![Smoke (34942422652)](https://upload.wikimedia.org/wikipedia/commons/5/58/Smoke_%2834942422652%29.jpg)
Tobacco smoking is the practice of burning
tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
and ingesting the resulting
smoke
Smoke is a suspension of airborne particulates and gases emitted when a material undergoes combustion or pyrolysis, together with the quantity of air that is entrained or otherwise mixed into the mass. It is commonly an unwanted by-product ...
. The smoke may be inhaled, as is done with
cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
s, or simply released from the mouth, as is generally done with
pipes
Pipe(s), PIPE(S) or piping may refer to:
Objects
* Pipe (fluid conveyance), a hollow cylinder following certain dimension rules
** Piping, the use of pipes in industry
* Smoking pipe
** Tobacco pipe
* Half-pipe and quarter pipe, semi-circula ...
and
cigars
A cigar is a rolled bundle of dried and fermented tobacco leaves made to be smoked. Cigars are produced in a variety of sizes and shapes. Since the 20th century, almost all cigars are made of three distinct components: the filler, the binder le ...
. The practice is believed to have begun as early as 5000–3000 BC in
Mesoamerica
Mesoamerica is a historical region and cultural area in southern North America and most of Central America. It extends from approximately central Mexico through Belize, Guatemala, El Salvador, Honduras, Nicaragua, and northern Costa Rica. W ...
and
South America
South America is a continent entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere at the northern tip of the continent. It can also be described as the southe ...
.
Tobacco was introduced to
Eurasia
Eurasia (, ) is the largest continental area on Earth, comprising all of Europe and Asia. Primarily in the Northern and Eastern Hemispheres, it spans from the British Isles and the Iberian Peninsula in the west to the Japanese archipelago a ...
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
The Western world, also known as the West, primarily refers to the various nations and state (polity), states in the regions of Europe, North America, and Oceania. onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.
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
The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed ''lamina propria''. The oral cavity has sometimes been descri ...
.
Many substances in cigarette smoke
trigger chemical reactions in nerve endings, which heighten heart rate, alertness
and reaction time, among other things.
Dopamine
Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...
and
endorphin
Endorphins (contracted from endogenous morphine) are chemical signals in the brain that block the perception of pain and increase feelings of wellbeing. They are produced and stored in an area of the brain known as the pituitary gland.
Hist ...
s are released, which are often associated with pleasure.
German scientists identified a link between smoking and
lung cancer
Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...
in the late 1920s, leading to the first
anti-smoking campaign in modern history, albeit one truncated by the
collapse
Collapse or its variants may refer to:
Concepts
* Collapse (structural)
* Collapse (topology), a mathematical concept
* Collapsing manifold
* Collapse, the action of collapsing or telescoping objects
* Collapsing user interface elements
** ...
of
Nazi Germany
Nazi Germany (lit. "National Socialist State"), ' (lit. "Nazi State") for short; also ' (lit. "National Socialist Germany") (officially known as the German Reich from 1933 until 1943, and the Greater German Reich from 1943 to 1945) was ...
at the end of
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
.
In 1950, British researchers demonstrated a clear relationship between smoking and cancer.
Evidence continued to mount in the 1960s, which prompted political action against the practice. Rates of consumption since 1965 in the
developed world
A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...
have either peaked or declined.
However, they continue to climb in the developing world.
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, 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
Adolescence () is a transitional stage of physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated with the t ...
or
early adulthood
Emerging adulthood refers to a phase of the life span between late adolescence and early adulthood, as initially proposed by Jeffrey Arnett in a 2000 article from the ''American Psychologist''. It primarily describes people living in developed co ...
.
During the early stages, a combination of perceived pleasure acting as
positive reinforcement
In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
and desire to respond to social
peer pressure
Peer pressure is the direct or indirect influence on peers, i.e., members of social groups with similar interests, experiences, or social statuses. Members of a peer group are more likely to influence a person's beliefs, values, and behavior. A g ...
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
Withdrawal means "an act of taking out" and may refer to:
* Anchoresis (withdrawal from the world for religious or ethical reasons)
* ''Coitus interruptus'' (the withdrawal method)
* Drug withdrawal
* Social withdrawal
* Taking of money from a ban ...
symptoms and
negative reinforcement
In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
become the key motivations to continue.
A 2009 study of first smoking experiences of
seventh-grade
Seventh grade (or grade seven) is a year or level of education. The seventh grade is the eighth school year, the second or third year of middle school, and the first year of junior high school. Students are around 13-14 years old in this stage of ...
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 feast 1](https://upload.wikimedia.org/wikipedia/commons/c/cf/Aztec_feast_1.jpg)
Smoking's history dates back to as early as 5000–3000 BC, when the agricultural product began to be cultivated in
Mesoamerica
Mesoamerica is a historical region and cultural area in southern North America and most of Central America. It extends from approximately central Mexico through Belize, Guatemala, El Salvador, Honduras, Nicaragua, and northern Costa Rica. W ...
and
South America
South America is a continent entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere at the northern tip of the continent. It can also be described as the southe ...
; 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
Babylonia (; Akkadian: , ''māt Akkadī'') was an ancient Akkadian-speaking state and cultural area based in the city of Babylon in central-southern Mesopotamia (present-day Iraq and parts of Syria). It emerged as an Amorite-ruled state c. ...
, 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
Shamanism is a religious practice that involves a practitioner (shaman) interacting with what they believe to be a spirit world through altered states of consciousness, such as trance. The goal of this is usually to direct spirits or spiritu ...
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.
Also, to stimulate respiration,
tobacco smoke enema
The tobacco smoke enema, an insufflation of tobacco smoke into the rectum by enema, was a medical treatment employed by European physicians for a range of ailments.
Tobacco was recognised as a medicine soon after it was first imported from the N ...
s were used.
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 pipe
A ceremonial pipe is a particular type of smoking pipe, used by a number of cultures of the indigenous peoples of the Americas in their sacred ceremonies. Traditionally they are used to offer prayers in a religious ceremony, to make a ceremonial ...
s, 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 uses as medicine. As a pain killer it was used for earache and toothache and occasionally as a
poultice
A poultice, also called a cataplasm, is a soft moist mass, often heated and medicated, that is spread on cloth and placed over the skin to treat an aching, inflamed, or painful part of the body. It can be used on wounds, such as cuts.
'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
''Salvia dorrii'', the purple sage, Dorr's sage, fleshy sage, mint sage, or tobacco sage, is a perennial spreading shrub in the family Lamiaceae. It is native to mountain areas in the western United States and northwestern Arizona, found mainly ...
'', or the root of
Indian balsam or
cough root
''Lomatium'' is a genus in the family Apiaceae. It consists of about 100 species native to western Northern America and northern Mexico. Its common names include biscuitroot, Indian parsley, and desert parsley. It is in the family Apiaceae and t ...
, ''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](https://upload.wikimedia.org/wikipedia/commons/d/da/Gentlemen_Smoking_and_Playing_Backgammon_in_an_Interior.jpg)
In 1612, six years after the settlement of
Jamestown, Virginia
The Jamestown settlement in the Colony of Virginia was the first permanent English settlement in the Americas. It was located on the northeast bank of the James (Powhatan) River about southwest of the center of modern Williamsburg. It was ...
