Air pollution is a mixture of natural and man-made substances in the air we breathe. It is typically separated into two categories: outdoor air pollution and indoor air pollution.
Outdoor Air Pollution
It involves exposures that take place outside of the built environment. Examples include:
- Fine particles produced by the burning of fossil fuels (i.e. the coal and petroleum used in energy production)
- Noxious gases (sulfur dioxide, nitrogen oxides, carbon monoxide, chemical vapors, etc.)
- Ground-level ozone (a reactive form of oxygen and a primary component of urban smog)
- Tobacco Smoke
Indoor Air Pollution
It involves exposures to particulates, carbon oxides, and other pollutants carried by indoor air or dust. Examples include:
- Gases (carbon monoxide, radon, etc.)
- Household products and chemicals
- Building materials (asbestos, formaldehyde, lead, etc.)
- Outdoor indoor allergens (cockroach and mouse dropping, etc.)
- Tobacco smoke
- Mold and pollen
In some instances, outdoor air pollution can make its way indoors by way of open windows, doors, ventilation, etc.
What health effects are linked to air pollution?
Over the past 30 years, researchers have unearthed a wide array of health effects which are believed to be associated with air pollution exposure. Among them are respiratory diseases (including asthma and changes in lung function), cardiovascular diseases, adverse pregnancy outcomes (such as preterm birth), and even death.
In 2013, the World Health Organization concluded that outdoor air pollution is carcinogen to humans.
How can I reduce my risk for air pollution exposure?
Indoor air pollution can be reduced by making sure that a building is well-ventilated and cleaned regularly to prevent the buildup of agents like dust and mold. Occupants would also be wise to remove any known pollutants and or irritants (aerosols, stringent cleaning supplies, etc.) whenever possible.
Outdoor air pollution exposures can be reduced by checking one's Air Quality Index (AQI), avoiding heavy traffic when possible, and avoiding secondhand tobacco smoke.
How is air pollution linked to climate change?
While climate change is a global process, it has very local impacts that can profoundly affect communities, not the least of which is air pollution.
Increasing temperatures are directly linked to poor air quality which, in turn, can affect the heart and exacerbate cardiovascular disease. Examples of this may include a rise in pollen, due to increased plant growth, or a rise in molds, due to severe storms — both of which can worsen allergies and other lung diseases, such as asthma.
Scientists say an increasing rise in ozone levels are also a concern.
Ozone is a highly reactive form of oxygen. In the upper atmosphere, ozone forms a protective layer that shields us from the sun's ultraviolet rays. At ground level, ozone is a harmful air pollutant and a primary constituent of urban smog. Ozone is produced when air pollutants from automobile emissions and manufacturing operations interact with sunlight.
Long-term exposure to high concentrations of ozone can cause a significant reduction in lung function, inflammation of the airways, and respiratory distress. People with lung diseases are particularly vulnerable to the respiratory effects of ozone.
How can ozone affect my health?
If you have asthma, bronchitis, or emphysema, ozone can make your symptoms worse. Carefully follow your asthma management plan on days when ozone levels are high.
Ozone has also been linked to:
- Coughing and pain when taking a deep breath
- Lung and throat irritation
- Wheezing and trouble breathing during exercise or outdoor activities
Who is most at risk?
Ozone can affect anyone, but it bothers some people more than others. People most likely to experience health effects caused by ozone include:
- People with asthma or other lung diseases
- Older adults
- People of all ages who exercise or work hard outside
- Babies and children
Protect Yourself and Your Family
The good news is there's a lot you can do to protect yourself and your family from the health effects caused by ground-level ozone.
Air Quality Index (AQI)
(AQI) tells you when air pollution is likely to reach levels that could be harmful. You can use the AQI as a tool to help you avoid particle pollution. Local TV stations, radio programs, and newspapers report the AQI. Try checking it when you're planning your daily activities.
When ground-level ozone levels are high, take steps to limit the amount of air you breathe in while you're outside. For example:
- Think about spending more time indoors, where ozone levels are usually lower.
- Choose easier outdoor activities (like walking instead of running) so you don't breathe as hard.
- Plan outdoor activities at times when ozone levels are lower (usually in the morning and evening).
Smoking and Vaping
The link between cigarette smoke and disease, particularly lung cancer and cardiovascular disease, is well known. Cigarette smoke contains hundreds of chemicals, including formaldehyde, lead, tar, and nicotine. Many of these chemicals act as irritants and worsen symptoms in people with asthma and allergies.
