Tobacco smoking

The cigarette is the most common method of smoking tobacco.

Tobacco smoking, often referred to as "smoking", is the act of burning the dried or cured leaves of the tobacco plant and inhaling the smoke for pleasure or ritualistic purposes, or more commonly out of habit and to satisfy addiction. The practice was common among Native Americans of The Plains Indian religion, and was later introduced to the rest of the world by sailors following European exploration of the Americas.

Tobacco smoke contains nicotine, an addictive stimulant which temporarily improves alertness and memory, but also forms a strong physical and psychological chemical dependence (addiction). Medical research has determined that smoking is a major contributing factor towards many health problems, particularly lung cancer (which has a survival percentage of 16%), emphysema, and cardiovascular disease. Many countries regulate or restrict tobacco sales and advertising and require warnings be placed prominently on the product packaging. Many municipalities now ban smoking in a variety of public venues due to health impacts on non-smokers breathing second-hand smoke.

While smoking is on the decline in many industrial nations due in part to these initiatives, smoking in less restrictive developing countries is on the rise and worldwide production and usage of tobacco continues to increase.

History

Main article: History of tobacco smoking

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Tobacco plantation in Kentucky

Tobacco smoking with pipes and cigars was common to many Native American cultures prior to the arrival of European explorers. The practice is depicted in early Mayan art dating back to around 1,500 years ago. The Mayans were also known to use tobacco as an all-purpose medicinal antidote, and the crop was widely believed to possess magical powers as its usage has been documented in ancient ceremonial sacrifices and divinations as well as in talismans.

On October 12, 1492, Christopher Columbus was given dry leaves by the Arawaks, but threw them away. Rodrigo de Jerez and Luis de Torres were the first Europeans to observe smoking, and Jerez became the first recorded smoker outside the Americas. Throughout the 16th century, the habit of smoking was common mainly among sailors. Tobacco was introduced to England in the 1560s by the crew of Sir John Hawkins but did not begin making an impact on European society until the 1580s. The cigar became immensely popular in England during the late 1820s. In 1828, the cigarette appeared in Spain and enjoyed immediate success but still remained less popular than both the cigar and pipe until the early 20th century when cheap mechanically manufactured cigarettes became standard.

During World War I, it was typical for tobacco products to be included in military rations. Following the war, cigarette smoking was advertised as part of a glamorous, carefree lifestyle, and became socially acceptable for women. In the 1930s, Nazi medical and military leaders grew concerned with the possibility that tobacco might be hazardous to human health and their scientists were the first to confirm this link. In the United States, biologist Raymond Pearl had demonstrated the negative health effects of tobacco smoking as early as 1938. In the 1950s and 1960s, the medical community along with various governmental bodies, and Readers Digest magazine, began a campaign to reduce the degree of smoking by showing how it damaged public health. Although tobacco smoking in many regions of the world has dropped dramatically in recent years, worldwide tobacco production is still growing. Smoking rates continue to remain relatively high in some Asian countries.

Methods of smoking

Various smoking equipment including different pipes.

Cigarette

Main article: Cigarette

A cigarette is a product manufactured from cured and cut tobacco leaves, which are rolled and/or stuffed into a paper-wrapped cylinder (generally less than 120 mm in length and 10 mm in diameter). The cigarette is lit, usually with a match or lighter at one end and allowed to burn for the purpose of inhalation of its smoke from the other (sometimes filtered) end, which is inserted in the mouth. Cigarettes are smoked by some with a cigarette holder. (See also Bidi). A cigarette holds over 4000 chemicals, over 60 of which increase the risk of cancer and other diseases in humans and other animals.

Cigar

Main article: Cigar

A cigar is a tightly-rolled bundle of dried and fermented tobacco, one end of which is lit with a match or lighter so that it produces smoke that can be drawn into the mouth. This smoke is usually not inhaled, but rather 'puffed' out. The word cigar is from the Spanish word cigarro, which the Oxford English Dictionary suggests is a variation on cigarra, Spanish for "cicada," due to their shape, especially that of what is now called the perfecto.

Cigar tobacco is grown in significant quantities in such nations as Brazil, Cameroon, Cuba, Dominican Republic, Honduras, Indonesia, Mexico, Nicaragua and the United States of America. Cigars manufactured in Cuba have been considered to be without peer as shown in contemporary media occasionally.

Smoking pipe

Main article: Smoking pipe

A smoking pipe is a device used for smoking tobacco. The smoking pipe typically consists of a small chamber (bowl) for combustion of the substance to be smoked and a thin stem (shank) that ends in a mouthpiece (also called a bit).

Pipes are made from a variety of materials (some obscure): briar, corncob, meerschaum, clay, wood, glass, gourd, bamboo, and various other materials, such as metal. Some pipes are carved by artists.

