The 1982 United States Surgeon General's report stated that"Cigarette smoking is the major single cause of cancer mortality (death) in the United States." This statement is as true today as it was in 1982.

Smoking is responsible for nearly 1 in 5 deaths in the United States. Because cigarette smoking and tobacco use are acquired behaviors -- activities that people choose to do -- smoking is the most preventable cause of premature death in our society.

Here you will find a brief overview of cigarette smoking: who smokes, how smoking affects health, what makes it so hard to quit, and what some of the many rewards of quitting are. For more on this topic, see our document, Guide to Quitting Smoking.

Who smokes?

Adults

The Centers for Disease Control and Prevention (CDC) reported that 43.4 million US adults were current smokers in 2007 (the most recent year for which numbers are available). This is 19.8% of all adults (22.3% of men, 17.4% of women) -- about 1 out of 5 people.

When broken down by race/ethnicity, the numbers were as follows:

There were more cigarette smokers in the younger age groups. In 2007, the CDC reported almost 22.8% of those 25 to 44 years old were current smokers, compared to 8.3% in those aged 65 or older.

High school and middle school students

Nationwide, 20% of high school students were smoking cigarettes in 2007. The most recent survey of middle school students shows that 6% were smoking cigarettes. More White and Hispanic students smoked cigarettes. (For more information, see our document, Child and Teen Tobacco Use.)

How does smoking cause illness and death?

About half of all Americans who keep smoking will die because of the habit. Each year about 443,000 people in the United States die from illnesses related to cigarette smoking. Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

Cancer caused by smoking

Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of the following cancers:

• lung
• voice box (larynx)
• mouth (oral cavity)
• throat (pharynx)
• bladder
• the swallowing tube connected to the stomach (esophagus)

Smoking is also linked to the following cancers:

• pancreas
• cervix
• kidney
• stomach
• some leukemias

Smoking is responsible for about 87% of lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women, and is one of the most difficult cancers to treat. Lung cancer is a disease that can often be prevented. Some religious groups that promote non-smoking as part of their religion, such as Mormons and Seventh-day Adventists, have much lower rates of lung cancer and other smoking-related cancers.

Other health problems caused by smoking

Only about half of the deaths related to smoking are from cancer. Smoking is also a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke, and it makes pneumonia and asthma worse.

Using tobacco can damage a woman's reproductive health and hurt babies. Tobacco use is linked with reduced fertility and a higher risk of miscarriage, early delivery (premature birth), stillbirth, infant death, and is a cause of low birth-weight in infants. It has also been linked to sudden infant death syndrome (SIDS).

Smoking has been linked to other health problems, too, including gum disease, cataracts, bone thinning, hip fractures, and peptic ulcers. It is also linked to macular degeneration, an eye disease that can cause blindness.

Smoking can cause or worsen poor blood flow in the arms and legs (peripheral vascular disease or PVD.) Even worse, surgery that aims to improve the blood flow often doesn't work in people who keep smoking. Because of this, many surgeons who work on blood vessels (vascular surgeons) won't do certain surgeries on patients with PVD unless they stop smoking. Studies looking at male smokers have found that they are more likely to have sexual impotence (erectile dysfunction) the longer they smoke, which may be due to the problem with blood flow.

If that's not enough, the smoke from cigarettes (called secondhand smoke or environmental tobacco smoke) has a harmful health effect on those exposed to it. Adults and children can have health problems from breathing secondhand smoke. (See our documents, Secondhand Smoke and Women and Smoking.)

Effects of smoking on how long you live and your quality of life

Based on data collected from 1995 to 1999, the CDC estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

But not all of the health problems related to smoking result in deaths. Smoking affects a smoker's health in many ways, harming nearly every organ of the body, and causing diseases. According to the CDC, in 2000 about 8.6 million people had at least one chronic disease because they smoked or had smoked. Many of these people were suffering from more than one smoking-related problem. The diseases seen most often were chronic bronchitis, emphysema, heart attacks, strokes, and cancer. These diseases can steal away a person's quality of life long before death. Smoking-related illness can limit a person's daily life by making it harder to breathe, get around, work, or play.

Taking care of yourself

If you have used tobacco in any form, now or in the past, tell your health care provider so he or she can be sure that you have right preventive health care. It is well known that smoking puts you at risk for certain health-related illnesses. This means 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 check the inside of your mouth regularly for any changes. If you do find any changes or problems, you should have an oral exam by your doctor or dentist. The American Cancer Society recommends that medical check-ups should include mouth (oral cavity) exams. By doing this tobacco users may be able to find changes such as leukoplakia (white patches on the membranes in the mouth) early. This may help prevent oral cancer.

