Questions About Smoking

Among US adults, cigarette smoking has declined from about 42% of the population in 1965 to about 21% in 2005 (the latest year for which numbers are available). About 45 million adults smoked cigarettes in 2005. About 23% of men and 19% of women were smokers. Education seems to affect smoking rates, as shown by a steady decrease in the smoking rates in groups with a higher level of education.

Cigarette smoke is a complex mixture of chemicals produced by the burning of tobacco and the additives. The smoke contains tar, which is made up of more than 4,000 chemicals, including over 60 known to cause cancer. Some of these substances cause heart and lung diseases, and all of them can be deadly. You might be surprised to know some of the chemicals found in cigarette smoke. They include:

Cigarette smoke also contains the poisonous gases nitrogen oxide and carbon monoxide. Its main active ingredient is nicotine, an addictive drug.

Yes. Tobacco use accounts for about one third of all cancer deaths in the United States. Smoking causes almost 90% of lung cancers. Smoking also causes cancers of the larynx (voice box), oral cavity, pharynx (throat), esophagus, bladder, and contributes to the development of cancers of the pancreas, cervix, kidney, and stomach; it is also linked to the development of some leukemias. Cigars, pipes, and spit tobacco all cause cancers, too. There is no safe way to use tobacco.

Damage of the lungs begins early in smokers, and all cigarette smokers have a lower level of lung function than nonsmokers. Cigarette smoking causes several lung diseases that can be just as dangerous as lung cancer. Chronic bronchitis -- a disease where the airways produce excess mucus, which forces the smoker to cough more often -- is a common ailment of smokers.

Cigarette smoking is also the major cause of emphysema -- a disease that slowly destroys a person's ability to breathe. For oxygen to reach the blood, it must move across large surfaces in the lungs. Normally, thousands of tiny sacs make up the surface area in the lungs. When emphysema occurs, the walls between the sacs break down and create larger but fewer sacs. This decreases the amount of oxygen reaching the blood. Eventually, the lung surface area can become so small that a person with emphysema often must gasp for breath.

Shortness of breath (especially when lying down), a chronic mild cough (which is often dismissed as "smoker's cough"), feeling tired, and sometimes weight loss are early symptoms of emphysema. People with emphysema are at risk for many other complications resulting from weakened lung function, including pneumonia. In later stages of the disease, patients can only breathe comfortably with the help of an oxygen tube under the nose. Emphysema cannot be reversed, but it can be slowed down--especially if the patient stops smoking.

More than 7 million current and former smokers suffer from chronic obstructive pulmonary disease (COPD), the name used to describe both chronic bronchitis and emphysema. COPD is the fourth leading cause of death in America, and the number of women dying from the disease is higher than the number of men. Smoking is the primary risk factor for COPD. About 80% to 90% of COPD deaths are caused by smoking. The late stage of chronic lung disease is one of the most miserable of all medical conditions. It creates a feeling of gasping for breath all the time -- similar to the feeling of drowning.

Cigarette smoke contains chemicals that irritate the air passages and lungs. When a smoker inhales these substances, the body tries to protect itself by producing mucus and coughing. The "early morning" cough of smokers happens for several reasons. Normally, tiny hair-like formations (called cilia) beat outward and sweep harmful material out of the lungs. Cigarette smoke slows the sweeping action, so some of the poisons in the smoke remain in the lungs and mucus remains in the airways. When a smoker sleeps, some cilia recover and begin working again. After waking up, the smoker coughs because the lungs are trying to clear away the poisons that built up the previous day. The cilia will completely stop working after long-term exposure to smoke. Then the smoker's lungs are even more exposed and susceptible than before, especially to bacteria and viruses in the air.

Yes. Wherever smoke touches living cells, it does harm. Even if smokers don't inhale they are breathing the smoke as secondhand smoke and are still at risk for lung cancer. Pipe and Cigar Smokers, who often don’t inhale, are at an increased risk for lip, mouth, tongue, and several other cancers.

Yes. Smoking cigarettes increases the risk of heart disease, which is the number one cause of death in the United States. Smoking, high blood pressure, high blood cholesterol, physical inactivity, obesity, and diabetes are all risk factors for heart disease, but cigarette smoking is the biggest risk factor for sudden heart death. Smokers who have a heart attack are more likely to die within an hour of the heart attack than nonsmokers. Cigarette smoke can cause harm to the heart at very low levels; even levels much lower than needed to cause lung disease.

