Questions About Smoking, Tobacco, and Health: American Cancer Society

Is there a safe way to smoke?

No. All cigarettes can damage the human body. Any amount of smoke is dangerous. Cigarettes are perhaps 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 have serious health consequences, including an increased risk of heart disease and a higher risk of dying at an earlier 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 alternative 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 frequently, 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 containing 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 numerous carcinogens and toxins that come from the tobacco itself, including tar and carbon monoxide.

Herbal cigarettes, even though they do not contain tobacco, also produce 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 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 causes a person to feel awake and alert, while later doses result in 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 plays an important role in increasing smokers' risk of heart disease and stroke. Because nicotine is such a powerful constrictor of arteries, many vascular surgeons refuse to operate on patients with peripheral artery disease unless they stop smoking.

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. While 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 in people is not yet known and more research is needed.

Why do people begin to smoke?

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

Another prevalent influence in our society is the tobacco industry's ads and other promotional activities for its products. 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 became addicted to tobacco at or before the age 18.
How many people smoke cigarettes?

Among US adults, cigarette smoking has declined from about 42% of the population in 1965 to about 21% in 2005 (the latest year for which numbers are available). About 45 million adults smoked cigarettes in 2005. About 23% of men and 19% 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, chewing or spit tobacco, and dipping snuff, remains 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 previous 12 months. Cigar smoking was also common among high school students (about 14%).
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.
Students who smoke are also 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. Its main active ingredient 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 almost 90% of lung cancers. Smoking also causes cancers of the larynx (voice box), oral cavity, pharynx (throat), esophagus, 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 leukemias. Cigars, pipes, and spit tobacco all cause cancers, too. There is no safe way to use tobacco.

How does cigarette smoke affect the lungs?

Damage of the lungs begins early in smokers, and all cigarette smokers have a lower level of lung function than nonsmokers. Cigarette smoking causes several lung diseases that can be just as dangerous as lung cancer. Chronic bronchitis -- a disease where the airways produce excess mucus, which forces the smoker to cough more often -- is a common ailment of smokers.
Cigarette smoking is also the major cause of emphysema -- a disease that slowly destroys a person's ability to breathe.

For oxygen to reach the blood, it must move across large surfaces in the lungs. Normally, thousands of tiny sacs make up the surface area in the lungs. When emphysema occurs, the walls between the sacs break down and create larger but fewer sacs. This decreases the amount of oxygen reaching the blood. Eventually, 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 symptoms of emphysema. People with emphysema are at risk for many other complications resulting from weakened 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 patient stops smoking.
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, and the number of women dying from the disease is higher than the number of men.

Smoking is the primary 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 -- similar to the feeling of drowning.

Why do smokers have "smoker's cough?"

Cigarette smoke contains chemicals that irritate the air passages and lungs. When a smoker inhales these substances, the body tries to protect itself by producing mucus and coughing. The "early morning" cough of smokers happens for several 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 remain in the lungs and mucus remains in the airways.

When 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 long-term exposure to smoke. 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 several other cancers.

Does cigarette smoking affect the 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 blood cholesterol, physical inactivity, obesity, and diabetes are all risk factors for heart disease, but cigarette smoking is the biggest risk factor for sudden heart death. Smokers who have a heart attack are more likely to die within an hour of the heart attack than nonsmokers. Cigarette smoke can cause harm to the heart at very low levels; even levels much lower than needed 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 10% 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 prevent the baby from getting essential nutrients and oxygen for growth.

Breast-feeding is a good way to feed a new baby, but smoking ma
y cause problems. If the mother smokes, the baby is exposed to the nicotine and other smoke poisons from her breast milk. Nicotine could cause numerous 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 nonsmokers. They are also more likely to smoke when they get older because they see their parents smoking.

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 related to smoking. Long-term, smoking is also a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke, and it contributes to the severity of pneumonia and asthma. Skin wounds take longer to heal and the immune system may be less effective in smokers compared to nonsmokers.

