Smoking: The Business of Quitting Smoking Home NBGH Home Search
Health Information


Employer Case Studies
Surveys
News and Events
Updated: August 2, 2011
Overview
Smoking-Related Health Problems
Women's Health
Maternal and Infant Health
Mothers, Children and Secondhand Smoke
Adolescent Health
Health Affects of Other Forms of Tobacco Use
Resources
Citations

Overview

No matter what form it comes in, there is no safe way to use tobacco. Tobacco use is the second major cause of death around the globe; half of all people who use it die from tobacco-related diseases.1 In fact, tobacco use is so deadly that it causes more deaths around the world than AIDS, illegal drugs, motor vehicle accidents, murder, and suicide combined. Globally, one person dies from tobacco use every 6.5 seconds.2

Back to top

Smoking-Related Health Problems

The most common way people use tobacco is by smoking cigarettes. Almost 1 billion men and 250 million women smoke cigarettes worldwide.3 In the United States alone, there are 44.5 million people who smoke.4

  • Cigarette smoking is the leading cause of preventable death in the United States, accounting for approximately 443,000 deaths, or 1 of every 5 deaths, in the United States each year.5
  • Cigarettes harm almost every organ in the body and cause serious health problems.2
  • Women who die of a smoking-related disease lose approximately 14.5 years of potential life.6
  • Men who die of a smoking-related disease lose approximately 13 years of potential life.6
  • Smokers of light and ultralight cigarettes are at the same risk for diseases as smokers of full-flavor cigarettes.7

In 2004, the Surgeon General reported that there was sufficient evidence to conclude a causal relationship between smoking and the following diseases:

Cancer8

  • In 2005, 7.6 million people around the world died of cancer, accounting for 13% of the deaths worldwide.9
  • It has been estimated that active smoking is responsible for close to 90 percent of lung cancer cases.10
  • Smoking, a main cause of small cell and non-small cell lung cancer, contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively.10
  • Men who smoke are 23 times more likely to develop lung cancer. Women are 13 times more likely, compared to never smokers.10
  • Between 2000 and 2004, an average of 125,522 Americans (78,680 men and 46,842 women) died of smoking-attributable lung cancer each year. Exposure to secondhand smoke causes approximately 3,400 lung cancer deaths among nonsmokers every year.10
  • According to the World Health Organization, 40% of cancer cases could be prevented simply by not using tobacco, eating a healthy diet, exercising, and avoiding infections that can cause cancer.11

Cardiovascular diseases8

According to the WHO, cardiovascular disease killed 17.5 million in 2005, representing 30% of deaths worldwide.11 In the United States, coronary heart disease is the leading cause of death for both men and women.8

Respiratory diseases8

  • Chronic obstructive pulmonary disease.
  • Pneumonia.
  • Respiratory complications in utero, such as reduced lung function.
  • Respiratory complications in childhood and adolescence, such as impaired lung growth, coughing, wheezing.
  • Respiratory complications in adulthood, such as decline in lung function.

Other effects8

Tobacco use also has an impact on the mental health and rates of substance abuse among its users.

  • Researchers have found that smokers report worse mental health than nonsmokers.12
  • According to the National Comorbidity Survey, individuals with mental illness are approximately twice as likely to smoke as individuals without mental illness.13
  • Individuals with depression are more likely to continue smoking, to initiate smoking, and to not quit than people without depression.14
  • Smokers are at two to three times greater risk for alcohol dependence than nonsmokers.15

Approximately 80% of people with alcoholism smoke cigarettes and most of these smokers are nicotine dependent.16 In addition, 20.2% of cigarette smokers age 12 or older reported use of an illicit drug in the past month, compared with 4.1% of persons who were not cigarette smokers.17

Back to top

Women's Health

There are over 250 million women around the world who smoke on a daily basis.1 Women face the same devastating, smoking-related diseases as men, but women are also subject to gender specific smoking-related problems as well.

Health Risks
Each year, smoking-related diseases kill an estimated 178,408 women in the United States.18 The three leading causes of smoking-related death in women are:19

  • Coronary heart disease
  • Lung cancer
  • Chronic obstructive pulmonary disease

Women who smoke are at a greater risk than nonsmokers for:19

  • Hip fractures.
  • Post menopausal low bone density.
  • Reproductive problems, such as infertility.
  • Pregnancy complications, such as pre-term delivery and stillbirth.

