Tips From Former Smokers ^®

All Groups (General Public)

Tips From Former Smokers ^®

Tips From Former Smokers ^®

Bill's Story

Tips From Former Smokers ^®

Brandon's Story

Cigar Smoking and Cancer

Selected References

1. Baker F, Ainsworth SR, Dye JT, et al.  Health risks associated with cigar smoking.  Journal of the American Medical Association 2000; 284(6):735–740.  [PubMed Abstract]
2. Kozlowski LT, Dollar KM, Giovino GA.  Cigar/cigarillo surveillance:  Limitations of the U.S. Department of Agriculture System.  American Journal of Preventive Medicine 2008; 34(5):424–426.  [PubMed Abstract]
3. National Cancer Institute (1998).  Smoking and Tobacco Control Monograph 9:  Cigars:  Health Effects and Trends.  Bethesda, MD.  Retrieved October 21, 2010, from:  http://www.cancercontrol.cancer.gov/tcrb/monographs/9/index.html.
4. U.S. Department of Health and Human Services.  Reducing Tobacco Use:  A Report of the Surgeon General.  Atlanta, GA:  U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health, 2000.

Know the Risks

Here’s the bottom line: There is no such thing as a “safe” or “safer” tobacco product.

Tips From Former Smokers ^®

Ellie’s Story

Using Nicotine Replacement Therapy

Many people use quit smoking medications to help reduce withdrawal feelings and cigarette cravings. These medications can double your chances of quitting for good.

Population Assessment of Tobacco and Health: An FDA and NIH Study

The Population Assessment of Tobacco and Health (PATH) Study is a uniquely large, long-term study of tobacco use and health in the United States. A collaboration between the U.S. Food and Drug Administration (FDA) Center for Tobacco Products and the National Institutes of Health (NIH) National Institute on Drug Abuse (NIDA), the study was launched in 2011, started the first wave of data collection in 2013, and is currently in its fourth wave.

By following study participants over time, the PATH Study helps scientists learn how and why people start using tobacco, quit using it, and start using it again after they’ve quit, as well as how different tobacco products affect health (such as cardiovascular and respiratory health) over time. Findings from the study may also inform FDA’s actions related to tobacco products, thereby helping to achieve the goals of the Family Smoking Prevention and Tobacco Control Act.

The PATH Study is conducted via a contract awarded to Westat and involves researchers from:

• Center for Tobacco Products, FDA
• National Institute on Drug Abuse, NIH
• Centers for Disease Control and Prevention
• Roswell Park Cancer Institute
• Dartmouth College
• Truth Initiative (formerly Legacy)
• The Medical University of South Carolina
• The University of California, San Diego
• The University of Waterloo
• The University of Minnesota

Research Goals for the PATH Study

By monitoring and assessing behaviors, attitudes, biomarkers, and health outcomes associated with tobacco use in the United States, the PATH Study helps enhance the evidence base available to inform FDA’s regulatory activities related to tobacco. Specifically, the study aims to:

• Examine what makes people susceptible to using a tobacco product
• Evaluate initiation and use patterns, including the:
  • use of newer products, such as  e-cigarettes or ENDS (electronic nicotine delivery systems)
  • use of multiple products
  • switching from one product to another
• Study patterns of tobacco product use, cessation, and relapse
• Track potential behavioral and health impacts, including biomarkers of exposure and harm
• Assess differences in tobacco-related attitudes, behaviors, and health conditions among racial/ethnic, gender, and age subgroups

Findings from the PATH Study

About 46,000 people aged 12 years and older, including tobacco users and non-users, are included in the first wave of the PATH Study.

Initial data on adult and youth tobacco use, published January 2017 in the New England Journal of Medicine, showed that more than 25 percent of American adults were current users of tobacco in 2013-14 and roughly 9 percent of youth reported using tobacco in the past 30 days. Multiple product use was common among tobacco users, accounting for roughly 40 percent of adult and youth tobacco users, with cigarettes and e-cigarettes being the most common combination among both age groups.

Among tobacco users who reported using more than one product:

• 23 percent of adults and 15 percent of youth used cigarettes and e-cigarettes
• 6 percent of adults and 4 percent of youth used cigarettes and hookah
• 2 percent of adults and 5 percent of youth used e-cigarettes and hookah
• 5 percent of adults and 10 percent of youth used cigarettes and cigarillos

The study reports prevalence for more product combinations used by study participants.

Data Access and Availability

Data and documentation (questionnaires, codebooks) related to the PATH Study are available on the National Addiction & HIV Data Archive Program (NAHDAP) website , including:

• Public-use files (PUFs)   from Waves 1 (Sep 2013–Dec 2014) and 2 (Oct 2014–2015) of data collection.
• Restricted-use files (RUFs)  from Waves 1 (Sep 2013–Dec 2014) and 2 (Oct 2014–Oct 2015). Qualified researchers are encouraged to apply for access through the NAHDAP website.
• Biomarker Restricted-use files (BRUFs)   from Wave 1 (Sep 2013 – Dec 2014).
• Biospecimen Access Program (BAP)  which provides the research community with access to urine, serum, and plasma collected from adult PATH Study participants during Wave 1.

PATH Study Publications

Listed below is a selection of peer-reviewed journal articles from the PATH Study. See the NAHDAP website  or search PubMed.gov  for a complete list of publications.

Note: The following publications are highlighted for illustrative purposes only. The information in these highlighted publications is not a formal dissemination of information by FDA and does not represent agency position or policy. The contents of the publications are the responsibility of the authors alone.

• Villanti AC, Johnson AL, Ambrose BK, et al. Flavored tobacco product use in youth and adults: findings from the first wave of the PATH Study (2013–2014) [published online March 13, 2017]. Am J Prev Med. doi:10.1016/j.amepre.2017.01.026
• Kasza KA, Ambrose BK, Conway KP, et al. Tobacco-product use by adults and youths in the United States in 2013 and 2014. N Engl J Med. 2017;376(4):342-353.
• Hyland A, Ambrose BK, Conway KP, et al. Design and methods of the Population Assessment of Tobacco and Health (PATH) Study [published online August 8, 2016]. Tob Control. doi:10.1136/tobaccocontrol-2016-052934.
• Ambrose BK, Day HR, Rostron B, et al. Flavored tobacco product use among US youth aged 12-17 years, 2013-2014. JAMA. 2015;314(17):1871-1873.

Harmful and Potentially Harmful Constituents (HPHCs)

The Food, Drug and Cosmetic Act (FD&C Act) requires tobacco manufacturers and importers to report the levels of harmful and potentially harmful constituents (HPHCs) found in their tobacco products and tobacco smoke. HPHCs are chemicals or chemical compounds in tobacco products or tobacco smoke that cause or could cause harm to smokers or nonsmokers. 

FDA must publish HPHC quantities in each brand and subbrand of tobacco product, in a way that people find understandable and not misleading. There are several efforts under way at FDA to make progress toward that goal.

