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Smoking Cessation Information

Tobacco Overview

What is Really in Cigarettes?

Cigarette smoke contains over 4,000 chemicals such as:

  • Arsenic (rat poison)
  • Ammonia (poisonous, in many household cleaners)
  • Acetone (fingernail polish remover)
  • Ammonium bromide (toilet cleaner)
  • Benzene (industrial solvent)
  • Carbon monoxide (exhaust pipe fumes)
  • Cadmium (used in rechargeable batteries)
  • Cyanide(poison used in gas chambers)
  • DDT (insecticide)
  • Formaldehyde (preservative for dead frogs, embalming fluid)
  • Lead (a poison removed from nearly all paints)
  • Mercury (highly poisonous and easily absorbed through respiration)
  • Nickel (poisonous, a known cancer-causing agent)
  • Hydrogen cyanide (deadly poison used in gas chambers)
  • Hydrogen sulfide (sewer gas)
  • Polonium-210 (radioactive substance)
  • 50 + cancer causing agents (carcinogens)
What is Nicotine?
  • The real reason people smoke is to get nicotine –highly addictive!
  • Insecticide – protects the tobacco plant from insects
  • Deadly poison – one drop (70 mg) could kill a human in a few minutes

Cigars contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative to cigarettes.1

Large cigars, cigarillos, and little cigars are the three major types of cigars sold in the United States.1

In 2005, cigar sales in the United States rose 15.3%2 and generated more than $2.9 billion in retail sales.2

Bidis and Kreteks

Bidis (pronounced "bee-dees") are small, thin hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries.3,4 They consist of tobacco wrapped in a tendu or temburni leaf (plants native to Asia), and may be secured with a colorful string at one or both ends.3,4 Bidis can be flavored (e.g., chocolate, cherry, and mango) or unflavored.1 They have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States.3,5

Kreteks (pronounced "cree-techs") are sometimes referred to as clove cigarettes.6,7 Imported from Indonesia, kreteks typically contain a mixture consisting of tobacco, cloves, and other additives.6,7 As with bidis, standardized machine-smoking analyses indicate that kreteks deliver more nicotine, carbon monoxide, and tar than conventional cigarettes.6 There is no evidence to indicate that bidis or kreteks are safe alternatives to conventional cigarettes.5,7


Pipe tobacco is usually a blend of tobacco. It may contain a large percentage of additives, such as sweeteners. Like cigar smoke, pipe smoke is alkaline.

Pipe smokers have higher death rates for smoking related disease than non-smokers, but lower death rates than cigarette smokers. The reasons for this are similar to those for cigar smokers: in particular they tend not to inhale the smoke into their lungs.

On comparing disease rates of pipe smokers who have never smoked cigarettes with cigarette smokers:

  • Pipe smokers have a higher risk for cancer of the lip than any other tobacco users.
  • Pipe smokers have similar risks to cigarette smokers for cancers of the mouth, throat, larynx and oesophagus.
  • Pipe smokers have lower risks than cigarette smokers for lung cancer, heart disease, emphysema, and chronic bronchitis. These risks are higher than non-smokers.
  • Pipe smoking also causes cancers of the pancreas, stomach and bladder.
Smokeless Tobacco

The two main types of smokeless tobacco in the United States are chewing tobacco and snuff.8,9 Chewing tobacco comes in the form of loose leaf, plug, or twist.8,9 Snuff is finely ground tobacco that can be dry, moist, or in sachets (tea bag-like pouches).9 Although some forms of snuff can be used by sniffing or inhaling into the nose,9 most smokeless tobacco users place the product in their cheek or between their gum and cheek.10 Users then suck on the tobacco and spit out the tobacco juices, which is why smokeless tobacco is often referred to as spit or spitting tobacco.10 Smokeless tobacco is a significant health risk and is not a safe substitute for smoking cigarettes.11


Hookahs are water pipes resembling slender metal vases. Charcoal is used to heat a sweet, sticky tobacco, producing smoke that is filtered through cooled water. The smoke is inhaled through a flexible hose that is passed from one user to the next. Smoke from the hookah contains the same cancer-causing chemicals as cigars and cigarettes. Hookah smokers also inhale carbon monoxide, heavy metals and other toxic compounds given off by the burning charcoal. And smoking in a group setting creates significant secondhand smoke — especially in so-called hookah cafes.