Tobacco used for smoking pipes are often chemically treated and altered to change smell and taste (both functions are affected negatively in humans by smoking) not available in other tobacco products sold commercially. Many of these are mixtures using staple ingredients of variously cured Burley and Virginia tobaccos which are mixed with tobaccos from different areas, such as Oriental or Balkan locations. Latakia (a fire-cured tobacco of Cypriot or Syrian origin), Perique (only grown in St. James Parish, Louisiana) or combinations of Virginia and Burley tobaccos of African, Indian, or South American origins. Traditionally, many U.S. tobacco's are made of American Burley with artificial sweeteners and flavorings added to create an artificial "aromatic" smell, whereas "English" blends are based on natural Virginia tobaccos enhanced with Oriental and other natural tobaccos. There is a growing tendency towards "natural" tobaccos which derive their aromas from blending with spice tobaccos alone and historically-based curing processes.

Pipes can range from the very simple machine-made briar pipe to handmade and artful implements created by pipemakers which can be very expensive collector's items.

Hookah

Main article: Hookah

A hookah is a traditional Middle Eastern or South Asian device for smoking, which operates by water-filtration and indirect heat. Hookah smoking is most popular in the Middle East, and is a niche market in most other places.

Popular myth suggests that hookah smoking is considered to be safer than other forms of smoking due to water-filtration. However, several serious negative health effects are still linked to hookah smoking and studies indicate that it is likely to be more harmful to health than cigarettes, due in part to the volume of smoke inhaled. One study found hookah smoke to be both clastogenic and genotoxic for human beings, while another study showed that the CO hazard is as high with hookah smoking as with cigarette smoking. In addition to the cancer risk, there is some risk of infectious disease resulting from pipe sharing, and other harm caused by any addition of alcohol or psychoactive drugs to the tobacco.

Health effects

Main article: Health effects of tobacco smoking

History

As the use of tobacco became popular in Europe, some people became concerned about its possible ill effects on the health of its users. One of the first was King James I of England. In 1604, he wrote "A Counterblaste to Tobacco" in which he asked his subjects:

Have you not reason then to bee ashamed, and to forbeare this filthie noveltie, so basely grounded, so foolishly received and so grossely mistaken in the right use thereof? In your abuse thereof sinning against God, harming your selves both in persons and goods, and raking also thereby the markes and notes of vanitie upon you: by the custome thereof making your selves to be wondered at by all forraine civil Nations, and by all strangers that come among you, to be scorned and contemned. A custome lothsome to the eye, hatefull to the Nose, harmefull to the braine, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse.

In 1761, English doctor John Hill published "Cautions against the Immoderate Use of Snuff" in which he warned snuff users that they were vulnerable to cancers of the nose. In 1795, American Samuel Thomas von Soemmering reported on cancers of the lip in pipe smokers. In 1912, American Dr. Isaac Adler was the first to strongly suggest that lung cancer is related to smoking. In 1929, Fritz Lickint of Dresden, Germany, published the first formal statistical evidence of a lung cancer–tobacco link, based on a study showing that lung cancer sufferers were likely to be smokers. Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less) (Borio 2006).

In 1950, Dr. Richard Doll published research in a 1950 issue of the British Medical Journal showing a close link between smoking and lung cancer. In 1964, Luther L. Terry, M.D., Surgeon General of the United States, released the report of the Surgeon General's Advisory Committee on Smoking and Health. It was based on over 7000 scientific articles that linked tobacco use with cancer and other diseases. This report led to laws requiring warning labels on tobacco products and to restrictions on tobacco advertisements. From this time, Americans became much more aware of the dangers of tobacco and its use in the United States began to decline. By 2004, nearly half of all Americans who had ever smoked had quit (CDC 2004).

Health risks of smoking

Because of their nicotine addiction, many smokers find it difficult to cease smoking despite their knowledge of ill health effects.

The health effects of tobacco smoking are related to direct tobacco smoking, as well as passive smoking, inhalation of environmental or secondhand tobacco smoke. A 50 year study of over thirty thousand British physicians showed that nonsmokers lived about 10 more years than the smokers. For those born between 1920 and 1929 the standardized mortality rate between the ages of 35 and 69 for nonsmokers was 15% and for smokers was 43% -- nearly three times greater. Claims that personalities of smokers account for these differences are not convincing in light of the fact that the heavy smokers were about 25 times more likely to die of lung cancer or chronic obstructive pulmonary disease than the nonsmokers.

Lung cancer rates are linked to the amount of people who smoke. It is noted that an increase in deaths from lung cancer appeared 20 years after an increase in cigarette consumption. The damage a continuing smoker does to their lungs can take up to 20 years before its physical manifestation in lung cancer. Women began smoking later than men, so the rise in death rate amongst women did not appear until later. More men than women smoke. More men than women die of lung cancer. The male lung cancer death rate decreased in 1975 -- roughly 20 years after the fall in cigarette consumption in men. Fall in consumption in women also began in 1975 but by 1991 had not manifested in a decrease in lung cancer related mortalities amongst women.