 

Chemicals in Cigarettes: From Plant to Product to Puff

Do you know how many harmful chemicals are in cigarettes or how they get into the product? Watch three videos to learn more about the stages of cigarettes, from plant to product to puff.

 

 

Preliminary HPHC List

FDA published a preliminary list of 93 HPHCs in March 2012. This HPHC list focuses on chemicals that are linked to the five most serious health effects of tobacco use (cancer, cardiovascular disease, respiratory effects, reproductive problems, and addiction.)  

Harmful and Potentially Harmful Constituents in Tobacco Products and Tobacco Smoke: Established List

Tobacco Industry Reporting Requirements

FDA issued draft guidance in 2012 that identified a subset of 20 HPHCs for which manufacturers and importers are to test and report to FDA. FDA chose these 20 because testing methods were well established and widely available. FDA is now evaluating the quality and reliability of the data submitted by manufacturers.  

Communicating to the Public

Making sure the public can clearly understand the real and potential risks of tobacco use is an important goal. Presently, FDA is conducting research about how best to ensure that the public is made aware of the dangers of the chemicals and chemical compounds in tobacco products and smoke and to communicate the levels of HPHCs in each brand and subbrand of tobacco product. In the meantime, FDA is including messages about HPHCs in its ongoing public health campaigns. FDA has also created three videos and interactive tools to lay the foundation for an important public health goal: we aim to publish a list of the levels of harmful and potentially harmful chemicals in tobacco, in a way that is easy for the public to understand. As an important step toward that goal, we invite you to explore the chemicals in tobacco in three stages of cigarettes, from plant to product to puff.

Tips From Former Smokers ^®

Jamason’s Story

Create My Quit Plan

Tips From Former Smokers ^®

Mariano’s Story

Know the Risks

Here’s the bottom line: There is no such thing as a “safe” or “safer” tobacco product.

Public Health Education Campaigns

CTP is investing in a number of public education campaigns to help educate the public—especially youth—about the dangers of regulated tobacco products. Rooted in science, these efforts are directly linked to FDA's authority to regulate the marketing and sales of tobacco products.

We encourage public health advocates and other interested members of the public to engage with our campaigns through the information and materials found here.

• The Real Cost campaign
• Fresh Empire campaign
• This Free Life campaign

"We have a responsibility…to reduce the death and disease toll from tobacco use. That includes educating kids about the harms of tobacco use in an effective way, in a way that will reach them."

-- Mitch Zeller, Director, Center for Tobacco Products
Washington Post, Dec. 9, 2013

Achieving our mission to reduce tobacco-related death and disease requires a comprehensive, innovative approach. Most of our campaigns will focus on changing the attitudes and beliefs that lead young people to start smoking by developing messages and tactics through an evidence-based process that includes:

• Identifying the problem to address
• Researching the target audience and the best way to reach them
• Testing messages and materials with the target audience
• Sharing the messages using a variety of media
• Assessing how effectively the messages reached the target audience and changing the messages if necessary

Current Campaigns

The Real Cost Campaign

"What's a pack of smokes cost?  Your smooth skin."

"Smoking causes wrinkles that age you prematurely. What are cigarettes costing you?"

So says FDA's first-ever national public education campaign to discourage youth tobacco use. The groundbreaking campaign, "The Real Cost” launched in February 2014 and continues to reach young people open to smoking or already experimenting with cigarettes in more than 200 markets across the country through TV, radio, print, digital, and out-of-home sites such as mall and theme park displays. In April 2016, “The Real Cost” expanded its campaign brand umbrella to include new advertising targeting rural male youth ages 12-17 at risk of smokeless tobacco use. The rural advertising will mainly air in targeted local markets. Edgy, innovative, and featuring the young people it seeks to reach, the campaign talks with youth by focusing on the issues they really care about, like loss of control due to addiction and cosmetic health effects.

Are you a teen looking for The Real Cost?

Fresh Empire Campaign

"Setting sights on CEO OF INDEPENDENCE as my goal. So I reject cigarettes to regain control."

"I reject anything, including tobacco, that tries to control me."

Empowering words from FDA's first campaign to discourage multicultural teens—specifically African American, Hispanic, and Asian American/ Pacific Islander youth who identify with hip-hop—from using tobacco. "Fresh Empire" launched in May 2015 and will reach multicultural youth who identify with the hip-hop peer crowd in markets throughout the country through TV, radio, print, the web, social media, and local hip-hop events by the end of 2016. Understanding that tobacco use is often portrayed as a norm amongst the hip-hop peer crowd, the campaign talks with youth using aspirational messaging to convey that tobacco use is not a necessary part of the hip-hop lifestyle.

Are you a teen looking for Fresh Empire?

This Free Life Campaign

"Joy is on the horizon. Health and happiness—these are our new destinations. But a factor that seems casual to some in the community can get in our way. Like tobacco.”

“This new life—free from judgment, free from the shadows—will also be free from tobacco.”

With these words, FDA presents “This Free Life,” a public education campaign designed to prevent and reduce tobacco use among lesbian, gay, bisexual and transgender (LGBT) young adults ages 18-24 in the United States. LGBT young adults are nearly twice as likely to use tobacco as other young adults. “This Free Life” launched in May 2016 and uses print, digital, social media, outdoor signage and local events to reach the more than 800,000 occasional smokers in the LGBT community to help protect them from tobacco-related disease and prevent the loss of tens of thousands of LGBT lives to tobacco use each year.  

The campaign uses authentic and credible messages from tobacco-free members of the LGBT community to challenge the perception that tobacco use is a necessary part of LGBT culture, and to show LGBT young adults they can be the person they want to be and still live tobacco free.

Are you an LGBT young adult looking for “This Free Life?”

Future Campaigns and Education Programs

Additional efforts are in development. These will target specific key audiences, including:

• Youth who are American Indian / Alaskan Native
• Tobacco users (to be implemented at tobacco point-of-sale)
• Tobacco product retailers

Report Potential Tobacco Product Violation

The minimum legal age to purchase tobacco is 18 – and yet, 87 percent of adult daily smokers begin smoking before age 18.¹ Together, we can change that.

The Tobacco Control Act and related regulations give FDA tools to help keep tobacco out of the hands of America’s youth. But you also have an opportunity to play a key role. The public is crucial in helping FDA enforce tobacco regulations to protect America’s youth. 

What Is a Potential Tobacco Product Violation?

Potential tobacco product violations include (but are not limited to):

• Sales to minors
• Flavored cigarette sales
• Illegal marketing and advertising – The Tobacco Control Act gives the FDA the ability to regulate certain marketing and advertising activities by the tobacco industry, including:
  • Describing tobacco products as “light,” “mild,” or “low” – or claiming a product is safer or less harmful without an FDA order
  • Distributing t-shirts or other promotional or novelty items with brand names of cigarette or smokeless tobacco products 
  • Sponsoring events using the brand name of a tobacco product
• Distribution of free samples of tobacco products except in limited circumstances
• Placement of cigarette or smokeless tobacco product vending machines in prohibited areas (or providing access to self-service or direct access of tobacco products in prohibited areas)
• Sale of cigarettes in packages of less than 20

How Can I Report a Potential Tobacco Violation?

