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Exposure to secondhand smoke, even for a short time, can be harmful to both children and adults. Most people are exposed to secondhand smoke in their homes or the places they work. People may also be exposed to secondhand smoke in public places like bars, restaurants, and casinos, as well as in vehicles. 1,2,3

Smokefree laws for all workplaces and public areas protect people who do not smoke. There are also steps you can take to protect yourself and your family from secondhand smoke, such as making your home and vehicles smokefree. 2,3 These laws and policies are the only way to fully protect people who do not smoke from secondhand smoke exposure. They also can help people who smoke quit, and can help keep young people from starting to smoke. 1,4,5

Secondhand smoke is smoke from burning tobacco products, like cigarettes, cigars, hookahs, or pipes.1,6,7

Secondhand smoke also is smoke that has been exhaled, or breathed out, by the person smoking.6,7

There are more than 7,000 chemicals in tobacco smoke, including hundreds of chemicals that are toxic and about 70 that can cause cancer.¹ Here are just a few of the chemicals and poisons in tobacco smoke:

Anyone who is exposed to it, even for a short time. Secondhand smoke can cause health problems in children and adults, and can even be deadly. 1,2,6 Since 1964, about 2,500,000 people who do not smoke have died from health problems caused by secondhand smoke exposure. ¹

Because more communities and states are adopting smokefree laws, the number of adults exposed to secondhand smoke in public places like worksites, bars, restaurants, and casinos has gone down. ⁸ However, for many, especially children, exposure to secondhand smoke happens in places like homes and vehicles. ⁹ You are especially likely to be exposed to secondhand smoke if you live in multi-unit housing-like apartment buildings with many homes next to one another in the same place. 9,10

How Secondhand Smoke Harms Adults 1,3,8

Even if you have never smoked, secondhand smoke can still cause:

Heart disease

Lung cancer

Stroke

How Secondhand Smoke Harms Children 1,3,8
Even brief exposure to secondhand smoke can be harmful to your heart and blood vessels.

Because their bodies are still growing, infants and young children are especially vulnerable to health risks from secondhand smoke.

Babies who breathe secondhand smoke are more likely to die unexpectedly from sudden infant death syndrome (SIDS), also called crib death, than babies who are not exposed to smoke from burning tobacco products.

Babies exposed to secondhand smoke in the womb or after birth are born and grow up with weaker lungs than babies that are not exposed to secondhand smoke.

Babies and children who breathe secondhand smoke are sick more often with bronchitis, pneumonia, and ear infections than those that are not exposed to secondhand smoke.

For children with asthma, breathing secondhand smoke can trigger an asthma attack.

Homes are the main places where babies, children, and teens are exposed to secondhand smoke. 1,9

In 2019, almost 7 million U.S. middle and high school students (about 25%) reported breathing secondhand smoke in their homes, and just over 6 million (about 23%) reported breathing secondhand smoke in vehicles.⁹

A larger percentage of non-Hispanic Black and non-Hispanic white middle and high school students in the U.S. reported being exposed to secondhand smoke in 2019 than Hispanic/Latinx middle and high school students or students of other races.⁹

Smoking in another room like a bathroom or bedroom can still spread secondhand smoke through the air in your home. In an apartment building, secondhand smoke can go in between apartments.

Smoking outside in a hall or stairwell does not protect children inside. Smoke goes under doors, windows, and through cracks.

Opening a window or using a fan does not protect children from secondhand smoke.

Air purifiers and air fresheners do not remove secondhand smoke.

Smoke from one cigarette can stay in a room for hours. Don't smoke at home, even when children aren't there.

Separating people who smoke from those who don't smoke, cleaning the air and ventilating buildings does not fully protect children or adults from secondhand smoke.

To protect the children inside, houses and apartment buildings must be smokefree. Across the country, more and more multiunit housing complexes, such apartments and condominiums, are making indoor spaces smokefree. However, people who live in multiunit housing are not protected until all units and common areas are smokefree. 1,9,11

You can help protect yourself, family, friends, and your community.