Pregnant women who smoke risk the health and lives of their unborn babies. Smoking during pregnancy is linked with a greater chance of miscarriage, premature delivery, stillbirth, infant death, low birth weight, and sudden infant death syndrome (SIDS). Up to 10% of infant deaths would be prevented if pregnant women did not smoke.

When a pregnant woman smokes, she's smoking for two. The nicotine, carbon monoxide, and other harmful chemicals enter her bloodstream, pass directly into the baby's body, and prevent the baby from getting essential nutrients and oxygen for growth.

Breast-feeding is a good way to feed a new baby, but smoking may cause problems. If the mother smokes, the baby is exposed to the nicotine and other smoke poisons from her breast milk. Nicotine could cause numerous unwanted symptoms in the baby (such as restlessness, a rapid heartbeat, vomiting, or diarrhea).

Some research has also suggested that children whose mothers smoked while pregnant or who have been exposed to secondhand smoke, even in small amounts, may be slower learners in school. They may be shorter and smaller than children of nonsmokers. They are also more likely to smoke when they get older because they see their parents smoking.

Smoking causes many types of cancer, which may not develop for years. But cancers account for only about half of the deaths related to smoking. Long-term, smoking is also a major cause of heart disease, aneurysms, bronchitis, emphysema, and stroke, and it contributes to the severity of pneumonia and asthma. Skin wounds take longer to heal and the immune system may be less effective in smokers compared to nonsmokers.

The truth is that cigarette smokers die younger than nonsmokers. In fact, according to a study from Centers for Disease Control and Prevention (CDC) done in the late 1990s, smoking shortened male smokers' lives by 13.2 years and female smokers' lives by 14.5 years. Both men and women who smoke are much more likely to die during middle age (between the ages of 35 and 69) than those who have never smoked.

Smoking also causes many short-term effects, such as decreased lung function. Because of this, smokers often suffer shortness of breath and nagging coughs; they often will tire easily during physical activity. Some other common short-term effects: a diminished ability to smell and taste, premature aging of the skin, bad breath, stained teeth, and increased risk of sexual impotence in men.

About half of all the people who continue to smoke will die because of the habit. In the United States, tobacco causes nearly 1 in 5 deaths, killing about 440,000 Americans each year. Smoking is the single most preventable cause of death in our society.

Based on current patterns, smoking will kill about 650 million people alive in the world today. Tobacco-caused deaths worldwide are expected to increase from about 5 million per year today to about 10 million per year by the 2030s. Most of these deaths will occur in developing countries.

ETS, also known as passive smoking or secondhand smoke, occurs when nonsmokers inhale other people’s tobacco smoke. This includes mainstream smoke (smoke that is inhaled and then exhaled into the air by smokers) and side-stream smoke (smoke that comes directly from the burning tobacco in cigarettes). ETS contains the same harmful chemicals as the smoke that smokers inhale. In fact, because side-stream smoke is formed at lower temperatures, it contains even larger amounts of some toxic and cancer-causing substances than mainstream smoke.

There is strong evidence that ETS causes serious damage to human health. ETS causes about 3,400 lung cancer deaths and about 46,000 deaths from heart disease each year in healthy nonsmokers who live with smokers. It can also affect nonsmokers by causing asthma and other respiratory problems, eye irritation, headaches, nausea, and dizziness. Children whose parents smoke are more likely to suffer from asthma, pneumonia, bronchitis, ear infections, coughing, wheezing, and increased mucus production. Babies of parents who smoke have a greater chance of dying of sudden infant death syndrome (SIDS). Pregnant women exposed to ETS are at risk for having a low birth weight baby and may also be at risk for pre-term delivery and miscarriage.

An issue that continues to be an active focus of scientific research is whether secondhand smoke may increase the risk of breast cancer. Both mainstream and secondhand smoke contain about 20 chemicals that, in high concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast tissue and are found in breast milk.

The evidence regarding secondhand smoke and breast cancer risk in human studies is controversial, at least in part because the risk has not been shown to be increased in active smokers. One possible explanation for this is that tobacco smoke may have different effects on breast cancer risk in smokers and in those who are just exposed to smoke.