If you see what you believe to be a violation of the Tobacco Control Act or other related regulations, you can:

• Submit online: Online Form
• Call the Tobacco Call Center using CTP's toll-free number: 1.877.CTP.1373
• Send an email: CTPCompliance@FDA.hhs.gov
• Print and mail: Paper form (PDF) to
  Potential Tobacco Products Violation Report
  Food and Drug Administration
  Center for Tobacco Products
  Office of Compliance and Enforcement
  Document Control Center
  Building 71, Room G335
  10903 New Hampshire Avenue
  Silver Spring, MD 20993

What Happens When I Submit a Potential Violation?

FDA will evaluate any report submitted to determine if the activity is a violation of the Tobacco Control Act or related regulations. Before deciding what follow-up action, if any, is necessary, we will check to see if the product named in the complaint is regulated by FDA. If the product is regulated by a different federal or state agency, or different part of FDA, we will forward the complaint to the applicable entity for review.

FDA does not rely solely on what was submitted to take enforcement action. After reviewing a complaint, our investigation may include:

• performing an inspection of a tobacco product manufacturer, distributor, or importer;
• conducting a compliance check inspection of a tobacco retailer; or
• initiating monitoring and surveillance of a tobacco product manufacturer’s or retailer’s website.

FDA may determine that there is no evidence of a violation, or we may find evidence of the reported violation or of other potential violations that requires additional surveillance, monitoring, and/or inspections.

Privacy and Anonymity

All reports to FDA remain private to the extent allowed by law as explained in FDA’s Privacy Policy. Reports can be submitted anonymously; however, reports accompanied by names and contact information are helpful if FDA regulators need to follow-up for more information.

Children's Privacy: FDA will not collect or store information from children under 13. If a child sends us an email inquiry or comment, we will answer it and then delete the email from our files.

Summary of Federal Rules for Tobacco Retailers

FDA regulates all tobacco products, including e-cigarettes, hookah tobacco, and cigars. If you sell tobacco products, you must comply with all applicable federal laws and regulations for retailers.

This page offers a summary of the federal rules. You can find comprehensive federal requirements for tobacco retailers in the Federal Food, Drug, and Cosmetic Act (FD&C Act), Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco and Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act.

How Do I Comply?

These rules apply to all "covered tobacco products" beginning August 8, 2016:

• Check photo ID of everyone under age 27 who attempts to purchase any tobacco product.
• Only sell tobacco products to customers age 18 or older.²
• Do NOT sell tobacco products in a vending machine unless in an adult-only facility.³
• Do NOT give away free samples of newly-regulated tobacco products to consumers, including any of their components or parts.⁴

These rules, along with rules specific to each tobacco product, are listed below.

“This Is Our Watch” Program

The “This Is Our Watch” program helps retailers comply with federal tobacco law and regulations and protect minors. Flyers are available for download and print, and all other materials will be distributed by mail.

Rules for Cigarettes, Cigarette Tobacco, and Roll-Your-Own Tobacco Sales

These rules have been in place since 2010:

• Check photo ID of everyone under age 27 who attempts to purchase cigarettes, cigarette tobacco, or roll-your-own tobacco.
• Only sell cigarettes, cigarette tobacco, and roll-your-own-tobacco to customers age 18 or older.²
• Do NOT sell cigarettes, cigarette tobacco, or roll-your-own tobacco in a vending machine or self-service display unless in an adult-only facility.³
• Do NOT give away free samples of cigarettes, cigarette tobacco, or roll-your-own tobacco to consumers, including any of their components or parts.⁴
• Do NOT sell cigarettes, cigarette tobacco, or roll-your-own tobacco that contain a characterizing flavor (except menthol or tobacco flavor).
• Do NOT sell cigarette packages containing fewer than 20 cigarettes, including single cigarettes, known as “loosies.”
• Do NOT break open packages of cigarettes, cigarette tobacco, or roll-your-own tobacco to sell products in smaller amounts.

Beginning August 10, 2018:

• Do NOT sell or distribute cigarette tobacco or roll-your-own tobacco products without a warning statement on the package.¹
• Do NOT display advertisements for cigarette tobacco or roll-your-own tobacco products without a warning statement.¹

Rules for Smokeless Tobacco Sales

• Check photo ID of everyone under age 27 who attempts to purchase smokeless tobacco.
• Only sell smokeless tobacco to customers age 18 and older.²
• Do NOT sell smokeless tobacco in a vending machine or self-service display unless in an adult-only facility.
• Do NOT give away free samples of smokeless tobacco unless in a “qualified adult-only facility” and in limited quantities as specified in the law. ^3,4
• Do NOT break open smokeless tobacco packages to sell products in smaller amounts.
• Do NOT sell smokeless tobacco without a health warning statement displayed on the package.
• Do NOT display advertisements for smokeless tobacco products without a warning statement.

Rules for Cigar Sales

• Check photo ID of everyone under age 27 who attempts to purchase cigars.
• Only sell cigars to customers age 18 and older.²
• Do NOT sell cigars in a vending machine unless in an adult-only facility.³
• Do NOT give away free samples of cigars to consumers, including any of their components or parts.⁴

Beginning August 10, 2018:

• Do NOT sell or distribute cigars without a health warning statement displayed on the package.¹
• Do NOT display advertisements for cigars without a health warning statement.¹
• If you sell cigars individually, and not in a product package, you must post a sign with six required warning statements within 3 inches of each cash register.¹

Rules for Hookah and Pipe Tobacco Sales

• Check photo ID of everyone under age 27 who attempts to purchase hookah tobacco or pipe tobacco. 
• Only sell hookah or pipe tobacco to customers age 18 and older.²
• Do NOT sell hookah and pipe tobacco in a vending machine unless in an adult-only facility.³
• Do NOT give away free samples of hookah or pipe tobacco to consumers, including any of their components or parts.⁴

Beginning August 10, 2018:

• Do NOT sell or distribute hookah or pipe tobacco without a health warning statement displayed on the package.¹
• Do NOT display advertisements for hookah or pipe tobacco without a health warning statement.¹

Rules for Sales of E-Cigarettes and Other Electronic Nicotine Delivery Systems (ENDS)

 Some examples of ENDS include e-cigarettes, vape pens, e-hookahs, e-cigars, personal vaporizers, and electronic pipes.

