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smoking

Study Finds Even Two Cigarettes a Day Can Significantly Raise Heart Disease Risk

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A new long-term analysis is challenging common assumptions about “light smoking,” suggesting that even very small amounts of tobacco exposure may substantially heighten the risk of heart disease and premature death.

The research, published Tuesday in PLOS Medicine, followed more than 320,000 U.S. adults for nearly two decades. Johns Hopkins University scientists found that just two cigarettes per day or as few as 100 cigarettes across an entire lifetime were tied to markedly worse health outcomes.

Overall mortality was 60% higher among people who smoked at this low level compared with individuals who had never smoked. Their risk of developing heart disease was 50% higher, the study reported.

Cardiologists say the findings reinforce what decades of research have already hinted at: that even small doses of tobacco can undermine cardiovascular health.

“Tobacco use is a very well-established risk factor for heart disease,” said Dr. Jennifer Miao, a cardiologist at Yale University and an ABC News Medical Unit fellow.

“It really damages the blood vessel lining, and it accelerates the development of plaques and coronary artery disease.”

She noted that tobacco exposure is also associated with problems like atrial fibrillation and stroke.

One of the study’s most concerning observations is that simply reducing cigarette consumption didn’t appear to erase the long-term consequences. Current smokers faced the highest dangers, but even former smokers carried elevated heart disease risks in some cases, persisting more than twenty years after quitting.

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Dr. Erfan Tasdighi, the study’s co-author and an internal medicine physician at Rutgers New Jersey Medical School, said the results should push clinicians to counsel patients toward full cessation, not merely reduction, because “no amount” appears safe.

“We actually have the evidence to say that even less than one cigarette a day can increase different multiple cardiovascular outcomes, and it’s not something that’s clinically insignificant.”

Despite dramatic drops in overall smoking rates in the United States, from about 42% of adults in 1965 to roughly 12% in 2022, according to the American Lung Association, the landscape of smoking has changed. The share of people who smoke fewer than 15 cigarettes per day has increased 85% over the same period, representing a growing group of “light smokers” who may underestimate their risks.

“In recent years, there has been an increase in the number of people who still smoke, but smoke less. As smoking patterns shift with more people smoking fewer cigarettes, it’s important to understand the cardiovascular risks of low-intensity smoking and the long-term benefits of quitting,” said study author Michael J. Blaha, M.D., M.P.H.

“This study, reflecting more than 320,000 U.S. adults over 20 years, gives us the statistical power to see relationships that other smaller studies cannot.”

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These shifting patterns mean physicians must adapt how they evaluate tobacco exposure, the authors argued. Traditional metrics, such as the number of packs smoked a year, may overlook the dangers of intermittent or low-intensity smoking.

“Clinicians need a more nuanced approach that incorporates other ways to identify and quantify cigarette use, like smoking status and smoking intensity,” Miao said.

Still, experts emphasize the difficulty many people face when trying to stop smoking entirely.

“It’s very, very important for us as clinicians to acknowledge that it’s a lot easier said than done.”

Miao encourages physicians to identify smokers who are struggling and connect them with cessation medications, counseling services, and other evidence-based support.

The researchers reported that the benefits of quitting accumulate most dramatically in the first decade after cessation. Yet even as the body begins healing right away, it may take many years for former smokers to approach the risk levels of people who never smoked.

Tasdighi stressed that early improvements shouldn’t be underestimated. “It’s important that people know that when they stop smoking, their risk goes down immediately and significantly,” he said.

Miao agreed, saying the research’s biggest message is straightforward. “It’s important to quit smoking early on, and no amount of smoking is without risk and health consequences,” she said.

nicotine

Rise of Zyn: USC Study Finds Teens Turning to Nicotine Pouches

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Teenagers are shifting away from vaping and increasingly turning to nicotine pouches, especially from brands like Zyn. Their use among U.S. high school students nearly doubled from 2023 to 2024, a recent study led by researchers at USC’s Keck School of Medicine revealed.

The findings, published in JAMA Network Open, are based on data from a national survey involving over 10,000 tenth and twelfth graders.

Nicotine pouches—small sachets containing nicotine that users tuck between their gums and lips—have rapidly increased in popularity, particularly due to aggressive social media promotion by “Zynfluencers,” who portray pouch use as enhancing confidence, masculinity, and mental clarity.