The truth is that cigarette smokers die younger than nonsmokers. In fact, according to a study from 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. Both 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 decreased 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: a diminished ability to smell and taste, premature aging of the skin, bad breath, stained teeth, and increased risk of sexual impotence in men.

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. 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 occur in developing countries.

What are the dangers of environmental tobacco smoke (ETS)?

ETS, also known as passive smoking or secondhand smoke, occurs when nonsmokers inhale 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 contains 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 3,400 lung cancer deaths and about 46,000 deaths from heart disease each year in healthy nonsmokers who live with smokers. It can also affect nonsmokers 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.

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 contain 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 regarding 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, The 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 is no research in the medical literature about 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 likely be minimal in comparison 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?

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. As of 2001, the 7 major cigar manufacturers in the United States began providing 5 health warnings that rotate on cigar labels, similar to those on cigarette packages.

Congress banned television and radio cigarette advertising on TV and radio in 1971 and spit tobacco advertising in 1987. The American Legacy Foundation and many states conduct creative antismoking public service messages that are featured on television, radio, and billboards.

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 less than 10 cents a pack in some states to more than 2 dollars a pack in others.

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 throat feeling that smokers often have. People who smoke these 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?

T There are many terms used to describe spit tobacco, such as oral, smokeless, chewing, and snuff tobacco. The use of spit tobacco by any name is a significant health risk. It is a less lethal substitute for smoking cigarettes. However, 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 receive about the same amount of nicotine as regular smokers.

The most harmful cancer-causing substances in spit tobacco are tobacco-specific nitrosamines (TSNAs), 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.

The juice from the smokeless tobacco is absorbed directly through the lining of the mouth. This creates sores and white patches (called leukoplakia) that often lead to cancer of the mouth.
Spit tobacco users 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 be at increased risk for heart disease.

What are the health risks of smoking pipes or cigars?

Many people view cigar smoking as more "civilized" and "glamorous," as well as less dangerous than cigarette smoking. Yet a single large cigar can contain as much tobacco as an entire pack of cigarettes.
Most of the same cancer-causing substances found in cigarettes are found in cigars. Most cigars have as much nicotine as several cigarettes. When cigar smokers inhale, nicotine is absorbed as rapidly as it is with cigarettes. For those who do not inhale, it is absorbed more slowly through the lining of the mouth. Both inhaled and non-inhaled nicotine are highly addictive.
Smoking cigars causes cancers of the lung, oral cavity (lip, tongue, mouth, throat), larynx (voice box), esophagus, and probably cancers of the bladder and pancreas.

Cigar smokers have a greater risk of dying from cancer of the oral cavity, larynx, or esophagus compared with nonsmokers. The risk of death from lung cancer is not as high as it is for cigarette smokers, but is still several times higher than the risk for nonsmokers.
Cigar smokers who inhale deeply and smoke several cigars a day are also at increased risk for heart disease and chronic lung disease.

Pipe smokers are at increased risk of dying from cancers of the lung, throat, esophagus, larynx, pancreas, and colon and rectum. They are also at increased risk of dying of heart disease, stroke, and chronic lung disease. The level of these risks seems to be about the same as that for cigar smokers.
Smoking cigars or pipes is not a safe alternative to smoking cigarettes.
What about more "exotic" forms of smoking tobacco, such as clove cigarettes, bidis, and hookahs?
Several forms of flavored tobacco have become popular in recent years, especially among younger people. Clove cigarettes (kreteks), bidis, and, more recently, hookahs, often appeal to those who want something a little different. They also provide young people with another way to experiment with tobacco. The false image of these products as clean, natural, and safer than conventional cigarettes seems to attract some young people who may otherwise not start smoking. But these products carry many of the same risks of cigarettes and other tobacco products and each has its own additional problems associated with it.