You should also be aware of any of the following:

• any change in a cough (for example, you cough up more phlegm or mucus than usual)
• a new cough
• coughing up blood
• hoarseness
• trouble breathing
• wheezing
• headaches
• chest pain
• loss of appetite
• weight loss
• feeling tired all the time (fatigue)
• frequent lung or respiratory infections (like pneumonia or bronchitis)

Any of these could be signs of lung cancer or a number of other lung conditions and you should report any symptom to your doctor. Although these can be signs of a problem, many lung cancers do not cause any symptoms most people would notice until they are advanced and have spread to other parts of the body.

If you have any health concerns that you think may be caused by your cigarette smoking, please see your health care provider right away. 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 smoking.

What is in tobacco?

Cigarettes, cigars, and spit and pipe tobacco are made from dried tobacco leaves, as well as ingredients added for flavor and other reasons. More than 4,000 different chemicals have been found in tobacco and tobacco smoke. Among these are more than 60 chemicals that are known to cause cancer (carcinogens).

There are hundreds of substances added to cigarettes by manufacturers to enhance the flavor or to make smoking more pleasant. Some of the compounds found in tobacco smoke include ammonia, tar, and carbon monoxide. Exactly what effects these substances have on the cigarette smoker’s health is unknown, but there is no evidence that lowering the tar content of a cigarette lowers the health risk. Manufacturers do not usually give out information to the public about the additives used in cigarettes, so it is hard to know the health risks.

Nicotine addiction

Addiction is marked by the repeated, compulsive seeking or use of a substance despite its harmful effects and unwanted consequences. Addiction is defined as physical and psychological (mental and emotional) dependence on the substance. Nicotine is the addictive drug in tobacco. Regular use of tobacco products leads to addiction in a high percentage of users.

In 1988, the US Surgeon General concluded the following:

• Cigarettes and other forms of tobacco are addicting.
• Nicotine is the addicting drug in tobacco.
• The ways people become addicted to tobacco are much like those that lead to addiction to other drugs such as heroin and cocaine.

These statements are as true today as they were 20 years ago. All forms of tobacco have a lot of nicotine. It is easily absorbed through the lungs with smoking and through the mouth or nose with oral tobacco (spit, snuff, or smokeless tobacco). From these entry points, nicotine quickly spreads throughout the body.

Tobacco companies are required by law to report nicotine levels in cigarettes to the Federal Trade Commission (FTC). But in most states they are not required to show the amount of nicotine on the cigarette package label. The actual amount of nicotine available to the smoker in a given brand of cigarettes is often different from the level reported to the FTC. In one regular cigarette, the average amount of nicotine the smoker gets ranges between about 1 mg and 2 mg. But the cigarette itself contains more than 1 or 2 mg. The amount people actually take in depends on how they smoke, how many puffs they take, how deeply they inhale, and other factors.

How powerful is nicotine addiction?

Although 70% of smokers say they want to quit and about 40% try to quit each year, only 4% to 7% succeed without help. This is because smokers not only become physically addicted to nicotine; there is a strong emotional (psychological) aspect and they often link smoking with many social activities. All of these factors make smoking a hard habit to break.

Why quit smoking?

Nicotine is a very addictive drug. People usually try to quit many times before they are successful. In September 1990, the US Surgeon General outlined what you gain when you quit smoking:

• Quitting smoking has major health benefits that start right away. This is true for people who already have smoking-related disease as well as those who don't.

• Former smokers live longer than people who keep smoking. For example, people who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with people who keep smoking.

• Quitting smoking lowers the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung diseases such as emphysema and chronic bronchitis.

• Women who stop smoking before they get pregnant reduce their risk of having a low birth-weight baby to that of women who never smoked. Even women who quit during the first 3 to 4 months of pregnancy have much healthier babies than those who keep smoking.

• The health benefits of quitting smoking are far greater than any risks from the small weight gain (usually less than 10 pounds) or any emotional or psychological problems that may follow quitting.

Your risk of having lung cancer and other smoking-related cancers depends on how much you have been exposed to cigarette smoke over your lifetime. This is measured by the number of cigarettes you smoked each day, how old you were when you started smoking, and the number of years you have smoked. There is no way to precisely measure a person's risk of getting cancer, but the more you smoke and the longer you do it, the greater your risk.

The good news is that the risk of having lung cancer and other smoking-related illnesses can be reduced if you stop smoking. The risk of lung cancer is less in people who quit smoking than in people who keep smoking the same number of cigarettes every day. The risk decreases as the number of years since quitting increases.

