Smoking is the inhalation of the smoke of burning tobacco that is used mostly in three forms: cigarettes, pipes, and cigars.


Casual smoking is the act of smoking only occasionally, usually in a social situation or to relieve stress. A smoking habit is a physical addiction to tobacco products. Many health experts as of 2004 regarded habitual smoking as a psychological addiction, one with serious health consequences. Nicotine, the active ingredient in tobacco, is inhaled into the lungs, where most of it stays. The rest passes into the bloodstream, reaching the brain in about 10 seconds and dispersing throughout the body in about 20 seconds.

Depending on the circumstances and the amount consumed, nicotine can act as either a stimulant or tranquilizer. This dual role explains why some people report that smoking gives them energy and stimulates their mental activity, while others note that smoking relieves anxiety and relaxes them. The initial effect results in part from the drug's stimulation of the adrenal glands and resulting release of epinephrine into the blood. Epinephrine causes several physiological changes: it temporarily narrows the arteries, raises the blood pressure, raises the levels of fat in the blood, and increases the heart rate and flow of blood from the heart. Some researchers think epinephrine contributes to smokers' increased risk of high blood pressure.

Nicotine, by itself, increases the risk of heart disease. However, when a person smokes, he or she is ingesting a lot more than nicotine. Smoke from a cigarette, pipe, or cigar is made up of many additional toxic chemicals, including tar and carbon monoxide. Tar is a sticky substance that forms as deposits in the lungs, causing lung cancer and respiratory distress. Carbon monoxide limits the amount of oxygen that the red blood cells can convey throughout the body. Nicotine may also damage the inner walls of the arteries, which allows fat to build up in them.

Besides tar, nicotine, and carbon monoxide, tobacco smoke contains 4,000 different chemicals. More than 200 of these chemicals are known to be toxic. Nonsmokers who are exposed to tobacco smoke also take in these toxic chemicals. They inhale the smoke exhaled by the smoker as well as the more toxic sidestream smoke—the smoke from the end of the burning cigarette, cigar, or pipe.

The harmful effects of teenage smoking are both short-term and long-term. During adolescence , smoking interferes with ongoing lung growth and development, preventing the attainment of full lung function. Teenagers who smoke are less fit than their nonsmoking peers and more apt to experience shortness of breath, dizziness , coughing, and excess phlegm in their lungs. They are also more vulnerable to colds, flu, pneumonia , and other respiratory problems. Smoking for even a short time can produce a chronic smoker's cough . In addition to respiratory problems and a diminished level of overall well-being in adolescence, teenage smoking is also responsible for health problems in adulthood.

It is estimated that one third of the teenagers who start smoking each year eventually die of diseases related to tobacco use, diseases that will shorten their lives by an average of 12–15 years. Cigarette smoking is a major risk factor for cardiovascular disease, including coronary heart disease, atherosclerosis (hardening of the arteries), and stroke . Reports by the surgeon general link teenage smoking to cardiovascular disease in both adolescents and adults. The same reports cite evidence that the length of time a person has smoked has a greater impact on the risk of developing lung cancer and other smoking-related cancers than the number of cigarettes smoked; in other words, starting to smoke at an early age is an even greater health risk than being a heavy smoker.


The National Survey on Drug Use and Health (NSDUH) is conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. The study found that an estimated 70.8 million Americans reported current (past month) use of a tobacco product in 2003. This is 29.8 percent of the population aged 12 or older, similar to the rate in 2002 (30.4%). Young adults aged 18–25 reported the highest rate of past month cigarette use (40.2%), similar to the rate among young adults in 2002. An estimated 35.7 million Americans aged twelve or older in 2003 were classified as nicotine dependent in the past month because of their cigarette use (15% of the total population), about the same as for 2002.

Young adults aged 18 to 25 had the highest rate of current use of cigarettes (40.2%), similar to the rate in 2002. Past month cigarette use rates among youths in 2002 and 2003 were 13 percent and 12.2 percent, respectively, not a statistically significant change. However, there were significant declines in past year (from 20.3% to 19%) and lifetime (from 33.3% to 31%) cigarette use among youths aged 12 to 17 between 2002 and 2003. Among persons aged twelve or older, a higher proportion of males than females smoked cigarettes in the past month in 2003 (28.1% versus 23%). Among youths aged 12 to 17, however, girls (12.5%) were as likely as boys (11.9%) to smoke in the past month. There was no change in cigarette use among boys aged 12 to 17 between 2002 and 2003. However, among girls, cigarette use decreased from 13.6 percent in 2002 to 12.5 percent in 2003.

