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Tobacco Use

Free smoking cessation for Members and their dependents available.

Tobacco use remains the single largest preventable cause of disease and premature death among both men and women in the United States. Health effects associated with tobacco use include heart disease, many types of cancer, pulmonary disease, adverse reproductive outcomes, and the intensification of symptoms for multiple chronic health conditions.

More than 480,000 US deaths every year are from cigarette smoking. About 1 in 7 US adults still smoke cigarettes, and about 3.9 million middle school and high school students use at least one tobacco products, including e-cigarettes. Nearly 9 in 10 adult cigarette smokers first tried a cigarette before age 18.  

Cigarette smoking damages nearly every organ in the body. Cigarette smokers miss more work, visit a doctor more ofter, are hospitalized more often, and die 10 to 12 years earlier than nonsmokers. Cigarette smoking has been linked to about 80 to 90 percent of all cases of lung cancer, the leading cause of cancer death for both men and women, and it is responsible for roughly 80 percent of deaths from this disease. Smoking increases lung cancer risk five to tenfold, with greater risk among heavy smokers. In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and it has been found to worsen asthma symptoms in adults and children. Smoking also substantially increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm.

Tobacco has serious effects on the health of users. The consequences of tobacco use threaten Americans in many ways, including:

  • Smoking is a major cause of cardiovascular disease, which is the single leading cause of death in the United States. Smoking cause 1 of every 3 deaths from cardiovascular disease.
  • Smoking increase risk for stroke. Deaths from stroke are more likely among smokers than among former smokers or people who have never smoked.
  • In the United States, 1 of every 3 cancer deaths is linked to smoking. Smoking can cause cancer nearly anywhere in the body, including the lungs, oral cavity, stomach, bladder, kidney, uterine cervix, colon and rectum, and liver. The Surgeon General reports have identified at least 12 cancers caused by smoking.
  • Smoking increases the risk of type 2 diabetes. More than 25 million adults in the United States suffer form diabetes. Smokers who have diabetes are more likely to have serious health problems, including heart and kidney disease, poor blood flow in the legs and feet that can lead to foot infections and other problems, and retinopathy (an eye disease that can cause blindness). 
  • Nearly 8 in 10 cases of chronic obstructive pulmonary disease (COPD) are caused by smoking. The number of American suffering from COPD is increasing, and there is no cure.

Most smokers use tobacco regularly because they are addicted to nicotine. The smoke from combustible tobacco products contains more than 7,000 chemicals. Nicotine is the primary reinforcing component of tobacco; it drives tobacco addiction. Hundreds of compounds are added to tobacco to enhance its flavor and the absorption of nicotine.

Cigarette smoking is the most popular method of using tobacco; however, many people also use smokeless tobacco products, such as snuff and chewing tobacco, which also contain nicotine. E-cigarettes, which deliver nicotine in the absence of other chemicals in tobacco, have increased in popularity in recent years.

The cigarette is a very efficient and highly engineered drug-delivery system. By inhaling tobacco smoke, the average smoker takes in 1–2 milligrams of nicotine per cigarette. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. A typical smoker will take 10 puffs on a cigarette over the roughly 5 minutes that the cigarette is lit.

Immediately after exposure to nicotine, there is a “buzz” caused in part by the drug’s stimulation of the adrenal glands and resulting discharge of epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes an increase in blood pressure, respiration, and heart rate.

There are effective treatments that support tobacco cessation, including both behavioral therapies and FDA-approved medications. FDA-approved pharmacotherapies include various forms of nicotine replacement therapy as well as bupropion and varenicline. Research indicates that smokers who receive a combination of behavioral treatment and cessation medications quit at higher rates than those who receive minimal intervention. 

Behavioral counseling is typically provided by specialists in smoking cessation for four to eight sessions. Both in-person and telephone counseling have been found beneficial for patients who are also using cessation medications.

Cognitive Behavioral Therapy (CBT) – CBT helps patients identify triggers—the people, places, and things that spur behavior—and teaches them relapse-prevention skills (relaxation techniques) and effective coping strategies to avoid smoking in the face of stressful situations and triggers.

Motivational Interviewing (MI) – In MI, counselors help patients explore and resolve their ambivalence about quitting smoking and enhance their motivation to make healthy changes. MI is patient-focused and non-confrontational, and providers point out discrepancies between patients’ goals or values and their current behaviors. They adjust to patients’ resistance to change and support self-efficacy and optimism.