Clove cigarettes, also called kreteks, are imported mainly from Indonesia and contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. The chemicals in cloves have been implicated in cases of asthma and other lung diseases. Users often have the mistaken notion that smoking clove cigarettes is a safe alternative to smoking tobacco. But they are a tobacco product with the same health risks as cigarettes and, in fact, have been shown to deliver more nicotine, carbon monoxide, and tar than conventional cigarettes.
Bidis or "beedies" are flavored cigarettes imported mainly from India. They are hand-rolled in an unprocessed tobacco leaf and tied with colorful strings on the ends. Their popularity has grown in recent years in part because they come in a variety of candy-like flavors such as strawberry, vanilla, and grape, they are usually less expensive than regular cigarettes, and they often give the smoker an immediate buzz.

Even though bidis contain less tobacco than regular cigarettes, they have higher levels of nicotine (the addictive chemical in tobacco) and other harmful substances such as tar and carbon monoxide. Because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette. They are also unfiltered. Bidis appear to have all of the same health risks of regular cigarettes, if not more. Bidi smokers have much higher risks of heart attacks, chronic bronchitis, and some cancers than nonsmokers.

Hookah (or narghile) smoking, which started in the Middle East, involves burning flavored tobacco in a water pipe and inhaling the smoke through a long hose. It has recently become popular among young people, especially around college campuses. Hookah smoking is usually a social event that allows conversation to take place among the smokers as they pass the shared pipe around. It is marketed as being a safe alternative to cigarettes because the percent of tobacco in the product smoked is low.

This claim for safety is false. The water does not filter out many of the toxins, and hookah smoke contains varying amounts of nicotine, carbon monoxide, and other hazardous substances. Several types of cancer have been linked to hookah smoking. Hookah is also linked to other unique risks not associated with cigarette smoking. For example, infectious diseases can be spread by pipe sharing or the uncontrolled, manual preparation of the tobacco used.

All forms of tobacco are dangerous. Even if the health risks were smaller for some tobacco products as opposed to others, all tobacco products contain nicotine, which can lead to increased use and addiction. Tobacco cannot be considered safe in any amount or form.

What can I do to help with any damage that may have occurred as a result of my smoking?
Any past or current tobacco use is important information for your health care provider to know so he or she can be sure that you have appropriate preventive health care.

It is well known that tobacco use puts you at risk for certain health-related illnesses, so part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. For example, you will want to be certain that you regularly check the inside of your mouth for any changes and have an oral exam by your doctor or dentist if you have any changes or problems. The American Cancer Society recommends that periodic checkups should include oral cavity (mouth) exams. By doing this tobacco users may be able to prevent, or detect early, oral changes, leukoplakia (white patches on the mouth membranes), and oral cancer.

You should also be aware of any change in cough, a new cough, coughing up blood, hoarseness, difficulty breathing, wheezing, headaches, chest pain, loss of appetite, weight loss, general fatigue, and repeated respiratory infections. Any of these could be signs of lung cancer or a number of other lung conditions and should be reported to your doctor. While these can be signs of a problem, many lung cancers do not cause any noticeable symptoms until they are advanced and have spread to other parts of the body.

Remember that tobacco users have an increased risk for other cancers as well, depending on the way they use tobacco. You can become familiar with the types of cancer you may be at risk for by reading the American Cancer Society document that discusses the way you use tobacco. Other risk factors for these cancers may be more important than your use of tobacco, but you should be aware of the additional risks that might apply to your situation.

If you have any health concerns that may be related to your tobacco use, please see your health care provider as quickly as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for successful treatment. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit using tobacco.

How does tobacco use affect the economy?

The tobacco industry is one of the most profitable businesses in the country, making billions of dollars yearly. But the costs of smoking are far higher than the income from cigarette sales.
Smoking causes more than $167 billion each year in health-related costs, including the cost of lost productivity due to smoking.

Smoking-related medical costs totaled more than $75 billion in 1998 and accounted for 8% of personal health care medical expenditures.

Death-related productivity losses due to smoking among workers cost the US economy more than $92 billion yearly (average for 1997-2001).

