Tobacco

Immediate and short term effects

Inhaling smoke from cigarettes is an extremely efficient method for delivering nicotine. Nicotine dissolves instantly in saliva, through the lining in the mouth and into the bloodstream in a few seconds. The smoker may experience immediate effects of dizziness and feeling light-headed. Other immediate effects include:

• increased heart rate
  
• nausea, watery eyes and acid in the stomach
• initial stimulation, then reduction in brain and nervous system activity
  
• enhanced alertness and concentration
  
• mild euphoria
  
• feeling of relaxation
  

As smoking becomes established other short term effects occur:

• bad breath
• smelly hair and clothes
• yellow stains on teeth
• decreased sense of taste and smell (food less enjoyable) and appetite
• shortness of breath
• loss of physical/athletic performance and endurance
• decreased lung capacity due to excess mucus and swelling of airways
• triggers asthma and increases severity of asthma
• increased blood pressure
• addiction to nicotine

Long term effects

Long term smokers have higher risk of developing the following diseases that can lead to premature death:

• cancer of the lung, throat, mouth, lips, gums, kidney and bladder
  
• heart disease and stroke
  
• emphysema and other lung diseases
  
• gangrene and other circulatory diseases
  
• blindness from macular degeneration and cataracts
  
• brittle bones that break easily
  
• impotence, infertility and miscarriages
  
• sickly and small babies
  

Tobacco comes in many forms including:

• cigarettes
• cigars
• loose leaf tobacco (chop chop) – used for rollies and pipes
• tobacco with molasses or glycerine – used for water-pipe which may also be called hookah/shisha/hubbly bubbly
• snuff
• chewing tobacco

Tobacco smoke is usually inhaled by smoking cigarettes, pipes and cigars. It may also be sniffed (snuff) or chewed (chewing tobacco). Cigarettes account for around 98 per cent of tobacco consumed in Australia.

Second hand smoke also known as environmental tobacco smoke is the smoke which smokers exhale after inhaling from a lit cigarette and the smoke emitted from a burning cigarette. In adults, breathing second hand tobacco smoke can increase the risk of heart disease, lung cancer and other lung diseases. It can worsen the effects of other illnesses such as asthma and bronchitis.

For children, inhaling second hand tobacco smoke is even more dangerous. This is because children’s airways are smaller, and their immune systems are less developed. These differences make children more likely to suffer health problems due to second hand smoke such as bronchitis, pneumonia and asthma.

Exposure to second hand smoke during pregnancy increases a woman’s risk of miscarriage, premature birth, having a baby with a low birth weight and a sickly baby. Infants exposed to second hand smoke are also at an increased risk for Sudden Infant Death Syndrome (SIDS), chest and ear infections and asthma.

There are no known safe levels of exposure to second hand smoke.

What are e-cigarettes?

An e-cigarette, most commonly known as a 'vape', is a battery powered device which heats up liquid, known as e-liquid, into an aerosol which a person then breathes into their lungs. Using an e-cigarette is also called 'vaping'. They come in many shapes and sizes and can be made to look like cigarettes, cigars, pipes or hookahs, or everyday items such as pens or USB memory sticks. There are over 7,000 e-liquid flavours which include tobacco, confectionery, fruit and chocolate.

What's in a e-cigarette?

Some e-cigarettes and e-liquids contain nicotine (in some instances in large quantities), even though they are not labelled as containing nicotine, which is highly addictive.

E-cigarettes and the vapour they produce can also contain many other harmful substances which are again not always labelled correctly. Substances which have been found in electronic cigarettes include:

• 2-chlorophenol (used in pesticides and disinfectants)
• propylene glycol and glycerine (may be non-toxic when ingested orally, but researchers aren't sure how safe they are when vaporized and inhaled)
• diethylene glycol (found in industrial products such as antifreeze)
• acetone (a solvent in nail polish remover)
• acetaldehyde and formaldehyde (known to cause cancer) 
• acrolein (a weed killer)
• heavy metals such as lead, chromium and nickel
• volatile organic compounds (common in paint and cleaning products)

Many electronic cigarettes use lithium batteries. These batteries can have a risk of fire and explosion.

E-cigarettes  and e-liquids should always be kept out of reach of young children.

Too much nicotine from e-cigarettes can cause nicotine poisoning. If you think someone has been poisoned by liquid nicotine, please call the Poisons Centre on 13 11 26 immediately or 000 if it is an emergency. For more information see NSW Poisons Information Centre

What are the health impacts of using e-cigarettes?