The United States' Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide". Twenty-four percent of pregnant women in Indiana smoke cigarettes. If they didn’t smoke, it is estimated by one source that Indiana would reduce its infant mortality rate (12th highest in the country) by 9%. Tobacco smoke reduces the delivery of oxygen to the fetus through the presence of carbon monoxide, cyanide, and aromatic hydrocarbons. Nicotine and other substances in tobacco smoke cause reduction in placental blood flow, creating further reductions in oxygen delivery as well as reductions in nutrients to the unborn baby. Secondhand smoke exposure during pregnancy produces twice the risk of low birth weight babies. Smoking is the single largest modifiable risk factor in intrauterine growth retardation.

The main health risks in tobacco pertain to diseases of the cardiovascular system, in particular smoking being a major risk factor for a myocardial infarction (heart attack), diseases of the respiratory tract such as Chronic Obstructive Pulmonary Disease (COPD) and emphysema, and cancer, particularly lung cancer and cancers of the larynx and tongue. Prior to World War I, lung cancer was considered to be a rare disease, which most physicians would never see during their career. With the postwar rise in popularity of cigarette smoking, however, came a virtual epidemic of lung cancer.

The carcinogenity of tobacco smoke is not explained by nicotine, which is not carcinogenic or mutagenic. Rather, any partially burnt material, tobacco or not, contains polycyclic aromatic hydrocarbons, particularly benzopyrene. The mechanism of their carcinogenity is well-known: oxidation produces an epoxide, which binds to DNA covalently and permanently distorts it. DNA damage is the cause of cancer.

The incidence of lung cancer is highly correlated with smoking.

A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired.

Nicotine is a powerful, addictive stimulant and is one of the main factors leading to the continued tobacco smoking. Although the amount of nicotine inhaled with tobacco smoke is quite small (most of the substance is destroyed by the heat) it is still sufficient to cause physical and/or psychological dependence.

However, smokers usually ignore these facts and trade health risk for other qualities such as enjoyment and satisfied addictions. These smokers often think of the benefits of smoking rather than the downsides. Some smokers claim that the depressant effect of smoking allows them to "calm their nerves", often allowing for increased concentration. This, however, is only partly true. According to the Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, whilst higher doses have stimulant effect."

The health risks of smoking are not uniform across all smokers but vary according to amount of cigarettes smoked, with those who smoke more cigarettes at greater risk, although light smoking is still a health risk.

According to the Canadian Lung Association, tobacco kills between 40,000-45,000 Canadians per year, more than the total number of deaths from AIDS, traffic accidents, suicide, murder, fires and accidental poisoning. However, the number of deaths related to smoking may be exaggerated because it is difficult to determine whether smoking actually caused the terminal illness.

Passive smoking

Main article: Passive smoking

This photo illustrates smoke in a pub, a common complaint from those concerned with passive smoking

Passive or involuntary smoking occurs when the exhaled and ambient smoke (otherwise known as environmental or secondhand smoke) from one person's cigarette is inhaled by other people. Passive smoking involves inhaling carcinogens, as well as other toxic components, that are present in secondhand tobacco smoke. Carcinogens that occur in secondhand tobacco smoke include benzene, 1,3-butadiene, benzo[a]pyrene, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, and many others.

It is confirmed that, in adults, secondhand smoke causes lung cancer, nasal sinus cancer, breast cancer in younger women, heart disease, heart attacks, and asthma induction. Secondhand smoke is also known to harm children, infants and reproductive health through acute lower respiratory tract illness, asthma induction and exacerbation, chronic respiratory symptoms, middle ear infection, lower birth weight babies, and Sudden Infant Death Syndrome.

In June 2006, US Surgeon General Richard H. Carmona called the evidence against passive smoke "indisputable" and said "The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and non-smoking adults.". Passive smoking is one of the key issues that have lead to introduction of smoking bans, particularly in workplaces.

The composition of Environmental tobacco smoke (ETS) is similar to fossil fuel combustion products that contribute to air pollution, and has been shown to be responsible for indoor particulate matter (PM) levels far exceeding official outdoor limits.

Sudden infant death syndrome

Main article: Sudden infant death syndrome

According to the U.S. Surgeon General’s Report (Chapter 5; pages 180-194), secondhand smoke is connected to SIDS. Infants who die from SIDS tend to have higher concentrations of nicotine and cotinine (a biological marker for secondhand smoke exposure) in their lungs than those who die from other causes. Infants exposed to secondhand smoke after birth are also at a greater risk of SIDS.