A report from the California Environmental Protection Agency in 2005 concluded that the evidence regarding secondhand smoke and breast cancer is "consistent with a causal association" in younger, mainly premenopausal women. The 2006 US Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, concluded that there is "suggestive but not sufficient" evidence of a link at this point. In any case, women should be told that this possible link to breast cancer is yet another reason to avoid contact with secondhand smoke.

Menthol cigarettes are not safer than any other brand. In fact, they may even be more dangerous. About one fourth of all cigarettes sold in the United States are flavored with menthol. These cigarettes are especially popular among African Americans. The added menthol produces a cooling sensation in the throat when the smoke is inhaled. It also decreases the cough reflex and covers the dry throat feeling that smokers often have. People who smoke these cigarettes can inhale deeper and hold the smoke in longer.

A recent study showed that people who smoke menthol cigarettes are less likely to try to quit and are less likely to be successful when they do try. This study proposed that menthol smokers might want to switch to non-menthol cigarettes before trying to quit in order of improving their chances to quit smoking.

There are many terms used to describe spit tobacco, such as oral, smokeless, chewing, and snuff tobacco. The use of spit tobacco by any name is a significant health risk. It is a less lethal substitute for smoking cigarettes. However, less lethal is a far cry from safe. The amount of nicotine absorbed is usually more than the amount delivered by a cigarette. Overall, people who dip or chew receive about the same amount of nicotine as regular smokers. The most harmful cancer-causing substances in spit tobacco are tobacco-specific nitrosamines (TSNAs), which have been found at levels 100 times higher than the nitrosamines that are allowed in bacon, beer, and other foods. These carcinogens cause lung cancer in experimental animals, even when injected.

The juice from the smokeless tobacco is absorbed directly through the lining of the mouth. This creates sores and white patches (called leukoplakia) that often lead to cancer of the mouth.

Spit tobacco users greatly increase their risk of other cancers including those of the pharynx (throat). Other effects of spit tobacco use include chronic bad breath, stained teeth and fillings, gum disease, tooth decay, tooth loss, tooth abrasion, and loss of bone in the jaw. Users may also have problems with high blood pressure and be at increased risk for heart disease.

Many people view cigar smoking as more "civilized" and "glamorous," as well as less dangerous than cigarette smoking. Yet a single large cigar can contain as much tobacco as an entire pack of cigarettes.

Most of the same cancer-causing substances found in cigarettes are found in cigars. Most cigars have as much nicotine as several cigarettes. When cigar smokers inhale, nicotine is absorbed as rapidly as it is with cigarettes. For those who do not inhale, it is absorbed more slowly through the lining of the mouth. Both inhaled and non-inhaled nicotine are highly addictive.

Smoking cigars causes cancers of the lung, oral cavity (lip, tongue, mouth, and throat), larynx (voice box), esophagus, and probably cancers of the bladder and pancreas. Cigar smokers have a greater risk of dying from cancer of the oral cavity, larynx, or esophagus compared with nonsmokers. The risk of death from lung cancer is not as high as it is for cigarette smokers, but is still several times higher than the risk for nonsmokers.

Cigar smokers who inhale deeply and smoke several cigars a day are also at increased risk for heart disease and chronic lung disease.

Pipe smokers are at increased risk of dying from cancers of the lung, throat, esophagus, larynx, pancreas, colon and rectum. They are also at increased risk of dying of heart disease, stroke, and chronic lung disease. The level of these risks seems to be about the same as that for cigar smokers.

What about more "exotic" forms of smoking tobacco, such as clove cigarettes, bidis, and hookahs?

Several forms of flavored tobacco have become popular in recent years, especially among younger people. Clove cigarettes (kreteks), bidis, and, more recently, hookahs, often appeal to those who want something a little different. They also provide young people with another way to experiment with tobacco. The false image of these products as clean, natural, and safer than conventional cigarettes seems to attract some young people who may otherwise not start smoking. But these products carry many of the same risks of cigarettes and other tobacco products and each has its own additional problems associated with it.

Clove cigarettes, also called kreteks, are imported mainly from Indonesia and contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. The chemicals in cloves have been implicated in cases of asthma and other lung diseases. Users often have the mistaken notion that smoking clove cigarettes is a safe alternative to smoking tobacco. But they are a tobacco product with the same health risks as cigarettes and, in fact, have been shown to deliver more nicotine, carbon monoxide, and tar than conventional cigarettes.