If you smoke cigarettes, the best decision you can make for your health and your family's health is to quit. Quitting smoking can be hard, and it can take many tries. Luckily, there are more science-backed tools than ever before to help you quit successfully, including:

Calling a quitline can connect you with a coach who can provide support, help you make a quit plan, and more.

If a loved one smokes, support them by encouraging them to quit.

Get rid of all ashtrays and tobacco products in your home.

Don't let anyone smoke in or around your house. If you have children or if you take care of children in your home, do not allow anyone to smoke there. Do not let babysitters or family and friends smoke around your children.

Don't let anyone smoke in your car, even with the windows down. Putting the windows down does not protect people from secondhand smoke

Make sure smoking is not allowed at your child's day care.

Make sure your child's school is smokefree inside and out. All school events should be tobacco-free, and make sure the tobacco-free policy includes e-cigarettes. You can talk to teachers or school officials about enforcing these rules.

If your state still allows smoking in public areas, look for restaurants and other public places that do not allow smoking.

"No Smoking" sections in restaurants that separate people who smoke from those who don't do not protect you or your children from secondhand smoke.

Ventilation, air conditioning, or air purifiers do not protect you or your children from secondhand smoke.

Talk to your employer about the benefits of a tobacco-free policy in your workplace.

Educate people who make decisions in your community about the benefits of smokefree laws and policies in public places, workplaces, and housing. Tell these leaders you support businesses going smokefree.

If you own or manage a business, adopt a smokefree policy for employees and customers. Find out why Going Smokefree Matters.

Protecting the people in your home also means not using other types of tobacco products, including e-cigarettes.

The aerosol from e-cigarettes is not harmless. It can contain cancer-causing chemicals, heavy metals like nickel, tin, and lead, among other things.

E-cigarettes are not safe for children, teens, young adults, pregnant adults, or people who do not already use tobacco.

Here are some printable hand-outs on protecting children from secondhand smoke for:

Children respect and learn from your actions and words. As caregivers, we teach our children by the choices we make. What we do now can change our children's future.

1. U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2021 Feb 2].

2. U.S. Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2021 Feb 2].

3. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2021 Feb 2].

4. Hopkins DP, Razi S, Leeks KD, Priva Kalra G, Chattopadhyay SK, Soler RE, et al. Task Force on Community Preventive Services. Smoke-Free Policies to Reduce Tobacco Use: A Systematic Review. American Journal of Preventive Medicine 2010;38(2 Suppl):S275-89 [accessed 2021 Feb 2].

5. Siegel M, Albers AB, Cheng DM, Biener L, Rigotti NA. Local Restaurant Smoking Regulations and the Adolescent Smoking Initiation Process: Results of a Multilevel Contextual Analysis Among Massachusetts Youth. Archives of Pediatric and Adolescent Medicine 2008;162(5):477-83 [accessed 2021 Feb 2].

6. Institute of Medicine Committee on Secondhand Smoke Exposure and Acute Coronary Events. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidenceexternal icon . Washington, D.C., National Academies Press 2010 [accessed 2021 Feb 2].

7. National Toxicology Program. Report on Carcinogens, Fourteenth Editionexternal icon . Research Triangle Park (NC): U.S. Department of Health and Human Services, Public Health Service, 2016 [accessed 2021 Feb 2].

8. Tsai J, Homa DM, Gentzke AS, Mahoney M et al. Exposure to Secondhand Smoke Among Nonsmokers-United States, 1988-2014. MMWR 2018;67(48): 1342-46 [accessed 2021 Feb 2].

9. Walton K, Gentzke AS, Murphy-Hoefer R, Kenemer B, Neff LJ. Exposure to Secondhand Smoke in Homes and Vehicles Among US Youths, United States, 2011-2019. Preventing Chronic Disease 2020(17) [accessed 2021 Feb 2].

10. Wilson KM, Klein JD, Blumkin AK, Gottlieb M, Winickoff JP .Tobacco Smoke Exposure in Children Who Live in Multiunit Housing.external icon Pediatrics 2011:127(1):85-92 [accessed 2021 Feb 2].

11. King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine and Tobacco Research 2013a;15(7):1316-21 [accessed 2021 Feb 2].