While nicotine pouch use climbed from 3.0% of teens in 2023 to 5.4% in 2024, vaping saw a slight decline over the same period. E-cigarette use dropped from 20% to 17.6%, yet dual usage—teens who reported using both e-cigarettes and nicotine pouches—increased from 2.1% to 3.6%. Additionally, more students reported lifetime and recent use of nicotine pouches.

The trend has raised significant public health concerns, echoing earlier apprehensions surrounding other tobacco products. Groups, including the American Heart Association and the Campaign for Tobacco-Free Kids, have asked for nicotine pouch legislation.

“This growing public health issue needs more attention. Like flavored e-cigarettes when they first emerged, use of this new oral nicotine product is becoming more widespread, particularly among adolescents,” said study lead author Dae-Hee Han, a postdoctoral researcher in population and public health sciences at USC’s Keck School of Medicine.

The demographic patterns for nicotine pouch users mirrored traditional smokeless tobacco users, with higher rates among males, non-Hispanic white teens, and those living in rural areas. According to Han, these distinctions underscore the need for tailored preventive approaches distinct from those used for vaping.

“We’re finding that the risk profile differs quite a bit between nicotine pouches and e-cigarettes, which means we need prevention approaches that are targeted for each.”

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Health implications of long-term nicotine pouch use remain unclear, though early reports indicate potential risks like addiction, mouth sores, and gum irritation. Moreover, prior studies have demonstrated that adolescent nicotine exposure can negatively impact brain development, particularly affecting learning, memory, and attention capabilities.

“Parents, teachers, and pediatricians should be aware that teen nicotine pouch use is increasing across the nation,” emphasized Adam M. Leventhal, executive director of the USC Institute for Addiction Science and a study co-author.

Leventhal told Business Insider he had anticipated a rise in the popularity of nicotine pouches, especially with the rapid increase in demand for Zyn products and frequent shortages. Still, the scale and speed of this uptick surprised him.

On platforms like TikTok, “Zyn” is gaining popularity among younger audiences, with users frequently posting about their favorite flavors and demonstrating how to discreetly place pouches, often referred to colloquially as “upper deckies.”

Another unexpected discovery from the study was that teen girls are vaping at higher rates than boys.

“Historically, any kind of substance, you typically see that males have higher-use levels than females. But vaping, it’s appeared to kind of switch over recent years.”

He theorizes that marketing might influence these gender disparities. Initially targeted towards women seeking an alternative to cigarettes, Zyn now markets itself broadly, appealing to diverse demographics, including Wall Street professionals and celebrities like Josh Brolin. Former user Tucker Carlson plans to launch his own nicotine pouch brand, criticizing Zyn as insufficiently masculine. This rebranding could make nicotine pouches particularly appealing to teen boys, according to Leventhal.

Leventhal’s chief concern is that nicotine pouches may expose teens to even higher nicotine doses than e-cigarettes alone. The health risks associated with Zyn include potential gum damage, altered brain chemistry, and increased heart rates. Vaping similarly carries significant health risks comparable to traditional smoking, with both products being highly addictive.

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Although some TikTok users claim to use Zyn as a strategy to quit vaping, Leventhal emphasized that this is not an effective solution. Instead, dual usage often occurs, exacerbating overall nicotine exposure. “We don’t want children to use any nicotine products,” he said. “So all nicotine products should be avoided.”

Despite extensive campaigns to educate teens about nicotine’s dangers, their attraction to its effects remains consistent. According to previous studies from Leventhal’s team, adolescents are drawn to nicotine for its mood-enhancing properties, appetite suppression, and metabolism boost.

Leventhal explained that nicotine pouches appeal particularly to teens due to their discreet nature. Unlike vaping, nicotine pouches can be used subtly during classes, in movie theaters, or even around parents, heightening the risk of frequent and unnoticed use.

“To reverse this trend, we need to heighten public awareness about pouches and educate youth about them. Policymakers might also consider ramping up regulation of the booming pouch market—including cinnamon, fruit and other attractive flavors—to protect youth.”

The study also highlighted ongoing regulatory debates. The U.S. Food and Drug Administration (FDA) authorized marketing flavored nicotine pouches like Zyn to adults 21 and over, citing their potential role in helping smokers quit. However, the FDA did not approve these products as formal smoking cessation aids and less than 1% of adults currently use them, prompting concerns over teen appeal.

