Tobacco smoking

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1: cigar box 2: cigar 3: various pipes 4: waterpipe 5: joss stick 6: bong Various smoking equipment including different pipes, and cigars.

Tobacco smoking is the act of smoking tobacco products, especially cigarettes and cigars. Tobacco smoking is considered a significant cause of human health problems, especially lung cancer, emphysema, and other disorders.

The practice of smoking tobacco originated among Native Americans in western North America, where tobacco is native. It was adopted by many Europeans following the colonization of the Americas. According to the World Health Organization, it is most common in east Asia, where as many as two-thirds of all adult males smoke tobacco. Because of concern over the health hazards of smoking, the practice has rapidly declined in recent years in the United States, Canada and western Europe.

Tobacco may be smoked in several forms, the most common being the cigarette, the cigar, and the pipe. Cigarette smoking is by far the most common. Pipes and cigars are less common, and are used almost exclusively by men. The hookah or water pipe is used in the Middle East.

In the case of cigarette smoking, smoke is inhaled into the lungs. Tobacco smoke contains nicotine, which forms a strong physical and psychological chemical dependence (addiction). According to the Centers for Disease Control and Prevention, nicotine is a "very addictive drug" that can be "as addictive as heroin or cocaine."Template:Fn Dependence is strongest when tobacco smoke is inhaled into the lungs and increases with quantity and speed of nicotine absorption.

History

File:Smokinghand.jpg
Cigarettes are the most common way of smoking tobacco

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 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, 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 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 neighbors 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 China in 1610 prohibited use and cultivation of tobacco; from 1638, smokers could be punished by decapitation in China. 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 Prosper Merimee'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.

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

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. This image continued to be prevalent to some degree until the 1950s and 1960s, when the medical community and government (particularly in the United States) began a campaign to reduce the degree of smoking by showing how it damaged public health. In recent years tobacco smoking in many regions of the world has dramatically dropped.

Health effects

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

An indirect public health problem posed by cigarettes is that of accidental fires, usually linked with consumption of alcohol. Numerous cigarette designs have been proposed, some by tobacco companies themselves, which would extinguish a cigarette left unattended for more than a minute or two, thereby reducing the risk of fire. However the tobacco companies have historically resisted this idea, on the grounds that the nuisance involved in having to relight a cigarette left untouched for too long would reduce their sales. In fact, untreated tobacco formed into a cigarette will extinguish itself relatively quickly if left alone, and as a result cigarette tobacco is treated chemically to allow it to smolder indefinitely.

The main health risks in tobacco smoking 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.

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 steadily although gradually decrease as the damage to their body is repaired.

Diseases linked to smoking tobacco cigarettes include:

Cigar and pipe smokers tend to inhale less smoke than cigarette smokers, so their risk of lung cancer is lower but is still several times higher than the risk for nonsmokers. Pipe and cigar smokers are also at risk for cancers of the oral cavity, larynx (voice box), or esophagus, a risk which was widely hypothesized before any link between smoking and cancer was scientifically proved as seen in the news coverage of the tobacco-related cancers of two American presidents; Ulysses S. Grant died in 1885 at age 63 after a long and painful public battle with throat cancer which was widely assumed at the time to be the result of his lifelong cigar habit, and his successor Grover Cleveland was diagnosed in 1893 with cancer of the left jaw, which was frequently remarked upon by the press and public as the side where he usually had a cigar clamped. Similarly, cancer of the mouth and jaw is also a risk for chewing tobacco.

It is generally assumed that the major motivational factor behind smoking is the nicotine it contains. However, the practice of ingesting the smoke from a smoldering leaf generates an enormous number of active chemical compounds, loosely lumped together as 'tar', many of which are biologically reactive and potential health dangers. (Chewing tobacco is also carcinogenic, likely because similar compounds are generated in the practice of curing it; the Nordic snus, which is steam cured and therefore does not generate these compounds, is much less carcinogenic.) There are around 3000 chemicals found in tobacco smoke. Long term exposure to other compounds in the smoke, such as carbon monoxide, cyanide, and other compounds that damage lung and arterial tissue, are believed to be responsible for cardiovascular damage and for loss of elasticity in the alveoli, leading to emphysema and COPD.

Tobacco and spontaneous abortion

A number of studies have shown that tobacco use is a significant factor in spontaneous abortions among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus.[1] Second-hand smoke appears to present an equal danger to the fetus, as one study noted that "heavy paternal smoking increased the risk of early pregnancy loss."[2] Many governments require printed rotating health warnings on cigarette packages. Often, one of these notes the negative effects of smoking on a fetus.

