Tobacco smoking is the practice of smoking tobacco and inhaling
tobacco smoke (consisting of particle and gaseous phases). (A more
broad definition may include simply taking tobacco smoke into the
mouth, and then releasing it, as is done by some with tobacco pipes
and cigars.) The practice is believed to have begun as early as
5000–3000 BC in
Mesoamerica and South America.
Eurasia in the late 17th century by European colonists,
where it followed common trade routes. The practice encountered
criticism from its first import into the
Western world onwards but
embedded itself in certain strata of a number of societies before
becoming widespread upon the introduction of automated
German scientists identified a link between smoking and lung cancer in
the late 1920s, leading to the first anti-smoking campaign in modern
history, albeit one truncated by the collapse of
Nazi Germany at the
end of World War II. In 1950, British researchers demonstrated a
clear relationship between smoking and cancer. Evidence continued
to mount in the 1980s, which prompted political action against the
practice. Rates of consumption since 1965 in the developed world have
either peaked or declined. However, they continue to climb in the
Smoking is the most common method of consuming tobacco, and tobacco is
the most common substance smoked. The agricultural product is often
mixed with additives and then combusted. The resulting smoke is
then inhaled and the active substances absorbed through the alveoli in
the lungs or the oral mucosa.
Combustion was traditionally enhanced
by addition of potassium or other nitrates. Many
substances in cigarette smoke trigger chemical reactions in nerve
endings, which heighten heart rate, alertness and reaction time,
among other things.
Dopamine and endorphins are released, which
are often associated with pleasure. As of 2008 to 2010, tobacco is
used by about 49% of men and 11% of women aged 15 or older in fourteen
low-income and middle-income countries (Bangladesh, Brazil, China,
Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey,
Ukraine, Uruguay and Vietnam), with about 80% of this usage in the
form of smoking. The gender gap tends to be less pronounced in
lower age groups.
Many smokers begin during adolescence or early adulthood. During
the early stages, a combination of perceived pleasure acting as
positive reinforcement and desire to respond to social peer pressure
may offset the unpleasant symptoms of initial use, which typically
include nausea and coughing. After an individual has smoked for some
years, the avoidance of withdrawal symptoms and negative reinforcement
become the key motivations to continue.
In a study conducted by Jennifer O'Loughlin and colleagues, first
smoking experiences of seventh-grade students were studied. They
found out that the most common factor leading students to smoke is
Smoking by parents, siblings and friends
also encourages students to smoke.
1.1 Use in ancient cultures
1.3 Social attitudes and public health
5 Public policy
5.3 Ignition safety
6 Gateway drug theory
8 See also
11 External links
History of tobacco
History of tobacco and History of smoking
Use in ancient cultures
Aztec women are handed flowers and smoking tubes before eating at a
banquet, Florentine Codex, 16th century.
Smoking's history dates back to as early as 5000–3000 BC, when the
agricultural product began to be cultivated in
Mesoamerica and South
America; consumption later evolved into burning the plant substance
either by accident or with intent of exploring other means of
consumption. The practice worked its way into shamanistic
rituals. Many ancient civilizations — such as the Babylonians,
the Indians, and the Chinese — burnt incense during religious
Smoking in the Americas probably had its origins in the
incense-burning ceremonies of shamans but was later adopted for
pleasure or as a social tool. The smoking of tobacco and various
hallucinogenic drugs was used to achieve trances and to come into
contact with the spirit world.
Eastern North American tribes would carry large amounts of tobacco in
pouches as a readily accepted trade item and would often smoke it in
ceremonial pipes, either in sacred ceremonies or to seal bargains.
Adults as well as children enjoyed the practice. It was believed
that tobacco was a gift from the Creator and that the exhaled tobacco
smoke was capable of carrying one's thoughts and prayers to
Apart from smoking, tobacco had a number of uses as medicine. As a
pain killer it was used for earache and toothache and occasionally as
Smoking was said by the desert Indians to be a cure for
colds, especially if the tobacco was mixed with the leaves of the
small desert Sage, Salvia dorrii, or the root of Indian balsam or
cough root, Leptotaenia multifida, the addition of which was thought
to be particularly good for asthma and tuberculosis.
For more about the commercial development of tobacco, see History of
commercial tobacco in the United States.
Smoking and Playing Backgammon in an Interior by Dirck Hals,
In 1612, six years after the settlement of Jamestown, Virginia, John
Rolfe was credited as the first settler to successfully raise tobacco
as a cash crop. The demand quickly grew as tobacco, referred to as
"brown gold", revived the
Virginia joint stock company
Virginia joint stock company from its failed
gold expeditions. In order to meet demands from the Old World,
tobacco was grown in succession, quickly depleting the soil. This
became a motivator to settle west into the unknown continent, and
likewise an expansion of tobacco production. Indentured servitude
became the primary labor force up until Bacon's Rebellion, from which
the focus turned to slavery. This trend abated following the
American Revolution as slavery became regarded as unprofitable.
However, the practice was revived in 1794 with the invention of the
Jean Nicot (from whose name the word nicotine is derived)
introduced tobacco to France in 1560, and tobacco then spread to
England. The first report of a smoking Englishman is of a sailor in
Bristol in 1556, seen "emitting smoke from his nostrils". Like tea,
coffee and opium, tobacco was just one of many intoxicants that was
originally used as a form of medicine.