FDA’s authorization decision partly depended on the National Youth Tobacco Survey, which reported no statistically significant increase in teen pouch use, when asked about usage over the last 30 days, between 2023 and 2024. Yet, both the USC-led research and the FDA’s survey found significant year-over-year increases in lifetime pouch use among teens, suggesting experimentation may be growing.

Moving forward, continued monitoring of nicotine pouch trends, initiation patterns, nicotine content variations, and potential health impacts is vital. Researchers recommend that future studies also assess the effectiveness of regulatory policies, especially for high-risk demographics and dual users of nicotine products.

“Nicotine pouches are relatively new, so we need time to collect data on prevalence, policy and prevention,” Han said.

cigarettes

Supreme Court Rejects Tobacco Industry’s Bid To Remove Graphic Images On Cigarette Packs

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On Monday, the Supreme Court declined to hear a challenge from major tobacco companies to the Food and Drug Administration’s requirement to display graphic images as health warnings on cigarette packages. 

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In 2020, the FDA rules that cigarette packages and advertisements must include health warnings that take 50% of the area of the front and back panels of the packages and at least 20% of the area on top of cigarette ads. 

There are 11 text-and-image graphics that the FDA created. One example shows a human lung that reads “WARNING: Tobacco smoke causes fatal lung disease in nonsmokers.”

Another shows a young boy holding an oxygen mask that states: “WARNING: Tobacco smoke can harm your children.”

Major tobacco companies sued against this choice, arguing that the warnings run “afoul of the First Amendment and that the agency violated federal rulemaking procedures when it issued it,” according to Devan Cole of CNN.

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While a federal judge in Texas initially agreed with the companies and got rid of the rule, the 5th US Circuit Court of Appeals reversed that decision in favor of the FDA. 

The appeals court stated that the FDA’s rule “passes constitutional muster” citing a Supreme Court standard that allows the government to compel commercial speech as long as it’s “purely factual, uncontroversial, justified by a legitimate state interest, and not unduly burdensome.”

Lawyers for the tobacco companies stated that the illustrations “are designed to shock rather than inform, because the massive and inflammatory graphics go far beyond what would be necessary to communicate a simple factual message.”

The Biden administration said that the appeals court was correct in their ruling to revive and maintain the rule “because the warnings are reasonably related to the government’s interest in promoting public understanding of those risks (associated with tobacco) and are not unduly burdensome.”

Healthy Lifestyle

Study Finds That a Healthy Lifestyle can Add a Decade of Life Free From Disease

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Everyone knows that practicing healthy habits, such as dieting, exercising, and avoiding cigarettes, can extend one’s life span and improve one’s quality of life. However, it can be difficult to conceptualize exactly how much of a benefit these habits offer in one’s life, as it’s easy for these metrics to become somewhat abstract. As such, a study published in the British Medical Journal sought to quantify exactly how much a healthy lifestyle benefits one’s life, and found that practicing a healthy lifestyle can expand one’s disease-free lifespan by an average of ten years.

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The study looked at five factors associated with a healthy lifestyle, which included drinking alcohol in moderation, not smoking, exercising regularly, maintaining a healthy weight, and eating well. The study, which looked at more than 100,000 people, found that people who practiced four of these five traits lived as much as ten years longer without diseases like heart disease, diabetes, and cancer, than people who practiced none of these habits. Not only does a healthy lifestyle allow people to live longer lives, but the quality of life increases when people practice healthy lifestyle habits, as the risk of developing diseases decreases dramatically.

Specifically, the study found that women who practiced any four of the five traits in question lived an average of 84 years without disease, whereas women who practiced none of the five habits only lived an average of 74 years without disease. Likewise, men with four out of the five healthy habits lived to 81 years old without disease, whereas men who practiced none of the healthy habits lived to 73 years old without disease. The most unhealthy characteristics a person can have, the study found, were smoking more than 15 cigarettes a day or having a BMI greater than 30, which is defined as obesity.

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While the study shows that moderate drinking is far healthier than heavy drinking, it’s important to note that other studies have shown that no amount of alcohol is good for you, despite persistent rumors that suggest that having a glass of wine with dinner can improve one’s health. In fact, using recreational drugs at all is widely considered to have either a neutral or a negative impact on one’s health, and definitely not a positive one. Instead of relying on drugs as a method of reducing stress, doctors recommend other methods that help to both relieve stress and improve health. Regular exercise, for instance, has been shown to improve one’s overall mood, and meditation, a practice whereby people focus on paying attention to their experiences in the present moment, can improve mental health as well. If, like most people, you’re concerned about extending the longevity and quality of your life, it’s not a bad idea to think about the various ways in which your current lifestyle habits might contribute to disease and develop strategies to improve your lifestyle habits.