E-cigarettes are not risk free. E-cigarettes may expose users to chemicals and toxins that can lead to issues such as irritation to skin, eyes and airways and to more severe health effects.

 The use of e-cigarettes, either with or without nicotine, may provide a gateway to a lifetime of nicotine addiction. Among non-smokers, those who use e-cigarettes are on average three times as likely to take up tobacco smoking as those who have not used e-cigarettes.

The direct health effects from using e-cigarettes need further investigation. The National Health and Medical Research Council  CEO Statement for electronic cigarettes stated that there is currently insufficient evidence to support claims that e-cigarettes are safe and further research is needed to enable the long-term safety, quality and efficacy of e-cigarettes to be assessed. Read the NHMRC CEO Statement.

Do e-cigarettes help you quit smoking?

Currently, there is insufficient evidence to conclude that e-cigarettes can assist smokers to quit.The Australian Therapeutic Goods Administration (TGA) has not assessed any e-cigarettes for quality, safety or performance as a smoking cessation aid.

Further information on safety and on how to access  e-cigarettes is available on the TGA website.

NSW Health recommends smokers use approved medications to help them quit smoking, in consultation with their doctors or other health professionals. These products include:  Nicotine replacement therapy (NRT) products such as patches, lozenges, mouth sprays or gums; Bupropion; and Varenicline. Alternatively, smokers can get help and support to quit from GPs or pharmacists, the free telephone based counselling service NSW Quitline  at 13 7848, and an interactive website iCanQuit. 

For more information on e-cigarettes, visit the NSW Health website.  

Smoke-free laws

In NSW, smoking and using e-cigarettes are  banned in all enclosed public places such as shopping centres, pubs, clubs, cinemas and libraries.

Smoking is also banned in a number of outdoor public places. These include:

• within 10 metres of a children's playground equipment

• public swimming pools

• spectator areas of sporting grounds used for organised sporting events

• public transport stops and platforms

• within 4 metres of the entrance to a public building

• in seated commercial outdoor dining areas where food is served

It is also against the law to smoke or use an e-cigarette in a car while a child under the age of 16 is present.

For more information on smoke free laws, visit 'Smoke free laws' on the NSW Health website.

Smoking and minors

It is against the law for a retailer to sell tobacco, e-cigarettes and e-cigarette accessories, and non-tobacco smoking products to people under the age of 18. It is also against the law for an adult to buy these products on behalf of a minor.

Police have the power to confiscate tobacco, e-cigarettes and non-tobacco smoking products from a child or young person under the age of 18.

There are a range of other laws associated with tobacco retailing. For further information visit 'Tobacco retailing laws' on the NSW Health website.

There is no safe level of smoking during pregnancy. Smoking causes immediate and long-term harm to developing babies. This is due to the inhaled carbon monoxide gas from smoking reducing the amount of oxygen in the mother’s blood. Less oxygen and nutrients flowing from the mother’s blood through the umbilical cord to the baby increases the baby’s heart rate and increases the stress on the baby’s developing body. Other toxins from tobacco smoke also cause harm to the developing foetus.

Harm during pregnancy and birth
Women who smoke during pregnancy have a greater risk of things going wrong during the pregnancy and the birth including having:

• a low birth weight (small and sickly) baby
• a miscarriage
• an ectopic pregnancy (a pregnancy that occurs outside the uterus)
• the baby dying during or soon after birth
• complications during pregnancy and labour

Harm after the baby is born
Children born to mothers who smoked beyond the first trimester of their pregnancy have higher risks of dying from sudden infant death syndrome (SIDS) and of developing a range of physical and mental health problems during childhood and in later life including:

• asthma, respiratory infections, impaired lung function and middle ear infections
• learning difficulties and behavioral disorders
• obesity, diabetes and cardiovascular disease
• twice as likely to be nicotine dependent and be a smoker themselves

For more information visit 'Smoking and Pregnancy' on the NSW Health website.

Dependence
Tobacco contains more than 7,000 chemicals that are harmful to people - including 70 chemicals that are known to cause cancer. Nicotine is the highly addictive chemical in tobacco. Some e-liquids used in e-cigarettes also contain nicotine. 

Nicotine dependence can develop quickly in some people, such as after the first few cigarettes or e-cigarettes containing nicotine. For others, the dependence develops more gradually. There is no way of knowing how an individual will respond to nicotine containing products and how quickly their dependence will develop.