Radioactive components of tobacco

In addition to chemical, nonradioactive carcinogens, tobacco and tobacco smoke contain small amounts of lead-210 (210Pb) and polonium-210 (210Po) both of which are radioactive carcinogens. Lead 210 is a product of the decay of radium-226 and, in turn, its decay product, radon-222; lead 210 then decays to bismuth-210 and then to polonium 210, emitting beta particles in both steps. Tarry particles containing these elements lodge in the smokers' lungs where airflow is disturbed; the concentration found where bronchioles bifurcate is 100 times higher than that in the lungs overall. This gives smokers much more intense exposure than would otherwise be encountered. Polonium 210, for instance, emits high energy alpha particles which because of their large mass are considered to be incapable of penetrating the skin more than 40 micrometres deep, but do considerable damage (estimated at 100 times as much chromosome damage as a corresponding amount of other radiation) when a process such as smoking causes them to be emitted within the body, where all their energy is absorbed by surrounding tissue. (Polonium 210 also emits gamma rays).

The radioactive elements in tobacco are accumulated from the minerals in the soil, as with any plant, but are also captured on the sticky surface of the tobacco leaves in excess of what would be seen with plants not having this property. As might be expected, the radioactivity measured in tobacco varies widely depending on where and how it is grown. One study found that tobacco grown in India averaged only 0.09 pCi per gram of polonium 210, whereas tobacco grown in the United States averaged 0.516 pCi per gram. Another study of Indian tobacco, however, measured an average of 0.4 pCi of polonium 210 per cigarette, which also would be approximately a gram of tobacco. One factor in the difference between India and the United States may be the extensive use of apatite as fertilizer for tobacco in the United States, because it starves the plant for nitrogen, thereby producing more flavorful tobacco; apatite is known to contain radium, lead 210, and polonium 210. This would also account for increased concentration of these elements compared to other crops, which do not use this mineral as fertilizer.

Smoke from one cigarette is reported to contain 0.0263 - 0.036 pCi of polonium 210, which is equivalent to about 0.1 pCi per milligram of smoke; or about 0.81 pCi of lead 210 per gram of dry condensed smoke. The amount of polonium 210 inhaled from a pack of 20 cigarettes is therefore about 0.72 pCi. This seems to be independent of any form of filtering or 'low tar' cigarette. This concentration results in a highly significant increase in the body burden of these compounds. Compared to nonsmokers, heavy smokers have four times greater radioisotope density throughout their lungs. The polonium 210 content of blood in smokers averages 1.72 pCi per kilogram, compared to 0.76 pCi per kilogram in nonsmokers. Higher concentrations of polonium 210 are also found in the livers of smokers than nonsmokers. Polonium 210 is also known to be incorporated into bone tissue, where the continued irradiation of bone marrow may be a cause of leukemia, although this has not been proved as yet.

The alpha particle dosage from polonium 210 received by smokers of two packs a day has been measured at 82.5 millirads per day, which would total 752.5 rads per 25 years, 150 times higher than the approximately 5 rem received from natural background radiation over 25 years. Other estimates of the dosage absorbed over 25 years of heavy smoking range from 165 to 1,000 rem, all significantly higher than natural background. In the case of the less radioactive Indian tobacco referred to above, the dosage received from polonium 210 is about 24 millirads a day, totalling 219 rads over 25 years or still about 40 times the natural background radiation exposure. In fact, all these numbers of total body burden are misleadingly low, because the dosage rate in the immediate vicinity of the deposited polonium 210 in the lungs can be from 100 to 10,000 times greater than natural background radiation. Lung cancer is seen in laboratory animals exposed to approximately one fifth of this total dosage of polonium 210.

Whether the quantities of these elements are sufficient to cause cancer is still a matter of debate. Most studies of carcinogenicity of tobacco smoke involve painting tar condensed from smoke onto the skin of mice and monitoring for development of tumors of the skin, a relatively simple process. However, the specific properties of polonium 210 and lead 210 and the model for their action, as described above, do not permit such a simple assay and require more difficult studies, requiring dosage of the mice in a manner mimicing smoking behavior of humans and monitoring for lung cancer, more difficult to observe as it is internal to the mouse.