• Check photo ID of everyone under age 27 who attempts to purchase e-cigarettes or other ENDS.
• Only sell e-cigarettes and other ENDS to customers age 18 and older.²
• Do NOT sell e-cigarettes or other ENDS in a vending machine unless in an adult-only facility. ³
• Do NOT give away free samples of e-cigarettes or other ENDS to consumers, including any of their components or parts.⁴

Beginning August 10, 2018, these rules apply to all “covered tobacco products”:

• Do NOT sell or distribute e-cigarettes or other ENDS without a health warning statement on the package.¹
• Do NOT display advertisements for e-cigarettes or other ENDS without a health warning statement.¹

Rules for Sales of Nicotine Gels

• Check photo ID of everyone under age 27 who attempts to purchase nicotine gel.
• Only sell nicotine gel to customers age 18 and older.³
• Do NOT sell nicotine gel in a vending machine unless in an adult-only facility.³
• Do NOT give away free samples of nicotine gel to consumers.⁴

Beginning August 10, 2018:

• Do NOT sell or distribute nicotine gel without a health warning statement on the package.¹
• Do NOT display advertisements for nicotine gel without a health warning statement.¹

Rules for Sales of Dissolvables

These rules apply to dissolvable tobacco products that are not already regulated as smokeless tobacco.

• Check photo ID of everyone under age 27 who attempts to purchase dissolvable tobacco products.
• Only sell dissolvable tobacco products to customers age 18 and older.²
• Do NOT sell dissolvable tobacco products in a vending machine unless in an adult-only facility. ³
• Do NOT give away free samples of dissolvable tobacco products to consumers.⁴

Beginning August 10, 2018:

• Do NOT sell or distribute a dissolvable tobacco product without a health warning statement on the package.¹
• Do NOT display advertisements for dissolvable tobacco products without a health warning statement.¹

Secondhand Smoke

Smoking harms both you and the ones you love. Quitting smoking will benefit you plus help you protect the people in your life.

Secondhand Smoke

Smoking harms both you and the ones you love. Quitting smoking will benefit you plus help you protect the people in your life.

Secondhand Smoke and Cancer

Selected References

1. National Toxicology Program. Report on Carcinogens. Eleventh Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program, 2005.
2. National Cancer Institute. Cancer Progress Report 2003. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 2004.
3. International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking. Lyon, France: 2002. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83.
4. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
5. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.
6. National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke. Bethesda, MD: National Cancer Institute; 1999. Smoking and Tobacco Control Monograph 10.
7. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking (Also Known as Exposure to Secondhand Smoke or Environmental Tobacco Smoke—ETS). U.S. Environmental Protection Agency, 1992.
8. California Environmental Protection Agency, Office of Environmental Health Hazard Assessment. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant: Part B Health Effects, 2005.

Don't Start

Although you may see people using tobacco in movies, tv, and advertisements, most teens, adults, and athletes don’t use it. The nicotine in tobacco products is addictive. The best way to be tobacco free is not to start.

• Seriously - Why Start?
• Learn More About
• For Parents, Teachers, and Coaches

Seriously - Why Start?

What Smoking Can Do To Your Lungs

Nearly all tobacco use begins in youth and young adulthood—88% of adult daily smokers smoked their first cigarette before turning 18. Approximately 18% of high school students smoke cigarettes. Nearly 10% use smokeless tobacco, and young people who use smokeless tobacco are more likely to become cigarette smokers as adults.

By helping teens and young adults avoid using tobacco, we will help them live longer and healthier lives. We can make the next generation tobacco free.

Risk & Protective Factors

Is your child at risk of using or becoming addicted tobacco? Learn the signs and factors in this Office of Adolescent Health (OAH) resource.

Talk to Your Kids about Tobacco, Alcohol, and Drugs

Learn the basics and start a conversation with your kids about the dangers of tobacco, alcohol, and drugs. Use this healthfinder.gov resource as your guide.

Talk With Your Teen

Get tips for talking about tobacco and tobacco use with your teen from this OAH resource.

Ideas for Getting Started

Unsure how to start a conversation about tobacco use with your kids? Get tips in this OAH resource.

Where there's Smoke: The Effects of Smoking on the Human Body

Use this lesson plan from the CDC to demonstrate what goes into a person's lungs with each puff of a cigarette and how that smoke affects a person's body.

Tobacco Free Sports Initiatives

Promote healthy alternatives to tobacco use with these CDC fact sheets, handouts, and guides.

What is SmokelessTobacco?

?Smokeless tobacco, also known as dip and chew, snuff, or chewing tobacco, comes in two forms. Chewing tobacco comes as loose leaves of tobacco, as plug tobacco (brick form), or in a twist form. Snuff is finely ground (powdered) tobacco that is sold moist, dry, or in tea bag-like pouches called sachets. But no matter what it’s called, smokeless tobacco is highly addictive and can harm your health. Here’s why:

• Smokeless tobacco is still tobacco. Tobacco contains cancer-causing chemicals called nitrosamines.
• Like cigarettes, smokeless tobacco also contains nicotine—an addictive drug. In fact, holding an average-size dip in the mouth for just 30 minutes can deliver as much nicotine as smoking three cigarettes. Nicotine addiction can make quitting difficult.
• Smokeless tobacco may cause mouth cancer and other health problems.

If You Want to Quit…

Quitting smokeless tobacco is not easy. The most effective way to quit chewing tobacco is to have a quit date and a quitting plan. Successful quitters also include support teams in their plan— friends, family, and co-workers who can help during the difficult times when urges and temptations are strongest.

Health InformationSmokeless Tobacco and Cancer  

• Smokeless Tobacco and Cancer  
  The NIH National Cancer Institute (NCI) has a fact sheet that answers common questions about smokeless tobacco, including how to get help quitting.?
• Smokeless Tobacco: Topics in Brief
  A description of smokeless tobacco products and who uses them from the NIH National Institute on Drug Abuse. 
• Smokeless (Oral) Tobacco
  Information from the Centers for Disease Control and Prevention on smokeless tobacco products, such as chewing tobacco and snuff.
• MedlinePlus: Smokeless Tobacco
  The NIH National Library of Medicine's compilation of links to government, professional and non-profit/voluntary organizations with information on smokeless tobacco. 
• BeTobaccoFree.gov
  A website with information from Health and Human Services divisions about tobacco (including smokeless tobacco), its health effects, and quitting.

Related Oral Health Topics

• Oral Cancer

Smokeless Tobacco and Cancer

Selected References

1. International Agency for Research on Cancer. Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines. Lyon, France: World Health Organization International Agency for Research on Cancer; 2007. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 89.

2. National Cancer Institute. Smokeless Tobacco or Health: An International Perspective. Bethesda, MD: National Cancer Institute; 1992. Smoking and Tobacco Control Monograph 2.

3. Richter P, Hodge K, Stanfill S, Zhang L, Watson C. Surveillance of moist snuff: total nicotine, moisture, pH, un-ionized nicotine, and tobacco-specific nitrosamines. Nicotine and Tobacco Research 2008; 10(11):1645–1652.

