Effects of tobacco on health

19 May 2025

Key facts

  • Each year, tobacco kills 1.1 million people in the WHO European Region. Of those, 153 000 die from exposure to second-hand smoke.
  • Tobacco accounted for 15.4% of total deaths in males and 4.7% of deaths in females in 2021 in the WHO European Region.
  • The proportion of deaths from ischaemic heart disease attributable to tobacco use is estimated to be 26% for men and 7% for women.
  • The proportion of deaths from lung cancer attributable to tobacco use is 71% for men and 46% for women.
  • Seven of 10 lung cancers in men are related to tobacco use.
  • Tobacco’s contribution to the leading causes of death in the WHO European Region in 2021: heart disease: 15.8%; stroke: 10.5%; trachea, bronchus and lung cancers: 63.5%; Alzheimer’s disease and other types of dementia: 2.7%; diabetes and kidney diseases: 8.9%; chronic obstructive pulmonary disease (COPD): 38.4%; colon and rectal cancer: 4.2%; lower respiratory infections and tuberculosis: 16.7% and 27.1%, respectively.
  • Exposure to second-hand smoke also contributes to deaths from major noncommunicable diseases (NCDs): heart disease (3.6%), lung cancer (3.4%), diabetes (3.7%) and COPD (4.4%).
  • Smokers are 2–4 times more likely than non-smokers to suffer coronary heart disease and stroke. Adults exposed to other people’s smoke have a 25–30% raised risk.
  • Tobacco use accounts for 25% of all cancer deaths globally and is the primary cause of lung cancer. Smokers are up to 22 times more likely than non-smokers to develop lung cancer in their lifetime.
  • Tobacco use and exposure to tobacco smoke during pregnancy is linked to increased risk of fetal death, miscarriage and stillbirth. In infancy, it can cause sudden infant death syndrome.
  • Children living with smokers are at greater risk for bronchitis, pneumonia and other respiratory infections. They are also more likely to acquire and be hospitalized for asthma and to develop middle ear infections.
  • The risk of developing diabetes is higher in smokers.
  • Tobacco use increases the risk of periodontal disease, a chronic inflammatory disease that wears away at the gums and destroys the jawbone, leading to tooth loss.
  • Smokers are likely to experience gastrointestinal disorders, such as stomach ulcers, inflammatory bowel disease, associated with abdominal cramps, persistent diarrhoea, fever and rectal bleeding, as well as cancers of the gastrointestinal tract.
  • Components of tobacco smoke weaken the immune system, putting smokers at risk of respiratory tract infections.
  • Smoking is a risk factor for dementia, a group of disorders resulting in mental decline.
  • Later in life, tobacco leads to higher rates of cancer (especially lung cancer), as well as higher rates of death associated with diseases of the respiratory system.

Overview 

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. Lifelong tobacco smokers lose at least 10 years of life on average. Tobacco use or exposure to tobacco smoking affects almost all organs of the human body and has a negative impact on health across the life course.

Although tobacco products are usually associated with NCDs, such as cancers and heart and respiratory diseases, tobacco is also an important factor in deaths from communicable diseases. For example, tuberculosis can at times be latent or dormant until activated by tobacco use.

Within NCDs, 64% of the deaths caused by cancer of the trachea, bronchus and lung, 16% of the deaths caused by ischaemic heart disease and 38% of COPD deaths were attributed to tobacco in 2021. For communicable diseases, 27% of tuberculosis deaths are attributed to tobacco, as are 17% of deaths from all lower respiratory infections. 

New and emerging nicotine and tobacco products

Heated tobacco products (HTPs) are tobacco products that produce emissions containing nicotine and toxic chemicals when tobacco is heated or the device containing the tobacco is activated. They contain the highly addictive substance nicotine, non-tobacco additives and are often flavoured.

Despite industry claims of “reduced risk”, there is currently no conclusive evidence that HTPs are less harmful than conventional cigarettes. While certain toxicants are present at lower levels in HTP aerosols than in cigarette smoke, others – such as glycidol, pyridine, dimethyl trisulfide, acetoin and methylglyoxal – are found at similar or even higher concentrations. Moreover, HTP emissions contain some toxic substances not present in conventional tobacco smoke, the health impacts of which are not yet fully understood.

HTPs are also highly variable in design and chemical composition, and some of the toxicants identified in their emissions are known carcinogens.

Evidence on second-hand exposure to HTP aerosols is still emerging, but independent studies suggest it may pose health risks to bystanders. Reported effects include asthma and asthma-like symptoms, sore throat, headaches and chest discomfort.

