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Nicotine is one of the reasons that people smoke. The Office for National Statistics (ONS) figures show that there are about 6.6 million adult cigarette smokers in the United Kingdom; this is the lowest proportion of current smokers since records started in 2011.
In the UK in 2021, those aged 25 to 34 years had the highest proportion of current smokers (15.8%), compared with those aged 65 years and over who had the lowest (8.0%). It was also found that 15.1% of men smoked compared with 11.5% of women; this trend has been consistent since 2011. Also, those who had no qualifications were more likely to be current smokers (28.2%) than those whose highest level of education was a degree or equivalent (6.6%).
Since 2012, the City of Kingston Upon Hull and the town of Blackpool have been in the 10 local authorities with the highest proportion of current smokers eight and nine times, respectively. In 2021, the proportion of current smokers in Kingston Upon Hull and Blackpool was 22.0% and 20.6%, respectively. Oadby and Wigston (3.2%) and West Oxfordshire (3.7%) had the lowest levels of smoking prevalence in England.
In 2021, 4.9% of survey respondents reported that they were currently daily users of an e-cigarette, which is an increase from 3.8% in 2020, although not statistically significant. A further 2.8% reported using an e-cigarette occasionally, which is an increase from 2.6% in 2020, although, again, not statistically significant. Together, this equates to around 4 million vapers in the population of Great Britain.
Also in 2021, the proportion of vapers was highest among current cigarette smokers (25.3%) and ex-cigarette smokers (15.0%). Only 1.5% of people who have never smoked reported that they currently vape.
What is nicotine?
Nicotine belongs to a family of compounds called alkaloids and occurs naturally in several varieties of plant, including tomatoes, aubergines and potatoes, but is found at its highest levels in the tobacco plant. Tobacco is the herb Nicotiana tabacum. The plant makes the toxic substance nicotine as a chemical defence to stop insects eating it.
Nicotine, a powerful insect neurotoxin, is one of many chemicals produced by tobacco that evolved to deter pests. The genus Nicotiana comprises some 70 species, the majority of which are from the Americas. The main species used for tobacco production are Nicotiana tabacum, known only from cultivation, and Nicotiana rustica, native to south-west Ecuador and Bolivia.
Tobacco was brought to Europe from the Americas five centuries ago. It is now considered the world’s single biggest cause of preventable death.
Can nicotine be addictive?
Nicotine is addictive, which is why the sale of any nicotine product should be age restricted. Once it leaves the brain, it can lead to withdrawal symptoms. These withdrawal symptoms, which may include difficulty concentrating, anxiety, and dysphoria (this is commonly understood as distress and/or discomfort with life), can affect many people when they initially quit smoking. Nicotine replacement therapies and other cessation products can help address withdrawal symptoms.
Almost everyone who smokes or uses tobacco can remember how their addiction started and how they never intended to become addicted. Because addiction changes the biochemical make-up of the brain, it becomes harder to quit the earlier a person starts using.
Young people are more susceptible to forming an addiction. This is because addictive substances like nicotine activate the brain’s reward system, which is still developing in the teen years. This part of the brain plays a huge role in the production of memories and addictive behaviour.
But nicotine is not the only factor relating to addiction. Other factors such as ritual, sensory experience, and social experiences all play a significant role. People addicted to tobacco products have a physical desire to continue using tobacco, but they also have a psychological desire because of memories associated with using. These memories trigger the urge to use tobacco.
Triggers can be anything from music to certain people or places. There is also a strong behavioural addiction associated with nicotine addiction. This is why many therapists suggest holding a pen between the fingers after quitting smoking cigarettes.
Most people with an addiction to nicotine are aware of the harm tobacco causes, yet they continue to use the substance. This behaviour is characteristic of addiction. There are several ways of measuring dependence on smoking including the desire to quit amongst those who nevertheless continue to smoke.
Other ways of measuring dependence include how soon the first cigarette of the day is smoked after waking. ONS 2018 data shows 35.4% of current smokers in Great Britain had their first cigarette within the first 30 minutes of waking. 58.4% of current smokers said they wanted to stop smoking, and only 21.8% said that they do not intend to stop.
