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The reason people are drawn to tobacco is mostly due to one chemical: Nicotine. Seconds after smoking, nicotine takes effect, causing the brain to initiate many ’pleasure’ signals and turn these into addictive cravings. Most people who smoke are surprised at how fast and strongly addiction can develop. Anyone who stops to quit can expect mood swings, a difficult time sleeping, and feelings of irritability. Some smokers decide to smoke again, as they think it can help them relax, but that short-lived feeling is no match for the repeating urge to smoke.
At the same time, the harm caused by tobacco is felt in areas other than the lungs. Infants to bartenders are at risk from breathing in secondhand smoke, along with the smoker’s body, which is exposed to all the chemicals found in smoke, many of which cause cancer. This article unpacks how nicotine dependence develops, the hidden benefits of quitting, the dangers of secondhand smoke, and the array of tools that help millions step away from tobacco for good. Let’s start by exploring what causes nicotine addiction.
The first exposure to nicotine is often enough to make someone addicted. Ten seconds after breathing tobacco smoke, the nicotine in it flows through the blood to the brain and latches on, which causes dopamine to be released. As a result, there is a strengthening of reward-related connections in the brain. It doesn’t take long for a smoker to conclude that a cigarette helps ease the discomfort caused at the start by smoking cessation.
A person can become physically dependent on nicotine after smoking regularly for a few weeks. Not having the first cigarette of the day can bring on irritation, while delaying another one makes it hard to focus. Common withdrawal symptoms include:
These discomforts aren’t mere inconveniences. The process is such that if you are stressed from quitting, smoking seems to relieve that stress. There is a belief that a cigarette can soothe stress, but the truth is it only gives temporary relief from nicotine rather than dealing with the root stress. The relief is short-lived and leads to more addiction.
The urge to smoke is strongest within the first several days after quitting, but it can return later on, caused by certain situations or feelings. This is why people who try to quit by themselves rarely succeed. Professional or peer support can make quitting better for you. Behavioral coaching helps reframe triggers: Instead of having a smoke when things get tough, a quitter might go for a small walk or try some deep breathing exercises. Nicotine patches or lozenges soothe the craving while the brain gets back in balance.
With every puff, a range of more than 7,000 compounds is delivered. Some particles interact with human DNA and pave the way for lung, mouth and throat cancer to develop. Tiny amounts of carcinogens like benzo[a]pyrene and nitrosamines have the ability to change cell DNA. As soon as you quit smoking, toxic chemicals stop entering your body, and it gets to work on removing any residues.
Each important moment reveals that there is more to quitting than just willpower. Every hour without smoking is a step toward healing for the body.
In the United States, each year, smoking and secondhand smoke costs the lives of over 400,000 adults and increases the odds of child mortality. Even people near someone smoking are exposed to a mix of sidestream and mainstream smoke, since both carry the same dangerous elements as smoke from a lit cigarette.
Breathing tobacco smoke over a long period as a non-smoker raises the risk of developing coronary heart disease by up to 30 percent and stroke by the same factor. Several mechanisms are at play: The damage caused by cigarette smoke involves endothelial cells, blood that clots more easily, and increased levels of chemicals that are harmful for both blood vessels and lungs.
Infants and children are uniquely vulnerable:
These early-life harms set the stage for chronic lung issues well into adulthood.
Certain professions confront disproportionate exposure. Here’s an example:
| Occupation | Estimated Exposure Level | Long-Term Impact |
|---|---|---|
| Bartenders/Servers | Average 8–12 hours/day in smoke | Elevated COPD and cardiac events |
| Blue-Collar Labor | Enclosed job sites, minimal laws | Higher rates of respiratory disease |
| Casino Staff | Almost continuous SHS in casinos | Significant increases in lung cancer |
Although smoke-free policies have reduced risks in many settings, gaps remain in bars, private clubs and older industrial facilities.
During the 1800s, people in rural areas put chewing tobacco in their lower lips. Bars, trains, and barbershops alike were filled with spittoons. Practically speaking, it was not just a routine, but it was tied to the culture of masculinity and long-standing traditions.