Tobacco was introduced
around 1600 by French merchants in what today is modern-day
Senegal. At the same time, caravans from
Morocco brought tobacco to
the areas around Timbuktu, and the Portuguese brought the commodity
(and the plant) to southern Africa, establishing the popularity of
tobacco throughout all of Africa by the 1650s.
Soon after its introduction to the Old World, tobacco came under
frequent criticism from state and religious leaders. James VI and I,
King of Scotland and England, produced the treatise A Counterblaste to
Tobacco in 1604, and also introduced excise duty on the product. Murad
IV, sultan of the
Ottoman Empire 1623–40 was among the first to
attempt a smoking ban by claiming it was a threat to public morals and
Chongzhen Emperor of China issued an edict banning smoking
two years before his death and the overthrow of the Ming dynasty.
Later, the Manchu rulers of the Qing dynasty, would proclaim smoking
"a more heinous crime than that even of neglecting archery". In Edo
period Japan, some of the earliest tobacco plantations were scorned by
the shogunate as being a threat to the military economy by letting
valuable farmland go to waste for the use of a recreational drug
instead of being used to plant food crops.
Bonsack's cigarette rolling machine, as shown on U.S. patent 238,640.
Religious leaders have often been prominent among those who considered
smoking immoral or outright blasphemous. In 1634, the Patriarch of
Moscow forbade the sale of tobacco, and sentenced men and women who
flouted the ban to have their nostrils slit and their backs flayed.
Urban VIII likewise condemned smoking on holy places in a papal
bull of 1624. Despite some concerted efforts, restrictions and bans
were largely ignored. When James I of England, a staunch anti-smoker
and the author of A Counterblaste to Tobacco, tried to curb the new
trend by enforcing a 4000% tax increase on tobacco in 1604 it was
unsuccessful, as suggested by the presence of around 7,000 tobacco
outlets in London by the early 17th century. From this point on for
some centuries, several administrations withdrew from efforts at
discouragement and instead turned tobacco trade and cultivation into
sometimes lucrative government monopolies.
By the mid-17th century most major civilizations had been introduced
to tobacco smoking and in many cases had already assimilated it into
the native culture, despite some continued attempts upon the parts of
rulers to eliminate the practice with penalties or fines. Tobacco,
both product and plant, followed the major trade routes to major ports
and markets, and then on into the hinterlands. The English language
term smoking appears to have entered currency in the late 18th
century, before which less abbreviated descriptions of the practice
such as drinking smoke were also in use.
Growth in the US remained stable until the American Civil War in
1860s, when the primary agricultural workforce shifted from slavery to
sharecropping. This, along with a change in demand, accompanied the
industrialization of cigarette production as craftsman James Bonsack
created a machine in 1881 to partially automate their manufacture.
Social attitudes and public health
Newsies smoking at Skeeter's Branch, St. Louis, MO. Photograph by
Lewis Hine, 1910
In Germany, anti-smoking groups, often associated with anti-liquor
groups, first published advocacy against the consumption of
tobacco in the journal Der Tabakgegner (The
Tobacco Opponent) in 1912
and 1932. In 1929,
Fritz Lickint of Dresden, Germany, published a
paper containing formal statistical evidence of a lung
cancer–tobacco link. During the Great Depression Adolf Hitler
condemned his earlier smoking habit as a waste of money, and later
with stronger assertions. This movement was further strengthened with
Nazi reproductive policy as women who smoked were viewed as unsuitable
to be wives and mothers in a German family.
The anti-tobacco movement in
Nazi Germany did not reach across enemy
lines during the Second World War, as anti-smoking groups quickly lost
popular support. By the end of the Second World War, American
cigarette manufacturers quickly reentered the German black market.
Illegal smuggling of tobacco became prevalent, and leaders of the
Nazi anti-smoking campaign were silenced. As part of the Marshall
Plan, the United States shipped free tobacco to Germany; with 24,000
tons in 1948 and 69,000 tons in 1949. Per capita yearly
cigarette consumption in post-war
Germany steadily rose from 460 in
1950 to 1,523 in 1963. By the end of the 20th century, anti-smoking
Germany were unable to exceed the effectiveness of the
Nazi-era climax in the years 1939–41 and German tobacco health
research was described by
Robert N. Proctor
Robert N. Proctor as "muted".
A lengthy study conducted in order to establish the strong association
necessary for legislative action (US cigarette consumption per person
blue, male lung cancer rate green)
Richard Doll published research in the British Medical
Journal showing a close link between smoking and lung cancer.
Beginning in December 1952, the magazine
Reader's Digest published
Cancer by the Carton", a series of articles that linked smoking with
In 1954, the British Doctors Study, a prospective study of some 40
thousand doctors for about 2.5 years, confirmed the suggestion, based
on which the government issued advice that smoking and lung cancer
rates were related. In January 1964, the United States Surgeon
General's Report on
Smoking and Health likewise began suggesting the
relationship between smoking and cancer.