What is nicotine used for?
Tobacco is consumed in numerous, often ritualistic, manners ranging from smoking cigarettes and cigars through snorting as snuff to chewing, and now also through vaporisation such as via electronic cigarettes and vaping devices.
Nicotine has also been used as a medicine; as a pharmaceutical drug it is used for smoking cessation to relieve withdrawal symptoms.
Tobacco is used as an insecticide. For centuries, gardeners have used home-made mixtures of tobacco and water as a natural pesticide to kill insect pests. As smoking diminishes across the world, scientists are looking for new uses for tobacco. One potential use is as a natural pesticide, due to tobacco’s content of toxic nicotine. A “green” pesticide industry based on tobacco could provide additional income for tobacco farmers, and as well as a new eco-friendly pest-control agent, the scientists say.
How is nicotine abused?
Nicotine can be absorbed into the body through the lungs, mouth or skin. The way nicotine is absorbed determines the speed and intensity of its delivery. When tobacco smoke is inhaled via cigarettes or cigars, nicotine is absorbed through the lungs into the bloodstream and reaches the brain in 10 to 20 seconds.
When absorbed through the skin via a patch, or through the mouth and stomach when chewing nicotine gum, nicotine is absorbed more slowly and therefore takes longer to reach the brain.
Cigarettes are made of fermented, processed and dried tobacco leaves and stems, with some additives. Smoking them allows the nicotine to be absorbed into the blood through the lungs. Blood carrying nicotine reaches the brain within seconds, producing the mental effects smokers are after and satisfying nicotine craving in addicts.
Unfortunately, as tobacco leaves burn, hundreds of harmful chemicals are created or released which are also drawn into the lungs. Half of the people who do not quit will die of a smoking-related disease. Smoke also drifts around, harming other people.
Cigars and pipes are alternative traditional ways of smoking. Some smokers of these do not inhale the smoke deeply into the lungs, but only draw it into the mouth. This causes less damage than cigarette smoking, although such smokers are still harmed by smoking. If users do inhale fully, the harm is likely to be similar to the harm of a similar amount of cigarette smoking.
A hookah, shisha or hubble-bubble is a sort of tobacco pipe where smoke is drawn through a bottle of water. The tobacco is flavoured and sweetened. Water pipe smoking is a cultural activity and commonly occurs in groups where the water pipe may be shared, such as at social or family gatherings.
People who smoke hookah regularly also have an increased chance of smoking-related diseases such as lung cancer. National data indicate that water pipe smoking in the British general population is very low, at around 1%. Young adults are more likely to have tried water pipe smoking than older adults, but current use remains low, at around 2% in 18- to 24-year-olds.
Water pipe use is higher in black and minority ethnic groups; the prevalence of current use is close to 7% in Asian/Asian British populations. In young people, water pipe use increases with age but is low in all age groups.
Smoke-free tobacco and other nicotine-containing products.
Electronic or e-cigarettes – These deliver a puff of vaporised liquid containing nicotine, which simulates smoking without burning. They have not been researched thoroughly, but it is very likely that they are much less harmful than actual cigarettes because they do not produce the range of damaging chemicals found in tobacco smoke, although they are not entirely harmless. It is still a matter of scientific and political controversy whether e-cigarettes and other alternatives to cigarettes can offer benefits to the health of society.
Chewing or dipping tobacco, snuff and snus – These are products which release their nicotine into the mouth or nose. Snus is illegal to sell in most of Europe. The nicotine fix is achieved with less of the cancer-causing chemicals produced by burning and without the damage smoke causes to the lungs. Chewing smokeless tobacco, such as Paan or Gutkha, is popular with many people from south Asian communities. Snuff is a powdered tobacco product which is inhaled up the nose, often making you sneeze. Whilst it increases the cancer risk for the places it contacts – the nose, mouth and throat – the overall level of risk of harm and death is also lower than with smoking cigarettes.
How does nicotine affect the body?