Some researchers suggest that the degree of carcinogenicity of these radioactive elements is sufficient to account for most, if not all, cases of lung cancer related to smoking. In support of this hypothetical link between radioactive elements in tobacco and cancer is the observation that bladder cancer incidence is also proportional to the amount of tobacco smoked, even though nonradioactive carcinogens have not been detected in the urine of even heavy smokers; however, urine of smokers contains about six times more polonium 210 than that of nonsmokers, suggesting strongly that the polonium 210 is the cause of the bladder carcinogenicity, and would be expected to act similarly in the lungs and other tissue. Furthermore, many of the lung cancers contracted by cigarette smokers are adenocarcinomas, which are characteristic of the type of damage produced by alpha particle radiation such as that of polonium 210. It has also been suggested that the radioactive and chemical carcinogens in tobacco smoke act synergistically to cause a higher incidence of cancer than each alone.

Skeptics of the role of polonium 210 in lung cancer note that it is soluble in water, and thus would be excreted (confirmed by the high polonium 210 concentrations in the urine of smokers, referred to above). However, the inhibition of the clearing action of the cilia in the respiratory tract by tobacco smoke, the stickiness of the particles of tar precipitated from the smoke, and deposits within the lung of insoluble lead 210 which then breaks down into polonium 210, have all been postulated as mechanisms by which polonium 210 exposure continues for long periods. Even after having stopped smoking for a year, concentrations of lead 210 and polonium 210 in rib bones and alveolar lung tissue remain twice as high in ex-smokers as in those who had never smoked.

Beneficial effects of smoking

Tobacco has sometimes been reported to have some positive health effects, presumably due to the effects of nicotine on the nervous system. Most notably, some studies have found that patients with Alzheimer's Disease are more likely not to have smoked than the general population, which has been interpreted to suggest that smoking offers some protection against Alzheimers. However, the research in this area is limited and the results are mixed. Some studies show that smoking increases the risk of Alzheimer's Disease. A recent review of the available scientific literature concluded that the apparent decrease in Alzheimer risk may be simply due to the fact that smokers tend to die before reaching the age at which Alzheimer normally occurs. "Differential mortality is always likely to be a problem where there is a need to investigate the effects of smoking in a disorder with very low incidence rates before age 75 years, which is the case of Alzheimer's disease", it stated, noting that smokers are only half as likely as non-smokers to survive to the age of 80. [3]

Smoking is more prevalent among the mentally ill than among the general population, and it has been theorized that nicotine may have a calming effect that alleviates some negative symptoms of psychiatric illnesses. This, however, would be a contradiction of the fact that nicotine is a stimulant and can increase feelings of anxiety; the 'calming' effect merely arising from the rather complex nature of tobacco addiction and short-term withdrawal. Other studies have found that smoking is associated with slightly reduced incidence of Parkinson's disease and ulcerative colitis. In women, smoking has been linked to decreased rates of endometriosis, endometrial cancer, development of leiomyomata, and hypertension during pregnancy.

Controversially, smoking can also prevent and in some cases 'cure' asthma as the smoke particulates have a tendency to desensitise the bronchia therefore preventing the onset of bronchiospasms when around allergenic substances or asthmatic attack causing environs. This topic is hotly argued between doctors and laymen alike, having a widespread reputation via word of mouth is the primary basis of the allegations, whilst scientific testing is inconclusive or alternately aligned depending on sources.

Smokers are less likely to suffer from obesity.

Nicotine and addiction

Nicotine is a powerful 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. The amount of nicotine absorbed by the body from smoking depends on many factors, including the type of tobacco, whether the smoke is inhaled, and whether a filter is used. Despite the design of various cigarettes advertised and even tested on machines to deliver less of the toxic tar, studies show that when smoked by humans instead of machines, they deliver the same net amount of smoke. Ingesting a compound by smoking is one of the most rapid and efficient methods of introducing it into the bloodstream, second only to injection, which allows for the rapid feedback which supports the smokers' ability to titrate their dosage. On average it takes about seven seconds for the substance to reach the brain.

Although nicotine does play a role in acute episodes of some diseases (including stroke, impotence, and heart disease) by its stimulation of adrenaline release, which raises blood pressure, heart rate, and free fatty acids, the most serious longer term effects are more the result of the products of the smoldering combustion process. This has enabled development of various nicotine delivery systems, such as the nicotine patch or nicotine gum, that can satisfy the addictive craving by delivering nicotine without the harmful combustion byproducts. This can help the heavily dependent smoker to quit gradually, while discontinuing further damage to health.

Smoking and cardiovascular disease

Smoking also increases the chance of heart disease. Several ingredients of tobacco lead to the narrowing of blood vessels, increasing the likelihood of a blockage, and thus a heart attack or stroke. According to a study by an international team of researchers, people under 40 are five times more likely to have a heart attack if they smoke [4].

Other tobacco chemicals lead to high blood pressure. Also, some chemicals may damage the inside of arteries, for example making it possible for cholesterol to adhere to the artery wall, possibly leading to a heart attack.

