Health Risks of Old and New Tobacco Products

"Learn about CDC’s Tobacco Laboratory and the harmful chemicals in different products.

There are a lot of harmful chemicals in tobacco products. The Centers for Disease Control and Prevention’s (CDC) Tobacco Laboratory studies cigarettes, e-cigarettes/vapes, cigars, snuff, and pipe tobacco, plus other nicotine products. CDC scientists help individuals, health care professionals, and legislators understand how tobacco products put people’s health at risk.

The Tobacco Laboratory not only measures ingredients in the products, but also in the smoke, aerosol, and other emissions from them. Ingredients range from nicotine and heavy metals to chemical preservatives and flavors like menthol.

Lung Injuries Associated with Use of E-Cigarette, or Vaping, Products

The Tobacco Laboratory played a key role in CDC’s response to a 2019-2020 EVALI outbreak that was connected to about 2,800 hospitalizations and 68 deaths. EVALI stands for e-cigarette, or vaping, product use-associated lung injury.

At first the cause of the outbreak was unknown. But most people affected were younger than 35 years old, and all had used e-cigarettes or other vaping products. What else did they have in common? CDC worked with the U.S. Food and Drug Administration (FDA) and state partners to find out.

The key piece of the puzzle turned out to be vitamin E acetate, a chemical that was being added to some vapes containing THC. Vitamin E acetate can damage lung tissue.

CDC’s Tobacco Laboratory helped shed light on the vitamin E acetate problem and other risks of using vapes.

CDC and FDA recommend that vitamin E acetate should not be added to any e-cigarette/vaping products.

Data Helps Protect Public Health

“Our goal is to collect data for decision-makers to use to help decrease harm to the U.S. population,” explains Ben Blount, CDC Tobacco and Volatiles branch chief.

CDC’s Tobacco Laboratory works closely with FDA and other federal agencies, the World Health Organization, Health Canada, universities, health departments, and many other partners to improve public health for the nation and the world..."
Tobacco Health Risks 

Tobacco use by youth is rising

"Tobacco product use among US youth is increasing. More than 1 in 4 high school students and about 1 in 14 middle school students in 2018 had used a tobacco product in the past 30 days. This was a considerable increase from 2017, which was driven by an increase in e-cigarette use. E-cigarette use increased from 11.7% to 20.8% among high school students and from 3.3% to 4.9% among middle school students from 2017 to 2018. No change was found in the use of other tobacco products, including cigarettes, during this time.

Among youth:

• E-cigarettes are still the most commonly used tobacco product, ahead of cigarettes, cigars, smokeless tobacco, hookah, and pipes.
• E-cigarettes are the most commonly used product in combination with other tobacco products.
• E-cigarette use is highest for boys, whites, and high school students.

• Tobacco product use among high school students—2018

  .."
  Tobacco and youth

Tobacco Product Use Among Adults — United States, 2017

"Cigarette smoking harms nearly every organ of the body and causes adverse health consequences, including heart disease, stroke, and multiple types of cancer (1). Although cigarette smoking among U.S. adults has declined considerably, tobacco products have evolved in recent years to include various combustible, noncombustible, and electronic products (1,2). To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Institutes of Health’s National Cancer Institute analyzed data from the 2017 National Health Interview Survey (NHIS). In 2017, an estimated 47.4 million U.S. adults (19.3%) currently used any tobacco product, including cigarettes (14.0%; 34.3 million); cigars, cigarillos, or filtered little cigars (3.8%; 9.3 million); electronic cigarettes (e-cigarettes) (2.8%; 6.9 million); smokeless tobacco (2.1%; 5.1 million); and pipes, water pipes, or hookahs (1.0%; 2.6 million). Among current tobacco product users, 86.7% (41.1 million) smoked combustible tobacco products, and 19.0% (9.0 million) used ≥2 tobacco products..."
Tobacco use

Celebrate This Veteran's Day Tobacco Free

"This Veteran’s Day, CDC is supporting veterans by sharing free resources available to help them quit tobacco use. Cigarette smoking and other tobacco use are harmful to the health of any user, but for active-duty military personnel tobacco use can be especially problematic. As with all users, cigarette smoking increases risk for diseases among veterans and active-duty members, including lung cancer, heart disease, chronic bronchitis, and many others. Additionally, their strength and performance can be impaired by smoking, either through exposure to nicotine and other poisons in cigarettes, or through nicotine withdrawal. Tobacco use can also result in soldiers being absent from duty or being unable to perform necessary tasks. Further, service members who use tobacco are more likely to drop out of basic training and to experience accidents and injuries, which negatively impact troop readiness.