Back to top

Maternal and Infant Health

Approximately 21% of American women of childbearing age smoke and 10.7% of women in the United States admit to smoking during pregnancy.20

Rates of Smoking for Pregnant Women by Race (2004)21-23

  • American Indians and Alaska Natives – 18.2%
  • Whites – 13.8%
  • African Americans – 8.4%
  • Asian American and Pacific Islander – 8.4%
  • Hispanic women – 2.7%

Consequences of smoking while pregnant24

  • Preterm delivery/prematurity.
  • Low birth weight.
  • Fetal deaths and stillbirths.
  • Sudden infant death syndrome (SIDS).
  • Doubles the risk that children will become smokers.25

Quitting smoking before pregnancy is most beneficial at reducing poor pregnancy outcomes, as a result, the preconception period is a good opportunity to assess and treat tobacco use.26-27 Furthermore, quitting smoking early during pregnancy also reduces the risk for poor pregnancy outcomes, but quitting at any point during pregnancy may result in health benefits.27 Quitting smoking is essential because smoking during pregnancy is the most preventable cause of illness and death among mothers and infants.28

Clinicians should encourage and offer smoking cessation treatment to pregnant smokers at the first prenatal visit, as well as throughout the course of the pregnancy.27 Clinicians may opt to offer pharmacotherapy to pregnant smokers if counseling is ineffective (although the risks of pharmacotherapy during pregnancy must be thoroughly discussed and weighed).27

Return on Investment for Employers
Tobacco cessation treatment for pregnant women is considered one of the most cost-saving preventive services. Research shows that a decline in smoking prevalence among pregnant women by one percentage point could prevent 1,300 low birth weight babies each year. This translates into a savings of $21 million in direct medical costs (1995 dollars).29 In addition, research shows that for every $1 spent on smoking cessation for pregnant women, $3 could be saved on reduced neonatal intensive care costs.30

Mothers, Children and Secondhand Smoke

According to a report by the Surgeon General, exposure to secondhand smoke is extremely detrimental to children and their health.31 The World Health Organization reports that 40% of children worldwide are exposed to secondhand smoke at home.

Secondhand Smoke and Maternal and Infant Health

  • Pregnant women exposed to secondhand smoke are more likely to give birth to a baby with a low birth weight.31
  • Infants exposed to secondhand smoke are at an increased risk to die from sudden infant death syndrome (SIDS).31

Children exposed to secondhand smoke are at an increased risk for:25

  • Asthma
  • Bronchitis
  • Pneumonia
  • Respiratory problems
  • Retarded lung development

Back to top

Adolescent Health

Every day approximately 4,000 adolescents in the United States try a cigarette, and 1,140 adolescents become regular smokers.32 Smoking during adolescence may increase the likelihood of lifetime addiction. Nearly 80% of adult smokers started smoking before the age of 18.33 Furthermore, the risk for smoking increases threefold if an adolescent has parents who smoke.34

In a global survey of students age 13-15:35

  • 9.5% currently smoke cigarettes.
  • 1 in 10 use tobacco products other than cigarettes.
  • 4 in 10 students were exposed to second hand smoke in the home during the week preceding the survey.
  • 78.3% thought smoking should be banned in the public sphere.
  • 68.7% of students who currently smoking reported that they wanted to quit.

Adolescent tobacco use hinders healthy development during a crucial period for growth. Risk of developing smoking-related diseases increases with total lifetime exposure to cigarette smoke, the age a person began smoking, the number of years smoked, the amount of exposure to secondhand smoke, and the intensity of smoking.7 This means that it is important to promote smoking cessation as soon as possible.

Adolescent Tobacco Use:33

  • Impairs lung growth and function.
  • Increases the risk for respiratory illness and cardiovascular disease.
  • Increases the likelihood for future smoking-related health problems.