,
John Rolfe
John Rolfe (1585 – March 1622) was one of the early English settlers of North America. He is credited with the first successful cultivation of tobacco as an export crop in the Colony of Virginia in 1611.
Biography
John Rolfe is believed ...
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
Indentured servitude is a form of labor in which a person is contracted to work without salary for a specific number of years. The contract, called an "indenture", may be entered "voluntarily" for purported eventual compensation or debt repayment, ...
became the primary labor force up until
Bacon's Rebellion
Bacon's Rebellion was an armed rebellion held by Colony of Virginia, Virginia settlers that took place from 1676 to 1677. It was led by Nathaniel Bacon (Virginia colonist), Nathaniel Bacon against List of colonial governors of Virginia, Colon ...
, from which the focus turned to slavery. This trend abated following the
American Revolution
The American Revolution was an ideological and political revolution that occurred in British America between 1765 and 1791. The Americans in the Thirteen Colonies formed independent states that defeated the British in the American Revolut ...
as
slavery
Slavery and enslavement are both the state and the condition of being a slave—someone forbidden to quit one's service for an enslaver, and who is treated by the enslaver as property. Slavery typically involves slaves being made to perf ...
became regarded as unprofitable. However, the practice was revived in 1794 with the invention of the cotton gin.
Frenchman
Jean Nicot
Jean Nicot de Villemain (; 1530 – May 4, 1604) was a French diplomat and scholar. He is famous for being the first to bring tobacco to France, including snuff tobacco. Nicotine is named after the tobacco plant ''Nicotiana tabacum,'' which in tur ...
(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
The Gambia,, ff, Gammbi, ar, غامبيا officially the Republic of The Gambia, is a country in West Africa. It is the smallest country within mainland AfricaHoare, Ben. (2002) ''The Kingfisher A-Z Encyclopedia'', Kingfisher Publicatio ...
and
Senegal
Senegal,; Wolof: ''Senegaal''; Pulaar: 𞤅𞤫𞤲𞤫𞤺𞤢𞥄𞤤𞤭 (Senegaali); Arabic: السنغال ''As-Sinighal'') officially the Republic of Senegal,; Wolof: ''Réewum Senegaal''; Pulaar : 𞤈𞤫𞤲𞤣𞤢𞥄𞤲𞤣𞤭 ...
. At the same time, caravans from
Morocco
Morocco (),, ) officially the Kingdom of Morocco, is the westernmost country in the Maghreb region of North Africa. It overlooks the Mediterranean Sea to the north and the Atlantic Ocean to the west, and has land borders with Algeria to ...
brought tobacco to the areas around
Timbuktu
Timbuktu ( ; french: Tombouctou;
Koyra Chiini: ); tmh, label=Tuareg, script=Tfng, ⵜⵏⴱⴾⵜ, Tin Buqt a city in Mali, situated north of the Niger River. The town is the capital of the Tombouctou Region, one of the eight administrativ ...
, 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
James VI and I (James Charles Stuart; 19 June 1566 – 27 March 1625) was King of Scotland as James VI from 24 July 1567 and King of England and Ireland as James I from the union of the Scottish and English crowns on 24 March 1603 until ...
, King of Scotland and England, produced the treatise ''
A Counterblaste to Tobacco
''A Counterblaste to Tobacco'' is a treatise written by King James VI of Scotland and I of England in 1604, in which he expresses his distaste for tobacco, particularly tobacco smoking.Steve Luck, ''The Complete Guide to Cigars: An Illustrated Gu ...
'' in 1604, and also introduced excise duty on the product.
Murad IV
Murad IV ( ota, مراد رابع, ''Murād-ı Rābiʿ''; tr, IV. Murad, was the Sultan of the Ottoman Empire from 1623 to 1640, known both for restoring the authority of the state and for the brutality of his methods. Murad IV was born in Cons ...
, sultan of the
Ottoman Empire
The Ottoman Empire, * ; is an archaic version. The definite article forms and were synonymous * and el, Оθωμανική Αυτοκρατορία, Othōmanikē Avtokratoria, label=none * info page on book at Martin Luther University) ...
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
The Chongzhen Emperor (; 6 February 1611 – 25 April 1644), personal name Zhu Youjian (), courtesy name Deyue (),Wang Yuan (王源),''Ju ye tang wen ji'' (《居業堂文集》), vol. 19. "聞之張景蔚親見烈皇帝神主題御諱字德 ...
of China issued an edict banning smoking two years before his death and the overthrow of the
Ming dynasty
The Ming dynasty (), officially the Great Ming, was an Dynasties in Chinese history, imperial dynasty of China, ruling from 1368 to 1644 following the collapse of the Mongol Empire, Mongol-led Yuan dynasty. The Ming dynasty was the last ort ...
. Later, the
Manchu
The Manchus (; ) are a Tungusic East Asian ethnic group native to Manchuria in Northeast Asia. They are an officially recognized ethnic minority in China and the people from whom Manchuria derives its name. The Later Jin (1616–1636) and ...
rulers of the
Qing dynasty
The Qing dynasty ( ), officially the Great Qing,, was a Manchu-led imperial dynasty of China and the last orthodox dynasty in Chinese history. It emerged from the Later Jin dynasty founded by the Jianzhou Jurchens, a Tungusic-speak ...
, would proclaim smoking "a more heinous crime than that even of neglecting archery". In
Edo period
The or is the period between 1603 and 1867 in the history of Japan, when Japan was under the rule of the Tokugawa shogunate and the country's 300 regional '' daimyo''. Emerging from the chaos of the Sengoku period, the Edo period was characteriz ...
Japan, some of the earliest tobacco plantations were scorned by the
shogunate
, officially , was the title of the military dictators of Japan during most of the period spanning from 1185 to 1868. Nominally appointed by the Emperor, shoguns were usually the de facto rulers of the country, though during part of the Kamakur ...
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 machine](https://upload.wikimedia.org/wikipedia/commons/c/ce/Bonsack_machine.png)
Religious leaders have often been prominent among those who considered smoking immoral or outright blasphemous. In 1634, the
Patriarch of Moscow
The Patriarch of Moscow and all Rus' (russian: Патриарх Московский и всея Руси, translit=Patriarkh Moskovskij i vseja Rusi), also known as the Patriarch of Moscow and all Russia, is the official title of the Bishop of Mo ...
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
Pope Urban VIII ( la, Urbanus VIII; it, Urbano VIII; baptised 5 April 1568 – 29 July 1644), born Maffeo Vincenzo Barberini, was head of the Catholic Church and ruler of the Papal States from 6 August 1623 to his death in July 1644. As po ...
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
James VI and I (James Charles Stuart; 19 June 1566 – 27 March 1625) was King of Scotland as James VI from 24 July 1567 and King of England and King of Ireland, Ireland as James I from the Union of the Crowns, union of the Scottish and Eng ...