That image never fully disappeared. Nowadays, smokeless tobacco is popular in small communities as well as among people who view it as a safer option than cigarettes. Studies, however, give a very different account. About 2 in every 100 adults in the United States use smokeless tobacco, and the use is increasing, especially among rural men and younger users. Smokeless tobacco is still considered safe, although the risks of smoking cigarettes are well recognized.
These products come in several forms, all delivering high levels of nicotine without combustion:
Despite their differences, all expose the user to carcinogens, especially tobacco-specific nitrosamines, among the most toxic known to science.
Smokeless tobacco is linked to cancers of the mouth, esophagus, and pancreas. Users often develop white or red patches in the mouth that can turn malignant. Gum recession, tooth decay, and chronic mouth sores are common. Many lose teeth entirely. Even short-term use can alter the bacterial balance in the mouth, setting off aggressive gum disease.
These products are addictive (sometimes more so than cigarettes) because the nicotine stays in the bloodstream longer. Flavored varieties and “spitless” designs make them easier to hide and harder to quit. Marketing may claim they’re safer, but there’s nothing safe about what they do to the body.
If you visit the parking lot at a high school or watch enough TikTok videos, chances are you’ll come across people vaping. Despite many years of improvement, tobacco use among young people is still an issue, appearing differently now. FDA reports show that over 2 million middle- and high-school students in the US use tobacco products. And it’s not just cigarettes. Youth are becoming addicted to nicotine more quickly due to flavored cigars, smokeless tobacco, and especially vapes.
If today’s rates persist, millions of minors below 18 could lose their lives because of smoking. Using nicotine at an early age can change the way their brains develop in systems that focus, balance mood, and put cravings in check. People who start smoking young are generally more prone to ongoing cigarette use and to feeling anxiety and depression.
Almost 40% of cigarettes smoked in the U.S. end up being smoked by those with behavioral health conditions. For years, both psychiatric hospitals and centers for substance misuse did not discourage smoking. Nurses would give cigarettes to those patients who behaved quietly or followed the rules. This leads to many who already have serious mental illness or addiction suffering from long-term nicotine dependence.
It has been found that smoking does not positively affect anxiety or depression. Although nicotine may give some temporary relief, it affects a person’s mood, leads to more depressive symptoms, and increases the chances of suicidal thoughts. There is a link between chronic use of tobacco in people suffering from schizophrenia, bipolar disorder, or major depression and both higher symptom levels and frequent stays in the hospital.
In low-income neighborhoods, tobacco use is common. From billboards in front of bus stops to the corner store selling cigarettes, the message is constant. Smoke for those people living below the poverty line is twice that of those above it. The more serious the economic hardship, the more pronounced the addiction.
Low-SES groups do want to quit; they attempt to do so just as often as high-SES groups. But there lies the catch: poorer individuals have more stressors in their daily lives, from unstable housing to food insecurity, smoking becomes a coping tool, and quitting becomes that much harder. Others start smoking at a younger age and will be smoking longer, increasing their risk.
Jobs for many in the low-income classes are in industries where exposure to secondhand smoke is rampant: construction sites, service jobs, and outdoor labor where smoke-free policies are unclear. Such activities affect not only smokers but also their colleagues, who do not smoke, and further increase the health risk.
The first step to quitting nicotine addiction is realizing and reaching out for help. Visit this CDC resource or call 1-800-QUIT-NOW to start your quitting journey.
Whatever people say, quitting tobacco is not just a matter of determination. It involves all that withdrawal, unlearning the coping mechanisms one has developed, and fighting against systems that keep certain communities much more exposed, addicted, and unsupported. From flavored vape pods in high-school backpacks to menthol cigarettes in low-income neighborhoods, barriers exist—and they're not evenly distributed. Still, movement is happening.
Now, former smokers exceed the active ones in number. Quitlines, digital tools, culturally tailored campaigns, and evidence-based therapies are opening doors for people who once struggled alone. We can see what science, policy, and real-life experience can accomplish in the field of public health. Any person who stops using becomes healthier and also feels more in control.