Electronic cigarettes (or e-cigarettes) are the most common form of electronic nicotine delivery systems and electronic non-nicotine delivery systems, but there are others, such as e-cigars and e-pipes. E-cigarettes heat a liquid to create aerosols that are inhaled by the user. E-liquids may contain nicotine and other additives, flavours and chemicals. Evidence reveals that these products are harmful to health and are not safe. Some of the substances they generate are known to cause cancer and, on their own, e-cigarettes are associated with increased risk of lung disorders, poisoning, injuries, burns and immediate nicotine toxicity through inhalation.

  • E-cigarettes can have negative effects on cardiovascular health, including increased heart rate and blood pressure.
  • Exposure to emissions from e-cigarettes also poses risks to bystanders.
  • All e-cigarettes emit toxic chemicals, often including nicotine. The consumption of nicotine in children and adolescents has deleterious long-term impacts on brain development, potentially leading to learning and anxiety disorders.
  • In pregnant women, e-cigarettes can have similar consequences for the brain development of the fetus.
  • Additional concerns involve customizable electronic cigarettes that allow the user to increase their nicotine intake, as well as newer disposable and pod systems with higher nicotine delivery.
  • Dual use, which is common, is at least as dangerous and likely more dangerous than smoking conventional cigarettes or using e-cigarettes alone.

Nicotine pouches are pre-portioned pouches that contain nicotine and are similar to traditional smokeless tobacco products such as snus in some respects, including appearance and manner of use. These pouches are often offered in a variety of appealing flavours, much like e-cigarettes and other smokeless tobacco products, which may increase their attractiveness to young people. They are available in different nicotine strengths, and higher doses have been shown to elevate heart rate and systolic blood pressure, particularly in persons who have never used tobacco before.

Additional concerns relate to product composition: synthetic nicotine may include R-nicotine, whose pharmacological and metabolic effects remain largely unknown. Meanwhile, nicotine derived from tobacco can be contaminated with tobacco-specific nitrosamines – known carcinogens – posing further potential health risks.

Effects of giving up smoking

It is never too late to quit. Cessation of tobacco use can significantly reduce the risk of many diseases and, in some cases, reduce risk to that of a person who has never smoked.

The effects of giving up smoking can be seen almost immediately:

  • within 20 minutes, the heart rate and blood pressure drop;
  • within 12 hours, the carbon monoxide level in the blood returns to normal;
  • within 2–12 weeks, circulation improves and lung function increases;
  • within 1–9 months, coughing and shortness of breath decrease;
  • a year after quitting, the risk of coronary heart disease is about half that of a smoker;
  • between 5 and 15 years after quitting, the risk of stroke is reduced to that of a non-smoker;
  • 10 years after quitting, lung cancer death rate is about half the rate of a smoker, and the risk of cancers of the mouth, throat, oesophagus, bladder, kidney and pancreas decreases; and
  • 15 years after quitting, the risk of coronary heart disease is that of a person who never smoked.

WHO response 

WHO countries translate commitments into action and progress towards a tobacco-free Europe.

The human and economic cost of tobacco is staggering, yet entirely preventable. Every year tobacco kills over a million people in the WHO European Region and puts immense pressure on health systems, social services and national economies. Still, the tobacco industry hides the dangers of its products and blocks life-saving policies.

In response, WHO Member States took a historic step in 2003 by unanimously adopting the WHO Framework Convention on Tobacco Control (WHO FCTC) – the world’s first public health treaty under the auspices of WHO. Since it came into force in 2005, the 183 Parties have ratified the treaty, making it a cornerstone of global and regional tobacco control efforts.

In 2008, to help countries put the WHO FCTC into action, WHO launched the MPOWER package. This set of 6 evidence-based technical measures supports the Convention goals and helps countries reduce tobacco use. The MPOWER measures include:

  • monitoring tobacco use and prevention policies
  • protecting people from tobacco smoke
  • helping people quit
  • warning about the dangers of tobacco
  • enforcing bans on advertising, promotion and sponsorship
  • raising taxes on tobacco.

Together, these measures provide a practical and powerful roadmap to reduce tobacco use and save lives.

In the WHO European Region, WHO works with all 53 Member States to strengthen tobacco control. It partners with ministries of health, civil society, academic institutions and communities to reduce the health, social, environmental and economic harms caused by tobacco.

More specifically, WHO supports countries by providing technical assistance to develop and enforce comprehensive legislative and regulatory measures in line with the WHO FCTC. It builds national capacities by training public health professionals, integrating cessation support into health systems and establishing robust surveillance systems such as the Global Tobacco Surveillance System. WHO also helps with policy-related research,  including monitoring tobacco industry interference, and engages in strategic communication and media advocacy, including the coordination of World No Tobacco Day each year on 31 May.