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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.

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.

Girl Vaping

Researchers at Yale use Virtual Reality to Fight Teen Vaping

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The phenomenon of teen vaping has certainly drawn a tremendous amount of concern this year, as a record number of teens report using vaping products and public health officials worry that a generation of kids will grow up to suffer from lifelong nicotine addictions due to the explosion in popularity of e-cigarette brands like Juul. Regrettably, while much of the work that’s been done to discourage young people from smoking cigarettes has been successful, teens are developing nicotine addictions nonetheless due to the marketing success of e-cigarette companies, which have been found to deliberately market tobacco products to young people and non-smokers. While vaping is widely considered to be healthier than other forms of tobacco consumption, it carries with it its own set of health risks, as the long-term effects of consuming nicotine via vapor are as-of-yet unknown and a series of vaping-relating hospitalizations earlier this year demonstrated that some vape products can be dangerous and even deadly.

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Dissuading young people from vaping is a difficult task for a number of reasons. For one, nicotine is one of the most addictive drugs that exists, and vaping products allow users to easily consume very large amounts of nicotine relative to smoking cigarettes or other methods of tobacco use. Additionally, as their brains are still developing, teenagers have difficulty assessing risk and making smart long-term decisions for the future, making it harder for them to appreciate the dangerous impact vaping could have on their lives. Teenagers are also notorious for their resistance to authority, and can have a natural inclination to reject messages from authority figures, instead taking cues from their peers in order to fit in with their social environment. Many young people believe vaping to be safer than other forms of nicotine addiction, and while this could be true, such a belief can cloud a person’s judgment when considering whether to start vaping. As such, researchers and doctors must come up with novel solutions for persuading children and teenagers not to engage in dangerous behaviors like vaping.

Like vaping, virtual reality is a new technology that has taken off in recent years

One such solution was imagined at Yale University, where researchers developed a virtual reality video game with the intent of discouraging vaping among teenagers. Like vaping, virtual reality is a new technology that has taken off in recent years, as display technology and advancements in computer graphics have made a product which for decades has been confined to science-fiction stories a reality. The game is called “Invite Only,” and puts players in the role of a student in a high school environment as they engage in scenarios such as being offered a vape pen at school or at a party and encouraging a friend to quit vaping. In addition to its educational value, the game is meant to be fun, engaging players with various activities and mini-games.

Though the project was developed at Yale, it was funded by Oculus, a virtual reality technology company owned by Facebook, and was created in collaboration with PreviewLabs Inc., a New Haven-based game developer. The game is the subject of an ongoing experiment, involving 300 students, designed to assess whether virtual reality technology holds promise as an educational and public health tool. The educational aspect of game-play involves players choosing from a number of dialogue options when engaging in conversations with in-game characters, which tests their knowledge about the effects of vaping products and the availability of resources to help people who want to quit. For instance, the game teaches players that they can text the word “quit” to 47848 for information about vaping-cessation resources, and that they should consult with a trusted adult, such as a parent or doctor, for help with their nicotine addictions.

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In the past, similar programs that leverage gaming to send an anti-drug-use message have been developed, with varying success. But the researchers hope that virtual reality will do a better job by immersing children and teenagers in a virtual environment that helps them imagine how drug use can impact their own lives as well as the lives of their peers, particularly in a world that is densely saturated with tablets and smartphones, which compete for young people’s attention. While the cost of virtual reality has decreased dramatically in recent years, the price of a virtual reality headset can still impose a burden on some, as the Oculus Go headset for which “Invite Only” was developed costs $150 or more. However, if schools are willing to invest in virtual reality technology, researchers hope that this platform can be leveraged not only to dissuade kids from vaping, but for other educational opportunities as well. The Yale researchers expect to have final results from the experiment by next year.

E-ciggs

FDA Failed to Act on E-Cigarette Regulations

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The F.D.A. is a longstanding American institution which is trusted to ensure that the products available to the American consumer are safe and effective. But the recent emergence of more than a thousand lung illnesses related to e-cigarette and vape pen use has raised questions about the organization’s effectiveness in ensuring the safety of the new category of products. While e-cigarettes have been around for more than ten years, they have long been presumed to be safe despite a lack of thorough scientific research, and in recent months this presumption of safety has been called into question. In response to the outbreak of vaping-related illnesses, some of which have been deadly, journalists have conducted interviews with current and former government officials and public health experts to reveal a myriad number of factors, from lobbying to fears of political ramifications to excessive bureaucracy, that paralyzed the F.D.A. and enabled the beginning of what may very well become a long-lasting public health crisis.

Though the general public has only recently come to understand the serious health complications posed by vaping, public health officials have warned of this risk as early as 2013, with limited success. Dr. Thomas R. Frieden, former director of the F.D.A., issued a public warning that year about the rise of vaping, the fact that potential health issues were as-of-then unknown, and in particular the risk of developing nicotine addiction vaping posed to adolescents. The F.D.A., however, was unable to regulate the burgeoning industry, as two e-cigarette companies successfully sued the F.D.A for treating the devices as drugs rather than as tobacco products, which are subject to less stringent regulations. At the time, the Obama administration was more focused on the rollout of the Affordable Care Act than on other regulations, and in Obama’s last year in office, his administration rejected an F.D.A. proposal to ban flavored e-cigarettes, amidst intense lobbying from the industry.