Vaping

Is Vaping Safer than Smoking?

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When e-cigarettes were first introduced to the American public, they were marketed in large part as a safe tobacco-cessation aid, promising to help people quit smoking by allowing them to gradually reduce their nicotine intake over time. E-cigarettes and vaping generally were also marketed as healthier alternatives to cigarettes, as e-cigarette vapor does not contain much of the same tar and other harmful chemicals as cigarette smoke. In fact, Juul, one of the world’s largest e-cigarette companies, was found to have directly marketed to high-school kids, leveraging designs and flavors meant to appeal to teens and telling them that their products were “totally safe.” E-cigarette use has exploded in popularity in particular among young people, threatening decades of work done by the government to dissuade the younger generation from using recreational drugs like nicotine.

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While e-cigarettes have long been assumed to be safe due to the lack of combustion involved, recent events have introduced doubt about the safety of these devices. A few months ago, a string of vaping-related hospitalizations, some of which led to death, renewed fears that vaping is in fact more dangerous than companies like Juul have let on. In the aftermath of these mysterious illnesses, Walmart decided to stop selling e-cigarette devices, and some states even moved to ban flavored vaping products in an effort to minimize use among children and teenagers. The federal government has contemplated banning the sale of flavored e-cigarette ingredients as well, but has not yet done so. Eventually, the CDC tied the incidences of sudden, severe lung illness to counterfeit THC cartridges that were distributed in the black market, but an overall attitude of skepticism towards vaping in general persisted. Specifically, the researchers found that the ingredient vitamin E acetate, which is used as an additive to alter the consistency of THC oil, was to blame in this particular phenomenon.

While this year’s major health scare related to vaping turned out to be limited to counterfeit products, perceptions about the dangers of vaping persist and are supported by new evidence that suggests vaping can be responsible for some long-term illnesses. Specifically, an article published in the American Journal of Preventive Medicine details a large study that compared the lungs of people who used e-cigarettes with cigarette smokers and those who did not consume nicotine over three years. Unsurprisingly, the last group had the lowest risk of developing a lung illness, but while e-cigarettes were found to cause problems in their own right, they were nonetheless considered safer and healthier than smoking.

“E-cigarettes should not be recommended.”

While differing in severity, the long-term health complications associated with vaping are similar to those associated with smoking cigarettes, and include chronic bronchitis and emphysema. The most dangerous form of nicotine consumption mentioned in the study was “dual use,” which is a combination of vaping and smoking, as not only does this practice maximize the amount of nicotine one consumes but it also exposes the lungs to the most amount of smoke or vapor. Dual use is the most common pattern of use the researchers found, signalling trouble for the millions of teenagers whose nicotine addictions are fueled by multiple vectors of drug consumption. The results of the three-year study corroborated animal studies on the effects of vapor on the lungs. Worryingly, the study also found that certain harmful ingredients, like propylene glycol, diacetyl, and even metals were present at a higher concentration in e-cigarette vapor than in combusted cigarette smoke. 

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Overall, the study is extremely critical of e-cigarettes, suggesting they are only valuable in a limited number of cases, and it concludes with the line “E-cigarettes should not be recommended.” In a small number of cases, e-cigarettes can be a good option for people who are trying to quit smoking as long as they use the devices with discipline and respect. While still harmful, e-cigarette vapor is less harmful than smoke, and vaping formulas can be adjusted over time to gradually reduce their nicotine content. That being said, as a result of the high prevalence of “dual use,” using e-cigarettes while trying to quit smoking can backfire, and indeed for most people using an e-cigarette is connected with an even lower chance of successfully quitting smoking. Other tobacco cessation aids, like nicotine-infused chewing gum or skin patches, are more effective in helping people quit and pose no threat to the health and safety of the lungs.

Smoking

The FDA Hopes A Picture Really Is Worth 1000 Words In New Proposed Anti-Smoking Effort

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The Food and Drug Administration has proposed for the use of graphic images portraying the negative effects of smoking on cigarette packages. This is part of a greater effort that the FDA has been working on for years involving graphic content to “scare” smokers into quitting. 

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