Common symptoms of smoke irritation include burning or watery eyes, nasal congestion, coughing, hoarseness, shortness of breath, and wheezing. Both cigarette smoking and secondhand smoke are associated with chronic hay fever and sinus infections, although the underlying reason is not completely understood. Also, studies have found that smoking decreases the effectiveness of inhalers used to treat asthma.
Children can be especially vulnerable to environmental irritants, such as cigarette smoke.
Cigarette smoke may also promote autoimmune diseases, which are caused by the body's immune system attacking healthy cells. Studies have shown cigarette smoke to be a risk factor in the development of rheumatoid arthritis, an autoimmune disease that affects joints.
E-Cigarettes and Vaping
An electronic cigarette, or e-cigarette, is a handheld electronic device that simulates the feeling of traditional tobacco smoking. Devices can resemble traditional cigarettes, cigars, or pipes, or items like pens or USB sticks. They work by heating a liquid, which typically contains nicotine, to generate an aerosol or vapor that users inhale. Vaping is the commonly used term for the use of e-cigarettes.
Vaping has gained popularity worldwide, particularly among teens and young adults, due to easy availability, targeted marketing, and creative e-liquid flavors. While e-cigarettes are often thought to be safer than tobacco cigarettes, little is known regarding the health effects of their use. Scientists are conducting the E-Cigs and Smoking Study, to develop new biomarkers, or measurable indicators of a normal or abnormal process or condition or disease, of tobacco smoke exposure or e-cigarette use.
Chemicals in Cigarette Smoke
A study revealed that acrolein, a substance that is abundant in cigarette smoke, irritates airways by creating free radicals, unstable molecules that can damage cells.
Menthol and Smoking
Research found that menthol suppresses respiratory irritation in mice, suggesting that its addition to cigarettes may facilitate smoke inhalation and promote nicotine addiction and smoking-related illness in humans.
Your Genes and Smoking
A study found that smoking can influence which genes are turned on or off. The new findings may provide researchers with potential targets for new therapies.
E-cigarettes and Transition to Traditional Smoking
The researchers found that use of e-cigarettes with higher nicotine concentrations by youth may increase the subsequent frequency and intensity of traditional cigarette smoking and vaping.
Smoking leads to disease and disability and harms nearly every organ of the body. For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis.
Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.
Health Effects of Cigarette Smoking
Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general.
Quitting smoking lowers your risk for smoking-related diseases and can add years to your life.
Smoking and Death
- Human immunodeficiency virus (HIV)
- Illegal drug use
- Alcohol use
- Motor vehicle injuries
- Firearm-related incidents
- Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths. More women die from lung cancer each year than from breast cancer.
- Smoking causes about 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD).
- Cigarette smoking increases the risk for death from all causes in men and women.
- The risk of dying from cigarette smoking has increased over the last 50 years in the U.S.
Smoking and Increased Health Risks
Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer.
- Estimates show smoking increases the risk:
- For coronary heart disease by 2 to 4 times
- For stroke by 2 to 4 times
- Of men developing lung cancer by 25 times
- Of women developing lung cancer by 25.7 times
- Smoking causes diminished overall health.
Smoking and Respiratory Disease
Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs.
- Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis.
- Cigarette smoking causes most cases of lung cancer.
- If you have asthma, tobacco smoke can trigger an attack or make an attack worse.
- Smokers are 12 to 13 times more likely to die from COPD than nonsmokers.
Smoking and Cancer
Smoking can cause cancer almost anywhere in your body:
- Blood (acute myeloid leukemia)
- Colon and rectum (colorectal)
- Kidney and ureter
- Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)
- Trachea, bronchus, and lung
Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors.
Smoking and Other Health Risks
Smoking harms nearly every organ of the body and affects a person's overall health.
- Smoking can make it harder for a woman to become pregnant. It can also affect her baby's health before and after birth. Smoking increases risks for:
- Preterm (early) delivery
- Stillbirth (death of the baby before birth)
- Low birth weight
- Sudden infant death syndrome (known as SIDS or crib death)
- Ectopic pregnancy
- Orofacial clefts in infants
- Smoking can also affect men's sperm, which can reduce fertility and also increase risks for birth defects and miscarriage.
- Smoking can affect bone health.
- Women past childbearing years who smoke have weaker bones than women who never smoked. They are also at greater risk for broken bones.
- Smoking affects the health of your teeth and gums and can cause tooth loss.
- Smoking can increase your risk for cataracts (clouding of the eye’s lens that makes it hard for you to see). It can also cause age-related macular degeneration (AMD). AMD is damage to a small spot near the center of the retina, the part of the eye needed for central vision.
- Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers.
