“Additive-free” cigarettes are still cigarettes, and these are the methods that help you quit

Key takeaways

• In 2017, the maker of Natural American Spirit agreed with the FDA to stop using “natural” and “additive-free” on its labels and ads, two advocacy groups reported, because the agency treated those words as a claim of lower harm¹.
• Cigarette smoking and secondhand smoke cause more than 480,000 U.S. deaths a year, and about 1 in 10 adults still smoked in 2024⁴⁵.
• Within minutes of your last cigarette, your heart rate drops; within 1 to 2 years, heart attack risk falls sharply⁷.
• In a Cochrane analysis of 319 trials, about 6 in 100 people quit with no aid, versus roughly 10 to 19 in 100 with varenicline, cytisine or nicotine e-cigarettes¹⁰.
• The free national quitline, 1-800-QUIT-NOW, offers confidential coaching, and pairing counseling with medicine can more than double your chances⁶⁸.

In August 2015, the FDA sent a warning letter to the company behind Natural American Spirit cigarettes. The agency objected to two words on the labels: “natural” and “additive-free”¹.

The letter treated those words as a claim of reduced harm. Under the 2009 federal tobacco law, such claims need the agency’s approval first¹.

On January 19, 2017, the company, Santa Fe Natural Tobacco, agreed to remove both words from its labels, ads and promotions¹. “Natural” could stay in the brand name, and the deal didn’t address the word “organic”¹. The deal’s details come from a joint release by two advocacy groups, the Campaign for Tobacco-Free Kids and Truth Initiative, which called the agreement far too weak¹.

The lesson for careful label readers: “natural” describes where tobacco comes from, not what it does to your body. Tobacco smoke contains more than 7,000 chemicals, and at least 69 of them can cause cancer, the National Cancer Institute reports². In the FDA’s words, “There is no safe tobacco product”³.

Smoking and secondhand smoke still cause more than 480,000 U.S. deaths a year, nearly one in five⁴. In 2024, 9.9% of adults smoked cigarettes, and outside metropolitan areas the rate was 15.4%⁵.

The hopeful part: three in five adults who ever smoked have quit⁶. This guide shows how the body recovers, which aids have the best evidence, how newer nicotine products compare and where natural supports fit.

Your body starts repairing within minutes of your last cigarette

CDC lays out how the benefits build over time⁷:

Time after quitting	What changes
Minutes	Heart rate drops
24 hours	Nicotine in your blood falls to zero
Several days	Carbon monoxide in your blood falls to a nonsmoker’s level
1 to 12 months	Coughing and shortness of breath ease
1 to 2 years	Heart attack risk drops sharply
3 to 6 years	Added risk of coronary heart disease is cut in half
5 to 10 years	Added risk of mouth, throat and voice box cancer is cut in half; stroke risk falls
10 to 15 years	Added risk of lung cancer is cut in half
15 years	Heart disease risk is close to a nonsmoker’s

The 2020 Surgeon General’s report on quitting concluded that stopping helps at any age, no matter how long you have smoked. Quitting can lengthen life by up to 10 years and lowers the risk of 12 kinds of cancer, heart disease and chronic lung disease⁶. It helps even people who already have heart disease or chronic lung disease⁶.

Age changes the size of the gain, not whether there is one. Citing a 2013 study, the National Cancer Institute reports that people who quit at 25 to 34 gained about 10 years of life, at 35 to 44 about 9 years, at 45 to 54 about 6 years and at 55 to 64 about 4 years².

Secondhand smoke matters for the people around you, too. It causes more than 40,000 deaths a year among adults who don’t smoke and about 400 among infants⁴. Our article “What every flame in your house puts into the air” covers smoke at home.

Help more than doubles your odds, yet most people try alone

Most people who smoke want to stop. Nearly 70% say so, and more than half try each year, but fewer than 1 in 10 succeed in a given year, the Surgeon General’s report found⁶.

Part of the gap is that help goes unused. Fewer than one in three adults who try to quit use counseling or FDA-approved medicine, and more than 40% of adults who smoke don’t get advice to quit from a health professional⁶.

The U.S. Preventive Services Task Force, an independent expert panel, gives its top grade, A, to asking every adult about tobacco, advising them to quit and offering both behavioral support and FDA-approved medicine⁹. That 2021 recommendation is now being updated⁹.