But the good news is that quitting significantly reduces your risk for heart attack, stroke, and some cancers. In addition to the health benefits, quitting smoking can also result in significant cost savings. The U.S. Department of Defense spends over $1.6 billion each year on tobacco-related medical care, increased hospitalization, and lost days of work..."
Veterans and tobacco

Consumption of Combustible and Smokeless Tobacco — United States, 2000–2015

"Combustible and smokeless tobacco use causes adverse health outcomes, including cardiovascular disease and multiple types of cancer (1,2). Standard approaches for measuring tobacco use include self-reported surveys of use and consumption estimates based on tobacco excise tax data (3,4). To provide the most recently available tobacco consumption estimates in the United States, CDC used federal excise tax data to estimate total and per capita consumption during 2000–2015 for combustible tobacco (cigarettes, roll-your-own tobacco, pipe tobacco, small cigars, and large cigars) and smokeless tobacco (chewing tobacco and dry snuff). During this period, total combustible tobacco consumption decreased 33.5%, or 43.7% per capita. Although total cigarette consumption decreased 38.7%, cigarettes remained the most commonly used combustible tobacco product. Total noncigarette combustible tobacco (i.e., cigars, roll-your-own, and pipe tobacco) consumption increased 117.1%, or 83.8% per capita during 2000–2015. Total consumption of smokeless tobacco increased 23.1%, or 4.2% per capita. Notably, total cigarette consumption was 267.0 billion cigarettes in 2015 compared with 262.7 billion in 2014. These findings indicate that although cigarette smoking declined overall during 2000–2015, and each year from 2000 to 2014, the number of cigarettes consumed in 2015 was higher than in 2014, and the first time annual cigarette consumption was higher than the previous year since 1973. Moreover, the consumption of other combustible and smokeless tobacco products remains substantial. Implementation of proven tobacco prevention interventions (5) is warranted to further reduce tobacco use in the United States..."Tobacco consumption

FDA’s New Regulations for E-Cigarettes, Cigars, and All Other Tobacco Products

"Tobacco use is the single largest preventable cause of disease and death in the United States. Since 2009, FDA has regulated cigarettes, smokeless, and roll-your-own tobacco. FDA finalized a rule, effective August 8, 2016, to regulate all tobacco products. For background information on this milestone in consumer protection, see The Facts on the FDA’s New Tobacco Rule.

Read the FDA Voice blog post by Center Director Mitch Zeller on Protecting the Public and Especially Kids from Tobacco Products, Including E-Cigarettes, Cigars and Hookah Tobacco..."
E-Cigarettes

Extending Authorities to All Tobacco Products, Including E-Cigarettes, Cigars, and Hookah

"Tobacco use is the single largest preventable cause of disease and death in the United States. As part of its goal to improve public health and protect future generations from the risks of tobacco use, the FDA has extended its authority to cover all products that meet the definition of a tobacco product.

Previously, the FDA regulated cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco, but in 2016, the FDA finalized a rule – Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act – which extends the FDA’s authority to include the regulation of electronic nicotine delivery systems (such as e-cigarettes and vape pens), all cigars, hookah (waterpipe) tobacco, pipe tobacco and nicotine gels, among others.

This action is a milestone in consumer protection – going forward, the FDA will be able to:

• Review new tobacco products not yet on the market;
• Help prevent misleading claims by tobacco product manufacturers;
• Evaluate the ingredients of tobacco products and how they are made; and
• Communicate the potential risks of tobacco product..."