   [PubMed Abstract]

4. Djordjevic MV, Doran KA. Nicotine content and delivery across tobacco products. Handbook of Experimental Pharmacology 2009; 192:61–82.

   [PubMed Abstract]

5. U.S. Department of Health and Human Services. The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General. Bethesda, MD: U.S. Department of Health and Human Services, 1986.

6. NIH State-of-the-Science Panel. National Institutes of Health State-of-the-Science conference statement: tobacco use: prevention, cessation, and control. Annals of Internal Medicine 2006; 145(11):839–844.

   [PubMed Abstract]
7. The Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. American Journal of Preventive Medicine 2008; 35(2):158–176. [PubMed Abstract]

• Introduction
• The Dangers of Dip and Chew
• Understanding Your Addiction 
• Myths and Truths
• Quitting Plan
  • Decide to quit
  • Reasons to quit
  • Pick a quit date
  • Get psyched up for quitting
  • Cut back before you quit
  • Right before your quit day
  • Quit day!
• First Week: Coping with Withdrawal
• Second Week: Dealing with Triggers
• Tips for Going the Distance
• Celebrate Your Success

Introduction

Maybe you've already found that quitting dip or chew is not easy. But you can do it! This guide is intended to help you make your own plan for quitting.

Many former dippers have shared advice on quitting that can help you. This guide is the result of advice from chewers and dippers who have canned the habit.

Like most dippers, you probably know that the health-related reasons to quit are awesome. But you must find your own personal reasons for quitting. They can motivate you more than the fear of health consequences. It's important to develop your own recipe for willpower.

Back to Top

The Dangers of Dip and Chew

• Smokeless tobacco use may cause cancer of the mouth. 
• Sugar in smokeless tobacco may cause decay in exposed tooth roots.
• Dip and chew can cause your gums to pull away from the teeth in the place where the tobacco is held.  The gums do not grow back. 
• Leathery white patches and red sores are common in dippers and chewers and can turn into cancer.

Recent research shows that smokeless tobacco use might also cause problems beyond the mouth.  Some studies have shown that using smokeless tobacco may cause pancreatic cancer.  And scientists are also looking at the possibility that its use might play a role in the development of cardiovascular disease--heart disease and stroke.

• It's expensive!
  
  A can of dip costs an average of nearly $3. A two-can-a-week habit costs about $300 per year. A can-a-day habit costs nearly $1,100 per year. Likewise, chewing tobacco costs about $2. A pouch-a-day habit costs over $700 a year. Think of all the things you could do with that money instead of dipping or chewing. It adds up.

• It's disgusting!
  
  If the health effects don't worry you, think of how other people see your addiction.
  
  The smell of smokeless tobacco in your mouth is not pleasant. While you may have become used to the odor and don't mind it, others around you notice.
  
  Check out your clothes. Do you have tobacco juice stains on your clothes, your furniture, or on your car's upholstery?
  
  Look at your teeth. Are they stained from tobacco juice? Brushing your teeth won't make this go away.

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Understanding your Addiction

• Believe it.

  Nicotine, found in all tobacco products, is a highly addictive drug that acts in the brain and throughout the body.
  
  Dip and chew contain more nicotine than cigarettes.
  
  Some facts:
  
  Holding an average-size dip in your mouth for 30 minutes gives you as much nicotine as smoking three cigarettes. A 2-can-a-week snuff dipper gets as much nicotine as a 1-1/2 pack-a-day smoker does.
  
  To the right is a chart comparing the nicotine levels of some selected snuff brands.
  
  Think about your own habit. Check how many of the following apply to you.

• I no longer get sick or dizzy when I dip or chew, like I did when I first started.
• I dip more often and in different settings.
• I've switched to stronger products, with more nicotine.
• I swallow juice from my tobacco on a regular basis.
• I sometimes sleep with dip or chew in my mouth.
• I take my first dip or chew first thing in the morning.
• I find it hard to go more than a few hours without dip or chew.
• I have strong cravings when I go without dip or chew.

The more items you check, the more likely that you are addicted.

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Myths and Truths

Sometimes these myths make users feel more comfortable in their habits.  Below are some myths and the truths that relate to them.

Myth: Smokeless tobacco is a harmless alternative to smoking.

Truth: Smokeless tobacco is still tobacco. In tobacco are nitrosamines, cancer-causing chemicals from the curing process. Note the warnings on the cans.

Myth: Dip (or chew) improves my athletic performance.

Truth: A study of professional baseball players found no connection between smokeless tobacco use and player performance. Using smokeless tobacco increases your heart rate and blood pressure within a few minutes. This can cause a buzz or rush, but the rise in pulse and blood pressure places an extra stress on your heart.

Myth: Good gum care can offset the harmful effects of using dip or chew.

Truth: There is no evidence that brushing and flossing will undo the harm that dip and chew are doing to your teeth and gums.

Myth: It's easy to quit using dip or chew when you want to.

Truth: Unfortunately, nicotine addiction makes quitting difficult. But those who have quit successfully are very glad they did.

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Quitting Plan

The best way to quit smokeless tobacco is to have a quit date and a quitting plan.  These methods make it easier. Try what you think will work best for you.

• Decide to quit
  
  Quitting smokeless tobacco is not something you do on a whim. You have to want to quit to make it through those first few weeks off tobacco. You know your reasons for stopping. Don't let outside influence -like peer pressure- get in your way. Focus on all you don't like about dipping and chewing.

• Reasons to quit

  Here are some reasons given by others. Are any of them important to you?
  • To avoid health problems
  • To prove I can do it
  • I have sores or white patches in my mouth
  • To please someone I care about
  • To set a good example for my kids or other kids
  • To save money
  • I don't like the taste
  • I have gum or tooth problems
  • It's disgusting
  • Because it's banned at work or school
  • I don't want it to control me
  • My girlfriend (or a girl I'd like to date) hates it
  • My wife hates it
  • My physician or dentist told me to quit

• Pick a quit date
  
  Pick your quit date. Even if you think you're ready to quit now, take at least a week to get ready. But don't put off setting a date.

• Get psyched up for quitting
  
  Cut back before you quit by tapering down.
  
  Have your physician or dentist check your mouth. Ask whether you need nicotine replacement therapy (gum, nicotine patches, etc.).
  
  There is no "ideal" time to quit, but low-stress times are best. Having a quit date in mind is important, no matter how far off it is. But it's best to pick a date in the next two weeks, so you don't put it off too long.
  
  Pick a date that looks good for you and write it in below.

• Cut back before you quit

  • Some people are able to quit smokeless tobacco "cold turkey". Others find that cutting back makes quitting easier. There are many ways to cut back.
    
  • Taper down. Cut back to half of your usual amount before you quit. If you usually carry your tin or pouch with you, try leaving it behind. Carry substitutes instead–sugar-free chewing gum or hard candies, and sunflower seeds. During this period, you might also try a mint-leaf snuff.
    