Back to top

Health Effects of Other Forms of Tobacco Use

Although cigarettes may be the most common form of tobacco use, other types of tobacco use such as smokeless tobacco, cigars, pipes, and waterpipes cause tobacco-related disease. While consumption of cigarettes has declined over the past few decades in the United States, the consumption of cigars, smokeless tobacco, and smoking tobacco (i.e., pipe) has actually increased from 1995-2006.36,37

Smokeless Tobacco
Although it does not emit smoke, smokeless tobacco, also known as chewing tobacco or snuff, is not a safe alternative to cigarettes.38,39

  • The nicotine from smokeless tobacco is absorbed into the bloodstream more slowly than the nicotine from cigarettes.40
  • The amount of nicotine absorbed into the body from smokeless tobacco is three to four times greater than the amount absorbed by one cigarette.41
  • Just like cigarettes, smokeless tobacco can lead to nicotine dependence.42
  • Research shows that over the past two decades smokeless tobacco consumption has tripled.43
  • Approximately 3% of Americans are regular smokeless tobacco users.43
  • There are significant health risks associated with the use of smokeless tobacco because it contains 28 cancer-causing agents.40,41

Health Risks of Smokeless Tobacco:41,44

  • Oral cancer (cancer of the lip, tongue, cheek, gums, and the bottom and top of the mouth).
  • Leukoplakia (white mouth lesions that can become cancerous).
  • Elevated blood pressure.
  • High cholesterol.
  • Gum disease.
  • Gum recession.
  • Bad breath.
  • Yellowing of teeth.

Quitting Smokeless Tobacco
Counseling programs are excellent tools in aiding smokeless tobacco cessation efforts. Self-help, telephone-based, individual and group tobacco cessation counseling programs help smokeless tobacco users understand their addiction, overcome cravings and withdrawal symptoms, and offer support.

Nicotine replacement therapy and medications such as Bupropion (Zyban┬« or Wellbutrin┬«) and Varenicline (Chantix™) have not been approved by the FDA for smokeless tobacco cessation.

Cigars
An estimated 13.6 million Americans are cigar users.45 Cigars contain the same toxic and carcinogenic (cancer causing) compounds found in cigarettes.46 Cigars are not a safe alternative to cigarettes.47

Health Risks of Cigars:45

  • Chronic obstructive pulmonary disease
  • Coronary heart disease
  • Esophageal cancer
  • Laryngeal cancer
  • Lung cancer
  • Oral cancer

Smoking one to two cigars per day doubles the risk for oral and esophageal cancer compared to a nonsmoker.48 In addition, the risk for laryngeal cancer increases six-fold, compared to a nonsmoker.48

The health risks from cigar smoking increase with the number of cigars smoked per day. For example, someone who smokes three to four cigars per day increases their risk for oral cancers 8.5 times to that of a nonsmoker.48 Someone who smokes more than five cigars per day increases their risk for oral cancers 16 times in comparison to a nonsmoker.48

Waterpipe Tobacco Smoking
Waterpipe tobacco smoking (also commonly known as hookah smoking) is a social practice that is extremely hazardous to a person's health. Smokers often use the waterpipe for 40 to 45 minutes, rather than the 5 to 10 minutes it takes to smoke a cigarette, and thus inhale dangerous chemicals equivalent to 100 cigarettes.49

Waterpipe tobacco smoking contains the same cancer-causing agents as cigarettes and puts regular smokers, and those exposed to the secondhand smoke, at risk for diseases. Furthermore, babies born to women who smoked one or more water pipes a day during pregnancy have lower birth weights (at least 3.5 ounces less) and are at an increased risk for respiratory diseases than babies born to nonsmokers.50

Health Effects of Waterpipe Smoking:51

  • Heart disease
  • Clogged arteries
  • Lung Cancer
  • Bladder Cancer
  • Oral Cancer

Back to top

Resources

For visual information on the health effects of smoking visit the World Health Organization, The Surgeon General's 2004 Report, and Campaign for Tobacco Free Kids.

Visit Smoke Free Families for comprehensive materials on the best way to help pregnant smokers quit.

There are many different tools available for smokeless tobacco users to quit successfully. For more information on quitting, visit the National Institute of Dental and Craniofacial Research's guide: Spit Tobacco: A Guide to Quitting.

