The Health and Economic Burden of Tobacco Use
Burden of Other Tobacco Products
Smokeless Tobacco: Smokeless tobacco contains many carcinogens and toxins like cigarette smoke. Smokeless tobacco products (e.g., chewing tobacco, oral moist snuff, dip, snus, dissolvable tobacco) pose considerable risks of oral, esophageal, and pancreatic cancer and dental diseases and related deaths and loss of healthy life years to people who use them (Maps 3.7.1 and 3.7.2). Globally, one in three cases of oral cancer are attributable to smokeless tobacco or areca nut consumption.1 The health risks may be greater among individuals using smokeless tobacco in combination with cigarettes or other tobacco products. During 2012-2015, the heath care burden of smokeless tobacco use was estimated to be 680,000 hospital nights, 624,000 emergency room visits, and 4.6 million doctor visits per year resulting in annual excess health care expenditure of $3.4 billion (in 2014 dollars).2
Cigar: The smoke of cigars (e.g., little cigars, cigarillos, large cigars) contains similar toxins and carcinogens as found in cigarette smoke with even higher concentrations of some harmful constituents (Figure 3.7.3). Cigar smoking was estimated to be responsible for approximately 9000 premature deaths and more than 140,000 years of life lost among US adults aged 35 years or older valued at approximately $23 billion in 2010.3 Furthermore, it cost $1.75 billion in excess health care expenditure annually during 2000-2015.4
Waterpipe: Waterpipe or hookah is used to heat tobacco and inhale smoke passed through water. Waterpipe smoking has been associated with several adverse health outcomes including lung cancer, esophageal cancer, stroke, coronary artery disease, respiratory illness, low birthweight, and periodontal disease.5,6,7,8
E-cigarettes: E-cigarette use exposes users to many chemicals that can be harmful to respiratory, cardiovascular, and oral health. In addition, there are safety concerns due to unintended injuries and burns from e-cigarette use; seizures, anoxic brain injury, vomiting and lactic acidosis from exposure to e-liquids; and fatalities from drinking or injecting e-liquids. The health risks and injuries associated with e-cigarette use in combination with cigarettes and/or other tobacco products create additional burden on the healthcare system and expenditures.9
Cigar: The smoke of cigars (e.g., little cigars, cigarillos, large cigars) contains similar toxins and carcinogens as found in cigarette smoke with even higher concentrations of some harmful constituents (Figure 3.7.3). Cigar smoking was estimated to be responsible for approximately 9000 premature deaths and more than 140,000 years of life lost among US adults aged 35 years or older valued at approximately $23 billion in 2010.3 Furthermore, it cost $1.75 billion in excess health care expenditure annually during 2000-2015.4
Waterpipe: Waterpipe or hookah is used to heat tobacco and inhale smoke passed through water. Waterpipe smoking has been associated with several adverse health outcomes including lung cancer, esophageal cancer, stroke, coronary artery disease, respiratory illness, low birthweight, and periodontal disease.5,6,7,8
E-cigarettes: E-cigarette use exposes users to many chemicals that can be harmful to respiratory, cardiovascular, and oral health. In addition, there are safety concerns due to unintended injuries and burns from e-cigarette use; seizures, anoxic brain injury, vomiting and lactic acidosis from exposure to e-liquids; and fatalities from drinking or injecting e-liquids. The health risks and injuries associated with e-cigarette use in combination with cigarettes and/or other tobacco products create additional burden on the healthcare system and expenditures.9
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Sources
- Rumgay H, Nethan ST, Shah R, Vignat J, Ayo-Yusuf O, Chaturvedi P, et al. Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption: a population attributable fraction analysis. The Lancet Oncology 2024; 25(11): 1413-1423.
- Wang Y, Sung HY, Lightwood J, Chaffee BW, Yao T, Max W. Health Care Utilization and Expenditures Attributable to Smokeless Tobacco Use Among US Adults. Nicotine & Tobacco Research 2018 Sep 25; 20(11): 1359–1368.
- Nonnemaker J, Rostron B, Hall P, MacMonegle A, Apelberg B. Mortality and economic costs from regular cigar use in the United States, 2010. American Journal of Public Health 2014 Sep;104(9):e86–91.
- Wang Y, Sung HY, Yao T, Lightwood J, Max W. Health Care Utilization and Expenditures Attributable to Cigar Smoking Among US Adults, 2000-2015. Public Health Reports 2018 May/Jun; 133(3): 329–337.
- Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The effects of waterpipe tobacco smoking on health outcomes: a systematic review. Int J Epidemiol. 2010 Jun;39(3):834-57.
- Montazeri Z, Nyiraneza C, El-Katerji H, et al. Waterpipe smoking and cancer: systematic review and meta-analysis. Tobacco Control 2017;26:92-97.
- Bagherpour-Kalo M, Jones ME, Darabi P, Hosseini M. Water pipe smoking and stroke: A systematic review and meta-analysis. Brain Behav. 2024 Jan;14(1):e3357.
- Morovatdar N, Poorzand H, Bondarsahebi Y, Hozhabrossadati SA, Montazeri S, Sahebkar A. Water Pipe Tobacco Smoking and Risk of Coronary Artery Disease: A Systematic Review and Meta-Analysis. Curr Mol Pharmacol. 2021;14(6):986-992.
- Wang Y, Sung H-Y, Lightwood J, Yao T. Healthcare utilisation and expenditures attributable to current e-cigarette use among US adults. Tobacco Control 2023; 32:723-728.