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CDC - Secondhand Smoke - Smoking & Tobacco Use

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Exposure to secondhand smoke, even for a short time, can be harmful to both children and adults. Most people are exposed to secondhand smoke in their homes or the places they work. People may also be exposed to secondhand smoke in public places like bars, restaurants, and casinos, as well as in vehicles.

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Centers for Disease Control and Prevention

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Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon. 1,2

Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking. 1,2

Hookah is also called narghile, argileh, shisha, hubble-bubble, and goza. 1,2

Hookahs vary in size, shape, and style. ²

A typical modern hookah has a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece. 3,4

Hookah smoking is typically done in groups, with the same mouthpiece passed from person to person. 1,2,3,4

Hookah smoking is NOT a safe alternative to smoking cigarettes. ¹
Tobacco users should quit all tobacco products to reduce health risks.

Hookah use began centuries ago in ancient Persia and India.1,2,3,4

Today, hookah cafés are gaining in popularity around the world, including Britain, France, Russia, the Middle East, and the United States.¹

In 2018, the Monitoring the Future survey found that-5,6

Nearly 1 in every 13 (7.8%) high school students in the United States had used a hookah to smoke tobacco during the previous year.

About 1 in every 8 (12.3%) young adults aged 19-30 years had used a hookah to smoke tobacco during the previous year.

Among 12th graders, annual hookah use increased from nearly 1 in 6 students (17.1%) in 2010 to about 1 in 4 students (22.9%) in 2014, but since that time has decreased sharply to nearly 1 in 13 students (7.8%) in 2018.⁵

Monitoring the Future also shows variations in hookah use by region and population density. In 2018, the highest prevalence of use were observed in the Northeast, where 1 in 6 (15.0%) young adults aged 19-30 years had used a hookah to smoke tobacco during the previous year, and in very large cities, where almost 1 in 5 (19.3%) young adults in this age group reported past year use .⁶

Other small studies of young adults have found high prevalence of hookah use among college students in the United States. These studies show past-year use ranging from 22% to 40%.⁷

New forms of electronic hookah products, including steam stones and hookah pens, have been introduced.

These products are battery powered and turn liquid containing nicotine, flavorings, and other chemicals into an aerosol, which is inhaled.⁸

Limited information is currently available on the health risks of electronic tobacco products, including electronic hookahs.8,9

Using a hookah to smoke tobacco poses serious health risks to smokers and others exposed to the smoke from the hookah.

Hookah Smoke and Cancer

The charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.1,4

Even after it has passed through water, the smoke from a hookah has high levels of these toxic agents.⁴

Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.1,4

Tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers.4,10

Other Health Effects of Hookah Smoke

Hookah tobacco and smoke contain many toxic agents that can cause clogged arteries and heart disease.1,4

Infections may be passed to other smokers by sharing a hookah.²

Babies born to women who smoked water pipes every day while pregnant weigh less at birth (at least 3½ ounces less) than babies born to nonsmokers.7,11

Babies born to hookah smokers are also at increased risk for respiratory diseases.¹⁰

Hookah Smoking Compared With Cigarette Smoking

While many hookah smokers may think this practice is less harmful than smoking cigarettes, hookah smoking has many of the same health risks as cigarette smoking.1,2

Water pipe smoking delivers nicotine-the same highly addictive drug found in other tobacco products.²

The tobacco in hookahs is exposed to high heat from burning charcoal, and the smoke is at least as toxic as cigarette smoke.1,2

Because of the way a hookah is used, smokers may absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do.1,2

An hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs.1,2

The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), compared with 500-600 ml inhaled when smoking a cigarette.⁴

Hookah smokers may be at risk for some of the same diseases as cigarette smokers. These include:3,4

Oral cancer

Lung cancer

Stomach cancer

Cancer of the esophagus

Reduced lung function

Decreased fertility

Hookahs and Secondhand Smoke

Secondhand smoke from hookahs can be a health risk for nonsmokers. It contains smoke from the tobacco as well as smoke from the heat source (e.g., charcoal) used in the hookah.1,7,12

Nontobacco Hookah Products

Some sweetened and flavored nontobacco products are sold for use in hookahs.¹³

Labels and ads for these products often claim that users can enjoy the same taste without the harmful effects of tobacco.¹³

Studies of tobacco-based shisha and "herbal" shisha show that smoke from both preparations contain carbon monoxide and other toxic agents known to increase the risks for smoking-related cancers, heart disease, and lung disease.13,14

1. Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review.external icon International Journal of Epidemiology 2010;39:834-57 [accessed 2019 Dec 30].

2. Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States.external icon American Journal of Health Behavior 2010;34(3):275-85 [accessed 2015 Sep 14].

3. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2012 [accessed 2015 Sep 14].

4. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016 [accessed 2020 Jan 10].

5. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes.external icon Washington, DC: The National Academies Press, 2018 [accessed 2020 Jan 10].

6. El-Hakim Ibrahim E, Uthman Mirghani AE. Squamous Cell Carcinoma and Keratoacanthoma of the Lower Lips Associated with "Goza" and "Shisha" Smoking. International Journal of Dermatology 1999;38:108-10 [cited 2015 Sep 14].

7. Nuwayhid, I, Yamout, B., Ghassan, and Kambria, M. Narghile (Hubble-Bubble) Smoking, Low Birth Weight and Other Pregnancy Outcomes.external icon American Journal of Epidemiology 1998;148:375-83 [accessed 2019 Dec 30].

8. Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T. Indoor Air Quality in Virginia Waterpipe Cafés. Tobacco Control 2012 Mar 24 doi:10.1136/tobaccocontrol-2011-050350 [cited 2015 Sep 14].

9. Shihadeh A, Salman R, Eissenberg T. Does Switching to a Tobacco-Free Waterpipe Product Reduce Toxicant Intake? A Crossover Study Comparing CO, NO, PAH, Volatile Aldehydes, Tar and Nicotine Yields.external icon Food and Chemical Toxicology 2012;50(5):1494-8 [accessed 2015 Sep 14].

10. Blank MD, Cobb CO, Kilgalen B, Austin J, Weaver MF, Shihadeh A, Eissenberg T. Acute Effects of Waterpipe Tobacco Smoking: A Double-Blind, Placebo-Control Study. Drug and Alcohol Dependence 2011external icon ;116(1-3):102-9 [cited 2015 Sep 14].

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
E-mail: tobaccoinfo@cdc.gov
Phone: 1-800-CDC-INFO

Media Inquiries: Contact CDC's Office on Smoking and Health press line at 770-488-5493.

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Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon. 1,2 Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking.

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On This Page

Cigarettes usually differ from cigars in size and in the type of tobacco used ( 1-3). Moreover, in contrast with cigarette smoke, cigar smoke is often not inhaled.

The main features of these tobacco products are:

Cigarettes: Cigarettes are uniform in size and contain less than 1 gram of tobacco each. U.S. cigarettes are made from different blends of tobaccos, which are never fermented, and they are wrapped with paper. Most U.S. cigarettes take less than 10 minutes to smoke.

Cigars: Most cigars are composed primarily of a single type of tobacco (air-cured and fermented), and they have a tobacco wrapper. They can vary in size and shape and contain between 1 gram and 20 grams of tobacco. Three cigar sizes are sold in the United States:

Large cigars can measure more than 7 inches in length, and they typically contain between 5 and 20 grams of tobacco. Some premium cigars contain the tobacco equivalent of an entire pack of cigarettes. Large cigars can take between 1 and 2 hours to smoke.

Cigarillos are a type of smaller cigar. They are a little bigger than little cigars and cigarettes and contain about 3 grams of tobacco.

Little cigars are the same size and shape as cigarettes, are often packaged like cigarettes (20 little cigars in a package), and contain about 1 gram of tobacco. Also, unlike large cigars, some little cigars have a filter, which makes it seem they are designed to be smoked like cigarettes (that is, for the smoke to be inhaled).

Yes. Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. Cigar smoke is possibly more toxic than cigarette smoke ( 3). Cigar smoke has:

A higher level of cancer-causing substances: During the fermentation process for cigar tobacco, high concentrations of cancer-causing nitrosamines are produced. These compounds are released when a cigar is smoked. Nitrosamines are found at higher levels in cigar smoke than in cigarette smoke.