Counseling and medicine each work alone, and together they can more than double the chance of quitting⁶. Phone coaching is free. CDC lists 1-800-QUIT-NOW for confidential support, plus a free texting program and the quitSTART app⁸. The Surgeon General’s report found that quitline counseling and text-message programs both help⁶.

The quit aids, ranked by the numbers

In 2023, Cochrane, an independent network that reviews medical evidence, pooled 319 trials with 157,179 adults¹⁰. Without any treatment or with a placebo, about 6 in 100 people stayed off cigarettes for at least six months¹⁰.

Aid	People quitting per 100	Extra quitters per 100 versus no aid	Certainty
Nicotine e-cigarettes	10 to 19	About 8	High
Varenicline (prescription)	12 to 16	About 8	High
Cytisine (not yet approved in the U.S.)	10 to 18	About 7	High
Nicotine patch alone	About 8	About 2	High
Nicotine gum or lozenge alone	About 9	About 3	High
Bupropion (prescription)	About 9	About 3	High

Combining a patch with a fast-acting form like gum or a lozenge came out about as well as the top three aids, although that figure was calculated rather than measured directly¹⁰. CDC also says pairing a long-acting patch with short-acting gum or a lozenge raises your chances more than one form alone⁸.

Serious side effects were uncommon across the trials, about 3% overall¹⁰. Bupropion may add about one serious event per 100 users, while the other aids showed no clear increase. Long-term data are limited¹⁰.

Varenicline and cytisine: two safety questions, answered

Varenicline and bupropion once carried boxed warnings about psychiatric effects. The EAGLES trial tested that concern in more than 8,000 smokers at 140 sites in 16 countries, and about half had a current or past psychiatric condition¹¹.

Neither varenicline nor bupropion significantly raised moderate-to-severe psychiatric side effects compared with placebo¹¹. The most common side effect of varenicline was nausea, in 25% of users¹¹. The FDA removed the boxed warnings in 2016 but noted that some people still face mental health risks¹¹.

Cytisine may appeal to natural-health readers. It is a naturally occurring compound that acts on the brain’s nicotine receptors, and it has a long history of use in Bulgaria and other Eastern European countries¹¹. In a New Zealand trial, 22% of cytisine users had quit at six months, compared with 15% using nicotine replacement, though nausea, vomiting and sleep problems were more common¹¹.

Cytisine is not yet available as an approved U.S. drug. Its developer, Achieve Life Sciences, says the FDA declined to approve its application in June 2026 over manufacturing issues at a former contract plant and unfinished labeling, and did not cite problems with the drug’s effectiveness or safety¹². That account comes from the company, which plans to resubmit by the end of 2026¹².

E-cigarettes help some smokers quit, and keep many of them vaping

The evidence on vaping as a quit tool has grown. In the Cochrane analysis, nicotine e-cigarettes ranked with varenicline and cytisine, with high certainty¹⁰. That 2023 analysis is the most recent Cochrane comparison this article could confirm.

One British trial shows both sides. Among 886 adults at stop-smoking services, 18.0% of those given e-cigarettes had quit smoking after a year, compared with 9.9% given nicotine replacement¹¹. But 80% of the e-cigarette group’s quitters were still vaping, while only 9% of the other group still used nicotine replacement¹¹.

U.S. guidance is more cautious. In 2021, the Task Force said the evidence was insufficient to judge e-cigarettes for quitting, an “I” statement, after weighing five trials, all done outside the U.S.⁹. It noted short-term effects such as cough, throat irritation, nausea and poor sleep, said data on long-term harms are lacking and voiced concern about youth vaping⁹.

The 2020 Surgeon General’s report found inadequate evidence that e-cigarettes in general increase quitting. It also noted that they aren’t FDA-approved quit aids and aren’t safe for young people, pregnant women or anyone who doesn’t already use tobacco⁶.

Youth use is the other side of the ledger. In 2025, 5.2% of middle and high school students vaped, part of about 2 million students using some tobacco product¹³.

Pouches, heated tobacco, cigars and hookah compared

“Lower risk than cigarettes” is not the same as safe. FDA decisions on these products respond to company applications, so we name the companies below.