- Smoking causes general adverse effects on the body, including inflammation and decreased immune function.
- Smoking is a cause of rheumatoid arthritis.
Quitting and Reduced Risks
- Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.
- Within 2 to 5 years after quitting smoking, your risk for stroke may reduce to about that of a nonsmoker's.
- If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.
- Ten years after you quit smoking, your risk for lung cancer drops by half.
Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year. Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.
Health Effects of Secondhand Smoke
Secondhand smoke is the combination of smoke from the burning end of a cigarette and the smoke breathed out by smokers. Secondhand smoke contains more than 7,000 chemicals. Hundreds are toxic and about 70 can cause cancer.
According to a report, 2.5 million adults who were nonsmokers died because they breathed secondhand smoke.
There is no risk-free level of exposure to secondhand smoke.
- Secondhand smoke causes numerous health problems in infants and children, including more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome (SIDS).
- Smoking during pregnancy results in more than 1,000 infant deaths annually.
- Some of the health conditions caused by secondhand smoke in adults include coronary heart disease, stroke, and lung cancer.
Secondhand Smoke Causes Cardiovascular Disease
Exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and can cause coronary heart disease and stroke.
- Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25–30%.
- Secondhand smoke increases the risk for stroke by 20−30%.
- Secondhand smoke exposure causes more than 8,000 deaths from stroke annually.
Breathing secondhand smoke can have immediate adverse effects on your blood and blood vessels, increasing the risk of having a heart attack.
- Breathing secondhand smoke interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of having a heart attack.
- Even brief exposure to secondhand smoke can damage the lining of blood vessels and cause your blood platelets to become stickier. These changes can cause a deadly heart attack.
People who already have heart disease are at especially high risk of suffering adverse effects from breathing secondhand smoke and should take special precautions to avoid even brief exposures.
Secondhand Smoke Causes Lung Cancer
Secondhand smoke causes lung cancer in adults who have never smoked.
- Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing lung cancer by 20–30%.
- Nonsmokers who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers.
- Even brief secondhand smoke exposure can damage cells in ways that set the cancer process in motion.
- As with active smoking, the longer the duration and the higher the level of exposure to secondhand smoke, the greater the risk of developing lung cancer.
Secondhand Smoke Causes SIDS
Sudden Infant Death Syndrome (SIDS) is the sudden, unexplained, unexpected death of an infant in the first year of life. SIDS is the leading cause of death in otherwise healthy infants.6 Secondhand smoke increases the risk for SIDS.
- Smoking by women during pregnancy increases the risk for SIDS.
- Infants who are exposed to secondhand smoke after birth are also at greater risk for SIDS.
- Chemicals in secondhand smoke appear to affect the brain in ways that interfere with its regulation of infants' breathing.
- Infants who die from SIDS have higher concentrations of nicotine in their lungs and higher levels of cotinine (a biological marker for secondhand smoke exposure) than infants who die from other causes.
Parents can help protect their babies from SIDS by taking the following three actions:
- Do not smoke when pregnant.
- Do not smoke in the home or around the baby.
- Put the baby down to sleep on its back.
Secondhand Smoke Harms Children
Secondhand smoke can cause serious health problems in children.
- Studies show that older children whose parents smoke get sick more often. Their lungs grow less than children who do not breathe secondhand smoke, and they get more bronchitis and pneumonia.
- Wheezing and coughing are more common in children who breathe secondhand smoke.
- Secondhand smoke can trigger an asthma attack in a child. Children with asthma who are around secondhand smoke have more severe and frequent asthma attacks. A severe asthma attack can put a child's life in danger.
- Children whose parents smoke around them get more ear infections. They also have fluid in their ears more often and have more operations to put in ear tubes for drainage.
Parents can help protect their children from secondhand smoke by taking the following actions:
- Do not allow anyone to smoke anywhere in or near your home.
- Do not allow anyone to smoke in your car, even with the window down.
- Make sure your children's day care centers and schools are tobacco-free.
- If your state still allows smoking in public areas, look for restaurants and other places that do not allow smoking. "No-smoking sections" do not protect you and your family from secondhand smoke.
Factors Associated With Youth Tobacco Use
Factors associated with youth tobacco use include the following:
- Social and physical environments
- The way mass media show tobacco use as a normal activity can promote smoking among young people.
- Youth are more likely to use tobacco if they see that tobacco use is acceptable or normal among their peers.
- Parental smoking may promote smoking among young people.
- Biological and genetic factors
- There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.
- Genetic factors may make quitting smoking more difficult for young people.
- A mother's smoking during pregnancy may increase the likelihood that her offspring will become regular smokers.
- Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress.
- Personal perceptions: Expectations of positive outcomes from smoking, such as coping with stress and controlling weight, are related to youth tobacco use.
- Other influences that affect youth tobacco use include:
- Lower socioeconomic status, including lower income or education
- Lack of skills to resist influences to tobacco use
- Lack of support or involvement from parents
- Accessibility, availability, and price of tobacco products
- Low levels of academic achievement
- Low self-image or self-esteem
- Exposure to tobacco advertising
Reducing Youth Tobacco Use
National, state, and local program activities have been shown to reduce and prevent youth tobacco use when implemented together. They include the following:
- Higher costs for tobacco products (for example, through increased taxes)
- Prohibiting smoking in indoor areas of worksites and public places
- Raising the minimum age of sale for tobacco products to 21 years, which has recently emerged as a potential strategy for reducing youth tobacco use
- TV and radio commercials, posters, and other media messages targeted toward youth to counter tobacco product advertisements
- Community programs and school and college policies and interventions that encourage tobacco-free environments and lifestyles
- Community programs that reduce tobacco advertising, promotions, and availability of tobacco products
Some social and environmental factors have been found to be related to lower smoking levels among youth. Among these are:
- Religious participation
- Racial/ethnic pride and strong racial identity
- Higher academic achievement and aspirations
Continued efforts are needed to prevent and reduce the use of all forms of tobacco use among youth.
A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco.
Cigars differ from cigarettes in that cigarettes are a roll of tobacco wrapped in paper or in a substance that does not contain tobacco.
The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.
The use of flavorings in some cigar brands and the fact that they are commonly sold as a single stick has raised concerns that these products may be especially appealing to youth.
Little cigars are the same size and shape as cigarettes, often include a filter, and are packaged in a similar way, but they are taxed differently than cigarettes. Rather than reduce consumption, cost-conscious smokers might switch from cigarettes to less costly little cigars.
Historically, cigar smoking in the United States has been a behavior of older men, but the industry's increased marketing of these products to targeted groups in the 1990s increased the prevalence of use among adolescents.
Cigar use is higher among youth who use other tobacco products or other drugs (e.g., alcohol, marijuana, and inhalants) than among youth who do not use these products.
Cigars contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative to cigarettes.
Description and Market Share of Cigar Types
- Regular cigar smoking is associated with an increased risk for cancers of the lung, esophagus, larynx (voice box), and oral cavity (lip, tongue, mouth, throat).
- Cigar smoking is linked to gum disease and tooth loss.
- Heavy cigar smokers and those who inhale deeply may be at increased risk for developing coronary heart disease.
- Heavy cigar smoking increases the risk for lung diseases, such as emphysema and chronic bronchitis.
Bidis and Kreteks
Bidi is a small and thin cigarette made mainly in India and other Southeast Asian countries. They comprise tobacco wrapped in a tendu or temburni leaf (plants native to Asia) and may be secured with a colorful string at one or both ends. Bidis can be flavored (e.g., chocolate, cherry, mango) or unflavored.
Kreteks—sometimes referred to as clove cigarettes—are imported from Indonesia and typically contain a mixture of tobacco, cloves, and other additives.
Neither bidis nor kreteks are safe alternatives to conventional cigarettes.
In a study that bidi smoking is associated with cancer and other adverse health conditions.
- Bidis are a combustible tobacco product. Smoke from a bidi contains three to five times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction.
- Bidi smoking increases the risk for oral cancer, lung cancer, stomach cancer, and esophageal cancer.
- Bidi smoking is associated with a more than threefold increased risk for coronary heart disease and acute myocardial infarction (heart attack).
- Bidi smoking is associated with emphysema10 and a nearly fourfold increased risk for chronic bronchitis.
Research studies from Indonesia indicate that kretek smoking is associated with lung problems.
- Kretek smoking is associated with an increased risk for acute lung injury (i.e., lung damage that can include a range of characteristics, such as decreased oxygen, fluid in the lungs, leakage from capillaries, and inflammation), especially among susceptible individuals with asthma or respiratory infections.
- Regular kretek smokers have 13 to 20 times the risk for abnormal lung function (e.g., airflow obstruction or reduced oxygen absorption) compared with nonsmokers.
"Low-yield cigarettes" are those that tobacco manufacturers label "light," "low," or "mild."
Tobacco advertisements once implied that "low-yield" cigarettes were safer than regular or "full-flavor" cigarettes. However, low-yield cigarettes are not less harmful to health than regular cigarettes.
