother’s blood to the placenta, cannot transfer enough oxygen and nutrients to the fetus, which will not be able to fully grow and develop. These conditions can result in heavy bleeding during delivery that can endanger mother and baby, although cesarean delivery can prevent most deaths. 8

Pregnancy induced hypertension edit

There is limited evidence that smoking reduces the incidence of pregnancy induced hypertension, 9 but not when the pregnancy is with more than one baby (i.e. it has no effect on twins etc.). 10

Effects of smoking during pregnancy on the child after birth edit Low birthweight edit

Smoking nearly doubles the risk of low birthweight babies. In 2004, 11.9% of babies born to smokers had low birthweight as compared to only 7.2% of babies born to nonsmokers. More specifically, infants born to smokers weigh on average 200 grams less than infants born to women who do not smoke. Premature and low birthweight babies face an increased risk of serious health problems as newborns have chronic lifelong disabilities such as cerebral palsy (a set of motor conditions causing physical disabilities), mental retardation and learning problems. Overall, they also face an increased risk of death. quantify citation needed

Sudden infant death syndrome edit

Sudden infant death syndrome (SIDS) is the sudden death of an infant that is unexplainable by the infant s history. The death also remains unexplainable upon autopsy. Infants exposed to smoke, both during pregnancy and after birth, are found to be more at risk of SIDS due to the increased levels of nicotine often found in SIDS cases. Infants exposed to smoke during pregnancy are up to three times more likely to die of SIDS that children born to non smoking mothers. quantify 11

Other birth defects edit Birth defects associated with smoking during pregnancy 12 Defect Odds ratio cardiovascular/heart defects 1.09 musculoskeletal defects 1.16 limb reduction defects 1.26 missing/extra digits 1.18 clubfoot 1.28 craniosynostosis 1.33 facial defects 1.19 eye defects 1.25 orofacial clefts 1.28 gastrointestinal defects 1.27 gastroschisis 1.50 anal atresia 1.20 hernia 1.40 undescended testes 1.13 hypospadias 0.90 skin defects 0.82 All defects combined 1.01

Smoking can also cause other birth defects, reduced birth circumference, altered brainstem development, altered lung structure, and cerebral palsy. Recently the U.S. Public Health Service reported that if all pregnant women in the United States stopped smoking, there would be an estimated 11% reduction in stillbirths and a 5% reduction in newborn deaths. citation needed

Future obesity edit

A recent study has proposed that maternal smoking during pregnancy can lead to future teenage obesity. While no significant differences could be found between young teenagers with smoking mothers as compared to young teenagers with nonsmoking mothers, older teenagers with smoking mothers were found to have on average 26 percent more body fat and 33 percent more abdominal fat than similar aged teenagers with non smoking mothers. This increase in body fat may result from the effect smoking during pregnancy, which is thought to impact fetal genetic programming in relation to obesity. While the exact mechanism for this difference is currently unknown, studies conducted on animals have indicated that nicotine may affect brain functions that deal with eating impulses and energy metabolism. These differences appear to have a significant effect on the maintenance of a healthy, normal weight. As a result of this alteration to brain functions, teenage obesity can in turn lead to a variety of health problems including diabetes (a condition in which the affected individual s blood glucose level is too high and the body is unable to regulate it), hypertension (high blood pressure), and cardiovascular disease (any affliction related to the heart but most commonly the thickening of arteries due to excess fat build up). 13

Future smoking habits edit

Studies indicate that smoking during pregnancy increases the likelihood of offspring beginning to smoke at an early age. citation needed

Quitting during pregnancy edit

Quitting smoking at any point during pregnancy is more beneficial than continuing to smoke throughout the entire 9 months of pregnancy, especially if it is done within the first trimester (within the first 12 weeks of pregnancy). A recent study suggests, however, that women who smoke anytime during the first trimester put their fetus at a higher risk for birth defects, particularly congenital heart defects (structural defects in the heart of an infant that can hinder blood flow) than women who have never smoked. That risk only continues to increase the longer into the pregnancy a woman smokes, as well as the larger number of cigarettes she is smoking. This continued increase in risk throughout pregnancy means that it can still be beneficial for a pregnant woman to quit smoking for the remainder of her gestation period. 8 There are many resources to help pregnant women quit smoking such as counseling and drug therapies. For non pregnant smokers, an often recommended aid to quitting smoking is through the use of Nicotine replacement therapy in the form of patches, gum, inhalers, lozenges, sprays or sublingual tablets (tablets which you place under the tongue). However, it is important to note that the use of Nicotine Replacement Therapies (NRTs) is questionable for pregnant women as these treatments still deliver nicotine to the child.
For some pregnant smokers, NRT might still be the most beneficial and helpful solution to quit smoking. It is important to talk to your doctor to determine the best course of action on an individual basis. 14

Smoking after pregnancy edit

Infants exposed to smoke, both during pregnancy and after birth, are found to be more at risk of sudden infant death syndrome (SIDS). 11

Breastfeeding edit