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Tobacco use is the largest single cause of preventable disease and premature death in the U.S. and globally. Knowing the health risks is important. But the next step, empowering millions of users to quit, is just as essential.

“People are getting the message about the dangers of smoking, but for some high-risk patients it’s not affecting their behavior,” said Lindsay M. Reynolds, an assistant professor of epidemiology and prevention at Wake Forest School of Medicine in Winston-Salem, North Carolina.

Reynolds was co-author of a study that examined survey responses from adults with a history of heart attack, heart failure, stroke or other heart condition. It found that over 90% of participants reported believing that smoking can cause heart disease. Despite knowing the dangers, more than one in four respondents with cardiovascular disease reported they still used tobacco products.

“It was surprising to see the overwhelming majority of people who know smoking isn’t good for you continue using tobacco despite knowing the risks,” Reynolds said. “I think this shows that educational efforts informing people on the increased risk of heart disease related to smoking have been very successful. Also, it highlights the importance of research efforts on approaches to reduce use and to help people quit.”

Public-health efforts to reduce tobacco use are important because there is no safe level of exposure, according to the World Health Organization. Cigarette smoking is the most common way to use tobacco. But tobacco in all forms – including cigars, pipes and smokeless varieties – contains many dangerous toxins and harms nearly every organ of the body. It’s a major risk factor for cardiovascular disease, heart failure, stroke and cancer. Tobacco use kills more than 8 million people around the world annually.

Even those who simply breathe second-hand smoke are at risk for serious cardiovascular and respiratory diseases. Each year, 1.2 million non-smokers die prematurely because of exposure to second-hand smoke.

“Smokers are not just harming themselves,” Reynolds said. “It’s also the harm they’re causing to others in their household, to their family and the other transgenerational effects that occur from growing up in a smoking environment.”

The far-reaching consequences of tobacco use is a worldwide problem, experts say. Global cardiovascular organizations, including the Â̾ÞÈËÊÓƵ, released a joint opinion this year calling for more action to target the tobacco epidemic. The group suggested multiple strategies to prevent and control tobacco use. These included raising tobacco prices; creating more smoke-free public places; and enforcing bans on sales and advertising. It also advocated for treatment interventions and policy measures to support adult smokers who want to quit.

Getting help for a tobacco addiction

For most people, having a heart attack or stroke are huge milestones that often lead tobacco users to make healthier choices, Reynolds said. However, several barriers can prevent smokers – even those with a history of health problems – from quitting.

The biggest reason users stay hooked is nicotine, the main addictive substance in tobacco products. Nicotine changes how the brain works. When users quit nicotine they may experience withdrawal symptoms like irritability and trouble concentrating.

Another barrier to quitting is lack of support. Counseling and smoking-cessation programs are crucial because tobacco users who have professional help and are given proven medications can more than double their chance of successfully quitting.

Some misinformation, such as the belief that e-cigarettes are safer causes problems, Reynolds said. Many e-cigarettes contain nicotine, which comes from tobacco. This is why the Food and Drug Administration classifies them as “tobacco products.”

The e-cigarette market is rapidly evolving with many new devices despite little research on the long-term health effects. To combat the troubling epidemic of youth e-cigarette use, the FDA has raised the minimum age of sale of tobacco to 21 and has banned the manufacturing of e-cigarettes with flavors that appeal to younger users, Reynolds said.

“We see e-cigarettes as a potential gateway to addiction in youth,” she said. “They think they’re not that harmful, when in fact there may be more subtle health effects that we’re not detecting now.”

So many reasons to quit tobacco

Overwhelmingly, research shows how important it is to quit using tobacco. “There is so much evidence that modifying unhealthy habits and changing behaviors like smoking leads to longer, healthier lives,” Reynolds said.

According to the AHA and the Centers for Disease Control and Prevention, the benefits of quitting smoking include:

• Improving overall health and quality of life.
• Adding as many as 10 years to life expectancy.
• Reducing the risk of premature death.
• Exercising and being physically active with less shortness of breath.
• Improving sense of taste and smell.
• Reversing many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases and cancer.
• Lowering the financial burden on people who smoke, health care systems and society.