As scientific evidence mounted in the 1980s, tobacco companies claimed
contributory negligence as the adverse health effects were previously
unknown or lacked substantial credibility. Health authorities sided
with these claims up until 1998, from which they reversed their
Tobacco Master Settlement Agreement, originally between
the four largest US tobacco companies and the Attorneys General of 46
states, restricted certain types of tobacco advertisement and required
payments for health compensation; which later amounted to the largest
civil settlement in United States history.
Social campaigns have been instituted in many places to discourage
smoking, such as Canada's National Non-
From 1965 to 2006, rates of smoking in the United States declined from
42% to 20.8%. The majority of those who quit were professional,
affluent men. Although the per-capita number of smokers decreased, the
average number of cigarettes consumed per person per day increased
from 22 in 1954 to 30 in 1978. This paradoxical event suggests that
those who quit smoked less, while those who continued to smoke moved
to smoke more light cigarettes. The trend has been paralleled by
many industrialized nations as rates have either leveled-off or
declined. In the developing world, however, tobacco consumption
continues to rise at 3.4% in 2002. In Africa, smoking is in most
areas considered to be modern, and many of the strong adverse opinions
that prevail in the West receive much less attention. Today Russia
leads as the top consumer of tobacco followed by Indonesia, Laos,
Ukraine, Belarus, Greece, Jordan, and China.
For more about the production of the agricultural product, see
Cultivation of tobacco, Types of tobacco, Curing of tobacco, and
Tobacco is an agricultural product processed from the fresh leaves of
plants in the genus Nicotiana. The genus contains a number of species,
Nicotiana tabacum is the most commonly grown. Nicotiana
rustica follows as second containing higher concentrations of
nicotine. These leaves are harvested and cured to allow for the slow
oxidation and degradation of carotenoids in tobacco leaf. This
produces certain compounds in the tobacco leaves which can be
attributed to sweet hay, tea, rose oil, or fruity aromatic flavors.
Before packaging, the tobacco is often combined with other additives
in order to enhance the addictive potency, shift the products pH, or
improve the effects of smoke by making it more palatable. In the
United States these additives are regulated to 599 substances. The
product is then processed, packaged, and shipped to consumer markets.
Tobacco field in Intercourse, Pennsylvania.
Basma leaves curing in the sun at
Pomak village of Xanthi, Thrace,
Processed tobacco pressed into flakes for pipe smoking.
Beedis are thin South Asian cigarettes filled with tobacco flakes and
wrapped in a tendu leaf tied with a string at one end. They produce
higher levels of carbon monoxide, nicotine, and tar than cigarettes
typical in the United States.
Tendu Patta (Leaf) Collection for
Cigars are tightly rolled bundles of dried and fermented tobacco which
are ignited so that smoke may be drawn into the smoker's mouth. They
are generally not inhaled because of the high alkalinity of the smoke,
which can quickly become irritating to the trachea and lungs. The
prevalence of cigar smoking varies depending on location, historical
period, and population surveyed, and prevalence estimates vary
somewhat depending on the survey method. The United States is the top
consuming country by far, followed by
Germany and the United Kingdom;
the US and Western Europe account for about 75% of cigar sales
worldwide. As of 2005 it is estimated that 4.3% of men and 0.3% of
women smoke cigars in the USA.
Cigarettes, French for "small cigar", are a product consumed through
smoking and manufactured out of cured and finely cut tobacco leaves
and reconstituted tobacco, often combined with other additives, which
are then rolled or stuffed into a paper-wrapped cylinder.
Cigarettes are ignited and inhaled, usually through a cellulose
acetate filter, into the mouth and lungs.
Hookah are a single or multi-stemmed (often glass-based) water pipe
for smoking. Originally from India. The hookah was a symbol of pride
and honor for the landlords, kings and other such high class people.
Now, the hookah has gained immense popularity, especially in the
Middle East. A hookah operates by water filtration and indirect heat.
It can be used for smoking herbal fruits, tobacco, or cannabis.
Kretek are cigarettes made with a complex blend of tobacco, cloves and
a flavoring "sauce". It was first introduced in the 1880s in Kudus,
Java, to deliver the medicinal eugenol of cloves to the lungs. The
quality and variety of tobacco play an important role in kretek
production, from which kretek can contain more than 30 types of
tobacco. Minced dried clove buds weighing about one-third of the
tobacco blend are added to add flavoring. In 2004 the United States
prohibited cigarettes from having a "characterizing flavor" of certain
ingredients other than tobacco and menthol, thereby removing kretek
from being classified as cigarettes.
Passive smoking is the usually involuntary consumption of smoked
Second-hand smoke (SHS) is the consumption where the burning
end is present, environmental tobacco smoke (ETS) or third-hand smoke
is the consumption of the smoke that remains after the burning end has
been extinguished. Because of its perceived negative implications,
this form of consumption has played a central role in the regulation
of tobacco products.
Pipe smoking typically consists of a small chamber (the bowl) for the
combustion of the tobacco to be smoked and a thin stem (shank) that
ends in a mouthpiece (the bit). Shredded pieces of tobacco are placed
into the chamber and ignited.
Roll-your-own or hand-rolled cigarettes, often called "rollies",
"cigi" or "Roll-ups", are very popular particularly in European
countries and the UK. These are prepared from loose tobacco, cigarette
papers, and filters all bought separately. They are usually much
cheaper than ready-made cigarettes and small contraptions can be
bought making the process easier.