, a staunch anti-smoker and the author of ''
A Counterblaste to Tobacco
''A Counterblaste to Tobacco'' is a treatise written by King James VI of Scotland and I of England in 1604, in which he expresses his distaste for tobacco, particularly tobacco smoking.Steve Luck, ''The Complete Guide to Cigars: An Illustrated Gu ...
'', 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
Slavery and enslavement are both the state and the condition of being a slave—someone forbidden to quit one's service for an enslaver, and who is treated by the enslaver as property. Slavery typically involves slaves being made to perf ...
to
sharecropping
Sharecropping is a legal arrangement with regard to agricultural land in which a landowner allows a tenant to use the land in return for a share of the crops produced on that land.
Sharecropping has a long history and there are a wide range ...
. This, along with a change in demand, accompanied the industrialization of cigarette production as craftsman
James Bonsack
__NOTOC__
James Albert Bonsack (October 9, 1859,
. URL last accessed 2006-10-11. created a machine in 1881 to partially automate their manufacture.
Social attitudes and public health
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 Fritz Balduin Lickint (1 October 1898 – 7 July 1960) was a German internist and social democrat, who investigated scientifically health problems and social problems related to alcohol and tobacco, described in the 1920s cancer of the lung from smo ...
of Dresden, Germany, published a paper containing formal statistical evidence of a lung cancer–tobacco link. During the Great Depression
Adolf Hitler
Adolf Hitler (; 20 April 188930 April 1945) was an Austrian-born German politician who was dictator of Nazi Germany, Germany from 1933 until Death of Adolf Hitler, his death in 1945. Adolf Hitler's rise to power, He rose to power as the le ...
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.
In the 20th century, smoking was common. There were social events like the
smoke night which promoted the habit.
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 Marshall Plan (officially the European Recovery Program, ERP) was an American initiative enacted in 1948 to provide foreign aid to Western Europe. The United States transferred over $13 billion (equivalent of about $ in ) in economic re ...
, 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
In Western usage, the phrase post-war era (or postwar era) usually refers to the time since the end of World War II. More broadly, a post-war period (or postwar period) is the interval immediately following the end of a war. A post-war period c ...
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
Robert Neel Proctor (born 1954) is an American historian of science and Professor of the History of Science at Stanford University, where he is also Professor by courtesy of Pulmonary Medicine. While a professor of the history of science at Penns ...
as "muted".
![Lung Cancer Incidece vers Cigarette Consumption](https://upload.wikimedia.org/wikipedia/commons/1/14/Lung_Cancer_Incidece_vers_Cigarette_Consumption.svg)
In 1950,
Richard Doll
Sir William Richard Shaboe Doll (28 October 1912 – 24 July 2005) was a British physician who became an epidemiologist in the mid-20th century and made important contributions to that discipline. He was a pioneer in research linking smoking ...
published research in the ''
British Medical Journal
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'' showing a close link between smoking and
lung cancer
Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...
. Beginning in December 1952, the magazine ''
Reader's Digest
''Reader's Digest'' is an American general-interest family magazine, published ten times a year. Formerly based in Chappaqua, New York, it is now headquartered in midtown Manhattan. The magazine was founded in 1922 by DeWitt Wallace and his wi ...
'' published "Cancer by the Carton", a series of articles that linked
smoking
Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...
with
lung cancer
Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...
.
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
In some common law jurisdictions, contributory negligence is a defense to a tort claim based on negligence. If it is available, the defense completely bars plaintiffs from any recovery if they contribute to their own injury through their own negl ...
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
The Tobacco Master Settlement Agreement (MSA) was entered on November 23, 1998, originally between the four largest United States tobacco companies ( Philip Morris Inc., R. J. Reynolds, Brown & Williamson and Lorillard – the "original participati ...
, 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-Smoking Week
National Non-Smoking Week is a yearly event in Canada. Established in 1977, it continues to be observed on the third full week of January, starting on Sunday. Coordinated by the Canadian Council for Tobacco Control, it aims to:
*educate Canadians ...
.
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
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
, 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
Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Guine ...
,
Laos
Laos (, ''Lāo'' )), officially the Lao People's Democratic Republic ( Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ, French: République démocratique populaire lao), is a socialist ...
,
Ukraine
Ukraine ( uk, Україна, Ukraïna, ) is a country in Eastern Europe. It is the second-largest European country after Russia, which it borders to the east and northeast. Ukraine covers approximately . Prior to the ongoing Russian inv ...
,
Belarus
Belarus,, , ; alternatively and formerly known as Byelorussia (from Russian ). officially the Republic of Belarus,; rus, Республика Беларусь, Respublika Belarus. is a landlocked country in Eastern Europe. It is bordered by R ...
, Greece,
Jordan
Jordan ( ar, الأردن; tr. ' ), officially the Hashemite Kingdom of Jordan,; tr. ' is a country in Western Asia. It is situated at the crossroads of Asia, Africa, and Europe, within the Levant region, on the East Bank of the Jordan Rive ...
, and China.
As a result of public pressure and the FDA, Walmart and Sam's club announced that they were raising the minimum age to purchase tobacco products, including all e-cigarettes, to 21 starting 1 July 2019.
Consumption
Methods
Tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
is an agricultural product processed from the fresh leaves of plants in the genus ''
Nicotiana
''Nicotiana'' () is a genus of herbaceous plants and shrubs in the Family (biology), family Solanaceae, that is Native plant, indigenous to the Americas, Australia, Southwestern Africa and the South Pacific. Various ''Nicotiana'' species, common ...
''. The genus contains several species, of which ''
Nicotiana tabacum
''Nicotiana tabacum'', or cultivated tobacco, is an annually grown herbaceous plant of the ''Nicotiana'' genus. The plant is tropical in origin, is commonly grown throughout the world, and is often found in cultivation. It grows to heights bet ...
'' is the most commonly grown. ''
Nicotiana rustica
''Nicotiana rustica'', commonly known as Aztec tobacco or strong tobacco, is a rainforest plant in the family Solanaceae. It is a very potent variety of tobacco, containing up to nine times more nicotine than common species of ''Nicotiana'' such ...
'' follows second, containing higher concentrations of nicotine. The leaves are harvested and cured to allow the slow
oxidation
Redox (reduction–oxidation, , ) is a type of chemical reaction in which the oxidation states of substrate change. Oxidation is the loss of electrons or an increase in the oxidation state, while reduction is the gain of electrons or a d ...
and degradation of
carotenoid
Carotenoids (), also called tetraterpenoids, are yellow, orange, and red organic compound, organic pigments that are produced by plants and algae, as well as several bacteria, and Fungus, fungi. Carotenoids give the characteristic color to pumpki ...
s 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 increase the addictive potency, shift the product's
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.
;Beedi:
Beedi
A beedi (also spelled bidi or biri) is a thin cigarette or mini-cigar filled with tobacco flake and commonly wrapped in a tendu (''Diospyros melanoxylon'') or ''Piliostigma racemosum'' leaf tied with a string or adhesive at one end. It origi ...
s 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.