  • Cut back on when and where you dip or chew. First, notice when your cravings are strongest. What events trigger dipping or chewing for you? Do you always reach for a dip after meals? When you work out? In your car or truck? On your job? Don't carry your pouch or tin. Use a substitute instead. Go as long as you possibly can without giving into a craving, at least 10 minutes. Try to go longer and longer as you approach your quit day. Now, pick three of your strongest triggers and stop dipping or chewing at those times. This will be hard at first. The day will come when you are used to going without tobacco at the times you want it most.
    
  • Notice what friends and coworkers who don't dip or chew are doing at these times. This will give you ideas for dip or chew substitutes. It's a good idea to avoid your dipping and chewing pals while you're trying to quit. That will help you avoid the urge to reach for a can or chew.
    
  • Switch to a lower nicotine tobacco product.  This way, you cut down your nicotine dose while you're getting ready to quit. This can help to prevent strong withdrawal when you quit.
    
  • Don't switch to other tobacco products like cigarettes or cigars! In fact, if you already smoke, this is a good time to quit smoking. That way you can get over all your nicotine addiction at once. 

•  Right before your quit day...build a support team
  
  Let friends, family, and coworkers know you're quitting. Warn them that you may not be your usual self for a week or two after you quit. Ask them to be patient. Ask them to stand by to listen and encourage you when the going gets rough.
  
  Suggest ways they can help, like joining you for a run or a walk, helping you find ways to keep busy, and telling you they know you can do it. If they've quit, ask them for tips. If they use dip or chew, ask them not to offer you any. They don't have to quit themselves to be supportive, but maybe someone will want to quit with you.

• Quit day!
• Make your quit day special right from the beginning. You're doing yourself a huge favor.
  
• Change daily routines to break away from tobacco triggers. When you eat breakfast, don't sit in the usual place at the kitchen table. Get right up from the table after meals.
  
• Make an appointment to get your teeth cleaned. You'll enjoy the fresh, clean feeling and a whiter smile.
  
• Keep busy and active. Start the day with a walk, run, swim, or workout. Aerobic exercise will help you relax. Plus, it boosts energy, stamina, and all-around fitness and curbs your appetite.
  
• Chew substitutes. Try sugar-free hard candies or gum, cinnamon sticks,  mints, beef jerky, or sunflower seeds. Carry them with you and use them whenever you have the urge to dip or chew.

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Your First Week off Smokeless Tobacco: Coping with Withdrawal

Symptoms are strongest the first week after you quit.  The worst part is over after 2 weeks.  As time passes, you'll feel better than when you dipped or chewed. So be patient with yourself.

• Urges to dip, cravings -- especially in the places you used to dip the most

  Wait it out .  Deep breathing and exercise help you feel better right away.

• Feeling irritable, tense, restless, impatient

  Walk away from the situation. Deep breathing and exercise help to blow off steam. Ask others to be patient.

• Constipation/irregularity

  Add fiber to your diet (whole grain breads and cereals, fresh fruits and vegetables).

• Hunger and weight gain

  Eat regular meals. Feeling hungry is sometimes mistaken for the desire to dip or chew.

• Desire for sweets
  
  Reach for low-calorie sweet snacks (like apples, sugar-free gums and candies).

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Your Second Week: Dealing with Triggers

If you can stay off one week, then you can stay off two.  Just use the same willpower and strategies that got you this far.

Cravings may be just as strong this week, but they will come less often and go away sooner.

Tobacco thoughts and urges probably still bother you. They will be strongest in the places where you dipped or chewed the most.

The more time you spend in these places without dipping or chewing, the weaker the urges will become. Avoid alcoholic beverages. Drinking them could bust your plan to quit.

Know what events and places will be triggers for you and plan ahead for them.

Write down some of your triggers. And write what you'll do instead of dip or chew. It may be as simple as reaching for gum or seeds, walking away, or thinking about how far you've come.

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Tips for Going the Distance

CONGRATULATIONS!  You've broken free of a tough addiction. If you can stay off 2 weeks, then you know you can beat this addiction.  It will get easier.

Keep using whatever worked when you first quit. Don't expect new rituals to take the place of smokeless tobacco right away. It took time to get used to chewing or dipping at first, too.

Keep up your guard.  Continue to plan ahead for situations that may tempt you.

Try not to slip, not even once. But, if you do slip, get right back on track.

Don't let feelings of guilt lead you back to chewing or dipping. A slip does not mean "failure". Figure out why you slipped and how to avoid it next time. Get rid of any leftover tobacco.

Pick up right where you left off before the slip. If slips are frequent, or you are dipping or chewing on a regular basis, make a new quitting plan. Quitting takes practice. The smokeless tobacco habit can be tough to beat. Most users don't quit for good on the first try. Don't give up! Figure out what would have helped. Try a new approach next time. Talk to your physician or dentist for extra help.

You may also wish to call one of these services for additional guidance and support:

The National Cancer Institute (NCI) Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)

The National Network of Tobacco Cessation Quitlines at 1-800-QUIT-NOW (1-800-784-8669)

The NCI's Smoking Cessation Quitline at 1-877-44U-QUIT (1-877-448-7848)

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Celebrate Your Success!

You're improving your health and your future. Celebrate with the people on your "support team."  Offer your support to friends and coworkers who are trying to quit using tobacco.  Pledge to yourself never to take another dip or chew.

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This information is not copyrighted. Print and make as many photocopies as you need.

NIH Publication No. 12-3270
August 2012

NIH…Turning Discovery Into Health®

Stamp Out Smoking
Tobacco-Free Living

Most of us know that smoking is unhealthy. So why do so many people still do it? The answers are complex. Researchers have found effective ways to help people quit smoking—or prevent them from starting in the first place. The tricky part is putting these tools to use. We can all take steps to help stamp out smoking.

Fifty years ago, the first Surgeon General’s Report on Smoking and Health revealed that smoking cigarettes raises your risk of developing several diseases. Since then, smoking rates have declined, saving millions of lives. But at the same time, more than 20 million Americans have died too soon because of smoking. And more than 3,200 children under age 18 smoke their first cigarette every day as a result of tobacco industry marketing and other influences.

We know a lot more than we used to about the dangers of tobacco smoke. “When you smoke, you inhale thousands of hazardous chemicals,” explains Dr. Michele Bloch, a tobacco control expert at NIH. “They travel all around inside your body and cause damage to numerous parts.”

Cigarette smoke can quickly damage delicate lung tissue. It doesn’t have a chance to heal when it’s exposed to smoke day after day. The result can be a wide range of deadly lung conditions, such as emphysema and chronic bronchitis.

The chemicals from tobacco smoke travel from the lungs into the bloodstream. They damage your heart and blood vessels to cause cardiovascular problems, such as heart disease and stroke. Cardiovascular disease kills over 800,000 people a year nationwide.