Indicators of nicotine dependence include:

• having a cigarette or e-cigarette (containing nicotine) within 30 minutes of waking
• having a cigarette or e-cigarette (containing nicotine) more than 10 times per day, or
• a history of withdrawal symptoms in previous quit attempts

Withdrawal
People experience nicotine withdrawal differently. Most people experience some of the symptoms of nicotine withdrawal and they usually don’t all happen at once. Common withdrawal symptoms experienced by people quitting include:

• irritability and anxiety
• difficulty concentrating
• restlessness and insomnia
• cravings
• dizziness
• increased appetite

Nicotine withdrawal is usually worst in the first few days after quitting and most people find the symptoms last no more than two weeks.

Some people are successful at quitting unaided. For most people, assistance is required to encourage and support quit attempts, manage symptoms of nicotine withdrawal and prevent relapse. For example, using over the counter nicotine replacement therapy (NRT) products (patch, gum, lozenge, inhalator and mouth spray) or prescription only pharmacotherapy products (Champix and Zyban) can reduce cravings and symptoms of nicotine withdrawal. A GP or other health professional can provide quit advice, counselling and prescribe quit aids. Talking with Quitline 13 7848 can also help with ideas to manage withdrawal symptoms related to smoking. 

It is usual to try to quit numerous times before successfully quitting.

There are many benefits of quitting smoking and they start straight away. After only a few weeks, your taste and smell improves, coughing reduces and breathing and exercise will be easier.

Instantly, you will be able to save money. If you spend $100 a week on cigarettes then you will save more than $5,000 for each year you don’t smoke.

Your appearance also benefits from quitting smoking. Your skin will look healthier, your teeth will be whiter and you will have better breath.

If you quit before age 35 your life expectancy is similar to someone who has never smoked, however quitting smoking at any age has health benefits.

When parents quit smoking, this also benefits the health of their children. A smoke-free home and car protects children from ‘second-hand smoke’ and lowers their risk of many illnesses like SIDS, ear infections, asthma, allergies and other lung problems. 

Want to know more? Download the 'Benefits of quitting' fact sheet.

Paths for quitting tobacco smoking   

Giving up tobacco smoking is definitely one of the best things you can do for your health. However, if you have developed a dependency on nicotine you may find it difficult to quit. Some people can stop smoking without assistance (cold turkey) but most people increase their chances of success by quitting in combination with various kinds of support as listed below:

The NSW Quitline 13 7848 (13 QUIT)

The Quitline is a confidential telephone information and advice service. For the cost of a local call (except mobiles), professional telephone advisors provide encouragement, resources and support to help smokers quit. They are friendly, helpful, non-judgmental and are able to assist smokers at whatever stage they may be at in the quitting process. The Quitline advisors can also provide advice to family and friends of smokers and to health professionals about the best evidence for quitting smoking.

NSW Quitline offers:

• a free callback service
• a Quit kit containing helpful information about quitting - available to download or order in English, Arabic, Chinese (Cantonese and Mandarin) and Vietnamese
• an individually tailored and culturally sensitive service for Aboriginal callers
  
• dedicated language lines in Arabic, Chinese (Cantonese and Mandarin) and Vietnamese
• callers from other culturally and linguistically diverse communities can also call the Translating and Interpreter Service.

iCanQuit website

The iCanQuit website is designed to motivate people to quit by providing them with the information and tools they need to make a quit attempt. It is interactive and allows smokers to share their stories about previous, current or planned quit attempts.

It provides helpful hints on how to quit as well as a goal tracker and savings calculator so smokers can see the everyday results of quitting.

My QuitBuddy

My QuitBuddy is a phone app personalised to help you quit smoking on your terms. You choose the time when you are ready to quit, set your own goals, and include photos and recordings of loved ones to spur you on. A popular feature of the app is a community forum which allows quitters to share success stories and tips.

Medical products

There is a range of medical products that can double your chances of quitting.

• Nicotine replacement therapies (NRT) including patch, gum, lozenge, inhalator and mouth sprays are available over the counter at local pharmacies without a prescription. NRT works by replacing some of the nicotine your body receives from smoking but at a much lower level which helps you to manage nicotine withdrawal symptoms.  

• Bupropion (Zyban) and varenicline (Champix) are prescription medicines that work by reducing the severity of withdrawal symptoms while also reducing the pleasurable sensation of nicotine. For details of the availability of NRT and other medical products on the Pharaceutical Benefits Scheme visit the PBS website.
  

For more information on medical products that can help you visit 'Products to quit'. Read about the 10 common myths about smoking and quitting.