![Diospyros melanoxylon Tendu](https://upload.wikimedia.org/wikipedia/commons/c/c2/Diospyros_melanoxylon_Tendu.jpg)
;Cigars:
Cigar
A cigar is a rolled bundle of dried and fermented tobacco leaves made to be smoked. Cigars are produced in a variety of sizes and shapes. Since the 20th century, almost all cigars are made of three distinct components: the filler, the binder l ...
s 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: ''
Cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
s'', 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
A hookah (Hindustani language, Hindustani: (Nastaleeq), (Devanagari), IPA: ; also see #Names and etymology, other names), shisha, or waterpipe is a single- or multi-stemmed instrument for heating or vaporizing and then smoking either tobacco ...
'' 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
''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
.
;Kretek: ''
Kretek
Kretek () are unfiltered cigarettes of Indonesian origin, made with a blend of tobacco, cloves, and other flavors. The word "kretek" itself is an onomatopoetic term for the crackling sound of burning cloves.
Partly due to favorable taxation ...
'' are cigarettes made with a complex blend of tobacco,
clove
Cloves are the aromatic flower buds of a tree in the family Myrtaceae, ''Syzygium aromaticum'' (). They are native to the Maluku Islands (or Moluccas) in Indonesia, and are commonly used as a spice, flavoring or fragrance in consumer products, ...
s 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.
;Pipe smoking:
Pipe smoking
Pipe smoking is the practice of tasting (or, less commonly, inhaling) the smoke produced by burning a substance, most commonly tobacco, in a pipe. It is the oldest traditional form of smoking.
Regular pipe smoking has been cited to carry seriou ...
is done with a tobacco pipe, typically consisting 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
A roll-your-own (RYO) cigarette, also called a handrolled cigarette, is a cigarette made from loose tobacco (usually a ''shag'' cut) and rolling paper. Factory-made cigarettes are called industrial cigarettes.
Rolling tobacco
Rolling tobacc ...
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
Vaporizer or vaporiser may refer to:
*Anesthetic vaporizer, a device used in the administration of anesthesia
* Electronic cigarette, or a part of one (often called a "PV" or "personal vaporizer")
*Humidifier, a household appliance that increases ...
is a device used to sublimate the active ingredients of plant material. Rather than burning the herb, which produces potentially irritating, toxic, or
carcinogen
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
ic 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
![Blood nicotine graph](https://upload.wikimedia.org/wikipedia/commons/7/75/Blood_nicotine_graph.jpg)
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 Alveolus (; pl. alveoli, adj. alveolar) is a general anatomical term for a concave cavity or pit.
Uses in anatomy and zoology
* Pulmonary alveolus, an air sac in the lungs
** Alveolar cell or pneumocyte
** Alveolar duct
** Alveolar macrophage
* ...
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
The pyrolysis (or devolatilization) process is the thermal decomposition of materials at elevated temperatures, often in an inert atmosphere. It involves a change of chemical composition. The word is coined from the Greek-derived elements ''py ...
.
Pipe and Cigar smoke are not inhaled because of its high
alkalinity
Alkalinity (from ar, القلوي, al-qaly, lit=ashes of the saltwort) is the capacity of water to resist acidification. It should not be confused with basicity, which is an absolute measurement on the pH scale.
Alkalinity is the strength of ...
, which are irritating to the
trachea
The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...
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
A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
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.
The absorbed
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
mimics nicotinic acetylcholine which when bound to
nicotinic acetylcholine receptor
Nicotinic acetylcholine receptors, or nAChRs, are receptor polypeptides that respond to the neurotransmitter acetylcholine. Nicotinic receptors also respond to drugs such as the agonist nicotine. They are found in the central and peripheral ne ...
s prevents the reuptake of
acetylcholine
Acetylcholine (ACh) is an organic chemical that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Part ...
thereby increasing that
neurotransmitter
A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell.
Neuro ...
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
The nucleus accumbens (NAc or NAcc; also known as the accumbens nucleus, or formerly as the ''nucleus accumbens septi'', Latin for "nucleus adjacent to the septum") is a region in the basal forebrain rostral to the preoptic area of the hypotha ...
, dopamine is associated with motivation causing
reinforcing
In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
behavior. Dopamine increase, in the
prefrontal cortex
In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA46, ...
, may also increase
working memory
Working memory is a cognitive system with a limited capacity that can hold information temporarily. It is important for reasoning and the guidance of decision-making and behavior. Working memory is often used synonymously with short-term 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
Harmane (harman) is a heterocyclic amine found in a variety of foods including coffee, sauces, and cooked meat. It is also present in tobacco smoke.
Chemistry
Harmane is a methylated derivative of β-carboline with the molecular formula C12H10N ...
(an
MAO inhibitor
Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). They are best known as effective antidepressants, espec ...
) from the acetaldehyde in tobacco smoke. This may play a role in nicotine addiction, by facilitating a dopamine release in the
nucleus accumbens
The nucleus accumbens (NAc or NAcc; also known as the accumbens nucleus, or formerly as the ''nucleus accumbens septi'', Latin for "nucleus adjacent to the septum") is a region in the basal forebrain rostral to the preoptic area of the hypotha ...
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
In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
.
Demographics
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.
As of 2019 in the United States, roughly 800,000 high school students smoke.
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(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
A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...
. In the
developing world
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
, 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
![Sigmund Freud, by Max Halberstadt (cropped)](https://upload.wikimedia.org/wikipedia/commons/3/36/Sigmund_Freud%2C_by_Max_Halberstadt_%28cropped%29.jpg)
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
Normative generally means relating to an evaluative standard. Normativity is the phenomenon in human societies of designating some actions or outcomes as good, desirable, or permissible, and others as bad, undesirable, or impermissible. A norm in ...
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
Peer pressure is the direct or indirect influence on peers, i.e., members of social groups with similar interests, experiences, or social statuses. Members of a peer group are more likely to influence a person's beliefs, values, and behavior. A g ...
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
In statistics, self-selection bias arises in any situation in which individuals select themselves into a group (sociology), group, causing a biased sample with nonprobability sampling. It is commonly used to describe situations where the characte ...
is a greater cause of adolescent smoking.
Psychologist
Hans Eysenck
Hans Jürgen Eysenck (; 4 March 1916 – 4 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other ...
(who later was questioned for nonplausible results
and unsafe publications
[Nigel Hawkes (2019)]
Works by eminent psychologist who doubted smoking caused cancer are “unsafe,” finds inquiry
/ref>) developed a personality profile for the typical smoker. Extraversion
The traits of extraversion (also spelled extroversion Retrieved 2018-02-21.) and introversion are a central dimension in some human personality theories. The terms ''introversion'' and ''extraversion'' were introduced into psychology by Carl J ...
is the trait that is most associated with smoking, and smokers tend to be sociable, impulsive, risk taking, and excitement seeking individuals.
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
A depressant, or central depressant, is a drug that lowers neurotransmission levels, which is to depress or reduce arousal or stimulation, in various areas of the brain. Depressants are also colloquially referred to as downers as they lower the ...
effect of smoking allows them to calm their nerves, often allowing for increased concentration. However, according to the Imperial College London
Imperial College London (legally Imperial College of Science, Technology and Medicine) is a public research university in London, United Kingdom. Its history began with Prince Albert, consort of Queen Victoria, who developed his vision for a cu ...
, "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.
