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Medicine LibreTexts

7.4: Tobacco Use

  • Page ID
    13373
  • 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 480,000 premature deaths in the United States each year—about 1 in every 5 U.S. deaths—and an additional 16 million people suffer with a serious illness caused by smoking. In fact, for every one person who dies from smoking, about 30 more suffer from at least one serious tobacco-related illness.

    The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death. Each year, an estimated 88 million nonsmoking Americans are regularly exposed to secondhand smoke and almost 41,000 nonsmokers die from diseases caused by secondhand smoke exposure.

    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 the period of about 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 pack (25 cigarettes) daily gets 250 “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.

    Similar to other addictive drugs like cocaine and heroin, 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.

    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.

    Electronic Cigarettes

    What are they?

    E-cigarettes are battery-operated devices that typically produce a flavored nicotine vapor that looks like tobacco smoke.

    Are they safe?

    Although e-cigarette vapor does not contain the tar currently responsible for most lung cancer and other lung diseases, it has been shown to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. There are currently no accepted measures to confirm their purity or safety, and the long-term health consequence of e-cigarette use remain unknown. NIDA is developing research programs to help answer these questions.

    In addition, the U.S. Food and Drug Administration (FDA) has established a new rule for e-cigarettes and their liquid solutions in an effort to help protect the public from the dangers of tobacco use. Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products, including the requirement that both in-store and online purchasers be at least 18 years of age (see “Government Regulation of Tobacco Extended to All Tobacco Products“).

    Can they help people quit smoking traditional cigarettes? 

    Because they deliver nicotine without burning tobacco, e-cigarettes are thought by many to be a safer alternative to conventional cigarettes, and some people even think they may help smokers lower nicotine cravings while they are trying to quit smoking. However, studies of the effectiveness of e-cigarettes have not shown they help with smoking cessation. It has also been suggested that they could perpetuate the nicotine addiction and actually interfere with quitting.

    In fact, early evidence suggests that e-cigarette use may not only put users at risk for nicotine addiction but also serve as an introduction to nicotine that could lead to use of regular cigarettes and other tobacco products. A recent study showed that students who have used e-cigarettes by the time they start 9th grade are more likely than others to start smoking traditional cigarettes and other smokable tobacco products within the next year.

    What Other Adverse Effects Does Tobacco Have on Health?

    Cigarette smoking accounts for about one-third of all cancers, including 85-90 percent of lung cancer cases. More people in the United States, both men and women, die from lung cancer than any other type of cancer. 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. On average, adults who smoke die 10 years earlier than nonsmokers.

    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 birthweight. 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.

    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.

    Note

    Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25–30 percent and lung cancer by 20–30 percent.

    In addition; secondhand smoke causes health problems in both adults and children, such as coughing, overproduction of phlegm, reduced lung function and respiratory infections, including pneumonia and bronchitis. Each year about 150,000 – 300,000 children younger than 18 months old experience respiratory tract infections caused by secondhand smoke.  Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, respiratory infections and death. In fact, more than 100,000 babies have died in the past 50 years from sudden infant death syndrome (SIDS), and other health complications as a result of parental smoking. 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.

    Note

    There is no safe level of exposure to tobacco smoke.

     

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