Bodily functions and how they are affected

Tobacco smoke contains nicotine, a stimulant. Nicotine acts as an inhibitor (or block), that attaches to cholinergic receptors in the brain that are usually used to control respiration, heart rate, memory, alertness, and muscle movement. As such all are affected by smoking. Normally, acetylcholine (a similar, naturally present healthy neurochemical) would attach to the receptors, however nicotine interferes in this natural biological process and attaches to the receptors instead and blocks them.

Nicotine's effect in the body results in reduced acetylcholine production in the brain -- a physiological response to a perceived 'excess' of acetylcholine, an assumption by the body which is incorrect. This replacement of natural neurochemicals with nicotine is largely responsible for nicotine's addictive properties, because it creates a dependency for nicotine to continue fulfilling the role of acetylcholine and stop the body from becoming erratic. If a smoker stops smoking, lack of acetylcholine causes respiration, heart rate, memory, alertness, and muscle movement to be temporarily affected -- this can be so distressing it can be hard to continue cessation for some.

Recent evidence has shown that smoking tobacco causes increases in dopamine levels in the brain, and lowers the levels of enzymes found in the brain that naturally stop the levels of dopamine becoming too high, this causes the promotion of abnormally high levels of dopamine similar to those experienced by heroin and cocaine addicts and users. Smokers have feelings of pleasure and reward when they smoke due to this chemical imbalance created. One study found that smokers exhibit better reaction-time and memory performance as they tire, compared to non-smokers.

Physical & Mental addiction

Nicotine, an element of tobacco smoke, is one of the most addictive substances that exists. 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. According to studies by Henningfield and Benowitz, nicotine is more addictive than marijuana and caffeine but of a lesser potential for somatic dependency than ethanol, cocaine and heroin. A study by Perrine concludes nicotine's potential for psychological dependency exceeds all other studied drugs - even ethanol, an extremely physically addictive substance with a severe withdrawal that can be fatal. Many smokers use nicotine compulsively. About half of Canadians who currently smoke have tried to quit. McGill University health professor Jennifer O'Loughlin stated that nicotine addiction can occur as soon as five months after the start of smoking.

It can be difficult to quit smoking due to the withdrawal symptoms which include insomnia, irritability, anxiety, decreased heart rate, weight gain, and nicotine cravings. The relapse rate for quitters is high: about 60% relapse in three months. Also, nicotine users are sometimes reluctant to quit smoking because they do not see any short-term damages it may cause.

Smoking and depression

Data from multiple studies suggest that depression plays a role in cigarette smoking. A history of regular smoking was observed more frequently among individuals who had experienced a major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Another study found that the average lifetime daily cigarette consumption was strongly related to lifetime prevalence, and to prospectively assessed one year prevalence of major depression. People with major depression are also much less likely to quit due to the increased risk of experiencing mild to severe states of depression, including a major depressive episode. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. The neurotransmitter systems affected by cigarette smoke mirror the neurotransmitter pathways that are thought to be involved in the biological mechanisms of depression, and the use of antidepressants as adjuvants to smoking-cessation treatment can enhance cessation success rates.

Health benefits of smoking

Several types of "Smoker’s Paradoxes" , i.e. cases where smoking appears to have specific beneficial effects, have been observed; often the actual mechanism remains undetermined. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI) , . Smoking appears to interfere with development of Kaposi's sarcoma , breast cancer among women carrying the very high risk BRCA gene , preeclampsia , and atopic disorders such as allergic asthma . A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an anti-inflammatory agent and interfering with the disease process.

A large body of evidence suggests that the risks of neurological diseases such as Parkinson's disease or Alzheimer's disease might be twice as high for non-smokers than for smokers. . Many such papers regarding Alzheimer's disease and Parkinson's Disease have been published. A plausible explanation for these cases may be the effect of nicotine, a cholinergic stimulant, decreasing the levels of acetylcholine in the smoker's brain; Parkinson's disease occurs when the effect of dopamine is less than that of acetylcholine. Opponents counter by noting that consumption of pure nicotine may be as beneficial as smoking without the risk.

Other studies, however, challenge these epidemiological studies on methodological grounds. A prospective Rotterdam Study found that the incidence of Alzheimer's disease is more than double for smokers as compared to non-smokers and the Honolulu Heart Program (a longitudinal cohort study) also found more than twice the risk for Alzheimer's disease among medium and heavy smokers as compared to non-smokers.

Smoking: Effects of the habit and industry on society

Link Between Tobacco use and use of Illicit drugs.