More tar: For every gram of tobacco smoked, there is more cancer-causing tar in cigars than in cigarettes.

A higher level of toxins: Cigar wrappers are less porous than cigarette wrappers. The nonporous cigar wrapper makes the burning of cigar tobacco less complete than the burning of cigarette tobacco. As a result, cigar smoke has higher concentrations of toxins than cigarette smoke.

Furthermore, the larger size of most cigars (more tobacco) and longer smoking time result in higher exposure to many toxic substances (including carbon monoxide, hydrocarbons, ammonia, cadmium, and other substances).

Cigar smoke can be a major source of indoor air pollution ( 1). There is no safe level of exposure to tobacco smoke. If you want to reduce the health risk to yourself and others, stop smoking.

Yes. Cigar smoking causes cancer of the oral cavity, larynx, esophagus, and lung. It may also cause cancer of the pancreas. Moreover, daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease. Regular cigar smokers and cigarette smokers have similar levels of risk for oral cavity and esophageal cancers. The more you smoke, the greater the risk of disease ( 3).

Unlike nearly all cigarette smokers, most cigar smokers do not inhale. Although cigar smokers have lower rates of lung cancer, coronary heart disease, and lung disease than cigarette smokers, they have higher rates of these diseases than those who do not smoke cigars.

All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the esophagus is exposed to carcinogens. These exposures probably account for the similar oral and esophageal cancer risks seen among cigar smokers and cigarette smokers ( 3).

Are cigars addictive?

Yes. Even if the smoke is not inhaled, high levels of nicotine (the chemical that causes addiction) can still be absorbed into the body. A cigar smoker can get nicotine by two routes: by inhalation into the lungs and by absorption through the lining of the mouth. Either way, the smoker becomes addicted to the nicotine that gets into the body.

A single cigar can potentially provide as much nicotine as a pack of cigarettes ( 1).

Nicotine replacement products, or nicotine replacement therapy (NRT), deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Strong and consistent evidence shows that NRT can help people quit smoking cigarettes ( 4). Limited research has been completed to determine the usefulness of NRT for people who smoke cigars. For help with quitting cigar smoking, ask your doctor or pharmacist about NRT, as well as about individual or group counseling, telephone quitlines, or other methods.

Selected References

1. Baker F, Ainsworth SR, Dye JT, et al. Health risks associated with cigar smoking. Journal of the American Medical Association 2000; 284(6):735-740. [ PubMed Abstract]
[PubMed Abstract]

2. Kozlowski LT, Dollar KM, Giovino GA. Cigar/cigarillo surveillance: Limitations of the U.S. Department of Agriculture System. American Journal of Preventive Medicine 2008; 34(5):424-426. [ PubMed Abstract]
[PubMed Abstract]

3. National Cancer Institute (1998). Smoking and Tobacco Control Monograph 9: Cigars: Health Effects and Trends. Bethesda, MD. Retrieved October 21, 2010, from: http://www.cancercontrol.cancer.gov/tcrb/monographs/9/index.html.
[PubMed Abstract]

4. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health, 2000.
[PubMed Abstract]

If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., "Cigar Smoking and Cancer was originally published by the National Cancer Institute."

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On This Page Cigarettes usually differ from cigars in size and in the type of tobacco used ( 1-3). Moreover, in contrast with cigarette smoke, cigar smoke is often not inhaled. The main features of these tobacco products are: Cigarettes: Cigarettes are uniform in size and contain less than 1 gram of tobacco each.

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Know the Risks: E-Cigarettes and Young People | U.S. Surgeon General's Report

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No matter how it's delivered, nicotine is harmful for youth and young adults. E-cigarettes typically contain nicotine as well as other chemicals that are known to damage health. For example, users risk exposing their respiratory systems to potentially harmful chemicals in e-cigarettes. Read about these and other risks young people face if they use e-cigarettes.

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Know the Risks: E-cigarettes & Young People | U.S. Surgeon General's Report

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Facts on e-cigarettes, addiction, and how nicotine can harm the developing brain from the U.S. Surgeon General. Risks of use along with resources and actions to help prevent harm to youth and young adults.