Bidis or "beedies" are flavored cigarettes imported mainly from India. They are hand-rolled in an unprocessed tobacco leaf and tied with colorful strings on the ends. Their popularity has grown in recent years in part because they come in a variety of candy-like flavors such as strawberry, vanilla, and grape, they are usually less expensive than regular cigarettes, and they often give the smoker an immediate buzz.

Even though bidis contain less tobacco than regular cigarettes, they have higher levels of nicotine (the addictive chemical in tobacco) and other harmful substances such as tar and carbon monoxide. Because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette. They are also unfiltered. Bidis appear to have all of the same health risks of regular cigarettes, if not more. Bidi smokers have much higher risks of heart attacks, chronic bronchitis, and some cancers than nonsmokers.

Hookah (or narghile) smoking, which started in the Middle East, involves burning flavored tobacco in a water pipe and inhaling the smoke through a long hose. It has recently become popular among young people, especially around college campuses. Hookah smoking is usually a social event that allows conversation to take place among the smokers as they pass the shared pipe around. It is marketed as being a safe alternative to cigarettes because the percent of tobacco in the product smoked is low. This claim for safety is false. The water does not filter out many of the toxins, and hookah smoke contains varying amounts of nicotine, carbon monoxide, and other hazardous substances. Several types of cancer have been linked to hookah smoking. Hookah is also linked to other unique risks not associated with cigarette smoking. For example, infectious diseases can be spread by pipe sharing or the uncontrolled, manual preparation of the tobacco used.

All forms of tobacco are dangerous. Even if the health risks were smaller for some tobacco products as opposed to others, all tobacco products contain nicotine, which can lead to increased use and addiction. Tobacco cannot be considered safe in any amount or form.

Tobacco use accounts for nearly one third of all cancer deaths. Tens of thousands of women will die this year from lung cancer, which has greatly surpassed breast cancer as the leading cause of cancer death among women. More than 90% of these deaths will be due to smoking. In addition to increasing the risk for lung cancer, smoking is a risk factor for cancers of the cervix, mouth, larynx (voice box), pharynx (throat), esophagus, kidney, bladder, pancreas, and stomach. It is also connected to some forms of leukemia. Environmental tobacco smoke (ETS), also known as secondhand smoke, has been shown to increase the risk of lung cancer. The 2006 Surgeon General's report on secondhand smoke concluded the following:

Women who smoke greatly increase their risk of heart disease (the leading killer among women) and stroke. Risk increases with the number of cigarettes smoked and the length of time smoked. Even though most of the women who die of heart disease are past menopause, smoking increases the risk more in younger women than in older women. Some studies suggest that smoking cigarettes dramatically increases the risk of heart disease among younger women who are also taking birth control pills. Smoking is also linked to peripheral vascular disease, a narrowing and hardening of major blood vessels in the body. These risks can be reversed after 10 to 15 years of quitting smoking.

Smoking damages the airways and small air sacs in the lungs, and is related to chronic coughing and wheezing. About 90% of deaths due to chronic bronchitis and emphysema -- collectively known as chronic obstructive pulmonary disease (COPD) -- are caused by smoking. The risk increases both with the number of cigarettes smoked each day and with the length of time a woman has been smoking. Female smokers aged 35 or older are almost 13 times more likely to die from emphysema or bronchitis. Smoking "low tar" or "light" cigarettes does not seem to reduce these risks, or any of the other health risks of tobacco. Teenage girls who smoke have reduced rates of lung growth and adult women who smoke have an early decline of lung function.

Women who smoke, especially after going through menopause, have lower bone density and a higher risk for fracture, including hip fracture, than women who do not smoke. They may also be at higher risk for developing rheumatoid arthritis and cataracts (clouding of the lenses of the eyes).

Tobacco use can damage a woman's reproductive health. Women who smoke have an increased risk for delayed conception and fertility problems. Smokers are younger at menopause than nonsmokers and may have more unpleasant symptoms while going through menopause. Smoking can also cause complications during pregnancy that can hurt both mother and baby. Smokers have a higher risk of the placenta growing too close to the opening of the uterus. Smokers are also more likely to have premature membrane ruptures and placentas that separate from the uterus too early. Bleeding, premature delivery, and emergency Caesarean section (C-section) may result from these problems. Smokers are also more likely to have miscarriages and stillbirths.