Tobacco products

FBI Takes Part in State Department Briefing on Just-Released Illicit Tobacco Trade Publication

"Today in Washington, D.C., the FBI took part in a briefing announcing the U.S. State Department’s launch of a publication that outlines the emerging negative impacts of the illicit tobacco trade and the whole-of-government approach to combating it. According to The Global Illicit Trade in Tobacco: A Threat to National Security, this low-risk, high-reward, often transnational criminal activity is a lucrative crime for some terrorist groups and a potential revenue source to finance acts of terror. It also provides funding for other criminal activities—including money laundering and trafficking in humans, weapons, drugs, antiquities, diamonds, and counterfeit goods—and it can encourage organized criminal enterprises, terrorist organizations, and other threat networks to work together. Additionally, the illicit tobacco trade deprives governments of tax revenues, causing billions of dollars in losses annually..."
Tobacco trade

E-cigarette use triples among middle and high school students in just one year

"Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) in today’s Morbidity and Mortality Weekly Report (MMWR). Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students.

This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes. E-cigarettes were the most used tobacco product for non-Hispanic whites, Hispanics, and non-Hispanic other race while cigars were the most commonly used product among non-Hispanic blacks..."
E-cigarette

Labor Secretary announces bulletin on preventing green tobacco sickness quote context: http://pllqt.it/sMF6ob

"Dehydration, dizziness, headaches and vomiting are just a  few of the symptoms of nicotine poisoning, also known as "green tobacco  sickness." Workers who plant, cultivate and harvest tobacco are particularly at  risk. U.S. Secretary of Labor Thomas E. Perez today announced the release of a recommended practices  bulletin with guidance on reducing the  hazards for tobacco workers.
In recent years, the tobacco industry has undertaken  voluntary efforts to curtail child labor in tobacco farming and increase  protections for young workers. The department has collaborated also with state  agencies, growers, farmers, manufacturers and others to increase education,  training and protections for tobacco workers.
"The best way to protect people from on-the-job hazards is  to prevent those hazards in the first place, and this bulletin outlines  commonsense steps to reduce nicotine exposure and prevent heat illness," said  Secretary Perez. "It's important that we continue to work with a wide array of  stakeholders in order to find solutions that protect all workers."
..."
Green tobacco poisoning

Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings

"This report presents a first look at results from the 2011 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. The report presents national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products. The report focuses on trends between 2010 and 2011 and from 2002 to 2011, as well as differences across population subgroups in 2011. NSDUH estimates related to mental health, which were included in national findings reports prior to 2009, are not included in this 2011 report..."
http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.pdf

Current Tobacco Use Among Middle and High School Students — United States, 2011

"Tobacco use continues to be the leading preventable cause of death and disease in the United States, with nearly 443,000 deaths occurring annually because of cigarette smoking and exposure to secondhand smoke (1). Moreover, nearly 90% of adult smokers begin smoking by age 18 years (2). To assess current tobacco use among youths, CDC analyzed data from the 2011 National Youth Tobacco Survey (NYTS). This report describes the results of that analysis, which indicated that, in 2011, the prevalence of current tobacco use among middle school and high school students was 7.1% and 23.2%, respectively, and the prevalence of current cigarette use was 4.3%, and 15.8%, respectively..."

Consumption of Cigarettes and Combustible Tobacco — United States, 2000–2011

"From 2000 to 2011, total cigarette consumption declined from 435.6 billion to 292.8 billion, a 32.8% decrease (Table 1). Per capita cigarette consumption declined from 2,076 in 2000 to 1,232 in 2011, a 40.7% decrease. Conversely, total consumption of noncigarette combustible products increased from 15.2 billion cigarette equivalents in 2000 to 33.8 billion in 2011, a 123.1% increase, and per capita consumption increased from 72 in 2000 to 142 in 2011, a 96.9% increase. Total consumption of all combustible tobacco decreased from 450.7 billion cigarette equivalents to 326.6, a 27.5% decrease from 2000 to 2011, and per capita consumption of all combustible tobacco products declined from 2,148 to 1,374, a 36.0% decrease..."