Cigarettes along with alcohol and marijuana are considered a “gateway drug.” A 1994 report from the Center on Addiction and Substance Abuse at Columbia University states that there is a consistent relationship between the use of cigarettes and alcohol and the subsequent use of marijuana. Cigarettes, alcohol and marijuana use and the subsequent use of illicit drugs like cocaine is also linked, regardless of the age, sex, ethnicity or race of the individuals involved. Children 12 to 17 years old who smoke are nineteen times more likely to use cocaine. The 1994 report also found that the younger children are when they use these gateway drugs and the more often they use them, the more likely they are to use cocaine, heroin, hallucinogens and other illicit drugs. The report concludes that the data is already robust enough to make a strong case to step up efforts to prevent childhood use of cigarettes, alcohol and marijuana and to take firm steps to reduce children’s access to these gateway drugs.

People who abuse drugs are likely to be cigarette smokers also. More than two-thirds of drug abusers are regular tobacco smokers, a rate more than double of that in the general population. NIDA researchers have found that craving for nicotine also increases craving for illicit drugs among drug abusers who smoke tobacco, and this suggests that smokers in drug rehabilitation programs may be less successful than nonsmokers in staying off drugs.

Tobacco advertising

Main article: Tobacco advertising

Before the 1970s, most tobacco advertising was legal in the United States and most European nations. In the United States, in the 1950s and 1960s, cigarette brands were frequently sponsors of television shows—most notably shows such as To Tell the Truth and I've Got a Secret. One of the most famous television jingles of the era came from an advertisement for Winston cigarettes. The slogan "Winston tastes good like a cigarette should!" proved to be catchy, and is still quoted today. Another popular slogan from the 1960s was "Us Tareyton smokers would rather fight than switch!," which was used to advertise Tareyton cigarettes.

Many nations, including Russia, still allow billboards advertising tobacco use. Tobacco smoking is still advertised in special magazines, during sporting events, in gas stations and stores, and in more rare cases on television.

In the United States, it was believed by many that tobacco companies are marketing tobacco smoking to minors. For example, Reynolds American Inc. used the Joe Camel cartoon character to advertise Camel cigarettes. Other brands such as Virginia Slims targeted women with slogans like "You've Come a Long Way Baby".

Some nations, including the UK and Australia, have begun anti-smoking advertisements to counter the effects of tobacco advertising.

The actual effectivness of tobacco advertisement is widely debated. According to an opinion piece by Henry Saffer, public health experts say that tobacco advertising increases cigarette consumption, but there is a significant empirical literature that finds little or no effect of tobacco advertising on smoking.

Peer pressure

Many anti-smoking organizations say that teenagers begin their smoking habits due to peer pressure. However, one study found that direct pressure to smoke cigarettes did not play a significant part in adolescent smoking. In that study, adolescents also reported low levels of both normative and direct pressure to smoke cigarettes. A similar study showed that individuals play a more active role in starting to smoke than has previously been acknowledged and that social processes other than peer pressure need to be taken into account. Another study's results revealed that peer pressure was significantly associated with smoking behavior across all age and gender cohorts, but that intrapersonal factors were significantly more important to the smoking behavior of 12-13 year-old girls than same-age boys. Within the 14-15 year-old age group, one peer pressure variable emerged as a significantly more important predictor of girls' than boys' smoking. It is debated whether peer pressure or self-selection is a greater cause of adolescent smoking.

Ethnic and cultural influences

Smoking is more popular in some cultures than in others. One study found that in the United States, white youths reported the highest rates of lifetime, current, and persistent smoking, and initiated smoking at a significantly earlier age than African-Americans and Hispanics. In the United States, 33.4% of American Indians and Alaskan Natives smoke, 22.2% of whites smoke, 20.2% of African Americans smoke, 15.0% of Hispanics smoke, and only 11.3% of Asian Americans smoke. Religion and local cultures play a significant role in the smoking prevalnce in the region. Utah, a predominantly Mormon state, has a smoking rate of 12%, while Kentucky, which is the second largest tobacco producing state and whose state economy is the most tobacco dependent, has a 31% smoking rate. In Europe, smoking is more common than it is in the United States. In Germany, 35% of the population smokes, and in Russia, 39% of the population smokes (63% of all males smoke) and in Greece, Europe's heaviest smoking nation, 45% smoke. In the United States, the smoking rate is 22.1%.

Parental smoking

Children of smoking parents are more likely to smoke than children with non-smoking parents. 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.

Smoking in movies and television

Exposure to smoking in movies has been linked with adolescent smoking initiation in cross-sectional studies. Hollywood movies tend to have a high incidence of smoking behavior. According to a study of movies created between 1988 and 1997, eighty-seven percent of these movies portrayed various tobacco use, with an average of 5 occurrences per film. R-rated movies had the greatest number of occurrences and were most likely to feature major characters using tobacco. Despite the declining tobacco use in the society, the incidence of smoking in 2002 movies was nearly the same as in 1950 movies.