Back to top


Citations

1 World Health Organization. Gender and tobacco control: a policy brief. Available at: http://www.who.int/tobacco/resources/publications/general/policy_brief.pdf. Accessed July 9, 2008.
2 World Health Organization. The tobacco health toll. Available at: http://www.emro.who.int/TFI/PDF/TobaccoHealthToll.pdf. Accessed October 17, 2007.
3 World Health Organization. The tobacco atlas. Available at: http://whqlibdoc.who.int/publications/2002/9241562099.pdf. Accessed November 19, 2007.
4 Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2004. MWWR. 2005;54(44).
5 Centers for Disease Control and Prevention. Adult cigarette smoking in the United States: current estimates. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Accessed August 2, 2011.
6 Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost and economic costs—United States, 1995-1999. MMWR. 2002; 51:300-303.
7 U.S. Department of Health and Human Services. 2004 Surgeon General's report—the health consequences of smoking. Washington, DC: Office of the Surgeon General; 2004. Available at: http://www.surgeongeneral.gov/library/smokingconsequences/index.html. Accessed August 2, 2011.
8 U.S. Department of Health and Human Services. The health consequences of smoking on the human body: a report of the Surgeon General. Washington, DC; Office of the Surgeon General: 2004. Available at: http://www.surgeongeneral.gov/library/smokingconsequences/index.html. Accessed August 2, 2011.
9 World Health Organization. Cancer. Available at: http://www.who.int/mediacentre/factsheets/fs297/en/index.html. Accessed November 19, 2007.
10 American Lung Association. Lung cancer fact sheet. Available at: http://www.lungusa.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html. Accessed August 2, 2011.
11 World Health Organization. Cardiovascular diseases. Available at: http://www.who.int/topics/cardiovascular_diseases/en/. Accessed October 12, 2007.
12 Mody R, Smith M. Smoking status and health-related quality of life: findings from the 2001 behavioral risk factor surveillance system data. Am J Health Promotion. 2006;20(4).
13 Lasser K, Boyd J, Woolhandler S, Himmelstein D, McCormick D, Bor D. Smoking and mental illness-a population-based prevalence study. JAMA. 2000;284:2606-2610.
14 Murphy J, Horton N, Monson R, Laird N, Sobol A, Leighton A. Cigarette smoking in relation to depression: historical trends from the Stirling County study. Am J Psychiatry. 2003;160(9):1663-1669.
15 Breslau N. Psychiatric comorbidity of smoking and nicotine dependence. Behavioral Genetics. 1995;25(2):95-101.
16 Hughes J. Treating smokers with current or past alcohol dependence. Am J Health Behavior. 1996;20:286-290.
17 Substance Abuse and Mental Health Services Administration. Results from the 2005 national survey on drug use and health: national findings. Available at: http://oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm. Accessed April 7, 2008.
18 Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997-2001. MMWR. 2005;54(25):625-628.
19 Centers for Disease Control and Prevention. Women and tobacco. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2001/complete_report/pdfs/chp3.pdf. Accessed August 2, 2011.
20 Detjen G, Nieto J, Trentham-Dietz A, Fleming M, Chasan-Taber L. Acculturation and cigarette smoking among pregnant hispanic women residing in the United States. Am J Public Health. 2007;97(11).
21 National Center for Health Statistics. Health, United States, 2006. Available at: http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed November 15, 2007.
22 Centers for Disease Control and Prevention. Infant mortality statistics from the 2003 period link birth/infant death data set. Available at: http://www.cdc.gov/nchs/births.htm. Accessed November 15, 2007.
23 Centers for Disease Control and Prevention. National vital statistics system birth data, 2003. Available at: http://www.cdc.gov/nchs/births.htm. Accessed November 15, 2007.
24 March of Dimes. Smoking during pregnancy. Available at: http://www.marchofdimes.com/professionals/14332_1171.asp. Accessed November 20, 2007.
25 Centers for Disease Control and Prevention. Tobacco use and pregnancy: home. Available at: http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/index.htm. Accessed September 14, 2007.
26 Rosenthal A, Melvin C, Barker D. Treatment of tobacco use in preconception care. Maternal Child Health Journal. 2006;10:S147-S148.
27 Fiore MC, Bailey WC, Cohen SJ, et al. A clinical practice guideline for treating tobacco use and dependence. Rockville, Maryland. U.S. Department of Health and Human Services, Public Health Service; 2000. Available at: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf. Accessed April 15, 2008.