Causes and symptoms

No one starts smoking to become addicted to nicotine. It is not known how much nicotine may be consumed before the body becomes addicted. However, once smoking becomes a habit, the smoker faces a lifetime of health risks associated with one of the strongest addictions known to humans.

Smoking risks

Smoking is recognized as the leading preventable cause of death, causing or contributing to the deaths of approximately 430,700 Americans each year. Anyone with a smoking habit has an increased chance of cancer (lung, cervical, and other types); respiratory diseases (emphysema, asthma , and chronic bronchitis ); and cardiovascular disease (heart attack, high blood pressure, stroke, and atherosclerosis). The risk of stroke is especially high in women who take birth control pills.

Smoking can damage fertility, making it harder to conceive, and it can interfere with the growth of the fetus during pregnancy. It accounts for an estimated 14 percent of premature births and 10 percent of infant deaths. There is some evidence that smoking may cause impotence in men. Because smoking affects so many of the body's systems, smokers often have vitamin deficiencies and suffer oxidative damage caused by free radicals. Free radicals are molecules that steal electrons from other molecules, turning the other molecules into free radicals and destabilizing the molecules in the body's cells.

Studies reveal that the more a person smokes, the more likely he is to sustain illnesses such as cancer, chronic bronchitis, and emphysema. But even smokers who indulge in the habit only occasionally are more prone to these diseases. Some brands of cigarettes are advertised as low tar, but no cigarette is truly safe. If a smoker switches to a low-tar cigarette, he is likely to inhale longer and more deeply to get the chemicals his body craves. A smoker has to quit the habit entirely in order to improve his health and decrease the chance of disease.

Though some people believe chewing tobacco is safer, it also carries health risks. People who chew tobacco have an increased risk of heart disease and mouth and throat cancer. Pipe and cigar smokers have increased health risks as well, even though these smokers generally do not inhale as deeply as cigarette smokers do. These groups have not been studied as extensively as cigarette smokers, but there is evidence that they may be at a slightly lower risk of cardiovascular problems but a higher risk of cancer and various types of circulatory conditions. Some research reveals that passive smokers, or those who unavoidably breathe in second-hand tobacco smoke, have an increased chance of many health problems such as lung cancer, asthma, and sudden infant death syndrome in babies.

Smokers' symptoms

Smokers are likely to exhibit a variety of symptoms that reveal the damage caused by smoking. A nagging morning cough may be one sign of a tobacco habit. Other symptoms include shortness of breath, wheezing, and frequent occurrences of respiratory illness, such as bronchitis. Smoking also increases fatigue and decreases the smoker's sense of smell and taste. Smokers are more likely to develop poor circulation, with cold hands and feet, and premature wrinkles.

Sometimes the illnesses that result from smoking come with little warning. For instance, coronary artery disease may exhibit few or no symptoms. At other times, there will be warning signs, such as bloody discharge from a woman's vagina, a sign of cancer of the cervix. Another warning sign is a hacking cough, worse than the usual smoker's cough, that brings up phlegm or blood, a sign of lung cancer.

Withdrawal symptoms

A smoker who tries to quit may expect one or more of these withdrawal symptoms: nausea , constipation or diarrhea , drowsiness, loss of concentration, insomnia, headache , nausea, and irritability.

When to call the doctor

Smokers should seek medical help if they want to quit smoking but are unable to do so, or if they exhibit signs of any of the illnesses associated with long-term tobacco use. Persons who are frequently around smokers should seek medical advice if they show any of the symptoms associated with illnesses caused by smoking since second-hand smoke can be more damaging to health than first-hand smoke.


It is not easy to quit smoking. That is why it may be wise for smokers to turn to their physician for help. For the greatest success in quitting and to help with the withdrawal symptoms, smokers should talk over a treatment plan with their doctor or alternative practitioner. They should have a general physical examination to gauge their general health and uncover any deficiencies. They should also have a thorough evaluation for some of the serious diseases that smoking can cause.

Research shows that most smokers who want to quit benefit from the support of other people. It helps to quit with a friend or to join a group such as those organized by the American Cancer Society. These groups provide support and teach behavior modification methods that can help the smoker quit. The smoker's physician can often refer him to such groups.

Other alternatives to help with the withdrawal symptoms include nicotine replacement therapy in the form of gum, patches, nasal sprays, and oral inhalers. These are available by prescription or over the counter. A physician can provide advice on how to use them. They slowly release a small amount of nicotine into the bloodstream, satisfying the smoker's physical craving. Over time, the amount of gum the smoker chews is decreased and the amount of time between applying the patches is increased. This process helps wean the smoker from nicotine slowly. However, if the smoker smokes while taking a nicotine replacement, a nicotine overdose may occur.