Impact
Health
Tobacco smoking is the leading cause of preventable death and a global public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
concern. There are 1.1 billion tobacco users in the world. One person dies every six seconds from a tobacco related disease.
Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for heart attacks
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tra ...
, stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
s, chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
(COPD), idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis (IPF), or (formerly) fibrosing alveolitis, is a rare, progressive illness of the respiratory system, characterized by the thickening and stiffening of lung tissue, associated with the formation of scar tissue. It is ...
(IPF), emphysema
Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces ( pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alve ...
, and various types and subtypes of cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
s (particularly lung cancer
Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...
, cancers of the oropharynx, larynx
The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...
, and mouth
In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...
, esophageal and pancreatic cancer
Pancreatic cancer arises when cell (biology), cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a Neoplasm, mass. These cancerous cells have the malignant, ability to invade other parts of t ...
). Cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
smoking increases the risk of Crohn's disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...
as well as the severity of the course of the disease. It is also the number one cause of bladder cancer
Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become mali ...
. Cigarette smoking has also been associated with sarcopenia
Sarcopenia is a type of muscle loss ( muscle atrophy) that occurs with aging and/or immobility. It is characterized by the degenerative loss of skeletal muscle mass, quality, and strength. The rate of muscle loss is dependent on exercise level, ...
, the age-related loss of muscle mass and strength. The smoke from tobacco elicits carcinogenic effects on the tissues of the body that are exposed to the smoke. Regular cigar
A cigar is a rolled bundle of dried and fermented tobacco leaves made to be smoked. Cigars are produced in a variety of sizes and shapes. Since the 20th century, almost all cigars are made of three distinct components: the filler, the binder l ...
smoking is known to carry serious health risks, including increased risk of developing various types and subtypes of cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
s, respiratory disease
Respiratory diseases, or lung diseases, are pathology, pathological conditions affecting the organs and tissues that make gas exchange difficult in Breathing, air-breathing animals. They include conditions of the respiratory tract including the t ...
s, cardiovascular disease
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
s, cerebrovascular disease
Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. The ...
s, periodontal disease
Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main caus ...
s and teeth loss, and malignant disease
Malignancy () is the tendency of a medical condition to become progressively worse.
Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...
s.
Tobacco smoke is a complex mixture of over 7,000 toxic chemicals, 98 of which are associated with an increased risk of cardiovascular disease and 69 of which are known to be carcinogen
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
ic. 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 Genotoxicity is the property of chemical agents that damage the genetic information within a cell causing mutations, which may lead to cancer. While genotoxicity is often confused with Mutagen, mutagenicity, all mutagens are genotoxic, but some geno ...
effect per microgram to identify the most carcinogenic
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
compounds in cigarette smoke: acrolein
Acrolein (systematic name: propenal) is the simplest unsaturated aldehyde. It is a colorless liquid with a piercing, acrid smell. The smell of burnt fat (as when cooking oil is heated to its smoke point) is caused by glycerol in the burning fa ...
, formaldehyde
Formaldehyde ( , ) (systematic name methanal) is a naturally occurring organic compound with the formula and structure . The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde (refer to section F ...
, acrylonitrile
Acrylonitrile is an organic compound with the formula and the structure . It is a colorless, volatile liquid although commercial samples can be yellow due to impurities. It has a pungent odor of garlic or onions. In terms of its molecular ...
, 1,3-butadiene
1,3-Butadiene () is the organic compound with the formula (CH2=CH)2. It is a colorless gas that is easily condensed to a liquid. It is important industrially as a precursor to synthetic rubber. The molecule can be viewed as the union of two viny ...
, acetaldehyde
Acetaldehyde (IUPAC systematic name ethanal) is an organic chemical compound with the formula CH3 CHO, sometimes abbreviated by chemists as MeCHO (Me = methyl). It is a colorless liquid or gas, boiling near room temperature. It is one of the mos ...
, ethylene oxide
Ethylene oxide is an organic compound with the chemical formula, formula . It is a cyclic ether and the simplest epoxide: a three-membered Ring (chemistry), ring consisting of one oxygen atom and two carbon atoms. Ethylene oxide is a colorless a ...
, and isoprene
Isoprene, or 2-methyl-1,3-butadiene, is a common volatile organic compound with the formula CH2=C(CH3)−CH=CH2. In its pure form it is a colorless volatile liquid. Isoprene is an unsaturated hydrocarbon. It is produced by many plants and animals ...
. In addition to the aforementioned toxic chemicals, flavored tobacco
Flavored tobacco products — tobacco products with added Flavoring#Flavorants or flavorings, flavorings — include types of cigarettes, cigarillos and cigars, hookahs and Muʽassel, hookah tobacco, various types of smokeless tobacco, an ...
contains flavorings which upon heating release toxic chemicals and carcinogens such as carbon monoxide
Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...
(CO), polycyclic aromatic hydrocarbons
A polycyclic aromatic hydrocarbon (PAH) is a class of organic compounds that is composed of multiple aromatic rings. The simplest representative is naphthalene, having two aromatic rings and the three-ring compounds anthracene and phenanthrene. P ...
(PAHs), furans
Furan is a heterocyclic organic compound, consisting of a five-membered aromatic ring with four carbon atoms and one oxygen atom. Chemical compounds containing such rings are also referred to as furans.
Furan is a colorless, flammable, highly ...
, phenols
In organic chemistry, phenols, sometimes called phenolics, are a class of chemical compounds consisting of one or more hydroxyl groups (— O H) bonded directly to an aromatic hydrocarbon group. The simplest is phenol, . Phenolic compounds are c ...
, aldehydes
In organic chemistry, an aldehyde () is an organic compound containing a functional group with the structure . The functional group itself (without the "R" side chain) can be referred to as an aldehyde but can also be classified as a formyl group ...
(such as acrolein
Acrolein (systematic name: propenal) is the simplest unsaturated aldehyde. It is a colorless liquid with a piercing, acrid smell. The smell of burnt fat (as when cooking oil is heated to its smoke point) is caused by glycerol in the burning fa ...
), and acids, in addition to nitrogenous carcinogens
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
, alcohols
In chemistry, an alcohol is a type of organic compound that carries at least one hydroxyl () functional group bound to a saturated carbon atom. The term ''alcohol'' originally referred to the primary alcohol ethanol (ethyl alcohol), which is ...
, and heavy metals
upright=1.2, Crystals of osmium, a heavy metal nearly twice as dense as lead">lead.html" ;"title="osmium, a heavy metal nearly twice as dense as lead">osmium, a heavy metal nearly twice as dense as lead
Heavy metals are generally defined as ...
, all of which are dangerous to human health. A comparison of 13 common hookah
A hookah (Hindustani language, Hindustani: (Nastaleeq), (Devanagari), IPA: ; also see #Names and etymology, other names), shisha, or waterpipe is a single- or multi-stemmed instrument for heating or vaporizing and then smoking either tobacco ...
flavors found that melon flavors are the most dangerous, with their smoke containing four classes of hazards in high concentrations.
The World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
estimates that tobacco caused 5.4 million deaths in 2004 and 100 million deaths over the course of the 20th century.[WHO Report on the Global Tobacco Epidemic, 2008]
/ref> Similarly, the United States Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide."[Nicotine: A Powerful Addiction]
." Centers for Disease Control and Prevention. 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.
