- Manage Your Risk
- Tobacco Control
Smoking and using tobacco accounts for up to one in three of all cancer-related deaths in the United States. MD Anderson is committed to ending tobacco use.
Smoking and using tobacco accounts for up to one in three of all cancer-related deaths in the United States. MD Anderson is committed to ending tobacco use.
MD Anderson is a leader in tobacco control, nationwide. We provide services directly to smokers who want to quit, to schools so they can make sure children never start, and to health care providers who want to eliminate tobacco use in their communities. MD Anderson also collaborates with institutions and policy makers across the United States in a movement to end tobacco use, once and for all.
MD Anderson can help you quit smoking
Stopping smoking is the most important thing you can do for your health. Quitting at any age reduces your risk for health problems including cancer, heart disease and stroke. MD Anderson offers services proven to help you stop.
Get more information and resources to help you quit.
Tobacco Research and Treatment Program
If you are a cancer patient, quitting smoking improves your chances of surviving cancer. MD Anderson's Tobacco Research and Treatment Program (TRTP) offers free tobacco cessation services to patients and includes in-person, phone and video counseling. Patients also have access to several tobacco cessation medications.
Tobacco Research Program
MD Anderson has studies available for people who smoke and are interested in quitting, as well as for people who may not be ready to stop smoking yet. Our studies aim to learn more about why people smoke and the best ways to quit.
Visit the program website and complete the online questionnaire.
Tobacco resources for educators
MD Anderson offers several programs for school-age children, teens and young adults.
ASPIRE (A Smoking Prevention Interactive Experience)
ASPIRE is a free online program for teens that tackles the big issues about tobacco, including e-cigarettes, hookah, JUUL and synthetic marijuana.
This is Quitting
In collaboration with the nationally renowned Truth Initiative, MD Anderson offers a text-based service to help young people ages 13 to 24 quit vaping. Young people can receive free, anonymous, 24/7 support through this program. Parents will receive messages with tips and advice to help their loved one.
Tobacco education presentations
MD Anderson health educators visit schools, either in-person or virtually, to arm young people with the facts on tobacco and vaping and provide tools to resist peer pressure. A puppet show is available for younger audiences, which breaks down this complex subject in a fun and entertaining way for kids in kindergarten through 4th grade.
Did You Know?
Protect your kids from tobacco
MD Anderson can help you keep your child away from tobacco. Find out what to know about vaping, e-cigarettes and other forms of tobacco, plus information on support services available to you and your children.Learn more to help your family stay tobacco free
Tobacco training programs and resources for health care providers
MD Anderson has training available to help you support your patients on their journey to becoming tobacco free.
Project ECHO TEACH is a telementoring service that provides tobacco education, consulting and cessation strategies to clinical providers across the United States.
Certified Tobacco Treatment Training Program. If you want to become a certified Tobacco Treatment Specialist, join MD Anderson’s five-day intensive training program, certified by the Council for Tobacco Treatment Training Programs.
Tobacco Outreach Education Program. MD Anderson offers free continuing medical education materials to help physicians counsel patients on the benefits of smoking prevention and cessation.
Quitline. If you are a Federally Qualified Health Center, collaborate with us to connect your patients to the MD Anderson Quitline. This enhanced service offers patients free access to one-on-one counseling and extended nicotine replacement therapy.
MD Anderson drives tobacco control policy
At MD Anderson, we know that tobacco control policies are key to eliminating tobacco use. Smoke-free laws and tobacco-free policies not only reduce exposure to secondhand smoke, but also motivate and help tobacco users quit and prevent initiation of tobacco use.
Americans die from smoking each year
teens report using e-cigarettes in the last 30 days
non-smoking Americans exposed to secondhand smoke
As a child, researcher Surendranath Shastri, M.D., D.Ph., worshiped his dad. “He was a lifetime smoker, so I thought it was cool to smoke,” says Shastri. “I started smoking around age 18, about the same time I started medical school.”