There have been moves to reduce the depiction of protagonists smoking in television shows, especially those aimed at children. For example, Ted Turner has taken steps to remove or edit scenes that depict characters smoking in cartoons such as Tom and Jerry, The Flintstones and Scooby-Doo, which are shown on his Cartoon Network and Boomerang television channels.

The use of smoking to project an image

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean Paul Sartre's Gauloise-brand cigarettes, Bertrand Russell's pipe, Lord of the Rings' Gandalf, or the news broadcaster Edward R. Murrow's cigarette. Writers in particular seemed to be known for smoking; see, for example, Cornell Professor Richard Klein's book Cigarettes are Sublime for the analysis, by this professor of French literature, of the role smoking plays in 19th and 20th century letters. British Prime Minister Harold Wilson was well known for smoking a pipe in public as was Winston Churchill for his cigars. Sherlock Holmes, the fictional detective created by Sir Arthur Conan Doyle also smoked a pipe.

Genetic connection

It is inconclusive if smoking is influenced by genetic factors; one 1990 study posited that 52% of the variance in smoking behaviour is attributable to heritable factors, while the other half were a function of the environment.

Opinions of society on smoking

Native Americans and smoking

Communal smoking of a sacred tobacco pipe was a common ritual of many Native American tribes, and was considered a sacred part of their religion. Sema, the Anishinaabe word for tobacco, was grown for ceremonial use and considered the ultimate sacred plant since its smoke was believed to carry prayers to the heavens. Smoking was chiefly done after the evening meal, in the sweathouse, and before going to sleep. The tobacco used during these rituals varies widely in potency -- the Nicotiana rustica species used in South America, for instance, has up to twice the nicotine content of the common North American N. tabacum. Many Native American tribes operate tobacco stores, including on the Internet, where they are usually exempt from taxes and therefore can sell products cheaper than non-Native American dealers.

Christianity and smoking (arguments against)

In more modern times, even before the health risks of smoking were identified for study, smoking was considered an immoral habit by certain Christian preachers and social reformers. Tobacco was listed, along with drunkenness, gambling, cards, dancing and theatre-going, in J.M. Judy's Questionable Amusements and Worthy Substitutes, a book featuring anti-smoking dialogue which was published in 1904 by the Western Methodist Book Concern of Chicago.

Moral concerns about self-injury are also prevalent in Catholic medical ethics on the grounds that people ought to be responsible stewards of the body as a gift from God; the stewardship argument is also used among Protestant groups as an argument against smoking.

Mormonism and smoking (arguments against)

The founder of the Latter Day Saint movement, Joseph Smith, Jr, recorded that on February 27, 1833, he received a revelation which addressed tobacco use. It is commonly known as the Word of Wisdom, and is found in section 89 of the Doctrine and Covenants, a book canonized as scripture by Mormons. (Covenant 89)

And again, tobacco is not for the body, neither for the belly, and is not good for man, but is an herb for bruises and all sick cattle, to be used with judgment and skill.

While initially viewed as a guideline, this was eventually accepted as a commandment; consequently, most Mormons do not smoke.

Judaism and smoking (arguments against)

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The Jewish leader Rabbi Yisrael Meir Kagan, an anti-smoking advocate.

Main article: Jewish law and history on smoking

The Jewish Rabbi Yisrael Meir Kagan (1838-1933) was one of the first Jewish authorities to speak out on smoking. He considered it a health risk and a waste of time, and had little patience for those who claimed addiction, stating that they never should have started smoking in the first place (Likutei Amarim 13, Zechor le-Miriam 23).

A shift toward health-oriented concerns may be observed in some people's interpretations of Jewish law (halakha). For instance, when the link between smoking and health was still doubted, Rabbi Moshe Feinstein response stated that smoking was permitted, although still inadvisable.

More recently, rabbinic responsa tend to argue that smoking is prohibited as self-endangerment under Jewish law and that smoking in indoor spaces should be restricted as a type of damage to others.

Other opinions on smoking

Much opposition to smoking is based on arguments grounded on alleged unethical corporate practices of the tobacco industry and public health concerns. Many public interest groups are interested in controlling smoking-induced problems through political means, and mostly consist of former smokers, health professionals, corporate responsibility advocates, school and community-based organizations, and environmental groups.

David Krogh (a smoker) argues for tobacco's uniqueness as a drug and accounts for the fact that in the past, many moralists who disapproved of "recreational" drugs approved of tobacco.

Krogh's book argues that tobacco is not like alcohol or controlled substances, including marijuana, and that smokers use tobacco to normalize their feelings within the narrow band necessary for functioning within an industrial society, where energy levels have to be carefully rationed according to expectations.

Kantians, however, argue against self-injury as a necessary duty, consistent with the moral law or categorical imperative.