Product	What regulators and federal reviews say	Notes
“Natural” or “additive-free” cigarettes	Still burned tobacco; there is no safe level of smoking2	FDA required one brand to drop those words1
Nicotine pouches (ZYN)	First authorized in January 2025; since June 2026, may claim that using them instead of cigarettes lowers the risk of mouth cancer, heart disease, lung cancer, stroke, emphysema and chronic bronchitis3	Claim based on Swedish Match USA’s application; 1.7% of students used pouches in 2025313
Heated tobacco (IQOS)	May claim that switching completely cuts your exposure to harmful chemicals; not a claim of lower disease risk14	Philip Morris products; orders renewed April 202614
E-cigarettes	Help some adults quit; long-term harms not well understood910	5.2% of students vaped in 202513
Smokeless tobacco (dip, chew)	Causes cancers of the mouth, esophagus and pancreas2	May also cause gum and heart disease2
Cigars	Cause cancers of the mouth, larynx, esophagus and lung2	Daily cigar smokers, especially those who inhale, face higher heart disease risk2
Hookah	Smoke at least as toxic as cigarette smoke2	No safe tobacco product3
Clove cigarettes (kreteks)	Linked to lung cancer and other lung diseases2	Contain tobacco as well as cloves2

The FDA says its ZYN decision covers only those products, that quitting all tobacco is best and that people who don’t use tobacco shouldn’t start³.

Natural supports: what helps and what’s unproven

For people who value purity and the body’s power to heal, quitting tobacco is about as direct as prevention gets. You remove the exposure, and the recovery timeline above starts on its own⁷.

Natural supports can sit alongside counseling and medicine, the proven therapies, but shouldn’t replace them. Here is what the National Center for Complementary and Integrative Health (NCCIH) reports¹⁵:

• Hypnosis: A 2019 Cochrane review found too little evidence that it beats other support or quitting on your own. Our article “Hypnosis Has a Real Evidence Base, and a Real Problem With Memory” covers hypnosis more broadly.
• Acupuncture: It may help for short periods, but a 2014 Cochrane review found no consistent evidence of lasting quitting.
• Mindfulness meditation: Programs sometimes beat standard counseling and sometimes tied it.
• Yoga: In a 2018 trial funded by NCCIH, yoga students were more likely than wellness-class students to be smoke-free after eight weeks. Three and six months later, the groups looked alike.
• Herbs and supplements: There’s no evidence that SAMe, lobeline or St. John’s wort helps. St. John’s wort interacts with many medicines, sometimes seriously.

NCCIH adds a point natural-health readers know well: natural doesn’t automatically mean safe¹⁵.

Your quit plan

This is our own plan, built on CDC and Surgeon General guidance.

1. Set a date. Pick a day in the next few weeks and tell the people around you.
2. Line up support. Call 1-800-QUIT-NOW for free coaching, or sign up for CDC’s texting program or the quitSTART app⁸.
3. Choose a medicine with your clinician. Over-the-counter options include the patch, gum and lozenge; prescription options include varenicline, bupropion, a nicotine inhaler and nasal spray⁸. If you are pregnant, the Task Force found too little evidence to weigh quit medicines, so start with counseling and talk with your clinician⁹.
4. Map your triggers. Write down when you smoke, such as with coffee, in the car or under stress, and plan a replacement for each. Our article “Old habits run on cues rather than willpower, and you can rewire them” explains why cues matter.
5. If you slip, keep going. Quitting often takes more than one try: more than half of people who smoke try each year, and fewer than 1 in 10 succeed in a given year⁶. Ask your clinician about adding or switching aids, and see “A slip doesn’t erase your progress, but your reaction to it can.”

When to talk with a clinician

• Before starting varenicline or bupropion, mention any past or current mental health condition; the FDA says some people still face mental health risks¹¹.
• Call your clinician if your mood changes after starting a quit medicine¹¹.
• Ask before combining quit aids with supplements, especially St. John’s wort¹⁵.
• If you are pregnant, ask about counseling first⁹.
• For chest pain or other emergency signs, see “The symptoms that mean call 911 now.”

How strong is the evidence?