By his early 20s, Shastri was smoking two packs of cigarettes a day. He lived in India, where smoking was a big part of the culture. Shastri recalls cigarettes were given as a party favor to guests at his wedding.
He knew smoking was dangerous to his own health, but that wasn’t enough to motivate him to quit, despite pleas from his wife. At the time, scientific evidence was still being gathered on the harms of secondhand smoke exposure, and that’s what finally convinced Shastri to quit.
“When my wife told me she was pregnant with our first child, the first thing that came to my mind was, ‘I must do everything I can to take care of this baby,’” Shastri recalls. “My wife asked me to start by giving up smoking.”
Thinking about the potential effects on their unborn daughter provided strong enough motivation for him to permanently quit smoking at age 26. His daughter is now a doctor with her own children. Shastri is a physician and researcher studying health disparities in cancer, including tobacco use.
Secondhand smoke is harmful
The same year that Shastri quit smoking, the first Surgeon General’s Report dedicated to the health effects of secondhand smoke was released. We now know that secondhand smoke exposure, which includes the smoke directly from a burning cigarette as well as the smoke exhaled by someone smoking, can cause serious health problems in non-smokers, including lung cancer.
“It’s a big myth that secondhand smoke exposure is not as harmful as smoking,” Shastri says. “Secondhand smoke exposure is equally harmful, particularly for young children whose respiratory systems are not as developed and for women who are pregnant.”
According to the Surgeon General, 2.5 million non-smokers have died due to secondhand smoke exposure since 1964. Secondhand smoke exposure can cause heart disease, stroke and sudden infant death syndrome. More than 7,300 nonsmokers die each year from lung cancer caused by exposure to secondhand smoke.
Disparities in secondhand smoke exposure
“The science shows that the health effects from secondhand smoke exposure are long-lasting,” Shastri says. “Although we’ve made progress in the US in reducing secondhand smoke exposure, that progress has stalled over the last decade, and disparities persist.”
From 1988 to 2012, secondhand smoke exposure among non-smokers declined from 87.5% to 25.3%. The latest available data shows the rates have barely decreased since then, to 24.6% in 2018. Shastri and Sanjay Shete, Ph.D., recently published a study in JAMA Internal Medicine that analyzed data on secondhand smoke from 2011-2018 to determine how common the problem is currently.
“We found very clear disparities in terms of who is exposed to secondhand smoke,” Shastri says. “There are significantly higher rates of secondhand smoke exposure in children ages 3 to 11, non-Hispanic Black individuals, and people living below the poverty line, in rental housing or without a high school education.”
Strategies to reduce secondhand smoke exposure
After beginning his career in internal medicine, Shastri was recruited to establish and lead the Preventive Oncology department at one of India’s largest cancer hospitals. In this role, he created the Smokefree Mumbai Campaign and implemented tobacco cessation clinics at cancer centers throughout the country. He’s continued to work on tobacco control projects since joining MD Anderson’s Health Disparities Research team in 2018.
Shastri’s team is currently working on a pilot project to address secondhand smoke exposure among public housing residents in Houston. The project will begin with a blood test to measure the baseline secondhand smoke exposure levels among non-smoking residents, followed by a series of interventions to identify and fill gaps in existing resources designed to help residents and property managers comply with the 2017 Smoke-Free Public Housing Rule. The project will also offer free, onsite tobacco cessation therapy to residents who smoke. After one year, the team will measure secondhand smoke exposure levels among non-smoking residents again to see if the interventions made a difference.
“It’s critical that we prioritize strategies to reduce secondhand smoke exposure among the groups who are disproportionally affected and may have long-term health issues as a result,” Shastri says. “I can’t think of a more powerful motivation to quit smoking than the health of your loved ones.”
MD Anderson offers resources for individuals who want to quit smoking, including smoking cessation studies for Texas residents and Tobacco Treatment Program for MD Anderson patients and employees. Anyone can call 1-800-QUIT-NOW or visit smokefree.gov to be connected to free quitting resources in their state.