The risk of lung cancer decreases almost from the first day someone quits smoking. Healthy cells that have escaped mutations grow and replace the damaged ones in the lungs. In the research dated December 2019, 40% of cells in former smokers looked like those of people who had never smoked.
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.
Smoking alters the transcriptome
The transcriptome is the set of all RNA transcripts, including coding and non-coding, in an individual or a population of cells. The term can also sometimes be used to refer to all RNAs, or just mRNA, depending on the particular experiment. The t ...
of the lung parenchyma
Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms.
Etymology
The term ''parenchyma'' is New Latin from the word π ...
; the expression levels of a panel of seven genes (KMO, CD1A, SPINK5, TREM2, CYBB, DNASE2B, FGG) are increased in the lung tissue of smokers.
Passive smoking
Passive smoking is the inhalation of tobacco smoke, called secondhand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke enters an environment, causing its inhalat ...
is the inhalation of tobacco smoke by individuals who are not actively smoking. This smoke is known as second-hand smoke (SHS) or environmental tobacco smoke (ETS) when the burning end is present, and third-hand smoke
Third-hand smoke is contamination by tobacco smoke that lingers following the extinguishing of a cigarette, cigar, or other combustible tobacco product. ''First-hand smoke'' refers to what is inhaled into the smoker's own lungs, while ''second-han ...
after the burning end has been extinguished. Because of its negative implications, exposure to SHS has played a central role in the regulation of tobacco products. Six hundred thousand deaths were attributed to SHS in 2004. It also has been known to produce skin conditions such as freckles and dryness.[Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries](_blank)
26 November 2010
In 2015, a meta-analysis found that smokers were at greater risk of developing psychotic disorder
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior t ...
. Tobacco has also been described an anaphrodisiac
An anaphrodisiac (also antaphrodisiac or antiaphrodisiac) is a substance that quells or blunts the libido. It is the opposite of an aphrodisiac, something that enhances sexual appetite. The word ''anaphrodisiac'' comes from the Greek privative p ...
due to its propensity for causing erectile dysfunction
Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men.Cunningham GR, Rosen RC. Overview of male ...
. There is a correlation between tobacco smoking and a reduced risk of Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
.
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 do not 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
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
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
The Czech Republic, or simply Czechia, is a landlocked country in Central Europe. Historically known as Bohemia, it is bordered by Austria to the south, Germany to the west, Poland to the northeast, and Slovakia to the southeast. The ...
called '' Public Finance Balance of Smoking in the Czech Republic'' and another by the Cato Institute
The Cato Institute is an American libertarian think tank headquartered in Washington, D.C. It was founded in 1977 by Ed Crane, Murray Rothbard, and Charles Koch, chairman of the board and chief executive officer of Koch Industries.Koch Indust ...
, 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
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(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).
The tobacco industry is known to be one of the largest global enterprises in the world. The six biggest tobacco companies made a combined profit of $35.1 billion (Jha et al., 2014) in 2010.
Social
Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean-Paul Sartre
Jean-Paul Charles Aymard Sartre (, ; ; 21 June 1905 – 15 April 1980) was one of the key figures in the philosophy of existentialism (and phenomenology), a French playwright, novelist, screenwriter, political activist, biographer, and litera ...
's Gauloises
Gauloises (, "Gaulish" eminine pluralin French; ''cigarette'' is a feminine noun in French) is a brand of cigarette of French origin. It is produced by the company Imperial Tobacco following its acquisition of Altadis in January 2008 in most co ...
-brand cigarettes; Albert Einstein
Albert Einstein ( ; ; 14 March 1879 – 18 April 1955) was a German-born theoretical physicist, widely acknowledged to be one of the greatest and most influential physicists of all time. Einstein is best known for developing the theory ...
's, Douglas MacArthur
Douglas MacArthur (26 January 18805 April 1964) was an American military leader who served as General of the Army for the United States, as well as a field marshal to the Philippine Army. He had served with distinction in World War I, was C ...
's, Bertrand Russell
Bertrand Arthur William Russell, 3rd Earl Russell, (18 May 1872 – 2 February 1970) was a British mathematician, philosopher, logician, and public intellectual. He had a considerable influence on mathematics, logic, set theory, linguistics, ...
's, and Bing Crosby
Harry Lillis "Bing" Crosby Jr. (May 3, 1903 – October 14, 1977) was an American singer, musician and actor. The first multimedia star, he was one of the most popular and influential musical artists of the 20th century worldwide. He was a ...
's pipes; or the news broadcaster Edward R. Murrow
Edward Roscoe Murrow (born Egbert Roscoe Murrow; April 25, 1908 – April 27, 1965) was an American broadcast journalist and war correspondent. He first gained prominence during World War II with a series of live radio broadcasts from Europe f ...
's cigarette. Writers in particular seem to be known for smoking, for example, Cornell
Cornell University is a private statutory land-grant research university based in Ithaca, New York. It is a member of the Ivy League. Founded in 1865 by Ezra Cornell and Andrew Dickson White, Cornell was founded with the intention to teach an ...
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
Kurt Vonnegut Jr. (November 11, 1922 – April 11, 2007) was an American writer known for his satirical and darkly humorous novels. In a career spanning over 50 years, he published fourteen novels, three short-story collections, five plays, and ...
addressed his addiction to cigarettes within his novels. British Prime Minister Harold Wilson
James Harold Wilson, Baron Wilson of Rievaulx, (11 March 1916 – 24 May 1995) was a British politician who served as Prime Minister of the United Kingdom twice, from October 1964 to June 1970, and again from March 1974 to April 1976. He ...
was well known for smoking a pipe in public as was Winston Churchill
Sir Winston Leonard Spencer Churchill (30 November 187424 January 1965) was a British statesman, soldier, and writer who served as Prime Minister of the United Kingdom twice, from 1940 to 1945 Winston Churchill in the Second World War, dur ...
for his cigars. Sherlock Holmes
Sherlock Holmes () is a fictional detective created by British author Arthur Conan Doyle. Referring to himself as a " consulting detective" in the stories, Holmes is known for his proficiency with observation, deduction, forensic science and ...
, the fictional detective created by Sir Arthur Conan Doyle
Sir Arthur Ignatius Conan Doyle (22 May 1859 – 7 July 1930) was a British writer and physician. He created the character Sherlock Holmes in 1887 for '' A Study in Scarlet'', the first of four novels and fifty-six short stories about Ho ...
, smoked a pipe, cigarettes, and cigars. The DC Vertigo
Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...
comic book character John Constantine
John Constantine () is a fictional character who appears in American comic books published by DC Comics. Constantine first appeared in ''Swamp Thing'' #37 (June 1985), and was created by Alan Moore, Stephen R. Bissette, Rick Veitch, and John ...
, created by Alan Moore
Alan Moore (born 18 November 1953) is an English author known primarily for his work in comic books including ''Watchmen'', ''V for Vendetta'', ''The Ballad of Halo Jones'', ''Swamp Thing'', ''Batman:'' ''The Killing Joke'', and ''From Hell' ...