Mindfulness – In mindfulness-based smoking cessation treatments, patients learn to increase awareness of and detachment from sensations, thoughts, and cravings that may lead to relapse. In this therapy, patients purposely focus on the thoughts that trigger cravings and urges for tobacco and cognitively reframe them as expected and tolerable. Patients learn techniques that help them tolerate negative emotions—including stress and cravings—without returning to tobacco use or other unhealthy behaviors.

Nicotine Replacement Therapy (NRT) – A variety of formulations of nicotine NRTs are available over the counter—including the transdermal patch, spray, gum, and lozenges—and are equally effective for cessation.

Secondhand smoke

About 58 million nonsmoking Americans are exposed to secondhand smoke, including 15 million children aged 3 to 11 years. Secondhand smoke causes nearly 54,000 deaths a year. There is no safe level of exposure to secondhand smoke. Even low levels of secondhand smoke can harm children and adults in many ways. Secondhand smoke exposure also causes many serious illnesses – such as heart disease, stroke, and lung cancer in nonsmoking adults.

The US Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20-30%. Exposure to secondhand smoke increases school children’s risk of ear infections, lower respiratory illnesses, more frequent and more severe asthma attacks, and slowed lung growth, and it can cause coughing, wheezing, phlegm, and breathlessness. In babies, secondhand smoke can cause sudden infant death syndrome. Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby less than a year old. 

Thirdhand Smoke

Smoking also leaves chemical residue on surfaces where smoking has occurred, which can persist long after the smoke itself has been cleared from the environment. This phenomenon, known as “thirdhand smoke,” is increasingly recognized as a potential danger, especially to children, who not only inhale fumes released by these residues but also ingest residues that get on their hands after crawling on floors or touching walls and furniture.

Youth and Tobacco

No tobacco product is safe for young people to use. Nicotine is highly addictive and can harm teens’ developing brains. According to the 2017 Monitoring the Future Survey, 9.7% of 12th graders, 5% of 10th graders, and 1.9% of 8th graders used cigarettes in the past month. 

Any exposure to nicotine among youth is a concern. The adolescent brain is still developing, and nicotine has effects on the brain’s reward system and brain regions involved in emotional and cognitive functions. Research suggests that the nicotine-related changes to these areas of the brain during adolescence may perpetuate continued tobacco use into adulthood. 

It is common for adolescent smoking to follow an intergenerational pattern, which has genetic, epigenetic, and environmental influences. Data from parents and adolescents suggests that current parental nicotine dependence is strongly linked with adolescent smoking and dependence. Other factors—such as parents’ education, marital status, and parenting behavior also influence teen smoking.

Pregnancy and Smoking

Smoking before, during, and after pregnancy can affect the baby’s health. Smoking in pregnancy has been linked to a number of serious health effects, including:

  • Higher risk of pregnancy complications (preterm labor and delivery)
  • Infants born to mothers who smoked during pregnancy are at a higher risk of low birth weight, lungs that don’t develop in a normal way, and sudden infant death syndrome.
  • Smoking cigarettes can reduce fertility in women.

Benefits of Quitting

As soon as you quit, your body begins to repair the damage caused by smoking. You’ll notice the health benefits you’ll experience as soon as 20 minutes to 15 years after quitting.

20 Minutes After Quitting:

  • Your heart rate drops to a normal level.

12 Hours After Quitting:

  • The carbon monoxide level in your blood drops to normal.

2 Weeks to 3 Months After Quitting:

  • Your risk of having a heart attack begins to drop.
  • Your lung function begins to improve.

1 to 9 Months After Quitting:

  • Your coughing and shortness of breath decrease.

1 Year After Quitting:

  • Your added risk of coronary heart disease is half that of a smoker’s.

5 to 15 Years After Quitting:

  • Your risk of having a stroke is reduced to that of a nonsmoker’s.
  • Your risk of getting cancer of the mouth, throat, or esophagus is half that of a smoker’s.

10 Years After Quitting:

  • Your risk of dying from lung cancer is about half that of a smoker’s.
  • Your risk of getting bladder cancer is half that of a smoker’s.
  • Your risk of getting cervical cancer or cancer of the larynx, kidney or pancreas decreases.

15 Years After Quitting:

  • Your risk of coronary heart disease is the same as that of a nonsmoker.


Links to various resources on the topics discuss on this page. 

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