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Tobacco smoking

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Various smoking equipment including different pipes.

Tobacco smoke contains a stimulant nicotine which forms a strong physical and psychological chemical dependence (addiction). The Centers for Disease Control and Prevention claim that nicotine is a "very addictive drug" that can be "as addictive as heroin or cocaine."[1] Dependence is strongest when tobacco smoke is inhaled into the lungs and increases with quantity and speed of nicotine absorption. Nicotine is typically eliminated from the body within 2 to 3 days, however, physical and psychological withdrawal symptoms may last for much longer depending on the individual. [3]

Medical research has found that smoking is a major contributing factor towards many human health problems, especially lung cancer, emphysema, cardiovascular disease, and other disorders. The actual extent of the damage caused by smoking is contested, but it has been found that many of the researchers reporting fewer problems receive funding indirectly from the tobacco industry. Tobacco industry documents, which are now available on the internet following litigation in the USA, show a carefully orchestrated campaign, designed to discredit the scientific evidence for the link between tobacco and death and disease[4]. In recent years and in many countries tobacco advertising has been regulated or restricted. In some countries smoking bans have come into effect.

History

Tobacco smoking, using both pipes and cigars, was common to many Native American cultures of the Americas. It is depicted in the art of the Classic-era Maya civilization about 1,500 years ago. The Mayans smoked tobacco and also mixed it with lime and chewed it in a snuff-like substance. Among the Mayans tobacco was used as an all-purpose medicine, and was widely believed to have magical powers, being used in divinations and talismans. It was also burned as a sacrifice to the gods; a tobacco gourd was worn as a badge by midwives.

On October 12, 1492, Christopher Columbus was given "certain dry leaves" by the Arawaks, but threw them away. Rodrigo de Jerez and Luis de Torres, who had erroneously been searching for the Khan of Cathay in Cuba, were the first Europeans to observe smoking, and Jerez also became the first recorded smoker outside the Americas. His neighbours in Spain were so frightened by the smoke billowing from his mouth and nostrils that they alerted the Spanish Inquisition, and Jerez was imprisoned for seven years. By the time he was released, smoking had become fashionable in Spain. In 1497 Ramon Pane who had been on the second voyage of Columbus describes the native use of tobacco in De Insularium Ribitus. Columbus in 1498 named the island of Tobago after the native tobacco pipe. Throughout the 16th century, the habit of smoking spread mainly among sailors. It was introduced to England by the crew of Sir John Hawkins in the 1560s. In 1559, Francisco Hernandez de Toledo introduced the plant to the court of Philippe II where it was at first only grown as an ornamental plant. Tobacco made an impact on European society only from the 1580s; in England, some returning Virginia colonists in 1586 caused a sensation by smoking tobacco from pipes. The tobacco plant in Elizabethan England was known as sotweed. The habit caught on, and in 1604, James I wrote his A Counterblaste to Tobacco, and multiplied import tax on tobacco by a factor of 40. Similarly, an imperial edict in 1610 prohibited the use and cultivation of tobacco in China, where, from 1638, smokers could be punished by decapitation. During the Thirty Years' War (1618-48), smoking Landsknechts spread tobacco use among the rural population of the European continent: records of smoking in Sweden date to 1630 and in Austria to 1650. In 1642, Urban VIII issued a papal bull against smoking in churches. In 1657, smoking was prohibited in Switzerland.

The cigar became immensely popular in England in the late 1820s. The cigarette appeared in 1828 in Spain, and enjoyed immediate success. The protagonist of Bizet's Carmen of 1845 is a girl working in a cigarette factory. But the cigarette remained less popular than the cigar or pipe until the early 20th century in most of Europe, when cheap mechanically made cigarettes became common. Queen Victoria hated tobacco, but after her death, in 1901, her son and successor Edward VII gathered his friends in a large drawing room at Buckingham Palace and entered with a lit cigar in his hand, announcing "Gentlemen, you may smoke", initiating the upper class British smoking room. Ironically, his grandson, King George VI (Queen Elizabeth's father) would later die at age 56 of lung cancer.

