Attachment A6 Cigarette, Cigar, Hookah, and E-cigarette Facts

Quantitative Study of Tobacco Facts Designed to Inform Youth Tobacco Prevention Messaging

Attachment A6: Cigarette, Cigar, Hookah, and E-Cigarette Facts for Testing

Cigarettes

Addiction:

• TF0016: Addiction keeps people smoking even when they want to quit.

• TF0051: Even smoking occasionally can lead to daily use.

Health Effects:

• TF0069: Smoking makes a person's breath smell like an ashtray.

• TF0068: Smoking causes gum disease that can lead to tooth loss.

  • Message variation: Losing teeth from gum disease is one of the L's that smoking cigarettes can hand you.

• TF0070: Smoking can stain a person's teeth.

• TF0028: Smoking accelerates skin aging and can lead to premature wrinkles.

• TF0090: Smokers generally are much less healthy than nonsmokers. Their overall health is worse and they need to go to the doctor more often. They are also admitted to the hospital more often.

• TF0265: Any amount of smoking—even an occasional cigarette—is harmful.

• TF0075: Smoking can cause cancer almost anywhere in the body.

• TF0026: Teens who smoke may develop smaller, weaker lungs that never grow to their potential size and never perform at maximum capacity.

HPHCs:

• TF0045: Cigarette smoke contains 7,000+ chemicals. Many of these chemicals are toxic, including more than 70 that can cause cancer.

• TF0014: Nicotine can change the way the brain works, causing a person to crave more nicotine.

  • Message variation: Nicotine can mess with your brain and have you craving it more.

Mortality:

• TF0003: Smokers are estimated to lose more than 10 years of life. 

• TF0185: In the U.S., 1 person dies every 66 seconds from smoking and exposure to cigarette smoke.

Social Norms and Myths:

• TF0213: Most high school students say they prefer to date nonsmokers.

Cigars

Addiction:

• TF0435 Cigarillo smoking can lead to nicotine addiction.

  • Message variation: Puffin' on cigarillos can make you addicted to nicotine.

Health Effects:

• TF0259: Cigarillo smoking poses significant health risks.

  • Message variation: Smoking cigarillos can lead to all types of health problems.

• TF0260: Cigarillo smoking causes cancers of the lung, oral cavity, esophagus, larynx, pancreas, stomach, and bladder.

• TF0261: Cigarillo smokers have increased risk for coronary heart disease, aortic aneurysms, and chronic obstructive pulmonary disease (COPD).

• TF0263: Cigarillo smokers inhale smoke regardless of whether they think they do.

• TF0294 Cigarillos contain toxic, cancer-causing chemicals that can cause serious health problems.

• TF0351: Using cigarillos instead of cigarettes may not reduce risk. Cigarillos may be even worse for health than cigarettes.

• TF0352: Cigarillo smoking can cause cancers of the mouth and throat, even if a person doesn’t think they inhale.

HPHCs:

• TF0255: Cigarillo smokers inhale similar types of harmful and cancer-causing substances as cigarette smokers.

• TF0256: Cigarillo smokers have higher levels of several toxic and cancer-causing substances in their blood than non-tobacco users.

• TF0258: Cigarillo smokers have blood concentrations of NNAL, a potent cancer-causing chemical that are comparable with that of cigarette smokers.

• TF0344: Cigarillo smokers don’t need to inhale to be exposed to nicotine. Nicotine from cigarillos can be absorbed through fingers and lips.

• TF0345: Cigarillos are not a safe alternative to cigarettes. Cigarillo smoke can expose smokers to at least as much nicotine and carbon monoxide as cigarettes.

• TF0393: Secondhand cigarillo smoke contains many of the same harmful and cancer-causing chemicals as cigarette smoke.

Other:

• TF0204: Cigar and cigarillo smoking causes nearly 9,000 premature deaths each year in the US.

Hookah

Health Effects:

• TF0284: Hookah smokers are at risk for the same kinds of diseases caused by cigarette smoking.

• TF0370: Secondhand hookah smoke is toxic.

• TF0378: Long term use of hookah is associated with mouth and lip cancers.

• TF0379: Smoking hookah significantly increases the risk of gum disease and tooth loss.

HPHCs:

• TF0034a: Hookah smoking delivers the addictive drug nicotine.

• TF0034b: Hookah smoking delivers many of the same toxic chemicals that are in cigarette smoke such as carbon monoxide, metals, and carcinogens.

• TF0283a: Hookah smokers may absorb even more of the toxic chemicals found in cigarette smoke because of the length of the session when smoking hookah.

• TF0283b: A typical 1-hour hookah session can produce as much smoke as 100 cigarettes.

• TF0375: The large volume of carbon monoxide consumed by hookah smokers is poisonous.

• TF0367: There is a large number of chemicals in hookah smoke including some that can cause cancer.

  • Message variation: Hookah smoke has a lot of chemicals in it, even some that can give you cancer.

• TF0362: Hookah smoke contains high levels of cancer-causing chemicals, even when used with tobacco-free or herbal shisha.

• TF0363a: Water does not filter out the chemicals in hookah smoke.

Addiction:

• TF0373: Hookah smoking is no less addictive than cigarette smoking.

  • Message variation: Hookah smoking can have you just as addicted as smoking cigarettes.

Other:

• TF0366: Hookah smokers can breathe in bacteria that live in hookah hoses.

• TF0364: There is no proof that any device or accessory can make hookah smoking less risky.

E-cigarettes

Addiction:

• TF0237: Like other tobacco products, vapes that contain nicotine may lead to addiction.

  • Message variation: Like other tobacco products, vapes with nicotine may have you addicted.

HPHCs:

• TF0234: Currently, people who vape have no way of knowing how much nicotine or other potentially harmful chemicals they are inhaling.

• TF0235: Vapes that contain nicotine can expose you to similar amounts of nicotine as regular cigarettes.

• TF0244: Vapes produce more than just water vapor. Chemicals that have been found in some vape aerosols include nicotine, volatile organic compounds, polycyclic aromatic hydrocarbons, flavorings, and metal particles.

• TF0245: Chemicals like formaldehyde and acetaldehyde that are known and suspected to cause cancer have been found in some vape aerosols.

  • Message variation: You can find a lot more than just water in vape aerosols. Some of the chemicals found in some vape aerosols, like formaldehyde and acetaldehyde, may cause cancer.

• TF0268: Some of the chemicals found in cigarette smoke like nicotine, formaldehyde, acetaldehyde, and acrolein are also found in some vape aerosols.

• TF0266: Some vapes are marketed as nicotine-free, but those claims may not be accurate.

• TF0333: Many vape liquids contain nicotine.

• TF0388: People who vape may also expose others to potentially harmful chemicals.

• TF0246: Some flavorings in vapes are safe to use in food, but they are not necessarily safe to inhale and may harm the lungs.

Health Effects:

• TF0247: Some vape liquids and vape aerosols contain chemicals that have been reported to damage lung cells in lab studies.

• TF0267: Vapes haven't been fully studied, so the potential health risks to users are unknown.

Adverse Events:

• TF0240 and TF0248: The liquid in vapes may accidentally leak out. Vape liquids containing nicotine may be poisonous if accidentally swallowed or absorbed through the skin.

• TF0239: Vapes have exploded, causing fires and burn injuries.

Other:

• TF0241: Ingredient listings for vapes are currently not required and they are not always accurate. People who vape have no way of knowing exactly what’s in a vape.