Dr. Nikhil Mehta, Surgical Oncologist, HCG Cancer Centre, Jaipur, explains how tobacco exposure affects the body from the first use and why quitting remains the most effective step toward reducing long term health risks.
The first puff of a cigarette is often shaped by curiosity, peer pressure or the belief that it offers relief. It may seem like a passing moment, but the body begins responding from the first inhalation.
As tobacco smoke enters the lungs, it carries thousands of chemicals, including nicotine, tar and carbon monoxide. Nicotine reaches the brain within seconds and triggers dopamine release, creating the reward response that makes smoking highly addictive. With repeated exposure, the body begins adapting to tobacco while dependence gradually develops.
According to the Global Adult Tobacco Survey 2, 2016 to 2017, 266.8 million adults were using tobacco in some form. The WHO Global Tobacco Report 2025 showed adult smoking prevalence rising to 9.3 percent in 2024 from 8.1 percent in 2020.
Dr. Nikhil Mehta, Surgical Oncologist, HCG Cancer Centre, Jaipur, notes that no form of tobacco is safe. India is the world’s second largest consumer of tobacco, with more than 267 million adults, about 29 percent of all adults, using tobacco in some form. While smoking is one part of the problem, smokeless tobacco such as khaini, gutkha and zarda accounts for a large share of use. Among 270 million tobacco users in India, around 200 million consume smokeless products.
From the first use, tobacco introduces more than 4,000 chemicals into the body, with over 250 known to be harmful. There is no safe level of tobacco exposure, and the damage builds across organs over time.
The earliest signs may appear minor: yellowed teeth, persistent cough, reduced lung capacity and chronic fatigue. The respiratory system is often among the first affected, with smokers facing higher rates of bronchitis, recurrent infections and aggravated asthma.
Over time, the risks become more serious. Tobacco is a major contributor to cancer, cardiovascular disease, respiratory illness and diabetes. Bidi and cigarette smokers in India die six to ten years earlier than non smokers, according to Jha et al., NEJM, 2008. Tobacco accounts for 27 percent of all cancers diagnosed in India, including cancers of the lung, mouth, throat, oesophagus, stomach, bladder and cervix, according to ICMR NCRP, 2021. Smokeless tobacco alone is responsible for nearly 90 percent of oral cancers in the country.
Smokers also face increased risk of heart attacks, strokes and chronic obstructive pulmonary disease. For people living with tuberculosis, smoking nearly doubles disease severity and treatment failure rates.
The harm also extends to non smokers. Secondhand smoke carries the same toxic chemicals and is associated with a 20 to 30 percent higher risk of lung cancer. Children exposed to secondhand smoke face higher risks of respiratory infections, asthma and ear infections. In infants, exposure is linked to sudden infant death syndrome.
Tobacco also places a heavy financial burden on families. According to the Tobacco Atlas 2025, the annual cost of illness attributable to smoking in India stands at INR 1.97 trillion, including direct healthcare costs and indirect losses from premature death and lost productivity. For many households, this leads to hospital expenses, long term treatment costs and loss of income.
On average, a smoker in India spends 8.43 percent of GDP per capita to sustain a 100 pack a year habit. For lower income households, this often diverts money away from food, education and essential healthcare.
Despite the risks, tobacco related diseases are among the most preventable. Quitting at any stage can bring measurable health benefits. Within hours, blood pressure can begin to drop, circulation can improve and lung function can start recovering. Over time, the risk of cancer and heart disease declines.
Tobacco users with persistent cough, unexplained weight loss, blood in sputum, mouth ulcers that do not heal or difficulty swallowing should seek medical attention immediately.
On World No Tobacco Day, the message is clear: tobacco harms users, families and communities, but help is available and quitting can begin at any time.
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