From Wikipedia, the free encyclopedia
Marlboro's package of the ice blast cigarette
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. Tobacco was introduced to
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
cigarette-rolling apparatus.
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
developing world.
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
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.
A study of first smoking experiences of
seventh-grade
students found out that the most common factor leading students to
smoke is cigarette advertisements. Smoking by parents, siblings and
friends also encourages students to smoke.
History
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 rituals.
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 heaven.
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 a
poultice.
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.
Popularization
Gentlemen Smoking and Playing Backgammon in an Interior by Dirck Hals, 1627.
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 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 cotton gin.
Frenchman
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
Gambia and
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 health. The
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. Pope
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 campaigns in 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 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)
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 position. The
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.
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.
Consumption
Methods
Tobacco is an agricultural product processed from the fresh leaves of plants in the genus
Nicotiana. The genus contains a number of species, however,
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.
Processed tobacco pressed into flakes for pipe smoking.
- Beedi
- 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 Beedi industries
- Cigars
- 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
- 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
- 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
- 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
- Passive smoking
is the usually involuntary consumption of smoked tobacco. 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 negative implications, this form of
consumption has played a central role in the regulation of tobacco
products.
-
- Pipe smoking
- 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
- 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.
-
- Vaporizer
- 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.
Physiology
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 m
2
(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 cigarette smoke. Nicotine and cocaine activate similar patterns of neurons, which supports the existence of common
substrates among these drugs.
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.
Demographics
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 males.
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 climb.
As of 2002, about twenty percent of young teenagers (13–15)
smoked worldwide. 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 20 years.
The
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.
Psychology
Takeup
Most smokers begin smoking during adolescence or early adulthood.
Some studies also show that smoking can also be linked to various mental
health complications.
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 unsuccessful.
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 reinforcement.
Persistence
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."
Patterns
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
at night.
Economic
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).
Health
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 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.
Cigarette smoking has also been associated with sarcopenia, the age-related loss of muscle mass and strength.
The
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
women).
Tobacco smoke can combine with other carcinogens present within the
environment in order to produce elevated degrees of lung cancer.
Rates of smoking have generally leveled-off or declined in the
developed world. 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 year.
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 dysfunction.
Social
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 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, centered around 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. 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 (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 discouraged though not forbidden.
Incomes
One of
the largest global enterprises in the world is known to be the tobacco
industry. The six biggest tobacco companies made a combined profit of
$35.1 billion (Jha et al., 2014) in 2010.
Public policy
On 27 February 2005 the
WHO Framework Convention on Tobacco Control,
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.
Taxation
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 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 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. For example,
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 £8.00 to £12.00 according to 2018 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.
Restrictions
An enclosed smoking area in a Japanese train station. Notice the air vent on the roof.
In June 1967, the US
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.
The 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 Television Without
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 well implemented.
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, Iceland and Brazil have 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 Kingdom,
Slovenia,
Turkey and
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
Romania
smoking 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.
Ignition safety
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 it.
Lorillard (purchased by
RJ Reynolds), the US' 3rd-largest tobacco company, seems to be ambivalent.
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.
Cessation
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. A meta-analysis from 2018, conducted on 61
RCT,
showed that one year after people quit smoking with the assistance of
first‐line smoking cessation medications (and some behavioral help),
only a little under 20% of smokers remained sustained abstinence.
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