The compounds in tobacco smoke can enter cells throughout your body and damage the DNA inside. DNA is the long threadlike molecule found in nearly all your cells. It’s an essential “blueprint” that controls how your cells grow, where they go, and what they do.

When DNA gets damaged, cells can begin to grow abnormally. The body usually attacks and kills such cells. But the toxic chemicals in cigarette smoke weaken this process, making it easier for the cells to multiply out of control. The result is cancer.

Smokers dramatically increase their risk of developing many types of cancer. Nearly all lung cancer—the number-one cancer killer—is caused by smoking. Smoking can lead to cancer in many parts of the body, including the throat, mouth, nasal cavity, stomach, pancreas, liver, kidney, bladder, colon, rectum, and cervix. It can also cause leukemia, a cancer of the blood.

Smoking can cause all sorts of other health issues, too. When the DNA in sperm becomes damaged, it can lead to infertility. Smoking while you’re pregnant can cause a host of problems, including low birth weight and preterm delivery. Smokers are 30% to 40% more likely to develop type 2 diabetes than nonsmokers. And smoking can make it harder for the body to fight disease.

“People who are exposed to secondhand smoke from other people’s cigarettes have many of these same problems,” Bloch says. Secondhand smoke contains a mixture of hazardous compounds similar to that inhaled by smokers. Researchers estimate that 2.5 million nonsmokers have died from secondhand smoke since 1964.

The best way to prevent tobacco-related health problems is to keep kids from smoking in the first place. “The vast majority of new smokers begin when they are too young to appreciate the risk,” Bloch says.

“Usually people start smoking when they are adolescents,” explains Dr. Ivan Montoya, an NIH expert on treating substance abuse. “Adolescents who start smoking regularly can very quickly become addicted to nicotine and tobacco. It is then very difficult to quit.”

Nicotine is the primary drug in tobacco that causes addiction. “Nicotine is a very addictive substance,” Montoya says. “It takes only a few contacts with the substance to become addicted.”

It takes just 10 seconds for the nicotine from one puff of smoke to reach the brain. Once it gets there, it causes cells in the brain to release a chemical called dopamine. The dopamine can make you feel calm and satisfied, or alert and focused. Over time, the brain cells of smokers change to expect regular bursts of extra dopamine. When smokers try to quit, their brains crave more nicotine.

“Some people are more susceptible than others to get addicted to tobacco,” Montoya says. Scientists have found some genes that seem to be involved in nicotine dependence, but the work is still ongoing.

Researchers do know that the health of even long-time smokers can improve quickly after quitting. Within a year of quitting, heart attack risk drops dramatically. Within 5 years, the risk of stroke can fall to nearly that of a nonsmoker. Quitting also lowers the risk of cancer and other diseases.

“If you are a smoker, the single most important thing you can do to protect your health and the health of your family is to quit,” Bloch says. “And help is available.”

Research has revealed effective strategies to help people quit smoking. That’s partly why quit rates for smokers are on the rise. More than half of all people who’ve smoked have already quit.

Studies show that people who talk to their doctors about quitting or call quit lines for advice are more successful than those who go it alone. Quitters can double or triple their chances of success by using medications approved by the U.S. Food and Drug Administration (FDA) and nicotine patches, gum, or lozenges, along with coaching support.

“Different things work for different people,” explains Dr. David Theodore Levy, a tobacco control expert at Georgetown University Medical Center. “Most people make many quit attempts before they’re successful.” Check to see if stop-smoking therapy is covered under your health plan.

You’ve probably seen electronic cigarettes, or e-cigarettes, promoted as an alternative to traditional cigarettes. These battery-powered devices deliver nicotine to the lungs without burning tobacco. However, they still release hazardous chemicals into the air. Unlike traditional cigarettes, e-cigarettes can be advertised on TV and radio, and many people worry that they’ll be attractive to kids.

E-cigarettes aren’t regulated by FDA. Scientists still don’t know their health effects, including how they could affect attempts to quit smoking. “The evidence is only beginning to come in,” Levy says, and research is ongoing.

NIH-funded scientists continue to look for more effective therapies and approaches to help people quit. Researchers are also developing vaccines against nicotine, Montoya says. The vaccine would prompt your body to identify nicotine as a foreign substance and fight to block it from reaching the brain, which might help extinguish the addiction.

“Quitting is lifesaving, and early quitting is especially good,” Bloch says. Let’s all work to end the use of cigarettes and other tobacco products. If you’re a smoker, free help is available at 1-800-QUIT-NOW (1-800-784-8669) and online at smokefree.gov.

Stress & Smoking

Some people smoke when they feel stressed. They use smoking as a way to cope. There are many problems with using cigarettes as a way to cope with stress or other unpleasant feelings.

 This information is not copyrighted. Print and make as many photocopies as you need.

"Take a Close Look at What the Tobacco Industry Won't Show You" poster is only available on the web.

The Real Cost: Research and Evaluation

Download, Print & Share

The Real Cost: Research and Evaluation

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This is Our Watch

To give retailers all the tools they need to comply with tobacco regulations, the FDA’s Center for Tobacco Products has developed a new education program called “This is Our Watch.” This program helps tobacco retailers better understand FDA tobacco regulations, the importance of compliance, and the greater purpose—protecting the nation’s youth from the harms of tobacco use.

“This is Our Watch” launched nationally in November 2017. A full toolkit of resources is available to retailers—including posters, stickers, age verification tools, and more—to help retailers better comply with federal tobacco regulations. 

Free Program Materials

“This is Our Watch” program materials include a mix of educational pieces for owners, managers, and clerks, as well as a variety of point-of-purchase tools to inform customers of the law and emphasize the retailer’s role.

• Poster
• Register stickers
• Regulation flyers
• Age verification calendar
• Register signage
• Instruction booklet

Connect with Us

You can find more information by connecting with us on Twitter and by signing up for email updates.

Tips From Former Smokers ^®

Tiffany’s Story

Tips From Former Smokers ^®

Nathan’s Story

Tips From Former Smokers ^®

Shawn’s Story

Tips From Former Smokers ^®

Terrie’s Story

Tobacco Facts and Figures

Tobacco use is the leading cause of preventable illness and death in the United States. It causes many different cancers as well as chronic lung diseases such as emphysema and bronchitis, heart disease, pregnancy-related problems, and many other serious health problems.

• Who smokes?
• Why is smoking harmful to smokers?
• Why is smoking harmful to non-smokers?
• Who uses smokeless tobacco?
• How is smokeless tobacco harmful?

Who smokes?

• Each day, more than 3,200 people under 18 smoke their first cigarette, and approximately 2,100 youth and young adults become daily smokers.
•  9 out of 10 smokers start before the age of 18,  and 98% start smoking by age 26.
• 1 in 5 adults and teenagers smoke.
• In 2011, an estimated 19% of U.S. adults were cigarette smokers.
• Approximately 18% of high school students smoke cigarettes.
• In 2011, nearly 18% of high school boys were current cigar users.
•  From 1964 to 2014, the proportion of adult smokers declined from 42.0% to 18.0%.