For each pack of cigarettes sold in 1999, $3.45 was spent on medical care due to smoking, plus $3.73 in lost productivity, for a total cost of $7.18 per pack.

Can quitting really help a lifelong smoker?

Yes. It is never too late to quit. The sooner smokers quit, the more they can reduce their chances of getting cancer and other diseases. Within minutes of smoking the last cigarette, the body begins to restore itself.

20 minutes After Quitting: Your heart rate and blood pressure drop. ("Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification", Mahmud, A, Feely, J. 2003. Hypertension:41:183.)
12 hours After Quitting: The carbon monoxide level in your blood drops to normal. (US Surgeon General's Report, 1988, p. 202)
2 weeks to 3 Months After Quitting: Your circulation improves and your lung function increases. (US Surgeon General's Report, 1990, pp.193, 194,196, 285, 323)
1 to 9 Months After Quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. (US Surgeon General's Report, 1990, pp. 285-287, 304)
1 Year After Quitting: The excess risk of coronary heart disease is half that of a smoker's. (US Surgeon General's Report, 1990, p. vi)
5 Years After Quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting. (US Surgeon General's Report, 1990, p. vi)
10 Years After Quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases. (US Surgeon General's Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)
15 Years After Quitting: The risk of coronary heart disease is that of a nonsmoker's. (US Surgeon General's Report, 1990, p. vi)

Visible and Immediate Rewards of Quitting

Quitting helps stop the damaging effects of tobacco on your appearance, including:

premature wrinkling of the skin
bad breath
stained teeth
gum disease
bad smelling clothes and hair
yellow fingernails
Kicking the tobacco habit offers benefits that you'll notice immediately and some that will develop gradually over time. These rewards can improve your day-to-day life immensely.
Food tastes better.
Your sense of smell returns to normal.
Ordinary activities no longer leave you out of breath (for example, climbing stairs or light housework).
Suppose I smoke for a while and then quit?

Smoking begins to cause damage right away and is highly addictive. Several studies have found nicotine to be as addictive as heroin, cocaine, or alcohol; it’s the most common form of drug addiction in the United States. Therefore, it’s obviously better never to start smoking cigarettes -- and become addicted to nicotine -- than it is to smoke with the thought of quitting later. Like alcohol, heroin, and cocaine, nicotine creates a tolerance in the body, making it hard to quit, but with the right support it can be done.
When an ex-smoker smokes a cigarette, even years after quitting, the body reacts in the same way as when the person was smoking, which can cause the person to want to smoke again. Don't think you can smoke for a short while and quit when you want to; it's seldom that easy.

How do people quit smoking?

Quitting smoking is not easy, and some people try several times before succeeding. There are many ways to quit smoking. For example, some have been successful by stopping "cold turkey," by taking part in the Great American Smokeout®, or by using other methods.

There's no single best way to quit. Quitting for good may mean using many methods, including step-by-step manuals, self-help classes or counseling, toll-free telephone-based counseling programs, and/or using medicine (see next question). Smokers may also need to make changes in their daily routine to help them break their smoking habits.

What is nicotine replacement therapy?

Nicotine replacement therapies (NRTs) are medicines that help decrease or stop a smoker's withdrawal symptoms by providing controlled doses of nicotine without the other harmful chemicals of cigarette smoke. NRTs are available as patches, gums, inhalers, nasal sprays, or lozenges. The US Food and Drug Administration (FDA) has approved all of these products as smoking cessation aids. Patches, gums, and lozenges are available "over-the-counter," while inhalers and nasal sprays require a doctor’s prescription.

These products work by helping smokers control their physical responses as they quit; for best results, smokers should use NRTs in combination with behavioral change programs that are designed to help smokers break their psychological (mental) dependence on cigarettes.

For more information on such programs, call the American Cancer Society at 1-800-ACS-2345.
Not everyone can use nicotine replacement therapy. People with certain medical conditions and pregnant women should use it only with a doctor's supervision. It is always a good idea to get your doctor's input and support when you make the decision to quit smoking.

