How does tobacco cause disease?

Tobacco smoke contains over 7,000 chemicals, of which at least 70 are known carcinogens. These chemicals cause direct DNA damage in lung and other epithelial cells, trigger chronic inflammation, damage blood vessel walls accelerating atherosclerosis, impair lung function causing COPD, and cause addiction through nicotine binding to brain receptors. All tobacco products — cigarettes, cigars, pipe tobacco, hookah, chewing tobacco — are harmful.

What diseases does tobacco cause?

Tobacco causes over 20 types of cancer — most prominently lung cancer (responsible for ~85% of lung cancer deaths) but also oral, oesophageal, stomach, pancreatic, kidney, bladder and cervical cancers. It is the leading cause of COPD (chronic obstructive pulmonary disease) and a major cause of cardiovascular disease (heart attack, stroke). Smoking in pregnancy causes low birth weight, premature birth and infant death.

What is second-hand smoke and why is it dangerous?

Second-hand smoke (SHS) is the combination of smoke exhaled by a smoker and smoke from the burning end of a cigarette. It is classified by IARC as a Group 1 carcinogen (definite cause of cancer in humans). Exposure causes lung cancer, heart disease and COPD in non-smokers, and is particularly harmful to children, causing respiratory infections, ear infections and worsening asthma. Approximately 1.3 million non-smokers die from SHS exposure each year.

What is the WHO FCTC and what does it require?

The WHO Framework Convention on Tobacco Control (2003) is the world's first global public health treaty, with 182 parties. It requires countries to implement demand reduction measures (tobacco taxes, smoke-free laws, advertising bans, product regulation, cessation support) and supply reduction measures (illicit trade control). The MPOWER package operationalises the FCTC's demand reduction articles. The 2012 Illicit Trade Protocol (ITP) addresses supply reduction.

What is the MPOWER package?

MPOWER is WHO's evidence-based policy package for reducing tobacco demand: Monitor (track tobacco use and prevention policies); Protect (smoke-free laws for public places and workplaces); Offer (cessation support); Warn (graphic health warnings on packaging); Enforce bans on advertising, promotion and sponsorship; Raise tobacco taxes (the most effective single measure — increasing price by 10% reduces consumption by ~4% in high-income and ~8% in LMICs). WHO tracks MPOWER implementation annually.

Are e-cigarettes and vapes safer than cigarettes?

E-cigarettes (vapes) are likely less harmful than cigarettes for long-term smokers who switch completely — but they are not safe, and their long-term health effects are not yet fully understood. They still deliver nicotine (causing addiction), other harmful chemicals, and ultrafine particles that affect the lungs. Critically, they have been aggressively marketed to young people who have never smoked, creating a new generation of nicotine-addicted youth. WHO recommends treating them as tobacco products under the FCTC.

What is the evidence for tobacco tax increases?

Increasing tobacco prices through excise taxes is the single most effective policy for reducing tobacco use. WHO recommends total tobacco taxes equal to at least 75% of the retail price. Evidence consistently shows that a 10% increase in the price of cigarettes reduces consumption by approximately 4% in high-income countries and by up to 8% in LMICs (where price sensitivity is higher). Tax increases also raise government revenue and are highly cost-effective. Tobacco industry opposition to tax policy is a major barrier.

Why is quitting smoking so difficult?

Nicotine is among the most addictive substances known — more so than heroin or cocaine by some measures of dependence criteria. It rapidly enters the brain and binds to nicotinic acetylcholine receptors, causing release of dopamine and creating powerful reinforcement. Withdrawal symptoms (irritability, anxiety, concentration difficulties, cravings) typically begin within hours of the last cigarette. However, quitting is achievable: combining behavioural support with pharmacotherapy (NRT, varenicline, bupropion) significantly increases success rates.

What are tobacco industry tactics to undermine regulation?

The tobacco industry has a long history of documented tactics to undermine tobacco control: funding research to manufacture doubt about the health harms of smoking; lobbying against tax increases, plain packaging and advertising bans; marketing to women and children in LMICs; using trade agreements to challenge tobacco control measures; funding academics and think tanks; and infiltrating policy discussions. The FCTC Article 5.3 requires governments to protect tobacco control policies from commercial and vested interests.

How does tobacco affect children?

Children are harmed by tobacco in multiple ways: prenatal exposure causes low birth weight, preterm birth and developmental harm; childhood SHS exposure causes respiratory infections, ear infections, asthma and sudden infant death syndrome; and nicotine advertising and marketing in social media recruit new smokers. Most adults who smoke started as adolescents. The tobacco industry has historically targeted young people — a documented strategy revealed in court documents.