Health Fraud

What is Tobacco-Related Health Fraud?

False or misleading claims in the promotion, advertising, distribution or sale of tobacco products, including suggestions that a tobacco product is safer, less harmful, contains a reduced level or is free of a harmful substance, or presents a lower risk of tobacco-related disease compared to other tobacco products.

Sections 902, 903 and 911 of the Family Smoking Prevention and Tobacco Control Act provide more information.

 

Health Fraud Example 2: The fictional ABC Cigarette promotion describes their product as "light," and claims that the filter "removes seven times more tar and nicotine." These claims may be misleading, suggesting a reduced harm.  Both of these claims require scientific evidence and an order from FDA before they can be used.

Tobacco-Related Health Fraud

All tobacco products are harmful to your health, despite what they taste, smell, or look like.¹  Claiming less harm or reduced risk of disease from using tobacco products misleads consumers to think that these products are safe to use.  FDA considers these kinds of claims to be health fraud. These kinds of claims can only be made after scientific evidence to support them has been submitted to FDA, and FDA has issued an order permitting their marketing use. To date, no tobacco products have met the requirements that would permit them to make claims of reduced risk or harm to users and nonusers of their regulated tobacco products. These requirements were put in place so that American tobacco consumers are not misled about the harms of tobacco products.

Examples of Tobacco-Related Health Fraud

Recently, FDA issued a number of warning letters to tobacco internet retailers for illegally marketing tobacco products and using claims or descriptions that may mislead consumers by suggesting reduced harm or risk in using a tobacco product.  The letters cited several, specific examples of tobacco-related health fraud including:

• Marketing, advertising or promotional claims that suggest the product is safer, healthier or less risky to use, like: 
  • “Safe Smoke Filter”
  • “Less Toxic”
• Labels, internet sites, or other promotions that describe a tobacco product as “Light,” “Low,” or “Mild”

Health Fraud Example 1: While the fictional XYZ brand of smokeless tobacco displays the required warning statement, the label also states that XYZ brand is a "less toxic product."  This is an example of health fraud unless this claim was submitted to FDA with supporting scientific evidence and FDA issued an order.

Vapes, E-Cigs, Hookah Pens, and other Electronic Nicotine Delivery Systems (ENDS)

Vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (e-cigarettes or ecigs), and e-pipes are some of the many terms used to describe electronic nicotine delivery systems (ENDS).

These products use a liquid “e-liquid” that may contain nicotine, as well as varying compositions of flavorings, propylene glycol, vegetable glycerin, and other ingredients. The liquid is heated into an aerosol that the user inhales.

ENDS may be manufactured to look like conventional cigarettes, cigars, or pipes. Some resemble pens or other everyday items. Larger devices, such as tank systems or mods, bear little or no resemblance to cigarettes.

Statistics about Electronic Nicotine Delivery System Use

• More than 2 million middle and high school students were current users of e-cigarettes in 2016.^{1, 2}
• 11% of high school and 4.3% of middle school students were current users of e-cigarettes in 2016.¹
• E-cigarette use rose from 1.5% to 16.0% among high school students and from 0.6% to 5.3% among middle school students from 2011 to 2015.¹
• In 2013-2014, 81% of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.³

FDA Regulation of Electronic Nicotine Delivery System

In 2016, FDA finalized a rule extending CTP's regulatory authority to cover all tobacco products, including electronic nicotine delivery systems (ENDS) that meet the definition of a tobacco product. FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS, including components and parts of ENDS but excluding accessories. Examples of components and parts of ENDS include:

• E-liquids
• A glass or plastic vial container of e-liquid
• Cartridges
• Atomizers
• Certain batteries
• Cartomizers and clearomizers
• Digital display or lights to adjust settings
• Tank systems
• Drip tips
• Flavorings for ENDS
• Programmable software

However, products marketed for therapeutic purposes (for example, marketed as a product to help people quit smoking) are regulated by the FDA through the Center for Drug Evaluation and Research (CDER). FDA published a rule clarifying the jurisdiction over tobacco products, drugs, and devices.

Manufacturing Electronic Nicotine Delivery Systems and E-Liquids

If you make, modify, mix, manufacture, fabricate, assemble, process, label, repack, relabel, or import ENDS, you must comply with these requirements for manufacturers.

CTP's Office of Small Business Assistance can answer specific questions about requirements of small businesses and how to comply with the law. This office also provides online educational resources to help regulated industry understand FDA regulations and policies.

Required Nicotine Addictiveness Warning on Packages and Advertisements

Beginning in 2018, all newly-regulated "covered" tobacco products* must bear the required nicotine addictiveness warning statement on product packages and advertisements. *Note: Cigars also have additional required warning statements.

Retail Sales of Electronic Nicotine Delivery Systems and, E-Liquids

Order FDA Rules for ENDS Sales Flyer

If you sell ENDS, e-liquids, or their components or parts made or derived from tobacco, please read this summary of federal rules that retailers must follow.

You may also order flyers with rules for electronic nicotine delivery system sales or download a PDF to print yourself.

You can find a list of retailer responsibilities for ENDS in the final rule Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act. In addition, our website offers more information on regulations, guidance, and webinars for retailers.

Vape Shops That Mix E-Liquids or Modify Products

If you operate a vape shop that mixes or prepares liquid nicotine or nicotine-containing e-liquids, or creates or modifies any type of ENDS, you may be considered a manufacturer. As a result, some vape shops may have legal responsibilities as both manufacturers and retailers of tobacco products. Please also see the Draft Guidance: Interpretation of and Compliance Policy for Certain Label Requirement; Applicability of Certain Federal Food, Drug, and Cosmetic Act Requirements to Vape Shops.

Importing Electronic Nicotine Delivery Systems and E-Liquids

Tobacco products imported or offered for import into the United States must comply with all the applicable requirements under the Federal Food, Drug, and Cosmetic Act (FD&C Act).

You can also learn more about the importation process in the FDA Regulatory Procedures Manual, Chapter 9, Import Operations and Actions.

If you have questions about importing a specific tobacco product, please contact the FDA district into which your product will be imported (PDF - 406 KB).

Report a Problem with a Tobacco Product or Potential Tobacco Product Violations

If you have experienced an unexpected health or safety issue with a specific tobacco product, you can report a problem with any tobacco product, including vapes, to the FDA. Knowledge about adverse experiences can help the FDA identify health or safety issues beyond those normally associated with product use.

If you believe these products are being sold to minors, or you see another potential violation of the FD&C Act or FDA’s tobacco regulations, report the potential violation.

You can read the adverse experience reports for tobacco products to FDA in the FOIA Electronic Reading Room.