The drug buproprion hydrochloride has shown some success in helping smokers quit. This drug contains no nicotine and was originally developed as an antidepressant. It is not known exactly how buproprion works to suppress the desire for nicotine.

Alternative treatment

There are a wide range of alternative treatments that can help a smoker quit the habit, including hypnotherapy, herbs, acupuncture, and meditation. For example, a controlled trial demonstrated that self-massage can help smokers crave less intensely, smoke fewer cigarettes, and in some cases completely give them up.


Research on smoking shows that 80 percent of all smokers desire to quit. But smoking is so addictive that fewer than 20 percent of the people who try ever successfully break the habit. Still, many people attempt to quit smoking over and over again, despite the difficulties—the cravings and withdrawal symptoms, such as irritability and restlessness.

For those who do quit, it is well worth the effort. The good news is that once a smoker quits the health effects are immediate and dramatic. After the first day, oxygen and carbon monoxide levels in the blood return to normal. At two days, nerve endings begin to grow back and the senses of taste and smell revive. Within two weeks to three months, circulation and breathing improve. After one year of not smoking, the risk of heart disease is reduced by 50 percent. After 15 years of abstinence, the risks of health problems from smoking virtually vanish. A smoker who quits for good often feels a lot better too, with less fatigue and fewer respiratory illnesses.


How do smokers give up their cigarettes for good and never go back to them again? Here are a few tips from the experts:

  • People should tell their friends and neighbors that they are quitting. Doing so helps make quitting a matter of pride.
  • They should chew sugarless gum or eat sugar-free hard candy to redirect the oral fixation that comes with smoking and to prevent weight gain.
  • They should eat as much as they want, but only low-calorie foods and drinks. They should drink plenty of water, which may help with the feelings of tension and restlessness that quitting can bring. After eight weeks, they will lose their craving for tobacco, so it is safe then to return to their usual eating habits.
  • They should stay away from situations that prompt smoking, avoiding other people who smoke and dining in the nonsmoking section of restaurants.

Parental concerns

Parents and guardians need to be aware of the power they have to influence the development of their kids throughout the pre-teen and teenage years. Adolescence brings a new and dramatic stage to family life. The changes that are required are not just the teen's to make; parents need to change their relationship with their teenager. It is best if parents are proactive about the challenges of this life cycle stage, particularly those that pertain to the possibility of experimenting with and using tobacco. Parents should not be afraid to talk directly to their kids about smoking, even if they have had problems with smoking themselves. Parents should give clear, nouse messages about smoking and its negative consequences on health. It is important for kids and teens to understand that the rules and expectations set by parents are based on parental love and concern for their wellbeing. Parents should also be actively involved and demonstrate interest in their teen's friends and social activities. Spending quality time with teens and setting good examples are essential. Even if tobacco use already exists in the teen's life, parents and families can still have a positive influence on their teen's behavior.



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Campaign for Tobacco-Free Kids. 1400 Eye Street, Suite 1200, Washington DC 20005. Web site:

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Barbara Boughton, Ph.D.

Ken R. Wells


Antioxidant —Any substance that reduces the damage caused by oxidation, such as the harm caused by free radicals.

Chronic bronchitis —A smoking-related respiratory illness in which the membranes that line the bronchi, or the lung's air passages, narrow over time. Symptoms include a morning cough that brings up phlegm, breathlessness, and wheezing.

Emphysema —A chronic respiratory disease that involves the destruction of air sac walls to form abnormally large air sacs that have reduced gas exchange ability and that tend to retain air within the lungs. Symptoms include labored breathing, the inability to forcefully blow air out of the lungs, and an increased susceptibility to respiratory tract infections. Emphysema is usually caused by smoking.

Epinephrine —A hormone produced by the adrenal medulla. It is important in the response to stress and partially regulates heart rate and metabolism. It is also called adrenaline.

Flavonoid —A food chemical that helps to limit oxidative damage to the body's cells, and protects against heart disease and cancer.

Free radical —An unstable molecule that causes oxidative damage by stealing electrons from surrounding molecules, thereby disrupting activity in the body's cells.

Nicotine —A colorless, oily chemical found in tobacco that makes people physically dependent on smoking. It is poisonous in large doses.

Nicotine replacement therapy —A method of weaning a smoker away from both nicotine and the oral fixation that accompanies a smoking habit by giving the smoker smaller and smaller doses of nicotine in the form of a patch or gum.

Secondhand smoke —A mixture of the smoke given off by the burning end of a cigarette, pipe, or cigar and the smoke exhaled from the lungs of smokers.

Sidestream smoke —The smoke that is emitted from the burning end of a cigarette or cigar, or that comes from the end of a pipe. Along with exhaled smoke, it is a constituent of second-hand smoke.

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