Tobacco is deadly in any form.

Smoked tobacco products, including waterpipes, contain over 7000 chemicals, including at least 250 chemicals known to be toxic or to cause cancer. Use of smokeless tobacco products
can result in serious – sometimes fatal – health problems. Exposure to second-hand smoke has also been implicated in adverse health outcomes, including death. Newer tobacco products contain similar chemicals
to traditional tobacco products and are harmful to health. Lifelong tobacco smokers lose at least 10 years of life on average. Globally, over 22 000 people die from tobacco use or second-hand smoke exposure every
day — one person every 4 seconds. Tobacco use affects almost all organs of the human body. Some of the health effects are depicted below – from head to toe.

DISEASES CAUSED BY DISEASES CAUSED BY

ALL FORMS OF TOBACCO 14 2 TOBACCO SMOKE
HEART ATTACK, STROKE, LUNG CANCER
11
AND OTHER CARDIOVASCULAR DISEASES 8a
Smokers are up to 22 times more likely to develop lung cancer (9) in their lifetime than non-smokers.
Tobacco smoking is the primary cause of lung cancer, causing over two thirds of lung cancer deaths globally and claiming roughly 1.2 million
One in three deaths worldwide is attributed to cardiovascular disease. Tobacco use and second-hand smoke exposure are major
12 lives every year. Non-smokers exposed to second-hand smoke at home or in the workplace are also at risk of developing lung cancer.
contributors, causing approximately 3 million cardiovascular deaths globally every year. Tobacco smokers have up to twice the risk of
stroke and a fourfold increased risk of heart disease. ASTHMA
Tobacco smoke damages the arteries of the heart, causing the build-up of plaque and development of blood clots, thereby Smoking is known to exacerbate asthma in adults, restricting their activity, contributing to disability and increasing the risk of severe
restricting blood flow and eventually leading to heart attacks (1) and strokes (2). Restricted blood flow, if left untreated, can lead
to gangrene (death of body tissue) (3) and amputation (4) of affected areas. Stroke, like heart disease, has a high risk of death, and 6 asthma requiring emergency health care. School-aged children of parents who smoke are exposed to the harmful effects of second-
hand smoke and are at risk of the onset and exacerbation of asthma through inflammation of the airways to the lungs.
survivors of stroke may experience disastrous disabling conditions, such as paralysis or loss of vision or speech. 5
Smoking is harmful, whatever the frequency of use. Those who smoke just one cigarette per day are already half as likely as those
who smoke 20 per day to develop heart disease and stroke. CHRONIC OBSTRUCTIVE PULMONARY DISEASE
However, it is not just tobacco smoking and second-hand smoke exposure that increase the risk of cardiovascular disease. Use of One in five tobacco smokers will develop chronic obstructive pulmonary disease (COPD) (10) in their lifetime,
smokeless tobacco products also increases the risk of death due to heart attack or stroke. especially people who start smoking during their childhood and teenage years, since tobacco smoke significantly
slows lung growth and development. Smokers are 3–4 times more likely to develop COPD than non-smokers.
7 Tobacco smoking causes a swelling and rupturing of the air sacs in the lungs that reduce the lung’s capacity to take
in oxygen and expel carbon dioxide. It also causes the build-up of purulent mucus, resulting in a painful cough and
ORAL CANCER AND OTHER ORAL DISEASES agonizing breathing difficulties. Adults who were exposed to second-hand smoke as children, and had frequent
Tobacco use (both smoked and smokeless) is responsible for a significant burden of oral disease. lower respiratory infections as a result, are also at risk of developing COPD.
Both forms are known to cause mouth cancer (5). In many countries, the chances of surviving more than five
years after an oral cancer diagnosis are low. Those who survive oral cancer often experience considerable
facial disfigurement and lose the ability to speak, swallow or chew.
TUBERCULOSIS
About one quarter of the world’s population has latent tuberculosis, placing them at risk of developing the
Tobacco use also increases the risk of periodontal disease, a chronic inflammatory disease that wears away
active disease. Tobacco smoking more than doubles the risk of transforming tuberculosis from a latent state to
at the gums and destroys the jawbone, leading to tooth loss (6). Smoking tobacco and the use of smokeless
tobacco products interfere with the mouth’s chemistry, creating excess plaque and yellowing teeth, and
9 an active state, and is also known to worsen the natural progression of the disease. In addition, second-hand
smoke exposure may increase the risk of progression from tuberculosis infection to active disease. Tuberculosis
causing bad breath.
damages the lungs, compounding the reduction in lung function caused by smoking, and increases the risk of
1 substantial disability and death from respiratory failure.