A vaporizer is a device used to sublimate the active ingredients of
plant material. Rather than burning the herb, which produces
potentially irritating, toxic, or carcinogenic by-products; a
vaporizer heats the material in a partial vacuum so that the active
compounds contained in the plant boil off into a vapor. This method is
often preferable when medically administrating the smoke substance, as
opposed to directly pyrolyzing the plant material.
See also: Chain smoking
A graph that shows the efficiency of smoking as a way to absorb
nicotine compared to other forms of intake.
The active substances in tobacco, especially cigarettes, are
administered by burning the leaves and inhaling the vaporized gas that
results. This quickly and effectively delivers substances into the
bloodstream by absorption through the alveoli in the lungs. The lungs
contain some 300 million alveoli, which amounts to a surface area of
over 70 m2 (about the size of a tennis court). This method is not
completely efficient as not all of the smoke will be inhaled, and some
amount of the active substances will be lost in the process of
combustion, pyrolysis. Pipe and
Cigar smoke are not inhaled because
of its high alkalinity, which are irritating to the trachea and lungs.
However, because of its higher alkalinity (pH 8.5) compared to
cigarette smoke (pH 5.3), non-ionized nicotine is more readily
absorbed through the mucous membranes in the mouth. Nicotine
absorption from cigar and pipe, however, is much less than that from
Nicotine and cocaine activate similar patterns of
neurons, which supports the existence of common substrates among these
The inhaled nicotine mimics nicotinic acetylcholine which when bound
to nicotinic acetylcholine receptors prevents the reuptake of
acetylcholine thereby increasing that neurotransmitter in those areas
of the body. These nicotinic acetylcholine receptors are located
in the central nervous system and at the nerve-muscle junction of
skeletal muscles; whose activity increases heart rate, alertness,
and faster reaction times.
Nicotine acetylcholine stimulation is
not directly addictive. However, since dopamine-releasing neurons are
abundant on nicotine receptors, dopamine is released; and, in the
nucleus accumbens, dopamine is associated with motivation causing
Dopamine increase, in the prefrontal cortex,
may also increase working memory.
When tobacco is smoked, most of the nicotine is pyrolyzed. However, a
dose sufficient to cause mild somatic dependency and mild to strong
psychological dependency remains. There is also a formation of harmane
(a MAO inhibitor) from the acetaldehyde in tobacco smoke. This may
play a role in nicotine addiction, by facilitating a dopamine release
in the nucleus accumbens as a response to nicotine stimuli. Using
rat studies, withdrawal after repeated exposure to nicotine results in
less responsive nucleus accumbens cells, which produce dopamine
responsible for reinforcement.
Main article: Prevalence of tobacco consumption
Percentage of females smoking any tobacco product
Percentage of males smoking any tobacco product. Note that there is a
difference between the scales used for females and the scales used for
As of 2000, smoking was practiced by around 1.22 billion people. At
current rates of 'smoker replacement' and market growth, this may
reach around 1.9 billion in 2025.
Smoking may be up to five times more prevalent among men than women in
some communities, although the gender gap usually declines with
younger age. In some developed countries smoking rates for men
have peaked and begun to decline, while for women they continue to
As of 2002, about twenty percent of young teenagers (13–15) smoked
worldwide. From which 80,000 to 100,000 children begin smoking every
day, roughly half of whom live in Asia. Half of those who begin
smoking in adolescent years are projected to go on to smoke for 15 to
World Health Organization
World Health Organization (WHO) states that "Much of the disease
burden and premature mortality attributable to tobacco use
disproportionately affect the poor". Of the 1.22 billion smokers, 1
billion of them live in developing or transitional economies. Rates of
smoking have leveled off or declined in the developed world. In
the developing world, however, tobacco consumption is rising by 3.4%
per year as of 2002.
The WHO in 2004 projected 58.8 million deaths to occur globally,
from which 5.4 million are tobacco-attributed, and 4.9 million as
of 2007. As of 2002, 70% of the deaths are in developing
countries. As of 2017, smoking causes one in ten deaths worldwide,
with half of those deaths in the US, China, India and Russia.
Sigmund Freud, whose doctor assisted his suicide because of oral
cancer caused by smoking
Most smokers begin smoking during adolescence or early adulthood. Some
studies also show that smoking can also be linked to various mental
Smoking has elements of risk-taking and
rebellion, which often appeal to young people. The presence of peers
that smoke and media featuring high-status models smoking may also
encourage smoking. Because teenagers are influenced more by their
peers than by adults, attempts by parents, schools, and health
professionals at preventing people from trying cigarettes are often
Children of smoking parents are more likely to smoke than children
with non-smoking parents. Children of parents who smoke are less
likely to quit smoking. One study found that parental smoking
cessation was associated with less adolescent smoking, except when the
other parent currently smoked. A current study tested the relation
of adolescent smoking to rules regulating where adults are allowed to
smoke in the home. Results showed that restrictive home smoking
policies were associated with lower likelihood of trying smoking for
both middle and high school students.