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President Trump’s director of the F.D.A., Dr. Scott Gottleib, who had previously served on the board of a chain of vaping lounges, granted a four-year extension to e-cigarette companies before they had to prove that the public benefits of their products outweigh their risks, creating an opportunity for companies like Juul to flourish. Dr. Frieden described this extension as “public health malpractice,” as the addictive potential of nicotine and e-cigarettes’ appeal to young people was by then already well-known. Unlike most public health experts, Dr. Gottleib saw e-cigarettes as having potential to become valuable smoking cessation tools, rather than as a gateway to nicotine addiction and other tobacco products. And when it comes to vaping T.H.C., the active ingredient in marijuana, the F.D.A. is virtually silent, as the drug is still illegal at a federal level, and the rise in popularity of this method for getting high has been rapid.

In the aftermath of the spate of vaping-related illnesses, the F.D.A. has finally announced an intention to ban flavored e-cigarettes, but faces an uphill battle in doing so, as the industry vehemently opposes this sort of regulation. However, a federal judge recently overturned Dr. Gottleib’s four-year extension, meaning e-cigarette companies will have to demonstrate the public benefit of their products sooner than they previously thought. Though e-cigarette companies claim their products offer a less harmful alternative to cigarettes, the continuing rise of e-cigarette use among teenagers threatens to undermine this argument, as regulators are likely to believe the risk of developing deadly lung illnesses outweighs the benefits of the technology as a smoking-cessation tool. But for now, e-cigarettes remain on the market, in most states largely unregulated, even as they continue to pose a serious risk to health and life, which is sure to get worse as time goes on unless action is taken.

Girl Vaping

Health Scares Spell Trouble for Vaping Industry

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Recently, a string of vaping-related hospitalizations made headlines and led to growing concerns about the safety of e-cigarettes marketed as healthier alternatives to cigarettes and other tobacco products. In the aftermath of this news, a number of states have moved to ban flavored vaping products, and the federal government even contemplated the idea of banning all flavors of vapor except tobacco nationwide. This sudden spike in concern has led to problems for the vaping industry, as blame is being placed squarely on the manufacturers of nicotine-containing products for the public health epidemic, and as the growing popularity of vaping among teenagers and young people threatens to undo the work of several decades of public campaigns aimed at curbing nicotine addiction.

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Juul, a brand which has become synonymous with vaping as it controls roughly 70% of the e-cigarette market, recently saw a change of leadership as it replaced its CEO with a former tobacco executive. A sudden change in leadership is never a good sign for a company, particularly one as large as Juul, and this news comes amidst other troubling developments for the company. Recently, the F.D.A. claimed that Juul broke the law by implying that e-cigarettes were safer than traditional cigarettes despite the lack of scientific evidence concerning the long-term health effects of using the products. Even more disconcertingly, the F.D.A found that Juul was marketing their products to teenagers in high schools as part of a campaign ostensibly targeted at reducing tobacco use by young people. Juul has said that it intends on fully cooperating with the F.D.A.’s regulations, and has announced it will not fight a proposed ban on flavored nicotine cartridges. Next year, e-cigarettes are scheduled to be banned in San Francisco, and Juul is considering whether or not they should abandon a ballot initiative to overturn the ban.

In order to stay on the market in the United States, Juul and other similar companies have to be able to prove that their products promote public health more than they harm it, which is growing increasingly difficult as the news reports of vaping-related hospitalizations and an epidemic of nicotine addiction in young people. While initially envisioned as a tool to help people quit smoking, vaping has instead become a fashionable trend, and many who are addicted to nicotine have no history of smoking cigarettes. The rise in popularity of e-cigarettes has been explosive, and while F.D.A. regulations concerning the sale of nicotine products have long been in effect, regulatory bodies have yet to catch up with the specific public health problems that e-cigarettes in particular pose. 

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Health professionals across the country are in virtual consensus in advising against the use of e-cigarettes, except as replacements for cigarettes as smoking cessation devices. Even then, there are nicotine delivery systems, such as chewing gum and patches, that are likely safer than vaping as they do not involve any inhalation of chemicals. The director of the National Institute on Drug Abuse, Dr. Nora Volkow, said that e-cigarettes should be clinically tested to determine whether they are effective as smoking cessation tools, and if they are they should only be available by prescription, which is the same standard to which other potentially dangerous drugs are held.

While recent develops certainly don’t bode well for the e-cigarette industry, it’s difficult to make any concrete predictions about the fate of affected companies. Famously, the tobacco industry spent millions of dollars lobbying against the notion that cigarettes cause cancer and other health problems, and were very successful in doing so for several years. Vaping has become so widespread that its popularity perhaps even eclipses that of the tobacco products that preceded it, and as a result, the industry has a lot of money to spend on resisting regulatory efforts. However, the government has fought Big Tobacco before, pioneering widespread public health campaigns in an attempt to stop tobacco use, and as such has plenty of relevant experience to apply to fighting Juul and similar companies. Meanwhile, a meaningful segment of an entire generation of young people who otherwise would not have been exposed to nicotine are addicted to vaping, and only time will tell how they will be able to get their nicotine fix in the years to come.

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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