, is synonymous with smoking, so much so that the first storyline by ''Preacher'' creator Garth Ennis
Garth Ennis (born January 16, 1970) is a Northern Irish–American comics writer, best known for the Vertigo series ''Preacher'' with artist Steve Dillon, his nine-year run on Marvel Comics' Punisher franchise, and '' The Boys'' with artist Dari ...
centered around John Constantine contracting lung cancer. Professional wrestler
Professional wrestling is a form of theater that revolves around staged wrestling matches. The mock combat is performed in a ring similar to the kind used in boxing, and the dramatic aspects of pro wrestling may be performed both in the ring or ...
James Fullington
James Fullington (born June 16, 1963), better known by his ring name The Sandman, is a semi-retired American professional wrestler, best known for his career with Extreme Championship Wrestling (ECW), where he developed into a smoking and drinkin ...
, 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
A ceremonial pipe is a particular type of smoking pipe, used by a number of cultures of the indigenous peoples of the Americas in their sacred ceremonies. Traditionally they are used to offer prayers in a religious ceremony, to make a ceremonial ...
, is a prominent part of the religious ceremonies of a number of Native American Nations. ''Sema'', the Anishinaabe
The Anishinaabeg (adjectival: Anishinaabe) are a group of culturally related Indigenous peoples present in the Great Lakes region of Canada and the United States. They include the Ojibwe (including Saulteaux and Oji-Cree), Odawa, Potawatomi, ...
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
The Latter Day Saint movement (also called the LDS movement, LDS restorationist movement, or Smith–Rigdon movement) is the collection of independent church groups that trace their origins to a Christian Restorationist movement founded by Jo ...
, Joseph Smith
Joseph Smith Jr. (December 23, 1805June 27, 1844) was an American religious leader and founder of Mormonism and the Latter Day Saint movement. When he was 24, Smith published the Book of Mormon. By the time of his death, 14 years later, he ...
, recorded that on 27 February 1833, he received a revelation
In religion and theology, revelation is the revealing or disclosing of some form of truth or knowledge through communication with a deity or other supernatural entity or entities.
Background
Inspiration – such as that bestowed by God on the ...
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
Rabbi Yisrael Meir ha-Kohen Kagan (January 26, 1838 – September 15, 1933), known popularly as the Chofetz Chaim, after his book on lashon hara, who was also well known for the Mishna Berurah, his book on ritual law, was an influential Lithuan ...
(1838–1933) was one of the first Jewish authorities to speak out on smoking. In Ahmadiyya Islam
Ahmadiyya (, ), officially the Ahmadiyya Muslim Community or the Ahmadiyya Muslim Jama'at (AMJ, ar, الجماعة الإسلامية الأحمدية, al-Jamāʿah al-Islāmīyah al-Aḥmadīyah; ur, , translit=Jamā'at Aḥmadiyyah Musl ...
, smoking is highly discouraged, although not forbidden. During the month of fasting
Fasting is the abstention from eating and sometimes drinking. From a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (see " Breakfast"), or to the metabolic state achieved after ...
however, it is forbidden to smoke tobacco. In the Baháʼí Faith
The Baháʼí Faith is a religion founded in the 19th century that teaches the Baháʼí Faith and the unity of religion, essential worth of all religions and Baháʼí Faith and the unity of humanity, the unity of all people. Established by ...
, smoking tobacco is discouraged though not forbidden.
Public policy
On 27 February 2005 the WHO Framework Convention on Tobacco Control
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. It became the first World Health Organization treaty adopted under ...
, 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 tax
file:Lincoln Beer Stamp 1871.JPG, upright=1.2, 1871 U.S. Revenue stamp for 1/6 barrel of beer. Brewers would receive the stamp sheets, cut them into individual stamps, cancel them, and paste them over the Bunghole, bung of the beer barrel so when ...
es on cigarettes in order to reduce the consumption of cigarettes. The World Health Organisation finds that:
In 2002, the Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
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
Missouri is a U.S. state, state in the Midwestern United States, Midwestern region of the United States. Ranking List of U.S. states and territories by area, 21st in land area, it is bordered by eight states (tied for the most with Tennessee ...
has a cigarette tax of only 17 cents per pack, the nation's lowest, while New York
New York most commonly refers to:
* New York City, the most populous city in the United States, located in the state of New York
* New York (state), a state in the northeastern United States
New York may also refer to:
Film and television
* '' ...
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 has a tax added of 16.5% of the retail price plus £4.90. The UK has a significant black market
A black market, underground economy, or shadow economy is a clandestine market or series of transactions that has some aspect of illegality or is characterized by noncompliance with an institutional set of rules. If the rule defines the se ...
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
In June 1967, the US Federal Communications Commission
The Federal Communications Commission (FCC) is an independent agency of the United States federal government that regulates communications by radio, television, wire, satellite, and cable across the United States. The FCC maintains jurisdiction ...
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
The Public Health Cigarette Smoking Act is a 1970 federal law in the United States designed to limit the practice of tobacco smoking. As approved by the United States Congress and signed into law by President Richard Nixon, the act required a stro ...
banning the advertising of cigarettes on television
Television, sometimes shortened to TV, is a telecommunication medium for transmitting moving images and sound. The term can refer to a television set, or the medium of television transmission. Television is a mass medium for advertisin ...
and radio
Radio is the technology of signaling and communicating using radio waves. Radio waves are electromagnetic waves of frequency between 30 hertz (Hz) and 300 gigahertz (GHz). They are generated by an electronic device called a transmit ...
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
The European Commission (EC) is the executive of the European Union (EU). It operates as a cabinet government, with 27 members of the Commission (informally known as "Commissioners") headed by a President. It includes an administrative body o ...
. 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[Tobacco – Health warnings](_blank)
Australian Government Department of Health and Ageing. Retrieved 29 August 2008 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
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
advertisements, one showing a cigarette filled with fatty deposits, as if the cigarette is symbolizing the artery of a smoker.
Some countries have also banned advertisement at point of sale. United Kingdom and Ireland have limited the advertisement of tobacco at retailers. This includes storing of cigarettes behind a covered shelf not visible to the public. They do however allow some limited advertising at retailers. Norway has a complete ban of point of sale advertising. This includes smoking products and accessories. Implementing these policies can be challenging, all of these countries experienced resistance and challenges from the tobacco industry. The World Health Organisation recommends the complete ban of all types of advertisement or product placement, including at vending machines, at airports and on internet shops selling tobacco. The evidence is as yet unclear as to the impact of such bans.
Many countries have a smoking age
smoking age is the minimum legal age required to purchase or use tobacco products. Most countries have laws that forbid sale of tobacco products to persons younger than certain ages, usually the age of majority.
This article does not discuss l ...
. 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
Ireland ( ; ga, Éire ; Ulster Scots dialect, Ulster-Scots: ) is an island in the Atlantic Ocean, North Atlantic Ocean, in Northwestern Europe, north-western Europe. It is separated from Great Britain to its east by the North Channel (Grea ...