The most effective time to start NRT is at the beginning of an attempt to quit. Many smokers ask if it is possible to start a program of nicotine replacement while you are still smoking. There is some research being done with smokers using NRT while still smoking, but the results are still too early to say for certain if this is dangerous to your health. The most important thing is to make sure that you are not overdosing on nicotine, which can have effects on your cardiovascular system. It is safest to be under a doctor's care if you wish to try smoking and using NRT while you are tapering down your cigarette use.

For more information, see the American Cancer Society document, Guide to Quitting Smoking.

Are there other medicines or vaccines to help smokers quit?

Yes. Some medicines that don't contain nicotine are already approved to help with quitting smoking.

Bupropion (Zyban) is an antidepressant that is FDA approved for helping people quit smoking. This medicine, which does not contain nicotine, is available only with a doctor's prescription. It affects chemicals in the brain that are related to nicotine craving. It can be used alone or together with nicotine replacement.

Newer medicines may help smokers (or former smokers) by stopping them from getting physical pleasure from smoking. The medicines seem to work by stopping nicotine from stimulating the brain, either by blocking the brain receptors that nicotine normally attaches to, or (in the case of the vaccines) preventing it from reaching the brain altogether.

One such medicine, varenicline (Chantix), is now FDA approved for help with quitting. It is taken in pill form twice a day. Once in the body, it attaches to nicotine receptors in the brain, reducing the pleasurable effects of smoking and helping to reduce nicotine withdrawal symptoms. Several studies have shown varenicline can more than double the chances of quitting smoking. Because varenicline is a new drug, there is no research supporting its safety in using it with nicotine replacement products at the same time.

Other medicines still being studied include rimonabant, which is also taken as a pill, and vaccines that are given as a series of injections. Early tests of these new medicines have been promising. They seem to be safe and to help some smokers to quit or stay quit. But larger studies are needed to show they are effective before they can be approved for use by the FDA. Several large studies of these medicines are now under way. If they prove effective, one or more of these drugs could be approved for use within the next few years
.
It is unlikely that any of these drugs will work in every person, however, and using different quitting aids at the same time increases the chances of success.

Where can I go for help?

It is hard to stop smoking, but you can do it! About 46 million Americans have quit smoking for good, and there are now more former smokers than current smokers. Many organizations offer information, counseling, and other services on how to quit, as well as information on where to go for help. Other good resources where help can be found include your doctor, dentist, local hospital, or employer.

If you want to quit smoking and need help, contact one of the following organizations:

American Cancer SocietyTelephone: 1-800-ACS-2345 (1-800-227-2345)Internet address: www.cancer.org

American Heart AssociationTelephone: 1-800-AHA-USA-1 (1-800-242-8721) Internet address: www.amhrt.org

American Lung AssociationTelephone: 1-800-586-4872 (1-800-LUNG-USA)Internet address: www.lungusa.org
National Cancer Institute Cancer Information ServiceTelephone: 1-800-4-CANCER (1-800-422-6237)Internet address: www.cancer.gov

Centers for Disease Control and Prevention Office on Smoking & Health Internet address: www.cdc.gov/tobacco

Smokefree.gov (Info on state telephone-based counseling programs) Telephone: 1-800-QUITNOW (1-800-784-8669) Internet Address: www.smokefree.gov

Additional Resources

More Information From Your American Cancer Society

The following information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345 (1-800-227-2345).

Child and Teen Tobacco Use (also available in Spanish)
Cigar Smoking (also available in Spanish r)
Cigarette Smoking (also available in Spanish)
Double Your Chances of Quitting Smoking
Guide to Quitting Smoking (also available in Spanish)
Helping a Smoker Quit: Dos and Don'ts
Quitting Smoking - Help for Cravings and Tough Situations (also available in Spanish)
Secondhand Smoke (also available in Spanish)
Women and Smoking (also available in Spanish)
References
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Revised: 05/18/2007