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Centers for Disease Control and Prevention

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Smokeless tobacco is associated with many health problems. Using smokeless tobacco:

Can lead to nicotine addiction1,2

Causes cancer of the mouth, esophagus (the passage that connects the throat to the stomach), and pancreas (a gland that helps with digestion and maintaining proper blood sugar levels)1,2

Is associated with diseases of the mouth1,3

Can increase risks for early delivery and stillbirth when used during pregnancy²

Can cause nicotine poisoning in children⁴

May increase the risk for death from heart disease and stroke1,3

Using smokeless products can cause serious health problems.
Protect your health; don't start. If you do use them, quit.

Smokeless tobacco contains nicotine, which is highly addictive.1,2

Because young people who use smokeless tobacco can become addicted to nicotine, they may be more likely to also become cigarette smokers.⁵

Many smokeless tobacco products contain cancer-causing chemicals.1,6

The most harmful chemicals are tobacco-specific nitrosamines, which form during the growing, curing, fermenting, and aging of tobacco. The amount of these chemicals varies by product.¹

The higher the levels of these chemicals, the greater the risk for cancer.²

Other chemicals found in tobacco can also cause cancer. These include:⁶

A radioactive element (polonium-210) found in tobacco fertilizer

Chemicals formed when tobacco is cured with heat (polynuclear aromatic hydrocarbons-also known as polycyclic aromatic hydrocarbons)

Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, mercury)

Smokeless tobacco causes cancer of the mouth, esophagus, and pancreas.¹

Smokeless tobacco can cause white or gray patches inside the mouth (leukoplakia) that can lead to cancer.¹

Smokeless tobacco can cause gum disease, tooth decay, and tooth loss.1,3

Using smokeless tobacco during pregnancy can increase the risk for early delivery and stillbirth.²

Nicotine in smokeless tobacco products that are used during pregnancy can affect how a baby's brain develops before birth.2,7

Using smokeless tobacco increases the risk for death from heart disease and stroke.1,3

Smokeless tobacco can cause nicotine poisoning in children.⁴

Additional research is needed to examine long-term effects of newer smokeless tobacco products, such as dissolvables and U.S. snus.

1. World Health Organization. [IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 89: Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines.PDF-3.18 MB] Lyon (France): World Health Organization, International Agency for Research on Cancer, 2007 [accessed 2014 Oct 31].

2. U.S. Department of Health and Human Services.The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 Oct 31].

3. Piano MR, Benowitz NL, Fitzgerald GA, Corbridge S, Heath J, Hahn E, et al. Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment: A Policy Statement from the American Heart Association. Circulation 2010;122(15):1520-44 [cited 2014 Oct 31].

4. Connolly GN, Richter P, Aleguas A Jr, Pechacek TF, Stanfill SB, Alpert HR. Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products. Pediatrics 2010;125(5):896-9 [cited 2014 Oct 31].

5. Lund I, Scheffels J. Smoking and Snus Use Onset: Exploring the Influence of Snus Debut Age on the Risk for Smoking Uptake With Cross-Sectional Survey Data. Nicotine and Tobacco Research 2014;16(6):815-9 [cited 2014 Oct 31].

6. Stanfill SB, Connolly GN, Zhang L, Jia LT, Henningfield JE, Richter P, et al. Global Surveillance of Oral Tobacco Products: Total Nicotine, Unionised Nicotine and Tobacco-Specific N-Nitrosamines. Tobacco Control 2011 May;20(3):e2. doi:10.1136/tc.2010.037465 [cited 2014 Oct 31].

7. California Environmental Protection Agency. [Safe Drinking Water and Toxic Enforcement Act of 1986: Chemicals Known to the State to Cause Cancer or Reproductive Toxicity (November 23, 2018). PDF-23.6 KB] California Environmental Protection Agency, Office of Environmental Health Hazard Assessment [accessed 2014 Oct 31].

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See the health effects associated with smokeless tobacco.