Behavioural research generally indicates that teenagers begin their
smoking habits due to peer pressure, and cultural influence portrayed
by friends. However, one study found that direct pressure to smoke
cigarettes played a less significant part in adolescent smoking, with
adolescents also reporting low levels of both normative and direct
pressure to smoke cigarettes. Mere exposure to tobacco retailers
may motivate smoking behaviour in adults. A similar study
suggested that individuals may play a more active role in starting to
smoke than has previously been thought and that social processes other
than peer pressure also need to be taken into account. Another
study's results indicated that peer pressure was significantly
associated with smoking behavior across all age and gender cohorts,
but that intrapersonal factors were significantly more important to
the smoking behavior of 12- to 13-year-old girls than same-age boys.
Within the 14- to 15-year-old age group, one peer pressure variable
emerged as a significantly more important predictor of girls' than
boys' smoking. It is debated whether peer pressure or
self-selection is a greater cause of adolescent smoking.
Psychologists such as
Hans Eysenck have developed a personality
profile for the typical smoker.
Extraversion is the trait that is most
associated with smoking, and smokers tend to be sociable, impulsive,
risk taking, and excitement seeking individuals. Although
personality and social factors may make people likely to smoke, the
actual habit is a function of operant conditioning. During the early
stages, smoking provides pleasurable sensations (because of its action
on the dopamine system) and thus serves as a source of positive
The reasons given by some smokers for this activity have been
categorized as addictive smoking, pleasure from smoking, tension
reduction/relaxation, social smoking, stimulation, habit/automatism,
and handling. There are gender differences in how much each of these
reasons contribute, with females more likely than males to cite
tension reduction/relaxation, stimulation and social smoking.
Some smokers argue that the depressant effect of smoking allows them
to calm their nerves, often allowing for increased concentration.
However, according to the Imperial College London, "
Nicotine seems to
provide both a stimulant and a depressant effect, and it is likely
that the effect it has at any time is determined by the mood of the
user, the environment and the circumstances of use. Studies have
suggested that low doses have a depressant effect, while higher doses
have stimulant effect."
A number of studies have established that cigarette sales and smoking
follow distinct time-related patterns. For example, cigarette sales in
the United States of America have been shown to follow a strongly
seasonal pattern, with the high months being the months of summer, and
the low months being the winter months.
Similarly, smoking has been shown to follow distinct circadian
patterns during the waking day—with the high point usually occurring
shortly after waking in the morning, and shortly before going to sleep
In countries where there is a universally funded healthcare system,
the government covers the cost of medical care for smokers who become
ill through smoking in the form of increased taxes. Two broad debating
positions exist on this front, the "pro-smoking" argument suggesting
that heavy smokers generally don't live long enough to develop the
costly and chronic illnesses which affect the elderly, reducing
society's healthcare burden, and the "anti-smoking" argument suggests
that the healthcare burden is increased because smokers get chronic
illnesses younger and at a higher rate than the general population.
Data on both positions has been contested. The Centers for Disease
Control and Prevention published research in 2002 claiming that the
cost of each pack of cigarettes sold in the United States was more
than $7 in medical care and lost productivity. The cost may be
higher, with another study putting it as high as $41 per pack, most of
which however is on the individual and his/her family. This is how
one author of that study puts it when he explains the very low cost
for others: "The reason the number is low is that for private
pensions, Social Security, and Medicare — the biggest factors in
calculating costs to society — smoking actually saves money. Smokers
die at a younger age and don't draw on the funds they've paid into
those systems." Other research demonstrates that premature death
caused by smoking may redistribute Social Security income in
unexpected ways that affect behavior and reduce the economic
well-being of smokers and their dependents. To further support
this, whatever the rate of smoking consumption is per day, smokers
have a greater lifetime medical cost on average compared to a non
smoker by an estimated $6000  Between the cost for lost
productivity and health care expenditures combined, cigarette smoking
costs at least 193 billion dollars (Research also shows that smokers
earn less money than nonsmokers). As for secondhand smoke, the
cost is over 10 billion dollars.
By contrast, some non-scientific studies, including one conducted by
Philip Morris in the
Czech Republic called Public Finance Balance of
Smoking in the Czech Republic and another by the Cato
Institute, support the opposite position. Philip Morris has
explicitly apologised for the former study, saying: "The funding and
public release of this study which, among other things, detailed
purported cost savings to the
Czech Republic due to premature deaths
of smokers, exhibited terrible judgment as well as a complete and
unacceptable disregard of basic human values. For one of our tobacco
companies to commission this study was not just a terrible mistake, it
was wrong. All of us at Philip Morris, no matter where we work, are
extremely sorry for this. No one benefits from the very real, serious
and significant diseases caused by smoking."
Between 1970 and 1995, per-capita cigarette consumption in poorer
developing countries increased by 67 percent, while it dropped by 10
percent in the richer developed world. Eighty percent of smokers now
live in less developed countries. By 2030, the World Health
Organization (WHO) forecasts that 10 million people a year will die of
smoking-related illness, making it the single biggest cause of death
worldwide, with the largest increase to be among women. WHO forecasts
the 21st century's death rate from smoking to be ten times the 20th
century's rate ("Washingtonian" magazine, December 2007).