What's in a Cigarette?

Nicotine	Nicotine is the main addictive ingredient in tobacco. Nicotine activates the synthesis of a chemical called dopamine in the brain. The effects of nicotine on the body are "biphasic," in that it can both stimulate and relax you.
Acetone	This is also used as a solvent to remove nail varnish.
Ammonia	Boosts the impact of nicotine.
Tar	Every time you smoke a cigarette, tar is deposited into the lungs. Heavy smokers (20+ cigarettes /day) can accumulate more than a pound of tar in their lungs each year.
Benzene	Benzene is used as a solvent in fuel and dyes. It is also carcinogenic.
Cadmium	Cadmium is used to make batteries; it is damaging to the kidney and increases the risk of developing lung cancer.

While a single cigarette contains up to 599 additives, of which many may seem to be harmless, it is the burning of these chemicals that produces toxic and carcinogenic compounds вЂ“ more than 4000 of them. The negative health effects of smoking cigarettes can be devastating - just look at the compounds being inhaled with each puff.

Here is a list of the main cigarette ingredients that are the most noxious:

What's in Cigarette Smoke?

If you thought the stuff in cigarettes was bad, wait 'til you burn it! It's alarming to know how many harmful chemicals are contained in cigarette smoke. The combination of them leads only to inevitable smoking-related disease and ultimately death. There are 43 known carcinogens contained in mainstream cigarette smoke, side-stream smoke, or both.

Hydrogen cyanide	This is a colorless-to-blue vapor, which can cause death within minutes if breathed in large concentrations. It is used as a pesticide and fumigant to kill rats. Breathing small amounts of it can cause headache, dizziness, weakness, nausea, and vomiting.
Ammonia	Ammonia is used in cigarettes to boost the impact of nicotine ("free-basing"). Ammonia can be irritating to the skin, eyes, nose, throat, and lungs.
Carbon monoxide (CO)	Carbon monoxide is a colorless, odorless gas which when inhaled reduces the body's ability to carry oxygen. Cigarette smoke can contain high levels of this gas. Breathing low levels of CO can cause fatigue while increasingly higher concentrations can lead to headache, nausea, confusion, disorientation, and eventually death.
Nitrogen oxides	Nitrogen oxides also contribute to air pollution and acid rain.

'Natural Tobacco' Poses Greater Health Risks

Do not be fooled by "natural tobacco" products that are marketed to teens and college students. They're not healthier. In fact, natural tobacco can be deadlier than average cigarettes.

Unfortunately, for today's youth and young adults, forms of natural tobacco, including bidis, clove cigarettes, cigars, little cigars, cigarillos, chew/dip tobacco, pipe tobacco and organic cigarettes, are viewed as trendy and perhaps even healthier, despite the real health risks.

"Natural tobacco doesn't have anything to do with being healthier," says Ross Payson, project director for tobacco programs at the Dental Health Foundation. "Natural means it has a small percentage of non-synthetic substances. It's a marketing scam."

Natural tobacco often contains higher concentrations of tar and nicotine, and the smoke has greater levels of toxic agents such as carbon monoxide, hydrogen cyanide, ammonia and carcinogenic hydrocarbons. This not only increases the smoker's risk of developing lung cancer or other diseases, but it also jeopardizes the health of everyone in the room.

"You're still inhaling carbon monoxide and 400 carcinogens and poisons," Payson says.

American Lung Associations in California and other groups, including the Dental Health Foundation and the California Youth Advocacy Network, are implementing new programs and adjusting others to combat the rise in natural tobacco use by teens and college students, and the ultimate disease and premature death it will cause.

New Study Shows 40 Percent of Teens Have Smoked Bidis

A recent report released by the Centers for Disease Control and Prevention (CDC) found in a Boston-area study of 642 high school students that 40 percent had tried bidis and 16 percent were current bidi smokers.

"Natural tobacco is an up and coming issue," says Jennifer Williams, director of Tobacco Control for the American Lung Association of the Central Coast. "We found that older and younger teens are asking about bidis and cloves because they think they are a lot safer than cigarettes."

Bidi cigarettes, also known as beadies or beedies, are handrolled tendu leaves containing low-grade tobacco and tied up with string. Widely available in grocery stores and convenience stores for about half the cost of cigarettes, the paper-wrapped bundles of bidis come in several flavors including Cinnamon, Chocolate, Vanilla and Strawberry.