Smoking cessation

Main article: Smoking cessation

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The Easy Way to Stop Smoking by Allen Carr, a famous book teaching smoking cessation

Many of tobacco's health effects can be minimised through smoking cessation. The British doctors study showed that those who stopped smoking before they reached 30 years of age lived almost as long as those who never smoked. It is also possible to reduce the risks by reducing the frequency of smoking and by proper diet and exercise. Some research has indicated that some of the damage caused by smoking tobacco can be moderated with the use of antioxidants.

Smokers wanting to quit or to temporarily abstain from smoking can use a variety of nicotine-containing tobacco substitutes, or nicotine replacement therapy (NRT) products to temporarily lessen the physical withdrawal symptoms, the most popular being nicotine gum and lozenges. Nicotine patches are also used for smoking cessation. Medications that do not contain nicotine can also be used, such as bupropion (Zyban).

Peer support can be helpful, such as that provided by support groups and telephone quitlines.(eg., 1-800-QuitNow in the US, 0800 169 0169 in the UK, and 13 7848 in Australia). In addition, there are many self-help books on the market, such as those by Allen Carr and David Marks.

Legal issues and regulation

On February 28 2005, an international treaty, the WHO Framework Convention on Tobacco Control, took effect. The FCTC is the world's first public health treaty. Countries that sign on as parties agree to a set of common goals, minimum standards for tobacco control policy, and to cooperate in dealing with cross-border challenges such as cigarette smuggling. Currently the WHO declares that 4 billion people will be covered by the treaty, which includes 168 signatories. Among other steps, signatories are to put together legislation that will eliminate secondhand smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

Sale to minors

In many countries, including the United States, the European Union member states, New Zealand, Canada, South Africa, Brazil and Australia, it is illegal to sell tobacco products to minors. In the United Kingdom, The Netherlands, Austria, Denmark and South Africa it is illegal to sell tobacco products to people under the age of 16. In 46 of the 50 United States, the minimum age is 18, except for Alabama, Alaska, New Jersey, and Utah where the legal age is 19 (also in Suffolk County of Long Island, New York). Some countries have also legislated against giving tobacco products to (i.e. buying for) minors, and even against minors engaging in the act of smoking. 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 other regions, cigarettes are still sold to minors because the fines for the violation are lower or comparable to the profit made from the sales to minors.

Taxation

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Cigarettes have become very expensive in places that want to reduce the amount of smoking in public; pictured is the cost of a carton of cigarettes in New Jersey

Many governments have introduced excise taxes on cigarettes in order to reduce the consumption of cigarettes. Money collected from the cigarette taxes are frequently used to pay for tobacco use prevention programs, therefore making it a method of internalizing external costs.

In 2002, the Centers for Disease Control and Prevention said that each pack of cigarettes sold in the United States costs the nation more than $7 in medical care and lost productivity. 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.

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. Currently, the average price and excise tax on cigarettes in the United States is well below those in many other industrialized nations.

The cigarette taxes vary from state to state in the United States. For example, South Carolina has a cigarette taxes of only 7 cents per pack, while Rhode Island has a cigarette tax of $2.46 per pack. In Alabama, Illinois, Missouri, New York City, Tennessee, and Virginia, counties and cities may impose an additional limited tax on a price of cigarettes.

Due to the high taxation, the price of an average pack of cigarettes in New Jersey is $6.35, which is still less than the approximated external cost of a pack of cigarettes.

Some nations are reluctant to increase tobacco taxes because they fear the reduction of tobacco tax revenues and increase in smuggling.

Restrictions on cigarette advertising

Several Western countries have also put restrictions on cigarette advertising. In the United States, all television advertising of tobacco products has been prohibited since 1971. In Australia, the Tobacco Advertising Prohibition Act 1992 prohibits tobacco advertising in any form, with a very small number of exceptions (some international sporting events are excepted, but these exceptions will be revoked in 2006). Other countries have legislated particularly against advertising that appears to target minors.

Package warnings

Main article: Tobacco packaging warning signs

File:Eurocigpack.jpg

The health warnings on a British cigarette pack

Some countries also impose legal requirements on the packaging of tobacco products. For example in the countries of the European Union, Turkey, Australia and South Africa, cigarette packs must be prominently labelled with the health risks associated with smoking. Canada, Australia and Brazil have also imposed labels upon cigarette packs warning smokers of the effects, and they include graphic images of the potential health effects of smoking. Cards are also inserted into cigarette packs in Canada. There are sixteen of them, and only one comes in a pack. They explain different methods of quitting smoking. Also, in the United Kingdom, there have been a number of graphic NHS advertisements, one showing a cigarette filled with fatty deposits, as if the cigarette is symbolising the artery of a smoker.

Currently in Australia, new package warnings are in place on labels. These warnings depict images of the affects of smoking (Gangrene, Children in hospital from passive smoking and browned teeth). Since then, the number of smokers have nearly cut down by one quarter.