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Centers for Disease Control and Prevention

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Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. 1,2

Quitting smoking lowers your risk for smoking-related diseases and can add years to your life. 1,2

Cigarette smoking is the leading cause of preventable death in the United States. ¹

Cigarette smoking causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths.1,2,3

Smoking causes more deaths each year than the following causes combined:⁴

Human immunodeficiency virus (HIV)

Illegal drug use

Alcohol use

Motor vehicle injuries

Firearm-related incidents

More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States.¹

Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths.1,2 More women die from lung cancer each year than from breast cancer.⁵

Smoking causes about 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD).¹

Cigarette smoking increases risk for death from all causes in men and women.¹

The risk of dying from cigarette smoking has increased over the last 50 years in the U.S.¹

Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer. ¹

Estimates show smoking increases the risk:

For coronary heart disease by 2 to 4 times1,6

For stroke by 2 to 4 times¹

Of men developing lung cancer by 25 times¹

Of women developing lung cancer by 25.7 times¹

Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost.¹

Smokers are at greater risk for diseases that affect the heart and blood vessels (cardiovascular disease). 1,2

Smoking causes stroke and coronary heart disease, which are among the leading causes of death in the United States.1,3

Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.¹

Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form.1,2

A stroke occurs when:

A clot blocks the blood flow to part of your brain;

A blood vessel in or around your brain bursts.1,2

Blockages caused by smoking can also reduce blood flow to your legs and skin.1,2

Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs. 1,2

Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis.1,2

Cigarette smoking causes most cases of lung cancer.1,2

If you have asthma, tobacco smoke can trigger an attack or make an attack worse.1,2

Smokers are 12 to 13 times more likely to die from COPD than nonsmokers.¹

Smoking can cause cancer almost anywhere in your body: 1,2

Bladder

Blood (acute myeloid leukemia)

Cervix

Colon and rectum (colorectal)

Esophagus

Kidney and ureter

Larynx

Liver

Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)

Pancreas

Stomach

Trachea, bronchus, and lung

Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors. ¹

If nobody smoked, one of every three cancer deaths in the United States would not happen. 1,2

Smoking harms nearly every organ of the body and affects a person's overall health. 1,2

Smoking can make it harder for a woman to become pregnant. It can also affect her baby's health before and after birth. Smoking increases risks for:1,2,5

Preterm (early) delivery

Stillbirth (death of the baby before birth)

Low birth weight

Sudden infant death syndrome (known as SIDS or crib death)

Ectopic pregnancy

Orofacial clefts in infants

Smoking can also affect men's sperm, which can reduce fertility and also increase risks for birth defects and miscarriage.²

Smoking can affect bone health.1,5
Women past childbearing years who smoke have weaker bones than women who never smoked. They are also at greater risk for broken bones.

Smoking affects the health of your teeth and gums and can cause tooth loss.¹

Smoking can increase your risk for cataracts (clouding of the eye's lens that makes it hard for you to see). It can also cause age-related macular degeneration (AMD). AMD is damage to a small spot near the center of the retina, the part of the eye needed for central vision.¹

Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30-40% higher for active smokers than nonsmokers.1,2

Smoking causes general adverse effects on the body, including inflammation and decreased immune function.¹

Smoking is a cause of rheumatoid arthritis.¹

Quitting smoking is one of the most important actions people can take to improve their health. This is true regardless of their age or how long they have been smoking. Visit the Benefits of Quitting page for more information about how quitting smoking can improve your health.

1. U.S. Department of Health and Human Services.The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2017 Apr 20].

2. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2017 Apr 20].

3. Centers for Disease Control and Prevention. QuickStats: Number of Deaths from 10 Leading Causes-National Vital Statistics System, United States, 2010. Morbidity and Mortality Weekly Report 2013:62(08);155. [accessed 2017 Apr 20].

4. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States. JAMA: Journal of the American Medical Association 2004;291(10):1238-45 [cited 2017 Apr 20].

5. U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 [accessed 2017 Apr 20].

6. U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989 [accessed 2017 Apr 20].

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See the data and statistical information on health effects of cigarette smoking.

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Smoking is a cause of rheumatoid arthritis.¹

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Smokers are at greater risk for diseases that affect the heart and blood vessels (cardiovascular disease).

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If you have asthma, tobacco smoke can trigger an attack or make an attack worse.