First-time users of nicotine often experience dizziness and/or nausea. After becoming accustomed to using nicotine, effects have been reported to range from helping adults to relax to acting as a stimulant. Other reported effects include improvements in mood and concentration. Nicotine can also temporarily increase a person’s heart rate and blood pressure.
Because of its position in our culture, tobacco and the nicotine it contains is often not considered a mind-altering drug. In fact, nicotine affects the brain in several different ways and changes it over the long term. Nicotine acts to increase the production of other chemicals in the brain known as neurotransmitters that affect brain function. Nicotine also produces long-term effects on the dopamine system, which is involved in reward, mood and addiction.
Nicotine can cause acute increases in heart rate and blood pressure. Nicotine products are not suitable for people with heart conditions, severe hypertension or diabetes. Nicotine use has been linked with adverse outcomes in pregnancy, so women should consult with their doctor before using any nicotine product during pregnancy.
What are the risks of nicotine?
Nicotine is highly toxic when ingested or absorbed in high doses, beyond those typically found in regulated smoking or vaping products. Rapid absorption of a large dose through skin contact or oral ingestion can cause severe reactions requiring medical attention and poses risk of fatality in children, animals or highly vulnerable persons.
Although nicotine is toxic, it is not poisonous at the levels normally consumed through the use of tobacco and vapour products. The exception is children. Babies and toddlers have been poisoned by chewing cigarettes and swallowing nicotine products.
Experimenting with taking multiple nicotine lozenges or similar things could be harmful or fatal and anyone suspected of having somehow consumed a nicotine overdose needs very prompt medical attention. The nicotine in e-liquids for vapour products is low dosage, but should only be used as intended. E-liquids should be kept out of the reach of children.
With some drugs you risk harm each time you use them, but with tobacco there is little risk immediately apart from the chance of an unpleasant coughing fit. However, there are enormous risks long term for addiction and to health. At least half of smokers will die due to smoking.
Their life expectancy is reduced by at least 10 years compared to those who have never smoked. Smoking only 1 to 4 cigarettes a day is enough to increase the risk of dying prematurely.
Data from the Global Burden Study of Disease 2019, reports the risk factors responsible for deaths in the United Kingdom:
- Smoking – 119,776.
- High body mass index – 56,215.
- Alcohol use – 25,242.
- Low physical activity – 14,335.
- Drug use – 5,015.
Because nicotine use is so prevalent, many smokers also abuse other drugs alongside it. Alcohol is the most common drug used alongside nicotine, and can also be an obstacle to overcoming nicotine use. Those who are used to smoking a cigarette when they are drinking will have a mental connection between the two. Quitting smoking can be much more difficult when continuing to drink.
Nicotine is also often abused with other stimulants, such as cannabis or cocaine. Using both together can amplify their effects. Nicotine may also be a gateway into illicit stimulants. In the UK particularly, cannabis is often smoked with tobacco, even when the user does not otherwise smoke cigarettes. This is likely to cause preventable cravings for and addiction to either drug, especially the tobacco.
Short-term and long-term effects of nicotine
The short-term effects of nicotine can include:
- Bad breath.
- Bad odours on clothes, hair, furnishings etc when smoked.
- Fatigue and a decrease in energy.
- Reduction in the senses of taste and smell.
- Shortness of breath.
There are no other legal products which are as harmful as cigarettes when used as they are designed to be used. Smoking causes gradual damage to your body as well as increasing the risk of various diseases. It also harms other people who breathe the smoke.
The long-term effects of nicotine can include:
- Reduces physical fitness, making you get out of breath easily.
- Damages the lungs’ ability to self-clean so you may cough heavily, especially in the morning.
- A major cause of male sexual dysfunction.
- Female fertility 30% lower.
- Menopause onset 1.74 years earlier on average.
- Yellowing of teeth, gingivitis, periodontitis (gum disease), tooth loss.
- Ageing of hair and skin, e.g. psoriasis, skin wrinkling.
- Mouth cancer.
- Oesophageal (food pipe) cancer.
- Lung disease.
- Cardiovascular disease.
- Harmful effects on blood vessels.