Cigarette smoking has been on the decline for years. But menthol cigarettes are one segment of the tobacco market that has remained strong.
The Food and Drug Administration (FDA) proposed new rules today to prohibit these products and flavored cigars. These proposed rules are in response to public health concerns about the dangers of menthol cigarettes and their huge popularity among young people and Black, Hispanic and Asian American smokers.
We spoke with Jennifer Cofer, director of the EndTobacco® Program at MD Anderson, about the harms posed by menthol cigarettes and why the FDA's decision matters.
What is menthol, and why do manufacturers add it to cigarettes?
Menthol is a flavor additive with a minty taste and smell. In addition to tasting good, it has a cooling and painkilling effect. Cigarette manufacturers add it to cigarette filters to cover up the unpleasant taste of tobacco and make cigarettes more appealing.
What does the FDA decision on menthol cigarettes mean?
The FDA has the authority to regulate ingredients, marketing and new products. It banned flavored cigarettes in 2009, but made an exception for menthols. The FDA is essentially catching up by including menthol as a banned flavor now. Last year, the FDA announced that a plan was in the works to catch up, essentially, by including menthol as a banned flavor.
Now, the public will have the opportunity to comment on the proposed rules this summer before the product standards are finalized. It could be several months before menthols and cigars disappear from shelves.
Who smokes menthol cigarettes?
About 18.5 million people in the United States are regular menthol smokers. That’s 37% of the cigarette market. Here’s a breakdown of their use by race in the United States:
- 85% of Black smokers smoke menthols
- 46% of Hispanic smokers smoke menthols
- 39% of Asian American smokers smoke menthols
Why is race important? Because people who smoke menthols tend to inhale more deeply and have a harder time quitting smoking. That means that the health effects of smoking have a disproportionate impact on those communities with a higher rate of menthol use.
Menthols and mint are also extremely popular among teenage smokers. More than half of cigarette smokers ages 12 to 17 use menthol cigarettes.
The hope is that, once finalized, the rules will help reduce the number of new, young adult nonsmokers and improve the health of people who currently use menthol cigarettes.
What does the research say about the dangers of menthol cigarettes?
Because menthol flavoring masks the harsh taste of cigarette smoke, menthol smokers engage in more intense smoking behaviors than smokers of regular cigarettes. As a result, they suffer greater damage to their health. Here are three reasons menthols are so dangerous:
- People who smoke menthols smoke more. The minty coolness of the menthol covers up the harshness of the cigarette, so smoking is easier to tolerate. As a result, menthol smokers inhale more deeply and they smoke more cigarettes. That means over their smoking lifetime, they take in more of toxic chemicals and tar from cigarettes.
- Menthols are harder to quit. Research by both the FDA and the Tobacco Products Scientific Advisory Committee shows that those who smoke menthol cigarettes are more likely to be dependent and have more trouble quitting. So, while Black smokers are more likely to try to quit smoking than white smokers, they’re less likely to be successful. That’s because of a higher nicotine dependence related to smoking menthol cigarettes. One result: Black men and women have a higher rate of lung cancer than any other race.
- Menthols appeal to young smokers. Studies show that young people who start smoking menthol cigarettes are more likely to become addicted and become long-term daily smokers.
What are the health risks of flavored cigars?
Flavored cigars, or cigarillos, come in flavors like cherry, grape and vanilla. They are typically available at convenience stores and gas stations for a very low price.
Like menthol cigarettes, flavored cigars were not covered by the 2009 flavor ban. Cigars are not regulated in the same way as cigarettes.
Removing these products would be an important step in reducing the overall impact of tobacco on public health, especially in communities where they are popular.
Is there anything else should we know about menthol cigarettes?
There is no safe tobacco product. If you are a smoker or vaper, one of the best things you can do to protect your health and reduce your risk of cancer is to quit. The best way to do that is through a comprehensive program that includes a combination of medications and counseling. MD Anderson offers free research studies for adults in Texas at any stage of smoking cessation. Learn more at SmokeFreeStudy.org.