THROAT CANCER 8f OTHER RESPIRATORY ILLNESSES AND

Use of smokeless tobacco products and tobacco smoking increase the risk of head and neck
cancers, including cancers of the lips, throat (pharynx and larynx) and oesophagus. Surgical removal REDUCED LUNG FUNCTION
of the cancerous larynx can lead to the need for tracheostomy (7), the creation of a hole in the
neck and windpipe that allows the patient to breathe. Radiation and chemotherapy for throat 10 Tobacco smoking is known to cause pneumonia and all major respiratory symptoms, including
coughing, wheezing and phlegm. Lung growth and function are also more likely to be impaired
cancer have damaging and highly debilitating effects, including loss of taste, decreased saliva among tobacco smokers. The children of parents who smoke suffer similar respiratory symptoms
production and increased throat mucus, which make it painful and at times impossible to eat. 8e and lower levels of lung function throughout childhood. Infants born to mothers who smoke during
pregnancy are especially susceptible, having been exposed to chemicals found
in tobacco during critical developmental stages in utero.
OTHER CANCERS
Tobacco use is also known to cause over 10 other types of cancer. With every puff of a cigarette, TYPE 2 DIABETES
toxins and carcinogens are delivered to the body. Of the many chemicals in tobacco smoke, at least
70 are known to cause cancer. Smokers are at a significantly higher risk of developing acute myeloid
8d The risk of developing diabetes is higher in smokers, and that risk is compounded as the number of
cigarettes smoked per day increases. Second-hand smoke exposure is also associated
leukaemia; cancer of the nasal and paranasal sinus cavities (8a); colorectal (8b), kidney (8c), liver,
pancreatic (8d), stomach (8e) or ovarian cancer; and cancer of the lower urinary tract (including
8c with type 2 diabetes.
the bladder, ureter and renal pelvis). Recent studies have also demonstrated a link between tobacco
smoking and an increased risk of breast cancer (8f), particularly among heavy smokers and women
who start smoking before their first pregnancy. Smoking is also known to increase the risk of cervical
DEMENTIA
cancer (8g) in women infected with human papillomavirus. The risk of these cancers typically Smoking is a risk factor for dementia, a group of disorders that result in mental decline and for which
increases with intensity and duration of smoking, because of the continued exposure to toxins there is currently no effective treatment or cure. Dementia is mostly progressive, affecting memory,
and carcinogens. Smokeless tobacco contains 28 carcinogens that cause cancer of the oral cavity, behaviour and other cognitive abilities and interfering with daily activities. Apart from contributing to
oesophagus and pancreas. significant disability in the person living with dementia, the disease can be emotionally demanding on