Main article: Health effects of tobacco
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Cigarette smoking is the leading cause of preventable death and a
major public health concern.
There are 1.1 billion tobacco users in the world. One person dies
every six seconds from a tobacco related disease.
Common adverse effects of tobacco smoking. The more common effects are
in bold face.
Tobacco use leads most commonly to diseases affecting the heart and
lungs, with smoking being a major risk factor for heart attacks,
strokes, chronic obstructive pulmonary disease (COPD), Idiopathic
Pulmonary Fibrosis (IPF), emphysema, and cancer (particularly lung
cancer, cancers of the larynx and mouth, esophageal cancer and
Cigarette smoking increases the risk of
Crohn's disease as well as the severity of the course of the
disease. It is also the number one cause of bladder cancer. The
smoke from tobacco elicits carcinogenic effects on the tissues of the
body that are exposed to the smoke.
Tobacco smoke is a complex mixture of over 5,000 identified chemicals,
of which 98 are known to have specific toxicological
properties. The most important chemicals causing cancer are
those that produce DNA damage since such damage appears to be the
primary underlying cause of cancer. Cunningham et al.
combined the microgram weight of the compound in the smoke of one
cigarette with the known genotoxic effect per microgram to identify
the most carcinogenic compounds in cigarette smoke. The seven most
important carcinogens in tobacco smoke are shown in the table, along
with DNA alterations they cause.
The most genotoxic cancer causing chemicals in cigarette smoke
Micrograms per cigarette
Effect on DNA
Reacts with deoxyguanosine and forms DNA crosslinks, DNA-protein
crosslinks and DNA adducts
DNA-protein crosslinks causing chromosome deletions and
Oxidative stress causing increased 8-oxo-2'-deoxyguanosine
Global loss of DNA methylation (an epigenetic effect) as well as DNA
Reacts with deoxyguanine to form DNA adducts
Hydroxyethyl DNA adducts with adenine and guanine
Single and double strand breaks in DNA
See also: polycyclic aromatic hydrocarbons
Tobacco smoke can combine with other carcinogens present within the
environment in order to produce elevated degrees of lung cancer.
Cigarette smoking has also been associated with sarcopenia, the
age-related loss of muscle mass and strength.
World Health Organization
World Health Organization estimates that tobacco caused 5.4
million deaths in 2004 and 100 million deaths over the course of
the 20th century. Similarly, the United States Centers for
Disease Control and Prevention describes tobacco use as "the single
most important preventable risk to human health in developed countries
and an important cause of premature death worldwide." Although
70% of smokers state their intention to quit only 3-5% are actually
successful in doing so.
The probabilities of death from lung cancer before age 75 in the
United Kingdom are 0.2% for men who never smoked (0.4% for women),
5.5% for male former smokers (2.6% in women), 15.9% for current male
smokers (9.5% for women) and 24.4% for male “heavy smokers”
defined as smoking more than 5 cigarettes per day (18.5% for
Tobacco smoke can combine with other carcinogens present
within the environment in order to produce elevated degrees of lung
Rates of smoking have generally leveled-off or declined in the
Smoking rates in the United States have dropped by
half from 1965 to 2006 falling from 42% to 20.8% in adults. In
the developing world, tobacco consumption is rising by 3.4% per
Second-hand smoke presents a known health risk, to which six hundred
thousand deaths were attributed in 2004. It also has been known to
produce skin conditions such as freckles and dryness.
In 2015, a meta-analysis found that smokers were at greater risk of
developing psychotic illness.
Tobacco has also been described an
anaphrodisiac due to its propensity for causing erectile
Tobacco advertising and Religious views on smoking
Famous smokers of the past used cigarettes or pipes as part of their
image, such as Jean-Paul Sartre's Gauloises-brand cigarettes; Albert
Einstein's, Douglas MacArthur's, Bertrand Russell's, and Bing Crosby's
pipes; or the news broadcaster Edward R. Murrow's cigarette. Writers
in particular seem to be known for smoking, for example, Cornell
Professor Richard Klein's book Cigarettes are Sublime for the
analysis, by this professor of French literature, of the role smoking
plays in 19th and 20th century letters. The popular author Kurt
Vonnegut addressed his addiction to cigarettes within his novels.
British Prime Minister
Harold Wilson was well known for smoking a pipe
in public as was
Winston Churchill for his cigars. Sherlock Holmes,
the fictional detective created by
Sir Arthur Conan Doyle
Sir Arthur Conan Doyle smoked a
pipe, cigarettes, and cigars. The DC Vertigo comic book character,
John Constantine, created by Alan Moore, is synonymous with smoking,
so much so that the first storyline by Preacher creator, Garth Ennis,
John Constantine contracting lung cancer. Professional
wrestler James Fullington, while in character as "The Sandman", is a
chronic smoker in order to appear "tough".
The problem of smoking at home is particularly difficult for women in
many cultures (especially Arab cultures), where it may not be
acceptable for a woman to ask her husband not to smoke at home or in
the presence of her children. Studies have shown that pollution levels
for smoking areas indoors are higher than levels found on busy
roadways, in closed motor garages, and during fire
storms.[clarification needed] Furthermore, smoke can spread from one
room to another, even if doors to the smoking area are closed.