28 Centers for Disease Control and Prevention. Preventing smoking and exposure to secondhand smoke before, during, and after pregnancy. Available at: http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/smoking.htm. Accessed August 2, 2011.
29 Lightwood JM, Phibbs CS, Glantz SA. Short-term economic and health benefits of smoking cessation: low birth weight. Pediatrics. 1999;104(6):1312-1320.
30 Marks J, Kaplan J, Hogue C. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. Am J Prev Med. 1990;6:282-291.
31 U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Washington, DC: Office of the Surgeon General; 2006. Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/. Accessed August 2, 2011.
32 U.S. Department of Health and Human Services. Results from the 2005 national survey on drug use and health. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006. Available at: http://oas.samhsa.gov/nsduh/2k5nsduh/2k5results.pdf. Accessed April 18, 2008.
33 Campaign for Tobacco-Free Kids. The path to smoking addiction starts at very young ages. Available at: http://tobaccofreekids.org/research/factsheets/pdf/0127.pdf. Accessed September 14, 2007.
34 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Association; 2000.
35 Centers for Disease Control and Prevention. Global youth tobacco surveillance, 2000-2007. MMWR. 2008;57:SS-1.
36 Capehart T. Leaf production rebounds. Washington DC: United States Department of Agriculture (USDA), Economic Research Service; 2006. Available at: http://usda.mannlib.cornell.edu/usda/ers/TBS//2000s/2006/TBS-09-26-2006.pdf.
37 United States Department of Agriculture. Leaf Production plummets with end of program. Washington DC: United States Department of Agriculture (USDA): Economic Research Service;2005. Available at: http://usda.mannlib.cornell.edu/usda/ers/TBS//2000s/2005/TBS-09-16-2005.pdf. Accessed April 18, 2008.
38 U.S. Department of Health and Human Services. The health consequences of using smokeless tobacco. Washington, DC: Office of the Surgeon General; 1986. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/smokeless_facts/index.htm. Accessed August 2, 2011.
39 American Association for Cancer Research. Snuff not safe: smokeless tobacco delivers more of some dangerous carcinogens than cigarettes. ScienceDaily. Available at: http://www.sciencedaily.com/releases/2007/08/070809130018.htm. Accessed December 31, 2007.
40 Centers for Disease Control and Prevention. Smokeless tobacco. Available at: http://www.powrcessationcenter.org/pdfs/fhp/newsarticles/TheEffectsofSpitTobacco.pdf. Accessed August 2, 2011.
41 National Cancer Institute. Smokeless tobacco and cancer: Questions and answers. Available at: http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless. Accessed November 27, 2007.
42 American Psychiatric Association. Practice guidelines for the treatment of psychiatric disorders. Washington: American Pyschiatric Association; 2005.
43 Arabi Z. An epidemic that deserves more attention: epidemiology, prevention, and treatment of smokeless tobacco. Southern Medical Journal. 2007;100(9):890-894.
44 American Cancer Society. Smokeless tobacco and how to quit. Available at: http://www.cancer.org/docroot/PED/content/PED_10_13X_Quitting_ Smokeless_Tobacco.asp?sitearea=&level. Accessed June 8, 2007.
45 Substance Abuse and Mental Health Services Administration. The national survey on drug use and health: 2005 detailed tables. Available at: http://oas.samhsa.gov/nsduh/2k5nsduh/tabs/Sect2peTabs42to46.pdf. Accessed April 21, 2008.
46 National Cancer Institute. Cigars: health effects and trends. Bethesda MD: USDHHS, NIH, NCI; 1998.
47 National Cancer Institute. Smoking and tobacco control monographs: monograph 9: cigars: health effects and trends. Available at: http://cancercontrol.cancer.gov/tcrb/monographs/9/index.html. Accessed November 15, 2007.
48 National Institutes of Health. Background on cigar monograph: cigars: health effects and trends. Available at: http://www.nih.gov/news/pr/apr98/nci-10a.htm. Accessed November 20, 2007.
49 World Health Organization. WHO advisory note: "waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators," WHO 2005.
50 Centers for Disease Control and Prevention. Hookahs. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/#effects. Accessed August 2, 2011.

Back to top

Copyright 2014 National Business Group on Health
20 F Street NW, Suite 200, Washington, DC 20001-6700   -   P: 202-558-3000   -   F: 202.628.9244
Email: healthservices@businessgrouphealth.org