People who stop smoking when they are young get the greatest health benefits from quitting. Those who quit in their 30s may avoid most of the risk due to tobacco use. But even smokers who quit after age 50 largely reduce their risk of dying early. The argument that it is too late to quit smoking because the damage is already done is not true. It is never too late to quit smoking!

For more information, see our document, Guide to Quitting Smoking.

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)

• Guide to Quitting Smoking (also available in Spanish)

• Double Your Chances of Quitting Smoking

• Helping a Smoker Quit: Dos and Don'ts

• Questions About Smoking, Tobacco, and Health (also available in Spanish)

• 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)

National organizations and Web sites*

In addition to the American Cancer Society, other sources of information and support include:

American Heart Association & American Stroke Association
Heart Association
Toll-free number: 1-800-242-8721 (1-800-AHA-USA-1)
Web site: www.americanheart.org
Stroke Association
Toll-free number: 1-888-478-7653 (1-888-4-STROKE)
Web site: www.strokeassociation.org

American Lung Association
Toll-free number: 1-800-548-8252 (1-800-LUNG-USA)
Web site: www.lungusa.org

Centers for Disease Control and Prevention (CDC)
Office of Smoking and Health
Toll-free number: 1-800-232-4636 (1-800-CDC-INFO)
Web site: www.cdc.gov/tobacco/quit_smoking/index.htm

National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER) -- Answers as "Cancer Information Service"
Toll-free number: 1-877-448-7848 (help in quitting smoking)
Web site: www.cancer.gov

Nicotine Anonymous
Toll-free number: 1-877-879-6422 (1-877-TRY-NICA)
Web site: www.nicotine-anonymous.org

Smokefree.gov
(Info on state phone-based quitting programs)
Toll-free number: 1-800-QUITNOW (1-800-784-8669)
Web site: www.smokefree.gov

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or visit www.cancer.org.

References

American Cancer Society. Cancer Facts & Figures 2008. Atlanta, GA. 2008.

American Lung Association. Trends in Tobacco Use. 2007. Available from: http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=67648. Accessed October 4, 2007.

American Lung Association. Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet. 2008. Available from: http://www.lungusa.org. Accessed October 1, 2008.

Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults --- United States, 2007. Morb Mort Wkly Rep. 2008;57(45):1221-1226. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a2.htmAccessed November 13, 2008.

Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses, United States, 2000--2004. Morb Mort Wkly Rep. 2008;57(45):1226-1228. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm. Accessed November 13, 2008.

Centers for Disease Control and Prevention (CDC). Smoking and Tobacco Use: National Youth Tobacco Survey, 2006 NYTS Data and Documentation. Available online at: www.cdc.gov/tobacco/data_statistics/surveys/NYTS/#NYTS2006. Accessed September 9, 2008.

Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Surveillance --- United States, 2007. Morbidity and Mortality Weekly Report. 2008; 57(SS-04);1-31. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5704a1.htm. Accessed September 3, 2008.

Chakravarthy U, Augood C, Bentham GC, et al. Cigarette smoking and age-related macular degeneration in the EUREYE Study. Ophthalmology. 2007;114:1157-1163.

Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519-1528.

He J, Reynolds K, Chen J, Chen CS, et al. Cigarette smoking and erectile dysfunction among Chinese men without clinical vascular disease. Am J Epidemiol. 2007;166:803-9.

National Cancer Institute (NCI). Cigarette Smoking and Cancer: Questions and Answers. 2004. Available at: www.cancer.gov/cancertopics/factsheet/Tobacco/cancer. Accessed October 7, 2008.

Office of the US Surgeon General. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1990. Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T. Accessed October 1, 2008.

Office of the US Surgeon General. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 2004. Available at: www.surgeongeneral.gov/library/smokingconsequences/. Accessed October 7, 2008.

Office of the US Surgeon General. The Health Consequences of Smoking: Cancer: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1982. Available at: http://profiles.nlm.nih.gov/NN/B/C/D/W/. Accessed October 1, 2008.

Office of the US Surgeon General. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1988. Available at: http://profiles.nlm.nih.gov/NN/B/B/Z/D/. Accessed October 1, 2008.

Office of the US Surgeon General. Reducing Tobacco Use: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 2000. Available at: www.cdc.gov/tobacco/data_statistics/sgr/sgr_2000/index.htm. Accessed October 7, 2008.

Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ. 2000;321:323-329.

US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services; 2006. Available at: www.surgeongeneral.gov/library/secondhandsmoke/. Accessed October 3, 2008.

Willigendael EM, Teijink JA, Bartelink ML, Peters RJ, et al. Smoking and the patency of lower extremity bypass grafts: a meta-analysis. J Vasc Surg. 2005;42:67-74.

Last Medical Review: 10/16/2008
Last Revised: 11/14/2008