About Tobacco

Effects of Tobacco Use

Nicotine is only one of 7000 chemicals found in the smoke from cigarettes, cigars and pipes and is the primary addictive chemical.

Ron Chapman, MD, MPH, CDPH Director and State Health Officer of California Department of Public Health recently wrote:

“Nicotine is a highly addictive neurotoxin, proven as addictive as heroin and cocaine. Nicotine affects the cardiovascular and central nervous systems, causing blood vessels to constrict, raising the pulse and blood pressure. Nicotine adversely affects maternal and fetal health during pregnancy, contributing to low birth weight, preterm delivery, and stillbirth. Nicotine is also known to cross the placenta and is detectable in the breast milk of smoking mothers as well as mothers exposed to secondhand smoke” (13).

Disease related to tobacco use:

  • Heart Disease
  • Cancer
  • Stroke
  • COPD
  • Pneumonia and Influenza
  • Diabetes

Tobacco smoke has been found to cause health problems to almost all parts of the body:

  • Nicotine reaches the brain within 10 seconds after smoke is inhaled. It has been found in every part of the body.*
  • Carbon monoxide binds to hemoglobin in red blood cells, preventing affected cells from carrying a full load of oxygen.*
  • Cancer-causing agents (carcinogens) in tobacco smoke damage important genes that control the growth of cells, causing them to grow abnormally or to reproduce too rapidly.*
  • The carcinogen benzo[a]pyrene binds to cells in the airways and major organs of smokers.*

Smokeless Tobacco


SnusThe nicotine in smokeless tobacco is absorbed more slowly, at higher amount and stays in the blood system longer than smoking a cigarette. Due to the high nicotine level, smokeless tobacco is potentially more addictive than cigarettes.

The use of smokeless tobacco:

  • Can lead to nicotine addiction*
  • Causes cancers of the lip, tongue, cheeks, gums, roof and floor of the mouth, larynx, esophagus and stomach.
  • Is associated with diseases of the mouth*
  • Can increase risks for early delivery and stillbirth when used during pregnancy*
  • Can cause nicotine poisoning in children*
  • May increase the risk for death from heart disease and stroke*

Risks and Diseases:

  • Smokeless tobacco can cause white or gray patches inside the mouth (leukoplakia) that can lead to cancer.*
  • Smokeless tobacco can cause receding gums, bad breath, tooth decay, and periodontal disease.
  • Using smokeless tobacco during pregnancy can increase the risk for early delivery and stillbirth.*
  • Nicotine in smokeless tobacco products that are used during pregnancy can affect how a baby’s brain develops before birth.*
  • Increases the risk for death from heart disease, stroke and diabetes.
  • Smokeless tobacco can cause nicotine poisoning in children.*
  • Additional research is needed to examine long-term effects of newer smokeless tobacco products, such as dissolvables and U.S. snus.*

*Information provided by the CDC.gov


There are over 5 million cigar smokers in the U.S. Cigar smokers in the past were mainly middle aged and older men with higher education and income, but many new cigar users today are teens and young adults. According to 2011 research nearly 30% of high school students had smoked a cigar within the last month. And in many states, more high school students smoke cigars than cigarettes.   Much of this is because cigars are most often cheaper and are sold as singles and in candy and fruit flavors that appeal to teens.

Today’s cigars are priced, promoted, packaged and placed in ways that appeal to kids.

Cigarette Little Cigar

little cigar

Cigarette vs Little Cigar

  • Little Cigars (Small Cigars) weigh less than 3 lbs/1000 and resemble cigarettes.*
  • Cigarettes are wrapped in white paper, while little cigars are wrapped in brown paper that contains some tobacco leaf. Generally, little cigars have a filter like a cigarette.*



Cigarillo tipped and Cigarillo

  • Cigarillos (classified as large cigars) weigh more than 3 lbs/1000 and are classified as “large” cigars by federal tax code.*
  • Cigarillos are longer, slimmer versions of a large cigar.*
  • Cigarillos do not usually have a filter, but sometimes have wood or plastic tips.*

Large Cigar



  • Large Cigars weigh more than 3 pounds/1000.*
  • Large cigars typically take 1-2 hours to smoke.

Cigars, particularly little cigars and cigarillos, come in a variety of flavors. As is the case with flavored cigarettes, such flavorings may appeal to youth and young people.*

A review of formerly secret tobacco industry documents found that little cigars were intended to replace cigarettes as cigarette advertising became increasingly restricted, and taxes on cigarettes, but not cigars, continued to increase.*

Health Effects of Cigars

  • One large cigar can contain as much tobacco as an entire pack of cigarettes
  • Smoking one large cigar is like smoking 3-10 Cigarettes
  • Increase risk of lung, lip, tongue, mouth, throat, esophagus, larynx cancer
  • Erodes teeth
  • Cancers of the mouth is worse if alcohol is consumed while smoking
  • Passive cigar smoke produces 30 times more CO than cigarettes

*Information found on Tobacco Fact Sheet by Legacy.