Smoking as part of a glamorous life was also conveyed through the media. This image shows actress Audrey Hepburn in the film Charade. (1963)

Tobacco companies succeeded in having their product included in military rations during World War I, where under the stress of warfare many soldiers took up smoking, becoming habitual smokers. After the war, during the Roaring Twenties, cigarette smoking was portrayed in advertising as part of a glamorous carefree lifestyle, and became socially acceptable for women as well.

In the 1930s Nazi medical and military leaders became concerned that tobacco might prove a hazard to human health, concluding that the "extraordinary rise in tobacco use" was "the single most important cause of the rising incidence of lung cancer," the first scientists to confirm this link. From 1933 to 1945 Germany had the world's strongest anti-smoking movement, with the full support of Adolf Hitler, who disapproved of smoking. He characterised tobacco as "the wrath of the Red Man against the White Man for having been given hard liquor." He also associated smoking, along with drinking, as affects of liberal decadence. Nazi propagandists even had a campaign to discourage smoking during pregnancy, which was medically progressive for its time. Ironically, one of Hitler's best known admirers -- George Lincoln Rockwell -- was a faithful smoker, rarely seen without a pipe. [5][6]

Germany's defeat in 1945 meant that its aggressive anti-tobacco movement declined. Hitler and the campaigners behind the movement were dead, had been silenced, or were later executed for crimes against humanity. Much of the science on the dangers of tobacco had been gathered through brutal experimentation on concentration camp prisoners. [7] German physician Knut-Olaf Haustein was known for his work studying the effects of tobacco smoking.

In the 1950s and 1960s, the medical community and government bodies (particularly in the United States), as well as Readers Digest magazine, began a campaign to reduce the degree of smoking by showing how it damaged public health. Filter-tip cigarettes, which reduce poisonous chemicals, were introduced and are now standard everywhere. Less potent brands were also introduced in the 1960s but did not satisfy smokers' cravings as well as traditional brands. The 1964 U.S. Surgeon General's Report, summarizing the findings of numerous medical research studies, was a major wake-up call, and led millions of Americans to quit, and tobacco commercials to be banned. In recent years tobacco smoking in many regions of the world has dramatically dropped, but remains extraordinarily high in regions such as the Asian Far East due to aggressive cigarette company marketing and lack of health education.

Health effects

Main article: Health effects of tobacco smoking
Because of their nicotine addiction, many smokers are unable 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.

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".[1] Twenty-four percent of pregnant women in Indiana smoke cigarettes. If they didn’t smoke, 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 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.

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.

Passive smoking

Main article: 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. Involuntary 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.

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." [8]. Passive smoking is one of the key issues in leading to smoking bans, particularly in workplaces.

Environmental tobacco smoke (ETS) presents health risks similar to those of air pollution in regard to respiratory and cardiovascular diseases, and is being counteracted by regulations in most countries.

The composition of ETS is similar to other 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.[9]

This knowledge can be used to develop an educational message on smoking prevention based on indoor versus outdoor pollution, an issue of concern also for the tobacco industry, as disclosed by the attempts to produce cigarettes with low PM emissions.

Smoking cessation

Many of tobacco's health effects can be minimised through smoking cessation. The "British doctors study" [2] 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 help 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, however, this does not apply to the millions of people worldwide with respiratory ailments, or the billions who live in an area with bad air pollution. (Including from fires from slash and burn (most of the third world), forest fires, sandstorms (covering most of East Asia as well as urban pollution.

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).

Discussing quitting smoking with supportive people can also be helpful, both in person and through telephone quitlines, such as 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, for example those by Allen Carr and David Marks.

Opinions 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 Anishnabe word for tobacco, is still used for ceremonial uses today among Native Americans. It was grown for ceremonial use and considered the ultimate sacred plant. Tobacco smoke was believed to carry prayers to the heavens. These rituals were performed, on average, no more than once a month, which differs widely from modern smoking, which is much more frequent and usually devoid of spiritual significance. The tobacco used during these rituals varied 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. To this day 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 from God 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 a health guideline, this was eventually accepted as a commandment, and faithful members of this religion do not generally smoke.