Smoking bans

Main article: Smoking ban

Smoking is prohibited on streets in some areas of Tokyo, hence smokers retreat into smoking lounges.

Some jurisdictions impose restrictions on where smoking is allowed. Several European countries such as the Republic of Ireland, Norway, Sweden, Italy, Spain and Scotland have legislated against smoking in public places, often including bars and restaurants. Similar bans will also take effect in the rest of the UK at various intervals (Northern Ireland and Wales from 02 April 2007, and England from summer 2007). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars. In New Zealand and Australia smoking is banned in all public places, including bars and restaurants.

See the List of smoking bans article for a full list of restrictions in various areas around the world.

See also

• Other forms of tobacco use:
  • Bidi
  • Chewing tobacco
  • Dipping tobacco
  • Kretek
  • Smoking pipe
  • Snuff
  • Snus
• Other forms of smoking:
  • cannabis
  • hashish
  • cocaine
• Cigarette packet warning signs
• List of iconic smokers
• Pack year
• Smoking culture
• Smoking fetish

References

• Boffetta, P., Agudo, A., Ahrens, W., Benhamou, E., Benhamou, S., Darby, S.C., Ferro, G., Fortes, C., Gonzalez, C.A., Jockel, K.H., Krauss, M., Kreienbrock, L., Kreuzer, M., Mendes, A., Merletti, F., Nyberg, F., Pershagen, G., Pohlabeln, H., Riboli, E., Schmid, G., Simonato, L., Tredaniel, J., Whitley, E., Wichmann, H.E., Saracci, R. 1998. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J. Natl. Cancer Inst. 90:1440-1450.
• Borio, G., 2006. The Tobacco Timeline. Tobacco.org.
• Centers for Disease Control and Prevention (CDC). 2004. History of the 1964 Surgeon General's Report on Smoking and Health. [2]
• James I of England. 1604. A Counterblaste to Tobacco.
• Joint Committee on Smoking and Health. Smoking and health: physician responsibility; a statement of the Joint Committee on Smoking and Health. Chest 1995; 198:201- 208
• Osvaldo P. Almeida, Gary K. Hulse, David Lawrence and Leon Flicker, "Smoking as a risk factor for Alzheimer's disease: contrasting evidence from a systematic review of case-control and cohort studies," Addiction, Volume 97, Issue 1, Page 15 - January 2002.

Further reading

• Iain Gately: La Diva Nicotina. The Story of How Tobacco Seduced the World (2001) (ISBN 0-7432-0812-9).
• David Krough: Smoking: The Artificial Passion (Freeman, 1992) (ISBN 0-7167-2347-6).
• G Invernizzi et al., Particulate matter from tobacco versus diesel car exhaust: an educational perspective. Tobacco Control 13, S.219-221 (2004)
• Ian Tyrrell;Deadly Enemies: Tobacco and Its Opponents in Australia (1999)
• John C. Burnham, Bad Habits: Drinking, Smoking, Taking Drugs, Gambling, Sexual Misbehavior, and Swearing in American History, New York University Press, 1993
• Jordan Goodman, Tobacco in History: The Cultures of Dependence, Routledge, London, 1993
• Richard Kluger, Ashes to Ashes, 1996, on smoking in U.S.
• Robin Walker, Under Fire: A History of Tobacco Smoking in Australia, Penguin, Ringwood, 1984.
• David Harley, "'The Beginnings of the Tobacco Controversy: Puritanism, James I, and the Royal Physicians'", Bulletin of the History of Medicine, vol. 67, Spring 1993, pp. 28-50
• Hendricks, P.S., et al. (2006). The early time course of smoking withdrawal effects. Psychopharmacology, 187, 385-396.
• Ness, R., Grisso, J., Hirschinger, N., Markovic, N., Shaw, L., Day, N., and Kline, J. (1999). Cocaine and Tobacco Use and the Risk of Spontaneous Abortion. New England J. Med. 340:333-339; Oncken, C., Kranzler, H., O'Malley, P., Gendreau, P., Campbell, W. A. (2002). The Effect of Cigarette Smoking on Fetal Heart Rate Characteristics. Obstet Gynecol 99: 751-755.
• Venners, S.A., X. Wang, C. Chen, L. Wang, D. Chen, W. Guang, A. Huang, L. Ryan, J. O'Connor, B. Lasley, J. Overstreet, A. Wilcox, and X. Xu. (2004). Paternal Smoking and Pregnancy Loss: A Prospective Study Using a Biomarker of Pregnancy Am J Epidemiol 159: 993-1001.
• "Blackwell Synergy - Cookie Absent (See above)". Retrieved 2005-12-18.
• "Health : Young smokers' heart attack risk". BBC. Retrieved 2005-12-18.

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