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A single cigar can potentially provide as much nicotine as a pack of cigarettes

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-Since 1964, about 2,500,000 people who do not smoke have died from health problems caused by secondhand smoke exposure.
-In 2019, almost 7 million U.S. middle and high school students (about 25%) reported breathing secondhand smoke in their homes, and just over 6 million (about 23%) reported breathing secondhand smoke in vehicles.
-For children with asthma, breathing secondhand smoke can trigger an asthma attack.
-Babies and children who breathe secondhand smoke are sick more often with bronchitis, pneumonia, and ear infections than those that are not exposed to secondhand smoke.
-You are especially likely to be exposed to secondhand smoke if you live in multi-unit housing—like apartment buildings with many homes next to one another in the same place.

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Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis

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Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis

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Can cause nicotine poisoning in children⁴

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Secondhand smoke also is smoke that has been exhaled, or breathed out, by the person smoking.6,7

There are more than 7,000 chemicals in tobacco smoke, including hundreds of chemicals that are toxic and about 70 that can cause cancer.¹ Here are just a few of the chemicals and poisons in tobacco smoke:

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E-cigarettes are very popular with young people

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flavorants such as diacetyl, a chemical linked to serious lung disease

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The nicotine in e-cigarettes and regular cigarettes is addictive. E-cigarettes are considered tobacco products because most of them contain nicotine, which comes from tobacco.

E-cigarettes are very popular with young people. Their use has grown dramatically in the last five years. Today, more high school students use e-cigarettes than regular cigarettes.

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Cigarette smoking causes most cases of lung cancer.1,2

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All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals

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Smoking kills people more than hiv, illegal drug use, and firearm related incidents.

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Smokeless tobacco can cause gum disease, tooth decay, and tooth loss

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these risks include nicotine addiction, mood disorders, and permanent lowering of impulse control

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In 2018, the Monitoring the Future survey found that—5,6

Nearly 1 in every 13 (7.8%) high school students in the United States had used a hookah to smoke tobacco during the previous year.

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E-cigarettes are very popular with young people. Their use has grown dramatically in the last five years.

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Smoking causes about 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD).¹

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Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking

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heavy metals, such as nickel, tin, and lead

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Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancer

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NCI dictionaries contain definitions for thousands of terms relating to cancer, drugs, genetics, and for scientists seeking research funds from NCI.

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Young people use e-cigarettes because they are curious about them, like the flavors e-cigarettes contain, and believe e-cigarettes are safer than regular cigarettes.

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smokeless tobacco can cause gum disease, tooth decay, and tooth loss

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Smoking in another room like a bathroom or bedroom can still spread secondhand smoke through the air in your home. In an apartment building, secondhand smoke can go in between apartments.

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Secondhand smoke is smoke from burning tobacco products, like cigarettes, cigars, hookahs, or pipes.

Babies who breathe secondhand smoke are more likely to die unexpectedly from sudden infant death syndrome (SIDS), also called crib death, than babies who are not exposed to smoke from burning tobacco products.

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Cigarillos are a type of smaller cigar. They are a little bigger than little cigars and cigarettes and contain about 3 grams of tobacco.

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Babies born to hookah smokers are also at increased risk for respiratory diseases

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Among 12th graders, annual hookah use increased from nearly 1 in 6 students (17.1%) in 2010 to about 1 in 4 students (22.9%) in 2014, but since that time has decreased sharply to nearly 1 in 13 students (7.8%) in 2018.

Hookah use began centuries ago in ancient Persia and India.

Today, hookah cafés are gaining in popularity around the world, including Britain, France, Russia, the Middle East, and the United States.

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There are more than 7,000 chemicals in tobacco smoke, including hundreds of chemicals that are toxic and about 70 that can cause cancer.¹Here are just a few of the chemicals and poisons in tobacco smoke

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Cigarillos are a type of smaller cigar. They are a little bigger than little cigars and cigarettes and contain about 3 grams of tobacco.

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Because young people who use smokeless tobacco can become addicted to nicotine, they may be more likely to also become cigarette smokers.⁵

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Hookah use began centuries ago in ancient Persia and India.1,2,3,4

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Secondhand smoke is smoke from burning tobacco products, like cigarettes, cigars, hookahs, or pipes.1,6,7