Youth and young adults who want to quit using tobacco products can text VAPEFREETX to 88709. Parents can text QUIT to 202-899-7550 to get tips and advice for helping their teens and young adults quit using tobacco or vape products.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
In the largest smoking cessation study of cancer patients to date, researchers from The University of Texas MD Anderson Cancer Center found that comprehensive tobacco treatment can help cancer patients successfully quit and abstain from smoking.
The prospective study, published today in JAMA Network Open, analyzed 3,245 smokers treated in MD Anderson’s Tobacco Treatment Program between 2006 and 2015. At three, six and nine-month follow-ups, smoking abstinence rates averaged 45%, 46% and 44%, respectively. Based on the program’s success, the authors advocate for full integration of comprehensive tobacco treatment into the oncological setting to ensure the best possible cancer treatment outcomes.
While the study was not designed as a randomized clinical trial and did not compare different types of smoking cessation programs, past studies have shown quitlines or other minimal interventions have abstinence rates of 20% or less. As with quitlines, abstinence rates for the Tobacco Treatment Program were self-reported and were not regularly biochemically verified.
“Patients deserve the absolute best opportunity we can give them to quit smoking,” said Paul Cinciripini, Ph.D., chair of Behavioral Science, director of the Tobacco Treatment Program and lead author on the study. “Based on our data, we recommend offering comprehensive smoking cessation to cancer patients as a clinical standard of care.”
MD Anderson’s program provides personalized tobacco treatment to nearly 1,200 new patients every year. Since 2013, patients have been automatically referred to the program through an electronic questionnaire used in all institutional clinics.
Program staff contact every new patient who self identifies as a smoker. Most patients who agree to participate in the comprehensive program receive both intensive counseling and proactive medication management.
“We tailor nicotine replacement therapy, non-nicotine medications, and combination of these as recommendations to each individual and provide support through behavioral counseling sessions over eight to 12 weeks following their initial consultation,” said Maher Karam-Hage, M.D., professor of Behavioral Science and medical director of the Tobacco Treatment Program. “Through this combined approach, we’ve seen effective results in cessation and abstinence.”
At MD Anderson, the average cost per quit ranges from $1,900 to $2,500. Participants receive treatment services for free, as the Tobacco Treatment Program is funded primarily through Texas Tobacco Settlement Funds awarded through the Tobacco Master Settlement. The authors note this funding arrangement is progressive and could serve as a model for other states.
“If we want to give patients the absolute best opportunity to treat their cancer, why shouldn’t we give them the best smoking cessation, too?” Cinciripini said. “It’s the right thing to do and it’s worth the investment.”
As smoking is a risk factor for many cancers and other diseases, the MD Anderson program is open to employees as well. The study did not find a difference in abstinence rates between cancer patients and non-patients. For cancer patients, smoking also negatively impacts survival and treatment.
“Many cancer patients wonder if quitting smoking once they already have cancer is worth it,” said Diane Beneventi, Ph.D., assistant professor of Behavioral Science. “The truth is, quitting at time of diagnosis increases the chance of survival by 30% to 40%. Patients also have less chance of a recurrence or secondary cancer if they quit. They will have fewer side effects and their treatments will be more effective. Longer term, they will enjoy a better quality of life. Quitting is crucial for cancer patients.”
Additional co-authors are George Kypriotakis, Ph.D., Jason D. Robinson, Ph.D., Vance Rabius, Ph.D., Jennifer Minnix, Ph.D. and Janice Blalock, Ph.D., all of Behavioral Science. Cinciripini and Karam-Hage received grant support and medication (Chantix) from Pfizer to conduct smoking cessation trials, and have participated in two multisite trials sponsored by Pfizer.
This study received funding support from the State of Texas Tobacco Settlement funds and from MD Anderson's Cancer Center Support Grant (CA016672).