Continuing to use tobacco following a cancer diagnosis aggravates the disease prognosis, since
8b 13 the patient’s family and caregivers. Alzheimer’s disease is the most common form of dementia, and an
estimated 14% of Alzheimer’s cases globally can be attributed to smoking.
toxins in tobacco smoke can alter cell biology, which may lead to tumour regrowth; interfere with
anticancer drugs; and increase treatment-related complications.
REDUCED FERTILITY IN MEN AND WOMEN
Smokers are more likely to experience infertility. Women who smoke are more likely than non-smokers
FETAL DEATH to experience challenges in becoming pregnant, increased time to conception and increased risk of
Tobacco use and exposure to tobacco smoke during pregnancy increase the risk for fetal miscarriage. Smoking also diminishes sperm count, motility and morphology (shape of the sperm) in men.
death. Women who smoke or are exposed to second-hand smoke during pregnancy
8g Smokers who try to conceive using assisted reproduction technology have much lower success rates,
are at an increased risk of miscarriage. Stillbirths (the delivery of fetuses that have died sometimes requiring twice as many cycles of in vitro fertilization to achieve conception.
in the womb) are also more common owing to fetal oxygen deprivation and placental
abnormalities induced by carbon monoxide in tobacco smoke and by nicotine in tobacco
smoke and smokeless tobacco. Smokers are at higher risk of ectopic pregnancy, a ERECTILE DYSFUNCTION
potentially fatal complication for the mother in which the fertilized egg attaches outside Smoking restricts blood flow to the penis, which can cause impotence (the inability to achieve an
the uterus. Therefore, smoking cessation and protection from exposure to second-hand erection). Erectile dysfunction is more common in smokers and very likely to persist or become
smoke are especially important for women of reproductive age planning to become 3 permanent unless the man stops smoking early in life.
pregnant and during pregnancy. 4
SUDDEN INFANT DEATH SYNDROME
REDUCED FETAL GROWTH, LOW BIRTH Sudden infant death syndrome (SIDS) is the sudden, unexplained death of a child under 1 year
of age. Prenatal smoking is known to increase the risk of SIDS, and the risk is further increased
WEIGHT AND PRETERM DELIVERY among the offspring of parents who continue to smoke after the birth of the child.

Any form of tobacco use or exposure during pregnancy can be detrimental to the development of the
child. Infants born to women who smoke, use smokeless tobacco, or are exposed to second-hand smoke MENSTRUATION AND MENOPAUSE
during pregnancy have a higher risk of preterm birth and low birthweight. Children born preterm and with
Women who smoke are more likely to experience painful menstruation and more severe menopausal
low birthweight may experience lifelong health complications, including developing chronic diseases in
symptoms. Menopause occurs 1–4 years earlier in female smokers because smoking reduces the production of
adulthood.
eggs in the ovaries, resulting in a loss of reproductive function and subsequent low estrogen levels.

BIRTH DEFECTS
Smoking can deform sperm and damage its DNA, which may cause birth defects. Some studies have found that men
who smoke have an increased risk of fathering a child who contracts cancer. Maternal smoking in early
pregnancy increases a baby’s chance of being born with a cleft lip and/or palate. It has also been noted that men
whose mothers smoked during pregnancy had lower sperm densities than men whose mothers never smoked.
Smoked tobacco product: any product made or derived from tobacco through
a combustion process. Examples include manufactured cigarettes, roll-your-own tobacco,
cigars, shisha (also known as waterpipe), kreteks and bidis.
VISION LOSS
Smoking causes many eye diseases which, left untreated, can lead to permanent vision loss. Smokers are more likely than
non-smokers to develop age-related macular degeneration, a condition that results in irreversible vision loss. Age-related
Smokeless tobacco: any product that consists of cut, ground, powdered, or leaf macular degeneration affects people’s ability to read, drive a car, recognize faces and colours and see objects in fine detail.
Smokers also have a higher risk of cataracts, a clouding of the eye’s lens that blocks light. Cataracts (11) cause vision
tobacco and that is intended to be placed in the oral or nasal cavity. Examples include snuff, impairment, and surgery is the only option to restore vision. New evidence suggests that smoking also causes glaucoma, a
chewing tobacco, gutka, mishri and snus. condition that increases pressure in the eye and can damage eyesight. Tobacco smoke irritates the eyes and worsens dry eye
syndrome in smokers and bystanders exposed to second-hand smoke, particularly among those who wear contact lenses.