There is no risk-free level of exposure to tobacco smoke, and there is no safe tobacco product.
Cigarette Descriptors and Design
In the past, the tobacco industry categorized low-yield cigarettes using measurements of tar on standardized smoking machines.
- Cigarette brands that yielded approximately 1–6 milligrams (mg) of tar were called "ultra light."
- Those with approximately 6–15 mg of tar were called "light."
- Brands yielding more than 15 mg of tar were called "regular" or "full flavor."
The following cigarette design changes made over the past decades affected the tar and nicotine measurements:
- Addition of different size and density filters
- Ventilation holes in the cigarettes to bring in air and dilute the smoke measured
- Chemical additives in the paper and/or tobacco
- Tobacco (i.e., using different types, blends, and curing methods)
Changes in cigarette design have not made cigarettes safe.
- Changes in cigarette design have not been scientifically shown to lead to a decrease in diseases caused by smoking cigarettes.
Most smokers are addicted to nicotine. Smokers may compensate when smoking low-yield cigarettes in order to take in more nicotine.
- Many smokers block the ventilation holes, thus inhaling more tar and nicotine than measured by machines.
- Many smokers inhale longer, harder, and more frequently when smoking low-yield cigarettes to get more nicotine.
- Smokers may get as much or more tar and nicotine from cigarettes with low-yield ratings as from regular cigarettes because of the ways they compensate when smoking them.
Smokers Who Use Low-Yield Cigarettes
- Many smokers consider smoking low-yield cigarettes, menthol cigarettes, or additive-free cigarettes to be safer than smoking regular cigarettes. However, no strong scientific evidence exists to support these beliefs.
- Many smokers may have switched to low-yield brands instead of quitting.
- Tar and nicotine levels decreased from 1954 to 1993.
- Tar decreased from 38 mg in 1954 to 12 mg in 1993; nicotine decreased from 2.7 mg to 0.95 mg.
- Tar and nicotine levels have remained stable since 1993.
Health Risks of Smoking
- Changes in cigarette designs over the last five decades have not reduced overall disease risk among smokers. In fact, they might have hindered prevention and cessation efforts.
- Overall health of the public could be harmed if low-yield cigarette products
- encourage tobacco use among people who would otherwise be unlikely to use a tobacco product.
Smokeless Tobacco: Health Effects
Smokeless tobacco is associated with many health problems. Using smokeless tobacco:
- Can lead to nicotine addiction
- Causes cancer of the mouth, esophagus (the passage that connects the throat to the stomach), and pancreas (a gland that helps with digestion and maintaining proper blood sugar levels)
- Is associated with diseases of the mouth
- Can increase risks for early delivery and stillbirth when used during pregnancy
- Can cause nicotine poisoning in children
- May increase the risk for death from heart disease and stroke
Using smokeless products can cause serious health problems. Protect your health; don't start. If you do use them, quit.
Addiction to Smokeless Tobacco
- Smokeless tobacco contains nicotine, which is highly addictive.
- Because young people who use smokeless tobacco can become addicted to nicotine, they may be more likely to also become cigarette smokers.
Smokeless Tobacco and Cancer
- Many smokeless tobacco products contain cancer-causing chemicals.
- The most harmful chemicals are tobacco-specific nitrosamines, which form during the growing, curing, fermenting, and aging of tobacco. The amount of these chemicals varies by product.
- The higher the levels of these chemicals, the greater the risk for cancer.
- Other chemicals found in tobacco can also cause cancer. These include: A radioactive element (polonium-210) found in tobacco fertilizer Chemicals formed when tobacco is cured with heat (polynuclear aromatic hydrocarbons—also known as polycyclic aromatic hydrocarbons) Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, mercury)
- A radioactive element (polonium-210) found in tobacco fertilizer
- Chemicals formed when tobacco is cured with heat (polynuclear aromatic hydrocarbons—also known as polycyclic aromatic hydrocarbons)
- Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, mercury)
- Smokeless tobacco causes cancer of the mouth, esophagus, and pancreas.
Smokeless Tobacco and Oral Disease
- Smokeless tobacco can cause white or gray patches inside the mouth (leukoplakia) that can lead to cancer.
- Smokeless tobacco can cause gum disease, tooth decay, and tooth loss.
Reproductive and Developmental Risks
- Using smokeless tobacco during pregnancy can increase the risk for early delivery and stillbirth.
- Nicotine in smokeless tobacco products that are used during pregnancy can affect how a baby's brain develops before birth.
- Using smokeless tobacco increases the risk for death from heart disease and stroke.
- Smokeless tobacco can cause nicotine poisoning in children.