Harms of tobacco smoking and nicotine dependence and benefits of intervention

Tobacco smoking, driven by nicotine dependence, is the leading preventable cause of death in Australia, associated with almost 20 500 deaths per yearGreenhalgh and Winnall, 2021. It is a major risk factor for stroke, coronary heart disease, peripheral vascular disease, chronic obstructive pulmonary disease, cancer, and many other illnesses in people who smoke and those exposed to others’ smokingAustralian Institute of Health and Welfare (AIHW). The risks of most harms from tobacco smoking correlate with cumulative exposurePleasants, 2020. Other forms of tobacco use (chewing, use of tobacco plugs and inhaling ‘heat-not-burn’ tobacco) are also harmful and are managed in the same way as tobacco smoking. Although nicotine vaping products cause harms, they are often used as second-line therapy when other measures are not successful or suitable in the management of nicotine dependence.

The prevalence of daily smoking in Australia has declined from 24% in 1991 to 11% in 2019Australian Institute of Health and Welfare (AIHW), largely because of public health measures, such as plain packaging and price increases. However, the prevalence of daily tobacco smoking remains much greater in some groups, including people:

Considerations for some specific populations in the management of tobacco smoking are discussed in Overview of substance use and addictive behaviours. Advice specific to management of tobacco smoking during pregnancy and management of tobacco smoking during breastfeeding is included in this topic.

Like other forms of substance dependence, nicotine dependence is a chronic relapsing illness; more than half of all people who smoke try to change their smoking behaviour every year. Without treatment, most individuals will not be able to make long-term changes; however, with treatment, even highly nicotine-dependent people can change their smoking behaviourGreenhalgh, 2020. Making changes has short- and long-term benefits to mental, physical and financial health, as outlined in Health benefits associated with stopping smoking. Managing tobacco smoking and nicotine dependence is important in people with other disorders of substance use, especially the use of cannabis, alcohol and stimulants.
Table 1. Health benefits associated with stopping smoking

Printable table

Time since stopping smoking

Health benefits

within 1 day
  • level of carbon monoxide in the blood will drop and more oxygen will reach the heart and muscles

within 1 week
  • the lung’s natural cleaning system will start to recover and become better at removing mucus, tar and dust from the lungs
  • there will be higher blood levels of protective antioxidants (eg vitamin C)

within 1 month
  • the body will be better at healing cuts and wounds

within 2 months
  • there will be less coughing and wheezing
  • the immune system will have started to recover
  • blood will be less thick and sticky and blood flow to the hands and feet will improve

within 6 months
  • lungs will no longer produce the extra phlegm caused by smoking

after 1 year
  • lungs will be healthier and breathing will be easier, making it easier to exercise

within 2 to 5 years
  • there will be a large drop in risk of heart attack and stroke; this risk will continue to gradually decrease

within 5 years
  • risk of cervical cancer will return to that of a person who has never smoked

after 10 years
  • risk of lung cancer will be markedly lower than that of a person who continues to smoke; this risk will continue to decline (provided the disease is not already present)

after 15 years
  • risk of heart attack and stroke will be close to that of a person who has never smoked