The ceremonial smoking of tobacco, and praying with a sacred pipe, is
a prominent part of the religious ceremonies of a number of Native
American Nations. Sema, the
Anishinaabe word for tobacco, is grown for
ceremonial use and considered the ultimate sacred plant since its
smoke is believed to carry prayers to the spirits. In most major
religions, however, tobacco smoking is not specifically prohibited,
although it may be discouraged as an immoral habit. Before the health
risks of smoking were identified through controlled study, smoking was
considered an immoral habit by certain Christian preachers and social
reformers. The founder of the Latter Day Saint movement, Joseph Smith,
recorded that on 27 February 1833, he received a revelation which
discouraged tobacco use. This "Word of Wisdom" was later accepted as a
commandment, and faithful Latter-day Saints abstain completely from
tobacco. Jehovah's Witnesses base their stand against smoking on
the Bible's command to "clean ourselves of every defilement of flesh"
(2 Corinthians 7:1). The Jewish Rabbi
Yisrael Meir Kagan
Yisrael Meir Kagan (1838–1933)
was one of the first Jewish authorities to speak out on smoking. In
Ahmadiyya Islam, smoking is highly discouraged, although not
forbidden. During the month of fasting however, it is forbidden to
smoke tobacco. In the Bahá'í Faith, smoking tobacco is too
discouraged though not forbidden.
On 27 February 2005 the WHO Framework Convention on
took effect. The FCTC is the world's first public health treaty.
Countries that sign on as parties agree to a set of common goals,
minimum standards for tobacco control policy, and to cooperate in
dealing with cross-border challenges such as cigarette smuggling.
Currently the WHO declares that 4 billion people will be covered by
the treaty, which includes 168 signatories. Among other steps,
signatories are to put together legislation that will eliminate
secondhand smoke in indoor workplaces, public transport, indoor public
places and, as appropriate, other public places.
Cigarette taxes in the United States
Many governments have introduced excise taxes on cigarettes in order
to reduce the consumption of cigarettes.
In 2002, the
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention said that each
pack of cigarettes sold in the United States costs the nation more
than $7 in medical care and lost productivity, around $3400 per
year per smoker. Another study by a team of health economists finds
the combined price paid by their families and society is about $41 per
pack of cigarettes.
Substantial scientific evidence shows that higher cigarette prices
result in lower overall cigarette consumption. Most studies indicate
that a 10% increase in price will reduce overall cigarette consumption
by 3% to 5%. Youth, minorities, and low-income smokers are two to
three times more likely to quit or smoke less than other smokers in
response to price increases.
Smoking is often cited[citation
needed] as an example of an inelastic good, however, i.e. a large rise
in price will only result in a small decrease in consumption.
Many nations have implemented some form of tobacco taxation. As of
1997, Denmark had the highest cigarette tax burden of $4.02 per pack.
Taiwan only had a tax burden of $0.62 per pack. The federal government
of the United States charges $1.01 per pack.
Cigarette taxes vary widely from state to state in the United States.
Missouri has a cigarette tax of only 17 cents per pack,
the nation's lowest, while New York has the highest cigarette tax in
the U.S.: $4.35 per pack. In Alabama, Illinois, Missouri, New York
City, Tennessee, and Virginia, counties and cities may impose an
additional limited tax on the price of cigarettes. Sales taxes
are also levied on tobacco products in most jurisdictions.
In the United Kingdom, a packet of 20 cigarettes typically costs
between £5.22 and £8.00 at 2007 prices, depending on the brand
purchased and where the purchase was made. The UK has a
significant black market for tobacco, and it has been estimated by the
tobacco industry that 27% of cigarette and 68% of handrolling tobacco
consumption is non-UK duty paid (NUKDP).
In Australia total taxes account for 62.5% of the final price of a
packet of cigarettes (2011 figures). These taxes include federal
excise or customs duty and Goods and Services Tax.
An enclosed smoking area in a Japanese train station. Notice the air
vent on the roof.
Tobacco packaging warning
messages, Plain tobacco packaging, and
In June 1967, the US
Federal Communications Commission
Federal Communications Commission ruled that
programmes broadcast on a television station which discussed smoking
and health were insufficient to offset the effects of paid
advertisements that were broadcast for five to ten minutes each day.
In April 1970, the US Congress passed the Public Health Cigarette
Smoking Act banning the advertising of cigarettes on television and
radio starting on 2 January 1971.
Tobacco Advertising Prohibition Act 1992 expressly prohibited
almost all forms of
Tobacco advertising in Australia, including the
sponsorship of sporting or other cultural events by cigarette brands.
