Health Effects of Smoking

Diseases Caused by Smoking

Impact on Life Expectancy

On average, smokers die 10 years earlier than nonsmokers. About half of all lifelong smokers will die from a smoking-related disease.

Secondhand Smoke

Secondhand smoke contains over 7,000 chemicals, hundreds of which are toxic and about 70 that cause cancer. In the US, secondhand smoke causes approximately 41,000 deaths per year among nonsmoking adults and 400 deaths in infants.

Benefits of Quitting at Every Age

Quit Strategies That Work

Nicotine Replacement Therapy (NRT)

NRT delivers controlled amounts of nicotine without the harmful chemicals in tobacco smoke. NRT approximately doubles quit success rates compared to willpower alone.

• Nicotine patches: Steady, all-day nicotine delivery (available over the counter)
• Nicotine gum: Fast-acting relief for acute cravings (2mg and 4mg strengths)
• Nicotine lozenges: Dissolve in mouth; discreet and easy to use
• Nicotine inhaler: Mimics hand-to-mouth habit (prescription required)
• Nicotine nasal spray: Fastest nicotine delivery of all NRT forms (prescription required)

Prescription Medications

Behavioral Therapy

Counseling and behavioral support can be delivered in person, by phone, or online. Even brief counseling sessions of 3 minutes increase quit rates. Combining medication with counseling produces the highest success rates (up to 25-30% at one year).

Cold Turkey Success Rates

About 3-5% of smokers who quit cold turkey (no aids) remain smoke-free at 6-12 months. While most successful former smokers eventually quit without aids, the process typically requires multiple attempts. Using evidence-based treatments significantly improves the odds.

Combination Approaches

The most effective strategy combines multiple approaches:

• Medication + counseling is more effective than either alone
• Patch + short-acting NRT (gum or lozenge) outperforms single NRT
• Varenicline + NRT may be considered for highly dependent smokers
• Quitlines, apps, and support groups add incremental benefit

Vaping & E-Cigarettes

E-Cigarette Risks

While e-cigarettes are generally considered less harmful than combustible cigarettes, they are not harmless. E-cigarette aerosol contains:

• Nicotine (highly addictive in any delivery form)
• Ultrafine particles that penetrate deep into the lungs
• Volatile organic compounds and heavy metals (lead, nickel, tin)
• Flavorings like diacetyl, linked to serious lung disease

Comparison to Smoking

E-cigarettes expose users to fewer toxic substances than conventional cigarettes. However, long-term health effects are still unknown since these products have not been available long enough for longitudinal studies. The UK Royal College of Physicians estimates e-cigarettes are likely to be at least 95% less harmful than smoking, but this figure remains debated.

Dual Use Dangers

Many smokers use both cigarettes and e-cigarettes (dual use). Research shows that dual use provides little to no health benefit over smoking alone because:

• Even a few cigarettes per day carry significant health risks
• There is no safe level of cigarette smoking
• Dual use may delay complete cessation
• Only completely switching away from cigarettes reduces harm

FDA Regulation Status

As of 2024, the FDA regulates e-cigarettes as tobacco products. Key regulatory actions include:

• All e-cigarette products require FDA premarket authorization
• Sales to those under 21 are prohibited (federal law)
• No e-cigarette has been approved by the FDA as a cessation aid
• Flavored cartridge-based products (except tobacco and menthol) face enforcement
• The FDA continues to review premarket applications from manufacturers