, Latvia
Latvia ( or ; lv, Latvija ; ltg, Latveja; liv, Leţmō), officially the Republic of Latvia ( lv, Latvijas Republika, links=no, ltg, Latvejas Republika, links=no, liv, Leţmō Vabāmō, links=no), is a country in the Baltic region of ...
, Estonia
Estonia, formally the Republic of Estonia, is a country by the Baltic Sea in Northern Europe. It is bordered to the north by the Gulf of Finland across from Finland, to the west by the sea across from Sweden, to the south by Latvia, a ...
, the Netherlands, Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore
Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, borde ...
, Italy, Indonesia
Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Guine ...
, India, Lithuania
Lithuania (; lt, Lietuva ), officially the Republic of Lithuania ( lt, Lietuvos Respublika, links=no ), is a country in the Baltic region of Europe. It is one of three Baltic states and lies on the eastern shore of the Baltic Sea. Lithuania ...
, Chile
Chile, officially the Republic of Chile, is a country in the western part of South America. It is the southernmost country in the world, and the closest to Antarctica, occupying a long and narrow strip of land between the Andes to the east a ...
, Spain, Iceland
Iceland ( is, Ísland; ) is a Nordic island country in the North Atlantic Ocean and in the Arctic Ocean. Iceland is the most sparsely populated country in Europe. Iceland's capital and largest city is Reykjavík, which (along with its s ...
, United Kingdom, Slovenia
Slovenia ( ; sl, Slovenija ), officially the Republic of Slovenia (Slovene: , abbr.: ''RS''), is a country in Central Europe. It is bordered by Italy to the west, Austria to the north, Hungary to the northeast, Croatia to the southeast, an ...
, Turkey
Turkey ( tr, Türkiye ), officially the Republic of Türkiye ( tr, Türkiye Cumhuriyeti, links=no ), is a list of transcontinental countries, transcontinental country located mainly on the Anatolia, Anatolian Peninsula in Western Asia, with ...
and Malta
Malta ( , , ), officially the Republic of Malta ( mt, Repubblika ta' Malta ), is an island country in the Mediterranean Sea. It consists of an archipelago, between Italy and Libya, and is often considered a part of Southern Europe. It lies ...
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 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
Victoria most commonly refers to:
* Victoria (Australia), a state of the Commonwealth of Australia
* Victoria, British Columbia, provincial capital of British Columbia, Canada
* Victoria (mythology), Roman goddess of Victory
* Victoria, Seychelle ...
, smoking is restricted in railway stations, bus stops and tram stops as these are public locations where second-hand smoke
Passive smoking is the inhalation of tobacco smoke, called secondhand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke enters an environment, causing its inhalat ...
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
Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
, 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
Romania ( ; ro, România ) is a country located at the crossroads of Central Europe, Central, Eastern Europe, Eastern, and Southeast Europe, Southeastern Europe. It borders Bulgaria to the south, Ukraine to the north, Hungary to the west, S ...
smoking is illegal in trains, metro stations, public institutions (except where designated, usually outside) and public transport. In Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
, in addition to smoking bans in public buildings and transport, 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 Fire safe cigarettes, abbreviated "FSC", also known as lower ignition propensity (LIP), reduced fire risk (RFR), self-extinguishing, fire-safe or reduced ignition propensity (RIP) cigarettes, are cigarettes that are designed to extinguish more quick ...
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
Richard Joshua Reynolds (July 20, 1850 – July 29, 1918) was an American businessman and founder of the R. J. Reynolds Tobacco Company.
The son of a tobacco farmer, he worked for his father and attended Emory & Henry College from 1868 to 1870 ...
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
Lorillard Tobacco Company was an American tobacco company that marketed cigarettes under the brand names Newport (cigarette), Newport, Maverick (cigarette), Maverick, Old Gold (cigarette), Old Gold, Kent (cigarette), Kent, True (cigarette), True, ...
(purchased by RJ Reynolds
Richard Joshua Reynolds (July 20, 1850 – July 29, 1918) was an American businessman and founder of the R. J. Reynolds Tobacco Company.
The son of a tobacco farmer, he worked for his father and attended Emory & Henry College from 1868 to 1870 ...
), 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. One study published by the NIH found that tobacco use may be linked to cocaine addiction and marijuana use. The study stated that 90% of adults who used cocaine had smoked cigarettes before (this was for people ages 18–34). This study could support the gateway drug theory.
Cessation
Smoking cessation
Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often make ...
, 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
"Cold turkey" refers to the abrupt cessation of a substance dependence and the resulting unpleasant experience, as opposed to gradually easing the process through reduction over time or by using replacement medication.
Sudden withdrawal from dru ...
, nicotine replacement therapy
Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
, contingent vouchers, antidepressant
Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
s, hypnosis
Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
, 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.
In the United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
, about 70% of smokers would like to quit smoking, and 50% report having made an attempt to do so in the past year. In recent years, especially in Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
and the United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...
, many smokers have switched to use electronic cigarette
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
s in order to quit smoking tobacco.
See also
* Cannabis smoking
Cannabis smoking (or colloquially smoking pot) is the inhalation of smoke or vapor released by heating the flowers, leaves, or extracts of cannabis and releasing the main psychoactive chemical, Δ9-tetrahydrocannabinol (THC), which is absorbe ...
* Cigarette smoking among college students
* Cigarette smoking for weight loss
Cigarette smoking for weight loss is a weight control method whereby one consumes tobacco, often in the form of cigarettes, to decrease one's appetite. The practice dates to early knowledge of nicotine as an appetite suppressant.
Tobacco smoking ...
* Electronic cigarette
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
* Herbal cigarette
Herbal cigarettes (also called tobacco-free cigarettes or nicotine-free cigarettes) are cigarettes that usually do not contain any tobacco or nicotine, instead being composed of a mixture of various herbs and/or other plant material. However, Chi ...
* List of cigarette smoke carcinogens
Commercial tobacco smoke is a mixture of more than 5,000 chemicals. According to the U.S. Department of Health and Human Services, the following are known human carcinogens found in cigarette smoke:
See also
* Composition of electronic cigarett ...
* Snuff (tobacco)
Snuff is a smokeless tobacco made from finely ground or pulverized tobacco leaves.
The Old Snuff House of Fribourg & Treyer at the Sign of the Rasp & Crown, No.34 James's Haymarket, London, S.W., 1720, 1920. Author: George Evens and Fribourg ...
* Smoker's paradox
Tobacco use has predominantly negative effects on human health and concern about health effects of tobacco has a long history. Research has focused primarily on cigarette smoking.
Tobacco smoke contains more than 70 chemicals that cause ca ...
* Tobacco advertising
Nicotine marketing is the marketing of nicotine-containing products or use. Traditionally, the tobacco industry markets cigarette smoking, but it is increasingly marketing other products, such as electronic cigarettes and heated tobacco products ...
* Tobacco control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use to ...
References
Bibliography
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External links
Tobacco History Links
– repository from Tobacco.org
Surgeon General: Tobacco Cessation
CDC: Smoking & Tobacco Use
WHO: Tobacco Free Initiative
The Tobacco Atlas
Tobacco Viz
Cigarette smoking prevalence in US counties: 1996–2012
{{DEFAULTSORT:Tobacco Smoking
Habits
IARC Group 1 carcinogens