All tobacco advertising and sponsorship on television has been banned
within the European Union since 1991 under the
Frontiers Directive (1989). This ban was extended by the Tobacco
Advertising Directive, which took effect in July 2005 to cover other
forms of media such as the internet, print media, and radio. The
directive does not include advertising in cinemas and on billboards or
using merchandising – or tobacco sponsorship of cultural and
sporting events which are purely local, with participants coming from
only one Member State as these fall outside the jurisdiction of
the European Commission. However, most member states have transposed
the directive with national laws that are wider in scope than the
directive and cover local advertising. A 2008 European Commission
report concluded that the directive had been successfully transposed
into national law in all EU member states, and that these laws were
Some countries also impose legal requirements on the packaging of
tobacco products. For example, in the countries of the European Union,
Turkey, Australia and South Africa, cigarette packs must be
prominently labeled with the health risks associated with
smoking. Canada, Australia, Thailand,
also imposed labels upon cigarette packs warning smokers of the
effects, and they include graphic images of the potential health
effects of smoking. Cards are also inserted into cigarette packs in
Canada. There are sixteen of them, and only one comes in a pack. They
explain different methods of quitting smoking. Also, in the United
Kingdom, there have been a number of graphic NHS advertisements, one
showing a cigarette filled with fatty deposits, as if the cigarette is
symbolizing the artery of a smoker.
Many countries have a smoking age. In many countries, including the
United States, most European Union member states, New Zealand, Canada,
South Africa, Israel, India, Brazil, Chile, Costa Rica and
Australia, it is illegal to sell tobacco products to minors and in the
Netherlands, Austria, Belgium, Denmark and South Africa it is illegal
to sell tobacco products to people under the age of 16. On 1 September
2007 the minimum age to buy tobacco products in
Germany rose from 16
to 18, as well as in the United Kingdom where on 1 October 2007 it
rose from 16 to 18. Underlying such laws is the belief that
people should make an informed decision regarding the risks of tobacco
use. These laws have a lax enforcement in some nations and states. In
China, Turkey, and many other countries usually a child will have
little problem buying tobacco products, because they are often told to
go to the store to buy tobacco for their parents.
Several countries such as Ireland, Latvia, Estonia, the Netherlands,
Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore,
Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United
Malta have legislated against smoking in
public places, often including bars and restaurants. Restaurateurs
have been permitted in some jurisdictions to build designated smoking
areas (or to prohibit smoking). In the United States, many states
prohibit smoking in restaurants, and some also prohibit smoking in
bars. In provinces of Canada, smoking is illegal in indoor workplaces
and public places, including bars and restaurants. As of 31 March 2008
Canada has introduced a smoke-free law ban in all public places, as
well as within 10 metres of an entrance to any public place. In
Australia, smoke-free laws vary from state to state. Currently,
Queensland has completely smoke-free indoor public places (including
workplaces, bars, pubs and eateries) as well as patrolled beaches and
some outdoor public areas. There are, however, exceptions for
designated smoking areas. In Victoria, smoking is restricted in
railway stations, bus stops and tram stops as these are public
locations where second-hand smoke can affect non-smokers waiting for
public transport, and since 1 July 2007 is now extended to all indoor
public places. In New Zealand and Brazil, smoking is restricted in
enclosed public places including bars, restaurants and pubs. Hong Kong
restricted smoking on 1 January 2007 in the workplace, public spaces
such as restaurants, karaoke rooms, buildings, and public parks (bars
which do not admit minors were exempt until 2009). In
is illegal in trains, metro stations, public institutions (except
where designated, usually outside) and public transport. In Germany,
additionally to smoking bans in public buildings and transports, an
anti-smoking ordinance for bars and restaurants was implemented in
late 2007. A study by the University of Hamburg (Ahlfeldt and Maennig
2010) demonstrates, that the smoking ban had, if any, only short run
impacts on bar and restaurant revenues. In the medium and long run no
negative effect was measurable. The results suggest either, that the
consumption in bars and restaurants is not affected by smoking bans in
the long run, or, that negative revenue impacts by smokers are
compensated by increasing revenues through non-smokers.
An indirect public health problem posed by cigarettes is that of
accidental fires, usually linked with consumption of alcohol. Enhanced
combustion using nitrates was traditionally used but cigarette
manufacturers have been silent on this subject claiming at first that
a safe cigarette was technically impossible, then that it could only
be achieved by modifying the paper. Roll your own cigarettes contain
no additives and are fire safe. Numerous fire safe cigarette designs
have been proposed, some by tobacco companies themselves, which would
extinguish a cigarette left unattended for more than a minute or two,
thereby reducing the risk of fire. Among American tobacco companies,
some have resisted this idea, while others have embraced it. RJ
Reynolds was a leader in making prototypes of these cigarettes in
1983 and will make all of their U.S. market cigarettes to be
fire-safe by 2010. Phillip Morris is not in active support of
Lorillard (purchased by RJ Reynolds), the US' 3rd-largest
tobacco company, seems to be ambivalent.
Gateway drug theory
Tobacco and other drugs and Gateway drug theory
The relationship between tobacco and other drug use has been
well-established, however the nature of this association remains
unclear. The two main theories are the phenotypic causation (gateway)
model and the correlated liabilities model. The causation model argues
that smoking is a primary influence on future drug use, while the
correlated liabilities model argues that smoking and other drug use
are predicated on genetic or environmental factors.
Smoking cessation, referred to as "quitting", is the action leading
towards abstinence of tobacco smoking. Methods of "quitting" include
advice from physicians or social workers, cold turkey, nicotine
replacement therapy, contingent vouchers, antidepressants,
hypnosis, self-help (mindfulness meditation), and support groups.
Cigarette smoking among college students
Cigarette smoking for weight loss
List of cigarette smoke carcinogens
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