Judaism and smoking (arguments against)

The Jewish leader 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 Moses 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 (See article on Jewish law and history on smoking).

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 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 so-called 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.

In many countries, including the United States, New Zealand, Canada, South Africa and Australia, it is illegal to sell tobacco products to minors. In the United Kingdom, Austria 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. 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.

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[3] 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.

Some countries also impose legal requirements on the packaging of tobacco products. For example in the countries of the European Union, Australia and South Africa, cigarette packs must be prominently labelled with the health risks associated with smoking [citation needed]. 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.

On February 28 2005, an international treaty, the WHO Framework Convention on Tobacco Control[citation needed], 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 92 signatories[citation needed]. Amongst 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.

Smoking bans

Main article: Smoking ban
Attention grabbing signs often mark locations where smoking is not permitted.

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 from April 2007, England from summer 2007 and Wales at a similar time). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars.

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

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, or the news broadcaster Edward R. Murrow's cigarette. Writers in particular seemed to be known for smoking; see, for example, Richard Klein's book Cigarettes are Sublime for the analysis, by this Cornell University professor of French literature, of the role smoking plays in 19th and 20th century letters. British Prime Minister Harold Wilson smoked a pipe in public, considering that it gave him the image of a plain working man; furthermore, the ritual of relighting the pipe gave him time to respond to difficult questions. In private, he smoked the more elitist cigars[citation needed].

Smoking journalists

Edward R. Murrow, after leaving CBS and joining the United States Information Agency under President Kennedy was diagnosed with lung cancer. Murrow was able to quit in the time remaining to him and was very open about the benefits he experienced[citation needed].

In April 2005, the ABC News anchor Peter Jennings appeared on-air to report his own diagnosis of lung cancer. Jennings had quit smoking in 1985 but confessed that he'd started again after the September 11 attacks, when he had been on air for over 60 hours and had to announce the multiple tragedies of that day. On August 7, 2005, Jennings succumbed to the cancer.

Possible health benefits of smoking

Ulcerative colitis is twice as common in non-smokers as in smokers[4]. However this is caused not by the smoking itself, but by the nicotine in tobacco smoke which acts as an anti-inflammatory agent[5].

Also, it is thought that the risks of Parkinson's disease may be significantly lower for smokers than for non-smokers though this idea has not been definitively proven. One explanation for this effect is nicotine allegedly increasing the levels of acetylcholine in the smoker's brain; studies have previously determined that Parkinson's disease is partly caused by low levels of dopamine and acetylcholine. However, nicotine is the only substance in tobacco smoke which has those positive effects, and the consumption of pure nicotine would likely be more beneficial than smoking.

Genetic connection

There is evidence that smoking is substantially influenced by genetic factors; a 1990 study found that 52% of the variance in smoking behaviour is attributable to heritable factors, with the remainder being a function of the environment[6].

See also

Further reading

  • Iain Gately: La Diva Nicotina. The Story of How Tobacco Seduced the World (2001) (ISBN 0743208129).
  • David Krough: Smoking: The Artificial Passion (Freeman, 1992) (ISBN 0716723476).
  • G Invernizzi et al., Particulate matter from tobacco versus diesel car exhaust: an educational perspective. Tobacco Control 13, S.219-221 (2004)

Notes

  • 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
  • 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.
  • 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.
  1. ^ a b "Nicotine: A Powerful Addiction." Centers for Disease Control and Prevention. [1]
  2. ^ "Mortality in relation to smoking: 50 years' observations on male British doctors -- Doll et al., 10.1136/bmj.38142.554479.AE -- BMJ (See above)". Retrieved 2005-12-18.
  3. ^ "Tobacco Advertising Prohibition Act 1992". Retrieved 2005-12-18.
  4. ^ Longmore, M., Wilkinson, I., Torok, E. Oxford Handbook of Clinical Medicine (Fifth Edition) p. 232
  5. ^ Scientific American, June 2006, p. 24; "Body Blazes" by Lisa Melton [2]
  6. ^ "Entrez PubMed". Retrieved 2006-05-12.

History

Prevention and self help

Smokers' rights sites

Statistics and studies

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