Second-hand smoke (SHS): the combination of “mainstream” smoke exhaled by

the smoker and “sidestream” smoke emitted into the environment from lit cigarettes and HEARING LOSS
other smoked tobacco products. The terms “passive smoking” or “involuntary smoking” are Parental smoking is known to cause middle-ear disease among children under 2 years of age who are exposed to second-hand
also often used to describe exposure to SHS. smoke at home. Chronic otitis media (middle-ear disease) among children is a common cause of acquired hearing loss (12)
and deafness. Adult smokers are more likely to suffer hearing loss owing to the effects of long-term smoking on cochlear blood
4 supply. Unaddressed hearing loss and deafness can have significant social, emotional and economic impacts.

GASTROINTESTINAL DISEASES
Smokers are likely to experience gastrointestinal disorders, such as stomach ulcers, inflammatory bowel disease,
13 such as Crohn’s disease, and cancers of the gastrointestinal tract. Inflammatory bowel disease is often associated
with abdominal cramps, persistent diarrhoea, fever and rectal bleeding.

All forms of tobacco are harmful, and there is no safe level of exposure to tobacco.
WEAKENED IMMUNE SYSTEM
Cigarette smoking is the most common form of tobacco use worldwide. Other Components of tobacco smoke weaken the immune system, putting smokers at risk of pulmonary infections. Additionally, smokers
tobacco products include bidis, kreteks, cigars, cigarillos, various smokeless with a genetic predisposition to autoimmune disorders are at an increased risk of several diseases, including rheumatoid arthritis,
Crohn’s disease, bacterial meningitis, postsurgical infection, and cancers. Smoking also puts immune-compromised individuals, such
tobacco products, roll-your-own tobacco, pipe tobacco, waterpipe tobacco and as those living with cystic fibrosis, multiple sclerosis or cancer, at a higher risk of disease-related comorbidities and premature death.
other newer tobacco products. The immunosuppressive effects of tobacco put people living with HIV at an increased risk of developing AIDS. Among HIV-positive
smokers, the average length of life lost is 12.3 years, more than double the number of years lost by HIV-positive non-smokers.

WEAK BONES
Carbon monoxide, the main poisonous gas in vehicle exhaust fumes and tobacco smoke, binds to haemoglobin in the blood more
easily than oxygen does, reducing the delivery of oxygen to the body’s tissues. Smokers are more likely to lose bone density, fracture
BENEFITS OF QUITTING more easily and experience serious complications, such as delayed healing or failure to heal.

It is never too late to quit. The cessation of tobacco use has the SKIN DAMAGE
potential to reduce the risk of many of these diseases significantly and, 3 Tobacco smoking increases the risk of developing psoriasis (13), a noncontagious inflammatory skin condition that leaves itchy, oozing
red patches all over the body. Smoking prematurely ages the skin by wearing away proteins that give the skin elasticity, depleting it of
in some cases, to reduce risk to that of a person who has never smoked. vitamin A and restricting blood flow. Smokers are more likely to develop dry, leathery and wrinkled skin (14),
especially around the lips and eyes.
For more information, please visit: www.who.int/tobacco/en

12 hours 1 to 9 months 5 years 15 years

Carbon monoxide level in your Your coughing and shortness Your stroke risk is reduced Your risk of coronary heart
blood drops to normal. of breath decrease. to that of a non-smoker disease is back to that
5-15 years after quitting. of a non-smoker.

20 minutes 2 weeks to 3 months 1 year 10 years

Your heart rate drops. Your heart attack risk begins to drop. Your added risk of coronary heart disease Your lung cancer death rate is about half that of a
Your lung function begins to improve. is half that of a smoker. smoker. Your risk of cancers of the mouth, throat,
oesophagus, bladder, kidney and pancreas decreases.
Source: WHO Regional Office for the Western Pacific.

Photographs and illustrations: © Australian Government Department of Health; © Convention Secretariat WHO Framework Convention on Tobacco Control; © Georgios Kekos; © Ministry of Public Health, Thailand; © Richard Schneider/lndiana University; © Shutterstock.com
WHO/NMH/PND/19.1
© World Health Organization 2019. Some rights reserved. This work is available under the CC BY-NC-5A 3.0 IGO licence.