Second-Hand Smoke

dogbreathingcatbreathingSecond-hand smoke (SHS) is the combination of the smoke from burning tobacco and the smoke exhaled by a smoker.

The environmental Protection Agency (EPA) has classified SHS as a Group A Carcinogen – the most toxic substances known to cause cancer in humans, others include benzene, radon and asbestos.

SHS is by far the most dangerous air pollutant most Americans will ever encounter.

The scientific evidence in the Surgeon General’s report indicates that:

  • There is no risk-free level of exposure to secondhand smoke.
  • Eliminating smoking in indoor spaces fully protects non-smokers from exposure to secondhand smoke separating smokers from non-smokers, cleaning the air, and ventilating buildings cannot eliminate exposures to secondhand smoke exposure.
  • Even 30 minutes of secondhand smoke exposure daily can cause heart damage similar to that of a habitual smoker.
  • People who are exposed to daily secondhand smoke have a 30% higher death and disease rate than that of nonsmokers.

Third-Hand Smoke:

The invisible yet toxic brew of gases and particles clinging to smokers’ hair and clothing, cushions, curtains, carpeting and pets, it lingers long after secondhand smoke has cleared from a room.

  • More than 53,000 non-smokers die each year from heart disease, lung diseases, or cancer caused by secondhand smoke.
  • For every person who dies from a smoking-related disease, 20 more people suffer with at least one serious illness from smoking.


State Health-e-cig report E cig examplesE-cigarettes were first introduced in the U.S. in 2007 and have skyrocketed in popularity, availability, and variety. From disposable and rechargeable e-cigarettes to “tank systems” that can hold a large volume of a liquid solution (e-liquid), customers can customize e-cigarettes in many ways.E-cigarettes are battery-operated devices, often designed to resemble cigarettes, which deliver nicotine (a highly addictive neurotoxin). The e-cigarette does not emit water vapor, but a concoction of chemicals toxic to the human cells in the form of an aerosol. E-cigarettes have many names, especially among youth and young adults, such as e-cigs, e-hookahs, hookah pens, vapes, vape pens, vape pipes, or mods.



  • Cartridge- contains a nicotine solution typically also serves as the mouthpiece for inhaling vapor
  • Vapor-inhaled by the smoker and exhaled into the environment
  • Atomizer-creates the nicotine solution in the cartridge
  • Battery-rechargeable typically lithium-ion
  • LED light- comes on during inhalation to mimic the glow of a traditional cigarette

ecig fireThe use of e-cigarettes among teens and young adults has rapidly increased since the introduction of e-cigarettes in the U.S. in 2007. According to State Health Officer, Ron Chapman, MD, “Nationally, the use of e cigarettes by high school students tripled in just two years and e-cigarette use by teens now surpasses the use of traditional cigarettes. With this age group the long-term impact that nicotine has on adolescent brain development is of particular concern” (5).

p0403-e-cigarette-poisonRecent studies show that e-cigarette poisoning in children under the age of 5 years old had risen from 7 in 2012 to 154 in 2014.

There is still much to be learned about the ingredients in e-cigarettes and the long-term health impacts in both teens and adults.

California Department of Public Health, California Tobacco Control Program, State Health Officer’s Report on E-Cigarettes: A Community Health Threat, Sacramento, CA 2015



thumbnailHookahs are water pipes that are used to smoke specially made tobacco. With the introduction of flavored tobacco; Hookah bars; aggressive marketing; and media hype the past decade has seen a dramatic rise in the popularity of hookah smoking among young people. Typically smoking a hookah is done in groups who share the same mouth piece. Since Hookah bars are not required to sterilize or replace the mouthpieces after use infections like tuberculosis, herpes, hepatitis and mononucleosis which can be transmitted through the sharing of the same mouthpiece.Many users believe the hookah is less harmful than smoking traditional cigarette however, hookah has many of the same health risks as cigarette smoking.

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.*

  • Even after it has passed through water, the smoke from a hookah has high levels of these toxic agents.*
  • Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.*
  • Tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers.*

Health Effects

  • Lung, oral and bladder cancer
  • Cancer of the esophagus and stomach
  • Heart Disease
  • Respiratory problems
  • Babies born to women who smoked water pipes every day while pregnant weigh less at birth, and are at increased risk for respiratory diseases.*
  • Babies born to hookah smokers are also at increased risk for respiratory diseases.*

*Information provided by the CDC.gov