Hookah smokers typically smoke longer and more often, take more puffs and inhale more deeply than cigarette smokers. They absorb more nicotine in higher concentrations because of the way that the smoke is cooled.

Secondhand Smoke

Secondhand Smoke (also called passive smoke or environmental tobacco smoke) is the combination of smoke from a burning cigarette and smoke exhaled by a smoker. The smoke that burns off the end of a cigarette or cigar actually contains more harmful substances than the smoke inhaled by the smoker. This means that people who don’t smoke but are regularly around those who smoke are exposed to the health risks of cigarette smoking.

Secondhand smoke is estimated to cause approximately 3,000 lung cancer deaths per year among nonsmokers and contributes to more than 35,000 deaths related to cardiovascular disease


Benefits of Quitting Smoking

Why should I quit?

If you smoke, the decision to quit smoking is the most important step you can take to protect your lungs and overall health. It is never too late to quit. If you quit you will:

  • Prolong your life
  • Decrease your risk of disease (including lung cancer, throat cancer, emphysema, heart disease, high blood pressure, ulcers, and other conditions)
  • Reduce your risk of respiratory and anesthesia complications after an operation
  • Decrease the chance that your children will become sick (respiratory infections are more common among children exposed to secondhand smoke)
  • Feel healthier (after quitting, you won’t cough as much, have as many sore throats, and will have an increased energy level)
  • Improve your sense of taste and smell
  • Improve your looks (smoking can cause face wrinkles, stained teeth, and dull skin)
  • Save money
It is Never Too Late to Quit

See what positive health benefits you can achieve in a very short time

20 Minutes

  • Blood pressure drops to normal.
  • Pulse rate drops to normal.

8 Hours

  • Carbon monoxide level in blood drops to normal.
  • Oxygen level in blood increases to normal.

24 Hours

  • Chance of heart attack decreases.

48 Hours

  • Nerve endings start regrowing.
  • Ability to smell and taste is enhanced.

2 Weeks To 3 Months

  • Circulation improves.
  • Walking becomes easier.
  • Lung function increases up to 30%.

1 To 9 Months

  • Coughing, sinus congestion, fatigue, and shortness of breath decrease.
  • Cilia regrow in lungs; clean the lungs, and reduce infection.
  • Body's overall energy increases.

1 Year

  • Excess risk of coronary heart disease is half that of a smoker.

5 Years

  • Lung cancer death rate for average smoker (one pack a day) decreases by almost half.
  • Stroke risk is reduced to that of a nonsmoker.
  • Risk of cancer of the mouth, throat and esophagus is half that of a smoker's.

10 Years

  • Lung cancer death rate similar to that of nonsmokers.
  • Precancerous cells are replaced.
  • Risk of cancer of the mouth, throat, esophagus, bladder, kidney and pancreas decreases.

15 Years

  • Risk of coronary heart disease is that of a nonsmoker.

Tobacco Treatment Medication

There are different medication options for people who wish to quit using tobacco.  Each smoker or chewer is different. There is not a perfect way or a magic pill to help you quit smoking or chewing. Some people are able to quit “cold turkey” while most others need help with medications and/or counseling.

Over the Counter Medication

Over the counter medications for tobacco treatment include the nicotine patch, nicotine gum and nicotine lozenges. These products contain nicotine.It might sound crazy – taking nicotine to help quit using nicotine – but some over-the-counter medicines that contain nicotine can be very helpful in fighting cravings. They won’t eliminate them, but they will help gradually reduce your intake of nicotine and ease off its addictive effects. In addition, by substituting nicotine from over the counter products instead of tobacco, you also stop the exposure of dangerous chemicals found in cigarette smoke.

When you regularly give your body a steady dose of nicotine through the use of tobacco and then stop suddenly, you will experience more side effects that make quitting more difficult. If you gradually lower the dose by quitting tobacco but substituting nicotine replacement products, you will increase your capacity to resist the cravings on your own.