Quitting methods not recommended

• Switching to lower nicotine and tar
  

Many Australian smokers mistakenly believe that weaker tasting cigarettes (previously known as 'light' and 'mild' cigarettes) are less dangerous. There is no evidence that smokers of weaker cigarettes have less risk of smoking-caused diseases than smokers of other cigarettes.

Research shows that there is little difference in the levels of nicotine, carbon monoxide and other toxins inhaled by smokers of weaker cigarettes compared to smokers of regular cigarettes. This is because smokers generally take more frequent and deeper puffs of these cigarettes to get the amount of nicotine they are used to. There is no evidence that switching to weaker tasting cigarettes reduces addiction or helps smokers to quit.

• E-Cigarettes/ Vaping
  

Currently there is insufficient evidence to conclude that e-cigarettes can assist smokers to quit.

The Australian Therapeutic Goods Administration (TGA) has not assessed any e-cigarettes for quality, safety or performance as a smoking cessation aid.

Further information on safety and other issues relating to electronic cigarettes is available on the TGA website.

For more information on e-cigarettes, visit 'Electronic cigarettes' on the NSW Health website.

Quitline 13 7848 (13 QUIT) is a confidential telephone information and advice service. For the cost of a local call (except mobiles), professional telephone advisors provide encouragement, resources and support to help smokers quit. They are friendly, helpful, non-judgmental and are able to assist smokers at whatever stage they may be at in the quitting process. The Quitline advisors can also provide advice to family and friends of smokers and to health professionals about the latest evidence on quitting smoking. 

iCanQuit website is designed to motivate people to quit by providing them with the information and tools they need to make a quit attempt. It is interactive and allows smokers to share their stories about previous, current or planned quit attempts. It also provides helpful hints on how to quit as well as a goal tracker and savings calculator so smokers can see the everyday results of quitting.

Visit www.icanquit.com.au

NSW Health smoking cessation fact sheetsSix fact sheets on various aspects of smoking cessation are available to download and order from the NSW Health website. They include fact sheets on ‘Supporting someone to quit smoking’, ‘Benefits of quitting smoking’, Nicotine dependence and withdrawal’, ’10 myths about smoking and quitting’ ‘Smoking and pregnancy’ and more.

Smoking cessation booklets for Aboriginal people

Three booklets are available to download and order from the NSW Health website. They include:

• smokers: Thinking of giving up
• smokers: Decided to give up
• ex-smokers: Keep up the good work

No Smokes website

No Smokes is a website designed to appeal to young Aboriginal and Torres Strait Islander Australians. It uses animations, games, video clips, blogs and personal stories to deliver messages about quitting smoking. No Smokes is funded by the Department of Health as part of its Indigenous Tobacco Control Initiative.

Visit www.nosmokes.com.au for further details.

Smoking cessation booklets for pregnant Aboriginal women

Five booklets are available to download and order from the NSW Health website. These include:

• why your baby needs you to quit smoking
  
• help a new mum to quit
  
• practical advice on quitting
  
• staying smoke-free during pregnancy and beyond
  
• protecting your baby from passive smoke
  

To access the booklets, visit the NSW Health website.

‘Quit for 2 Quit for you’ is a Smartphone app that provides support and encouragement to help pregnant women give up smoking. It includes practical quit tips and advice and fun exercises and games that distract women when they feel the urge to light up. It inspires women to keep going with amazing facts about the baby's development. And, it gives women ideas for what they could buy with the money they are saving every day they don't spend money on cigarettes.

The ‘Quit for you - Quit for Two’ app can be downloaded for free on iPhone or iPad from Apple app store or for android phone in the Google Play store.

Mental health and smoking 

For further information on smoking, quitting and mental health, visit the NSW Health website.

When someone uses tobacco or e-cigarettes, it can affect everyone around them. This site offers a variety of resources for friends and families concerned about their loved ones, including information about vaping and the chemicals found in e-cigarette liquids. Support services are available specifically to help people supporting others with substance use or misuse. There are also tips for talking with kids about alcohol and other drugs (part 1 and part 2). ACON provides support specifically for LGBTQ+ families through Pivot Point.

Informational resources are available in 27 languages. This includes videos providing information about where and how to get help for yourself or someone you care about.

General resources include:
Information and support for family and carers
Managing aggression, alcohol and drug use in the home: A guide for those concerned about children 5-12 years
Coping with aggression, alcohol and drug use in the home - A guide for teenagers
A parents' guide to drug slang