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Tobacco smoking

Tobacco smoking

Smoking tobacco cigarettes is the main cause of many lung diseases. Tobacco smoke contains more than 4,000 chemicals, many of which are toxic and can cause cancer. 

  • What is it?

    The World Health Organization (WHO) defines smoking as a disorder or disease. This is because people can become physically dependent on nicotine found within cigarettes in addition to the behavioural, psychological and social aspects of smoking.

    According to the European Commission’s Eurobarometer survey carried out in 2012, 24% of women and 32% of men smoked, with rates varying considerably with age. However, tobacco use is not high everywhere – in Iceland it is 14% in both sexes. 

  • Harmful Effects

    Smoking is one of the most important risk factors for heart diseases and cancers of several different organs. 

    Nicotine found within cigarettes is highly addictive. Nicotine receptors have been identified in the brain. These receptors are activated when a person inhales nicotine and dopamine is released. Dopamine is a reward-driven hormone that gives a good feeling and can increase the likelihood of addiction.


    Approximately one third of all cancers are caused by tobacco use and between 80% and 90% of all lung cancer cases are attributable to tobacco. Lung cancer also kills more people in the EU than any other cancer, accounting for about 20% of all cancer deaths. Tobacco smoking can also cause cancers in the mouth, larynx, pharynx, nose and sinuses, oesophagus, stomach, liver, pancreas, kidney, bladder, cervix and bowel, along with one type of ovarian cancer and some types of leukaemia. 


    Smoking is the main cause of COPD, particularly in Europe. If a person smokes during childhood or early adulthood, smoking can reduce the speed at which lung function develops. In later life, smoking can then accelerate the decline of lung function in old age.

    Schematic diagram of the decline in lung function with age in non-smokers, smokers and those who quit.

    • Black: never-smoker or not susceptible to smoke;
    • Red: regular smoker and susceptible to smoke; green: quitter at age 45 years;
    • Blue: quitter at age 65 years.
    • FEV1: forced expiratory volume in 1 s.

    The horizontal red line indicates the level at which symptoms are likely to be disabling and the broken black line the level at which death is likely. Note that stopping smoking slows the rate of decline of lung function.


    Smoking is a cause of childhood asthma and a risk factor for the development of asthma in adults. It is also linked to an increased risk of asthma attacks and difficulty in controlling asthma. 


    Smoking is known to make people more susceptible to infection and people with TB who smoke are at a higher risk of death.

    Diseases of other organs

    Tobacco smoke is also a risk factor for a number of other conditions outside the respiratory system. These include heart disease, including coronary artery disease and stroke, osteoporosis, reproductive disorders, adverse post-operative events and delayed wound healing, duodenal and gastric ulcers, periodontal disease and diabetes. 

  • Burden

    • Estimates suggest that around 100 million people worldwide were killed by tobacco in the 20th century and that this number will increase to 1 billion in the 21st century
    • In Europe, smoking leads to more than 650,000 premature deaths every year
    • Although only 15% of the world’s population live in Europe, nearly a third of the burden of tobacco-related disease occurs in Europe
    • The total economic costs of tobacco reduces national wealth in terms of gross domestic product (GDP) by as much as 3.6%

    The best way to reduce the negative health effects of smoking in the next 10-20 years is to promote cessation among current smokers and stopping smokers taking up the habit now will decrease the impact of smoking-related disorders in the long-term.

    Some experts believe that tobacco should be banned entirely, however no country in Europe is yet ready to do ban tobacco outright due to the legal processes that would need to be adhered to. Finland estimates that they can ban tobacco by the year 2040.

    Some methods to help smokers quit: 


    The WHO Framework Convention for Tobacco Control was the first international treaty negotiated for tobacco control, providing a set of universal standards stating the dangers of tobacco and limiting its use. All EU countries are among the nations that have signed it.


    Price is the most powerful tool for reducing tobacco. Overall there is a 3-4% fall in consumption for every 10% increase in price. The tobacco industry opposes tax rises and often argues that a price increase will lead to a loss of revenue through an increase in smuggling. However, several studies have shown that this isn’t the case.

    Restricting teenage smoking

    85% of smokers take up the habit in their teens therefore policymakers should focus on banning the sale of cigarettes to people in their teenage years.

    The EU Tobacco Products Directive

    Banning advertising, sponsorship and promotion is an important aspect of tobacco control and such bans are widespread in the EU.

    The Tobacco Products Directive is currently being revised (at the time of publication) and includes a number of restrictions on the marketing of cigarettes including the use of health warnings and graphic images of diseases caused by tobacco.


    Nicotine replacement products such as patches, gum, inhalers, nasal sprays, lozenges and oral sprays can be used to help quit smoking. In addition, two drugs called varenicline and bupropion can also be used. Most healthcare professionals suggest that these products can work when used in combination with psychological support, to help smokers break their addictive behaviour. 

    Counselling for smoking cessation

    Self-help materials, telephone counselling and group therapy can also help smokers quit. 

  • Current and Future Needs

    • More smoke free areas in public across Europe can help prevent the uptake of smoking amongst younger people
    • Increasing the price of cigarettes further can help to reduce long-term illness and death from smoking in the next 20 years and beyond
    • Community, country and EU interventions against smoking should be strengthened, with plain packaging, and aiming at phasing out cigarettes
    • All smokers should be encouraged to quit, reducing the burden of smoking over the next two decades
    • Smoking cessation treatments are cost effective and should be used more widely
    • Education in cessation of tobacco should be included in the training for all health professionals and medical students
    • The proposals of the WHO Framework Convention of Tobacco Control should be further implemented across Europe