Claim	Evidence level	Basis
Counseling plus medicine helps people quit	Strong evidence	Federal reviews and Task Force grade A69
Varenicline, cytisine and nicotine e-cigarettes help people quit	Strong evidence	High-certainty Cochrane results10
A single form of nicotine replacement or bupropion helps	Strong evidence	Smaller effect: 2 to 3 extra quitters per 10010
Varenicline raises moderate-to-severe psychiatric side effects overall	Evidence says no, or unsafe	No significant increase in EAGLES11
Mindfulness or yoga helps people quit	Promising but early	Mixed or short-lived results15
Hypnosis or acupuncture leads to lasting quitting	Not enough evidence	Cochrane reviews15
St. John’s wort, SAMe or lobeline helps people quit	Not enough evidence	No evidence of benefit; St. John’s wort also interacts with many drugs15
“Natural” or “additive-free” cigarettes are safer	Evidence says no, or unsafe	No safe tobacco product23

Questions readers ask

The bottom line

A natural-sounding label doesn’t change what happens when tobacco burns. Quitting does change it, starting within minutes and building for decades, at any age.

The best odds come from combining support with a proven aid. Call 1-800-QUIT-NOW, talk with a clinician about medicine, add natural supports you enjoy and treat a slip as part of the process.

Keep exploring: social connection and heart health and fall prevention older adults.

Related reading

• Why “natural” on a food label guarantees almost nothing
• What every flame in your house puts into the air
• Old habits run on cues rather than willpower, and you can rewire them
• A slip doesn’t erase your progress, but your reaction to it can
• Hypnosis has a real evidence base, and a real problem with memory

Sources

1. Campaign for Tobacco-Free Kids and Truth Initiative (advocacy organizations). “FDA/Santa Fe Natural Tobacco Agreement” (joint press release). March 2, 2017. tobaccofreekids.org
2. National Cancer Institute. “Harms of Cigarette Smoking and Health Benefits of Quitting.” NCI fact sheet, reviewed December 19, 2017. cancer.gov
3. U.S. Food and Drug Administration, Center for Tobacco Products. “FDA Authorizes 20 ZYN Nicotine Pouches to Be Marketed with Specific Modified Risk Claim.” FDA, June 30, 2026. fda.gov
4. Centers for Disease Control and Prevention. “Cigarette Smoking.” CDC, September 17, 2024. cdc.gov
5. National Center for Health Statistics. “Cigarette and Electronic Cigarette Use Among Adults by Urbanization Level: United States, 2024.” Health E-Stat 115, CDC, March 2026. cdc.gov
6. U.S. Department of Health and Human Services. “A Summary of Smoking Cessation: A Report of the Surgeon General” (2020). CDC fact sheet. cdc.gov
7. Centers for Disease Control and Prevention. “Benefits of Quitting Smoking.” CDC, May 15, 2024. cdc.gov
8. Centers for Disease Control and Prevention. “How to Quit Smoking.” CDC, May 15, 2024. cdc.gov
9. U.S. Preventive Services Task Force. “Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions.” Final recommendation, January 19, 2021. uspreventiveservicestaskforce.org
10. Lindson N, et al. “Pharmacological and Electronic Cigarette Interventions for Smoking Cessation in Adults: Component Network Meta-Analyses.” Cochrane Database of Systematic Reviews, 2023 (plain-language summary). cochrane.org
11. National Cancer Institute. “Cigarette Smoking: Health Risks and How to Quit (PDQ), Health Professional Version.” NCI, updated February 21, 2025. cancer.gov
12. Achieve Life Sciences (company press release). “Achieve Life Sciences Receives Complete Response Letter from FDA for Cytisinicline NDA.” June 22, 2026. ir.achievelifesciences.com
13. U.S. Food and Drug Administration, Center for Tobacco Products. “National Youth Tobacco Survey: FDA Publishes Peer-Reviewed Journal Article, Releases 2025 Findings.” FDA, June 23, 2026. fda.gov
14. U.S. Food and Drug Administration, Center for Tobacco Products. “FDA Renews Authorization for Five IQOS Products to be Marketed with Exposure Modification Claims.” FDA, April 17, 2026. fda.gov
15. National Center for Complementary and Integrative Health. “Quitting Smoking With Complementary Health Approaches.” NIH, last updated January 2021. nccih.nih.gov