- Diminishes bone density causing osteoporosis (in both sexes), ligament, tendon and muscle injuries, neck and back pain.
- Rheumatoid arthritis.
- Increases the chance of miscarriage and significantly lowers birth weights.
- Lingering smell of tobacco smoke on clothes, hair, skin and in homes.
- May be impossible to foster or adopt children.
- Nicotine withdrawal can be very unpleasant – Feeling fidgety and stressed, craving nicotine, and rise in heart rate.
- Rates of relapse after quitting are extremely high.
According to the NHS, smoking is the primary cause of preventable illness and premature death, accounting for approximately 74,600 deaths a year in England. Smoking harms nearly every organ of the body and dramatically reduces both quality of life and life expectancy. Smoking causes lung cancer, respiratory disease and heart disease as well as numerous cancers in other organs including the lip, mouth, throat, bladder, kidney, stomach, liver and cervix.
Most smoking-related deaths arise from one of three types of disease: lung cancer, chronic obstructive pulmonary disease (COPD which incorporates emphysema and chronic bronchitis) and coronary heart disease (CHD). In 2019, 15% (74,600) of all deaths of adults aged 35 and over in England were estimated to be attributable to smoking.
Of these, smoking caused:
- 35,500 (52%) of all cancer deaths.
- 23,700 (35%) of all respiratory deaths.
- 14,700 (13%) of all circulatory disease deaths (Source NHS Digital).
Non-smokers can also be exposed to the chemical substances such as nicotine in smoke when in the presence of smokers. This is known as “exposure to second-hand smoke”. Second-hand smoke can affect the health and well-being of people who are exposed to it, whether they smoke or not.
These people are at higher risk of developing health issues such as:
- Heart problems.
- Respiratory or lung problems, such as asthma or excessive coughing.
- Lung cancer.
Second-hand smoke can be one of the most dangerous environmental contaminants. All exposure to second-hand smoke is dangerous, even inhaling a small amount of second-hand smoke can be harmful to health. Being in close proximity to family members and others who smoke and exposure to second-hand smoke are major causes of health problems in foetuses, babies and children.
Babies and young children are particularly sensitive to second-hand smoke because their lungs are not yet completely developed. Children breathe faster than adults, so they are also more exposed to the chemical substances contained in second-hand smoke.
Babies and children exposed to second-hand smoke are more at risk of suffering from:
- Lung problems.
The risk of sudden infant death syndrome increases if babies are exposed to second-hand smoke during pregnancy.
What are the different forms of nicotine?
The most common and traditional form in which nicotine comes is cigarettes and cigars; this is known as standard nicotine. It is also in chewing tobacco and in hookah where tobacco and water get heated by coals which turns the smoke from the tobacco into water vapour, which is then consumed through a water pipe.
Synthetic nicotine – synthetically produced nicotine is known as “non-tobacco” nicotine. It is artificial nicotine that is used in vaping cartridges as well as nicotine gum and nicotine patches. Synthetic nicotine is also found in dissolvable products, which are sold in the form of sticks, lozenges, strips or nicotine gum.
Nicotine salt is new to the market and it allows vaping at higher nicotine levels. A major benefit of salt nicotine is its stability. This makes it better for consumption than synthetic and standard forms of tobacco. Because of that increased stability, salt nicotine has a higher melting point, which makes it more difficult for the vaporised ions to reach the receptors in the body.
Whilst nicotine is addictive, it is possible to quit. Each year, millions of smokers succeed in quitting cigarettes and nicotine use altogether. Nicotine replacement therapies and other cessation products can help address withdrawal symptoms.
Local NHS stop smoking services are free, friendly and can massively boost your chances of quitting for good. Call the free Smoke Free National Helpline on 0300 123 1044. They can also help with quitting nicotine that you do not smoke with such as chewing tobacco and hookah.
When people stop using nicotine, NHS studies show the mental health benefits include:
- Anxiety, depression and stress levels are lower.
- Quality of life and positive mood improve.
- The dosage of some medicines used to treat mental health problems can be reduced.