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The lost lives from these dynamite-loaded cigarettes approximate those from today’s
actual cigarettes. A teen-to-the-grave smoker has a 50 percent chance of dying from the
habit, and each year, tobacco kills nearly 7 million people worldwide, with another 1.2 million
people killed due to exposure to second-hand smoke (WHO, 2020b). By 2030, annual
tobacco deaths are expected to increase to 8 million. That means that 1 billion people this
century may be killed by tobacco (WHO, 2012a).
Tobacco products include cigarettes, cigars, chewing tobacco, pipe tobacco, snuff,
and — most recently — e-cigarettes. Inhaling e-cigarette vapor (vaping) gives users a jolt of
nicotine without cigarettes’ cancer-causing tar. Thanks to vaping’s rapid increase — the fast-
est drug use increase on record — U.S. high school students in 2021 daily used e-cigarettes
at 2.7 times the rate of traditional cigarettes (Johnston et al., 2021).
Distributed by Bedford, Freeman & Worth Publishers. Not for redistribution.
In one survey of regular e-cigarette users from the United States, England, Canada,
and Australia, 85 percent reported they vaped because they believed it would help them
cut down on smoking traditional cigarettes (Yong et al., 2019). Experts debate whether
e-cigarettes can really help smokers quit smoking (Hajek et al., 2019; HHS, 2020a). But they
agree that cigarettes are addictive nicotine dispensers that introduce nonsmokers to smok-
ing (Prochaska, 2019). In a British study, nonsmoking teens who started vaping became four
times more likely to move on to cigarette smoking (Miech et al., 2017).
Teen use has prompted legal restrictions as well as investigations, including one by the
U.S. Food and Drug Administration on whether e-cigarette companies target teenage users
(Richtel & Kaplan, 2018). Fruity flavors, for example, increase teen use (Buckell & Sindelar,
2019; O’Connor et al., 2019). These troubling trends prompted U.S. Surgeon General Jerome
Adams to “officially declar[e] e-cigarette use among youth an epidemic” (Stein, 2018).
Smoke a cigarette and nature will
Nic-a-teen Seeing celebrities, charge you 12 minutes — ironically, just
such as singer Lily Allen, vaping or about the length of time you spend smok-
smoking may tempt young people in Copyright © Bedford, Freeman & Worth Publishers.
ing it (Discover, 1996). (Researchers don’t
the vulnerable teen and early-adult
years to imitate. In 2017, more than yet know how e-cigarette use affects life
one-third of youth-rated (G, PG, PG-13) expectancy.) Compared with nonsmok-
American movies showed smoking ers, smokers’ life expectancy is “at least 10
(CDC, 2020b).
years shorter” (CDC, 2013). Eliminating
smoking would increase life expectancy
more than any other preventive measure.
Why, then, do so many people smoke?
Tobacco products are as power-
VYPe/MeGA/Newscom cocaine. Attempts to quit tobacco use even
fully and quickly addictive as heroin and

within the first weeks often fail (DiFranza,
2008). And, as with other addictions, smok-
ers develop tolerance. Those who attempt to
quit will experience nicotine withdrawal symptoms — craving, insomnia, anxiety, irritability,
and distractibility. When trying to focus on a task, their mind wanders at three times the normal
rate (Sayette et al., 2010). When not craving a cigarette, they tend to underestimate the power
of such cravings (Sayette et al., 2008).
All it takes to relieve this aversive state is a single drag from a cigarette. With that inha-
lation, a rush of nicotine will signal the central nervous system to release a flood of neu-
rotransmitters (Figure 1.3-8). Epinephrine and norepinephrine will diminish appetite and
boost alertness and mental efficiency. Dopamine and opioids will temporarily calm anxiety
and reduce sensitivity to pain (Ditre et al., 2011; Gavin, 2004). No wonder some ex-users,
under stress, resume their habit — as did some 1 million Americans after the 9/11 terrorist
attacks (Pesko, 2014). Ditto for people with major depressive disorder, who are more likely
than others to see their efforts to quit go up in smoke (Zvolensky et al., 2015).

46 Unit 1 Biological Bases of Behavior

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