When your parents were young, people could buy cigarettes and smoke pretty much anywhere — even in hospitals! Ads for cigarettes were all over the place. Today we're more aware about how bad smoking is for our health. Smoking is restricted or banned in almost all public places and cigarette companies are no longer allowed to advertise on TV, radio, and in many magazines.

Almost everyone knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. So how come people are still lighting up? The answer, in a word, is addiction.

Once You Start, It's Hard to Stop

Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal.

People start smoking for a variety of different reasons. Some think it looks cool. Others start because their family members or friends smoke. Statistics show that about 9 out of 10 tobacco users start before they're 18 years old. Most adults who started smoking in their teens never expected to become addicted. That's why people say it's just so much easier to not start smoking at all.

How Smoking Affects Your Health

There are no physical reasons to start smoking. The body doesn't need tobacco the way it needs food, water, sleep, and exercise. And many of the chemicals in cigarettes, like nicotine and cyanide, are actually poisons that can kill in high enough doses.

The body is smart. It goes on the defense when it's being poisoned. First-time smokers often feel pain or burning in the throat and lungs, and some people feel sick or even throw up the first few times they try tobacco.

The consequences of this poisoning happen gradually. Over the long term, smoking leads people to develop health problems like heart disease, stroke, emphysema (breakdown of lung tissue), and many types of cancer — including lung, throat, stomach, and bladder cancer. People who smoke also have an increased risk of infections like bronchitis and pneumonia.

These diseases limit a person's ability to be normally active, and they can be fatal. In the United States, smoking is responsible for about 1 out of 5 deaths.

Smokers not only develop wrinkles and yellow teeth, they also lose bone density, which increases their risk of osteoporosis, a condition that causes older people to become bent over and their bones to break more easily. Smokers also tend to be less active than nonsmokers because smoking affects lung power.

Smoking can also cause fertility problems and can impact sexual health in both men and women. Girls who are on the pill or other hormone-based methods of birth control (like the patch or the ring) increase their risk of serious health problems, such as heart attacks, if they smoke.

The consequences of smoking may seem very far off, but long-term health problems aren't the only hazard of smoking. Nicotine and the other toxins in cigarettes, cigars, and pipes can affect a person's body quickly, which means that teen smokers experience many of these problems:

• Bad skin. Because smoking can slow the flow of blood vessels, it can prevent oxygen and nutrients from getting to the skin — which is why smokers often appear pale and unhealthy. Studies have also linked smoking to an increased risk of getting a type of skin rash called psoriasis.
• Bad breath. Cigarettes leave smokers with a condition called halitosis, or persistent bad breath.
• Bad-smelling clothes and hair. The smell of stale smoke tends to linger — not just on people's clothing, but on their hair, furniture, and cars. And it's often hard to get the smell of smoke out.
• Reduced athletic performance. People who smoke usually can't compete with nonsmoking peers because the physical effects of smoking (like rapid heartbeat, decreased circulation, and shortness of breath) impair sports performance.
• Greater risk of injury and slower healing time. Smoking affects the body's ability to produce collagen, so common sports injuries, such as damage to tendons and ligaments, will heal more slowly in smokers than nonsmokers.
• Increased risk of illness. Studies show that smokers get more colds, flu, bronchitis, and pneumonia than nonsmokers. And people with certain health conditions, like asthma, become more sick if they smoke (and often if they're just around people who smoke). Because teens who smoke as a way to manage weight often light up instead of eating, their bodies also lack the nutrients they need to grow, develop, and fight off illness properly.

Hookahs and E-Cigarettes

It's not only cigarettes that get people dependent on tobacco. Hookahs, staples of Middle Eastern café society, are water pipes used to smoke tobacco through a hose with a tapered mouthpiece. There's a myth going around that hookahs are safer because the smoke is cooled when it passes through the water.

But take a look at the black, resinous gunk that builds up in a hookah hose. Some of that gets into users' mouths and lungs. Indeed, experts say hookahs are no safer than cigarettes — and since they don't have filters and people often use them for long periods, the health risks might be even greater. Hookahs are usually shared, so there's the additional risk from germs being passed around along with the pipe.

Also beware of electronic cigarettes (e-cigarettes), which contain cancer-causing chemicals and other toxins, including a compound used in antifreeze. These battery-operated devices use cartridges filled with nicotine, flavorings, and other chemicals and convert them into a vapor that's inhaled by the user.

E-cigarettes haven't been evaluated or approved by the U.S. Food and Drug Administration (FDA), so they don't have to post the health warnings that nicotine replacement products or conventional cigarettes do. But there's no such thing as a safe nicotine product.

Kicking Butts and Staying Smoke Free

All forms of tobacco — cigarettes, pipes, cigars, hookahs, and smokeless tobacco — are hazardous. It doesn't help to substitute products that seem like they're better for you than regular cigarettes, such as e-cigarettes or filtered or low-tar cigarettes.

The only thing that really helps a person avoid the problems associated with smoking is staying smoke free. This isn't always easy, especially if everyone around you is smoking and offering you cigarettes. It may help to have your reasons for not smoking ready for times you may feel the pressure, such as "I just don't like it" or "I want to stay in shape for soccer" (or football, basketball, or other sport).

The good news for people who don't smoke or who want to quit is that studies show that the number of teens who smoke has dropped dramatically. Today, about 20% of high school students smoke — which means 4 out of 5 don't.

If you do smoke and want to quit, you have lots of information and support available. Different approaches to quitting work for different people. For some, quitting cold turkey is best. Others find that a slower approach is the way to go. Some people find that it helps to go to a support group especially for teens. These are sometimes sponsored by local hospitals or organizations like the American Cancer Society. The Internet offers a number of good resources to help people quit smoking.

When quitting, it can be helpful to realize that the first few days are the hardest. So don't give up. Some people find they have a few relapses before they manage to quit for good.

Staying smoke free will give you a whole lot more of everything — more energy, better performance, better looks, more money in your pocket, and in the long run, more life to live!

Reviewed by: Steven Dowshen, MD
Date reviewed: February 2013