Smokefree.gov

"Smokefree.gov allows you to choose the help that best fits your needs. You can get immediate assistance in the form of:

A step-by-step quit smoking guide
Information about a wide range of topics related to smoking and quitting
An interactive U.S. map highlighting smoking information in your state
LiveHelp, National Cancer Institute's instant messaging service
National Cancer Institute's telephone quitline, 1-877-44U-QUIT
Local and state telephone quitlines, 1-800-QUIT-NOW
Publications to download, print, or order.."

Preventing Tobacco Use Among Youth and Young Adults

"The fight against youth tobacco use was accelerated today by Surgeon General Dr. Regina Benjamin, with the release of the Surgeon General’s Report, Preventing Tobacco Use Among Youth and Young Adults. This report details the scope, health consequences and influences that lead to youth tobacco use and proven strategies that prevent its use.

To help communicate the report findings and steps every American can take to join the fight against youth tobacco use, the surgeon general also unveiled a guide with practical information on addressing tobacco use in young people, Preventing Tobacco Use Among Youth and Young Adults: We Can Make the Next Generation Tobacco-Free. In addition, the Centers for Disease Control and Prevention’s Office on Smoking and Health will launch the Surgeon General’s Video Challenge to engage youth and young adults in developing original videos that feature one or more of the report’s findings..."

Nicotine Dependence and Its Risk Factors Among Users of Veterans Health Services, 2008-2009

"Tobacco use is the leading preventable cause of death in the United States and is disproportionately higher among veterans than nonveterans. We examined the prevalence of nicotine dependence and its associated risk factors among veterans who used health services in the US Department of Veterans Affairs (VA) system..."

Adult Smoking in the United States

"Tobacco use remains the single largest preventable cause of disease, disability, and death in the US. Some people who smoke every day are smoking fewer cigarettes; however, even occasional smoking causes harm. The percentage of American adults who smoke decreased from 20.9% in 2005 to 19.3% in 2010. That translates to 3 million fewer smokers than there would have been with no decline. But almost 1 in 5 adults still smoke..."
View detailed report

CDC's Vital Signs: Adult Smoking in the US
"Tobacco use remains the single largest preventable cause of disease, disability, and death in the US. Some people who smoke every day are smoking fewer cigarettes; however, even occasional smoking causes harm. The percentage of American adults who smoke decreased from 20.9% in 2005 to 19.3% in 2010. That translates to 3 million fewer smokers than there would have been with no decline. But almost 1 in 5 adults still smoke..."

FTC Releases Reports on Cigarette and Smokeless Tobacco Advertising and Promotion
"The amount spent on cigarette advertising and promotion by the largest cigarette companies in the United States declined from $12.49 billion in 2006 to $10.86 billion in 2007, and again to $9.94 billion in 2008, according to a report released today by the Federal Trade Commission.

The largest spending category in both 2007 and 2008 was spending on price discounts
paid to cigarette retailers or wholesalers in order to reduce the price of cigarettes to consumers. This category accounted for $7.70 billion, or 70.9 percent of total spending on advertising and promotion in 2007, and $7.17 billion, or 72.1 percent of that total, in 2008.

The number of cigarettes sold or given away to wholesalers and retailers in the United States declined from 350.5 billion in 2006 to 342.8 billion in 2007, and to 322.6 billion in 2008..."

Proposed Cigarette Product Warning Labels
"Overview
The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) requires that cigarette packages and advertisements have larger and more visible graphic health warnings.

FDA issued a proposed rule, Required Warnings for Cigarette Packages and Advertisements, proposing to modify the required warnings that appear on cigarette packages and in cigarette advertisements. These new required warnings would consist of nine new textual warning statements accompanied by color graphics depicting the negative health consequences of smoking.

Timeline for Final Regulations
The Tobacco Control Act requires FDA to issue final regulations requiring these color graphics by June 22, 2011. It also specifies that the requirement for the new health warnings on cigarette packages and advertisements will take effect 15 months after issuance of this final rule..."