How does tobacco relate to poverty?

Tobacco use is disproportionately concentrated in low-income populations, and spending on tobacco directly competes with spending on food, education and healthcare. In LMICs, tobacco spending can represent a significant fraction of household income in poor families. The tobacco industry deliberately targets poor populations and countries with weaker regulatory environments. Effective tobacco taxes — progressive in their health impact — can break the poverty-tobacco cycle by both reducing use and raising revenue for health.

How does GMJ News cover tobacco?

GMJ News follows WHO MPOWER reports, FCTC Conference of the Parties (COP) decisions, e-cigarette regulatory developments and tobacco industry tactics. Georgia has historically had high tobacco use, particularly among men, and tobacco control policy is a direct public health priority for PHIG and the Georgian Medical Journal.

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Tobacco

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Tobacco kills more than 8 million people every year — including around 1.3 million non-smokers exposed to second-hand smoke — making it the world's single largest preventable cause of death (WHO). About 1.25 billion adults use tobacco, with 80% of users in low- and middle-income countries where the industry now concentrates its marketing. The WHO Framework Convention on Tobacco Control — one of the most widely ratified treaties in UN history — and the MPOWER package (taxation, smoke-free laws, plain packaging, advertising bans, cessation support) have measurably cut smoking prevalence, while e-cigarettes and nicotine pouches open a new regulatory battleground that GMJ News follows closely.

Primary sources: WHO fact sheet — Tobacco · WHO Framework Convention on Tobacco Control

Key messages

Leading killer

Tobacco kills more than 8 million people every year — including around 1.3 million non-smokers exposed to second-hand smoke — making it the world's single largest cause of preventable death (WHO).

Scale

About 1.25 billion adults use tobacco worldwide. Around 80% of users live in low- and middle-income countries, where the tobacco industry now concentrates its marketing as high-income markets contract.

All tobacco kills

All tobacco products are harmful — cigarettes, smokeless tobacco, waterpipe/hookah, cigars, and heated tobacco products. There is no safe level of tobacco use.

FCTC and MPOWER

The WHO Framework Convention on Tobacco Control (2003) is one of the most widely ratified treaties in UN history. The MPOWER package operationalises it with six proven policy interventions that have demonstrably reduced tobacco use.

E-cigarettes

Electronic cigarettes and nicotine pouches are not safe alternatives to smoking. Their long-term health effects are not yet fully understood, and they are aggressively marketed to youth — a new regulatory battleground.

Quitting works

Cessation is effective at any age. Quitting smoking before age 40 reduces the risk of dying from tobacco-related disease by about 90%. WHO recommends combining behavioural support with cessation medicines (NRT, varenicline, bupropion).

Key statistics

8M+

deaths/year from tobacco

WHO

1.25B

adults use tobacco

WHO

1.3M

non-smoker deaths from SHS

WHO

80%

of users in LMICs

WHO

22%

of cancer deaths attributable to tobacco

IARC

182

parties to the WHO FCTC

WHO FCTC

Global age-standardised tobacco smoking prevalence (%) 2000-2022 — WHO

Source: WHO global estimates. Includes daily and non-daily smokers of any tobacco product.

Glossary of key terms

MPOWER
WHOA package of six proven tobacco control measures: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit; Warn about the dangers of tobacco; Enforce bans on advertising and promotion; Raise taxes on tobacco products.

FCTC
WHOFramework Convention on Tobacco Control (2003) — the WHO's first global public health treaty, now with 182 parties. It provides the international legal framework for tobacco demand and supply reduction measures.

Second-hand smoke (SHS)
WHO/IARCSmoke exhaled by a smoker or emitted from the burning end of a cigarette — classified as a Group 1 carcinogen. Kills approximately 1.3 million non-smokers per year. The primary justification for smoke-free legislation.

Nicotine replacement therapy (NRT)
WHO/CochranePharmaceutical-grade nicotine delivered without tobacco — as patches, gum, lozenges, inhaler or nasal spray — to reduce craving during quitting. Increases cessation success rates by 50-70% compared to placebo.

Plain packaging
WHO/FCTCStandardised cigarette packaging with no branding — mandated by law in Australia (2012) and subsequently many other countries. Evidence shows it reduces the appeal of tobacco products, particularly to young people.

Heated tobacco products
WHODevices that heat tobacco to produce an aerosol — marketed by the industry as reduced-risk alternatives. WHO states they are harmful and addictive and should be regulated as tobacco products.