When considering a nicotine-based product, be sure to tell your doctor about any conditions you might have, especially:

  • Asthma or breathing problems
  • Heart or blood vessel disease
  • High blood pressure
  • Stomach ulcer
  • Type 1 diabetes mellitus
  • Liver disease
  • Overactive thyroid
  • Pheochromocytoma (PCC)

Additional things to consider when taking nicotine-based medications include:

  • You must stop smoking or using other tobacco products. You could risk overdosing on nicotine.
  • Tell your doctor what medications you are currently taking or allergies you have.
  • Avoid nicotine replacement medications if you are breastfeeding, pregnant or might be pregnant.
  • Keep this and all medications out of the reach of children and pets.

Over-the-counter treatments, including the nicotine patch, nicotine gum and nicotine pill or lozenge, are typically used for up to 12 weeks as part of a smoking cessation program. Always follow the instructions on the box and carefully read through all the product information before use. Be sure to contact your doctor if you have any questions.

Prescription Medication

There are several prescription medications that increase long-term tobacco quit rates. When used as part of a smoking cessation program, these prescription medications can be extremely effective.

Prescription medications that act as Nicotine Replacement Therapy include Nicotine Nasal Spray or Nicotine Inhaler. Prescription Nicotine Replacement Therapy works similarly to over the counter products – the amount of nicotin is gradually decreased over the course of 12 weeks by slowly decreasing the dose.

Prescription medications that do not contain nicotine include Bupropion (Zyban, Wellbutrin) and Varenicline (Chantix).

Bupropion is an antidepressant that is only available by prescription. It does not contain nicotine. It is thought to go to the same areas of the brain that nicotine does and will help control cravings. It is prescribed along with counseling to aid in smoking cessation.

Varenicline is a prescription medication that does not contain nicotine. It works by targeting nicotine receptors in the brain and preventing nicotine from reaching them. It helps to reduce the cravings and can minimize the withdrawal effects. Typically, this medication is recommended for a minimum of 12 weeks in conjunction with smoking cessation counseling.

As with all medications, there can be side effects. Always read the product information carefully before use, and be sure to contact your doctor if you have any questions.

Quit Rates

Research shows that the combination of counseling and medication is more effective than either medication or counseling alone.

In addition, there is a strong relation between the number of sessions of counseling, when it is combined with medication, and the likelihood of successful smoking cessation.(Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service. May 2008)

Typical Long Term Quit Rates

No Therapy Brief Advice Behavior Therapy
*Hughes, JR. New Treatments for Smoking Cessation. CA Cancer J Clin. 2000: 50: 143-151
No Medication 5% 10% 15%
Medication 10% 20% 30%

Cleveland Clinic Quit Rates:

In 2011, the Tobacco Treatment Center achieved quit rates over 40%

Tobacco Use

  • Tobacco use remains the single largest preventable cause of death and disease in the United States.1
  • Approximately 443,000 U.S. adults die from smoking-related illnesses each year.1
  • There have been more than 12 million premature deaths attributable to smoking since the first published Surgeon General’s report on smoking and health in 1964.2
  • Smoking is the primary causal factor for at least 30% of all cancer deaths, for nearly 80% of deaths from chronic obstructive pulmonary disease, and for early cardiovascular disease and deaths.4
  • Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined.3
  • Smokers lose an average of 13 to 14 years of life because of their smoking.3
  • Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general.2
  • Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.5
  • Quitting smoking has immediate as well as long-term benefits, reducing risks for diseases caused by smoking and improving health in general.2
  • Smoking has been estimated to cost the United States $96 billion in direct medical expenses and $97 billion in lost productivity annually.3
  • Of all the kids who become new smokers each year, almost a third will ultimately die from it.3

Second Hand Smoke

  • In 2005, it was estimated that exposure to secondhand smoke kills more than 3,000 adult nonsmokers from lung cancer, approximately 46,000 from coronary heart disease, and an estimated 430 newborns from sudden infant death syndrome.6
  • Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic (cancer-causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide.6
  • Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.6
  • Concentrations of many cancer-causing and toxic chemicals are higher in secondhand smoke than in the smoke inhaled by smokers.6
  • Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack.6
  • Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 - 30 percent.6
  • The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.6