Nearly 70 percent of bidi brands do not have warning labels as required by law, according to a Dental Health Foundation fact sheet.

Bidis are known as the "poor man's cigarette" in India. They are made by women and children in India's poor households, according to research compiled by the Dental Health Foundation. In addition to a lack of health precautions and poor working conditions, it has been shown that bidi assemblers absorb nicotine through their skin.

"Teens are aware of the health risks from smoking tobacco and it may not have an impact," Payson says. "But I think it would have more of an impact if they knew that children in India roll 1,000 to 1,500 bidis a day, for 30 cents per day in a 12 to 16-hour work day. They work under poor conditions and there is no quality assurance."

American Lung Association Fights Dangerous Trend

To combat this dangerous rise in bidi smoking, American Lung Associations throughout the state are implementing Teens Against Tobacco Use (TATU), in cooperation with the American Heart Association and the American Cancer Society. The all-day training and education workshop trains teens how to talk to children about the dangers and myths about tobacco.

"We found that using teens as anti-tobacco educators for elementary school children is more effective than using adults," Williams says.

More than 90 percent of adult smokers started smoking in their teens, resulting in the creation of tobacco control programs that focus on early prevention in junior high and high school. There are very few prevention and cessation programs for young adults ages 18 to 25.

"Mind the Gap" is an advocacy project implemented by the American Lung Association of Santa Clara-San Benito Counties focusing on college students in that age category on seven college campuses in Santa Clara and San Benito counties. The project focuses on education and prevention.

"Our goal is to make campuses smoke-free," says Francis Capili, project director at the American Lung Association of Santa Clara-San Benito Counties. "We want to protect people from secondhand smoke and limit tobacco accessibility."

Tobacco Companies Target Colleges with Sponsorships

"Some tobacco companies are targeting colleges by sponsoring fraternity parties and giving away free chew tobacco," says Susan Snoke, college project consultant for the California Youth Advocacy Network.

Snoke is part of a three-year project to develop student advocacy coalitions at California schools, including the University of California at Davis, University of California at Santa Cruz, Sonoma State University, San Diego State University and Vanguard University of Southern California.

The coalitions are implemented and facilitated by college students who determine which campus smoking policies and issues to address. Marie Boman, a college liaison for anti-tobacco advocacy at San Diego State University (SDSU), led a movement to enforce SDSU's no smoking policy in a specific campus building. She was able to get the college to remove cement ashtrays from the breezeways and the doorways to prevent smoke from flowing inside the building.

Boman volunteers for the American Lung Association and believes tobacco companies are currently targeting colleges for cigars, clove cigarettes and chew/dip tobacco.

"There's a misconception in defining cloves as natural," Boman says. "Clove cigarettes are processed just like regular cigarettes." Clove cigarettes are typically made of 60 percent poor quality tobacco. They deliver twice as much nicotine, tar and carbon monoxide as tobacco cigarettes in addition to the unknown hazards associated with chemicals in cloves. Clove cigarette smokers can suffer immediate effects including coughing up blood, nose bleeds, severe sore throats, and upper respiratory infections.

Cigar Smokers More Likely to Develop Cancer

Although cigars may also be marketed as a natural and safer alternative to cigarettes, they contain larger amounts of nicotine and carcinogens. A bill requiring cigar manufacturers to add labels comparing the danger of cigar smoking with cigarettes or warning smokers of cancer and other diseases was passed by the state Legislature.

"It seems that cigars are also being pushed on college campuses to the 18 to 24-year-old men and women," Payson says. "Cigars are marketed to portray cigar smokers as affluent, powerful and sexy."

Cigar smokers are four to 10 times more likely than non-smokers to die of cancer of the mouth and throat. Cigarettes can contain 11 milligrams of nicotine while a cigar can contain as much as 444 milligrams. Cigars also give off five times as much tar and 25 times more carbon monoxide than a cigarette.

So even cigar smokers who say they don't inhale are risking their health. Not only are they choking on their own secondhand smoke, along with everyone else in the room, cigar smokers suffer higher rates of cancer and other diseases.

"Smoking, is smoking," Payson says. "Tobacco, no matter the form, is poisonous and addictive to all ages."