Epidemiology of smoking

A team of British scientists headed by Richard Doll carried out a longitudinal study of 34,439 medical specialists from 1951 to 2001, generally called the "British doctors study" [5]. The study demonstrated that smoking decreased life expectancy by 10 years and that almost half of the smokers died from smoking (cancer, heart disease, and stroke). About 5,900 of the study participants are still alive and only 134 of them still smoke.

Effects on smokers

Smokers report a variety of physical and psychological effects from smoking tobacco. Those new to smoking will experience nausea, dizziness, and rapid heart beat. The negative symptoms will eventually vanish over time, with repeated use, as the body builds a tolerance to the nicotine. Nicotine is an unusual chemical because when absorbed slowly, it can act as a sedative and when absorbed quickly it can act as a stimulant. Pipe and cigar smokers usually experience more of the sedative/relaxation effect while cigarette smokers usually experience more of the stimulant effect.

In many respects, nicotine acts on the nervous system in a similar way to caffeine. Some writings have stated that smoking can also increase mental concentration. Most smokers say they enjoy smoking, which is part of the reason why many continue to do so even though they are aware of the health risks. Taste, smell, and visual enjoyment are also major contributions to the enjoyment of smoking, in addition to camaraderie with other smokers.

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean Paul Sartre's Gauloise (a French cigarette, particularly odorous and powerful in its traditional unfiltered form), Bertrand Russell's pipe, or the news broadcaster Edward R. Murrow's cigarette. Writers in particular seemed to have had difficulty in the past with smoking, perhaps because as writers, they succumb to tobacco's fictions and in effect those fictions become the writer's reality: 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.

Many smokers are defensive about their habit and skeptical about scientific predictions while crediting science in all other areas of their lives, but successful reformed smokers are often quite happy and relieved, proud of their success, and anti-tobacco. One case was Edward R. Murrow as mentioned above who, after leaving CBS and joining the U.S. Information Agency under President Kennedy was diagnosed with lung cancer. Despite the death sentence this implied, Murrow was able to quit in the time remaining to him and was very open about the benefits he experienced.

In April of 2005, another news broadcaster reported another occurrence of one of smoking's tragic effects. 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 Jennings 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.

Experienced smokers, when denied access to nicotine, will often exhibit symptoms such as irritability, dry mouth, and rapid heart beat. Longer abstinence can lead to insomnia and even mild depression. Smokers abstaining from nicotine for approximately ten to twenty days will, eventually, eliminate the chemical dependence, although the psychological dependence may linger for months or even many years. Unlike illicit recreational drugs and alcohol, nicotine does not measurably alter a smoker's motor skills, cognition, judgment, or language abilities.

What can't be measured, of course, is the smoker's purely psychological dependence in the form of a belief that he "needs" to "concentrate". The many smokers who in the past have belied smoking's contemporary image as a "loser's" habit through success in their chosen fields (from Sartre to Peter Jennings) may have regarded themselves as addicted because of the self-reinforcing belief even when presented with evidence that quitting smoking (and its attendant irritations, from health problems to the forgotten lighter) would increase their creativity or job performance. This is a denial of the scientific world-view which (as Professor Klein's book shows) forces the smoker to spiritual recoveries in which he no longer has to regard himself as a pure object, subject completely to scientific predictions and forces.

Theodore Adorno, never a smoker, wrote "human beings need to be subjects of their world, not objects". Many smokers replace its effect with spiritual recovery including traditional religion, AA-inspired 12 Step programs, and New Age holistic therapy because purely scientific predictions objectify the smoker.

Smoking cessation

Many of tobacco's health effects can be minimised through smoking cessation. The "British doctors study" [6] 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.

Smokers wanting to quit (or to temporarily abstain from) smoking can use a variety of nicotine-containing tobacco subsitutes to temporarily lessen the physical withdrawal symptoms, the most popular being nicotine gum and lozenges. Nicotine patches are also used for smoking cessation. They can also use medications, such as welbutrin, that do not contain nicotine. Pharmaceutical assistance has been shown to increase cessations success rates by 50%. Discussing the problem with supportive people can also be helpful, both in person and through telephone quitlines, such as 1-800-QuitNow, in the U.S. In addition, there are lots of self-help books on the market, for example those by Allen Carr.

Moral aspects

Communal smoking of a sacred tobacco pipe was a universal ritual through Native America. Native Americans considered tobacco a sacred part of their religion. It was grown for ceremonial use and considered the ultimate sacred plant. Tobacco smoke was believed to carry prayers to the heavens.

In more modern times, even before the health risks of smoking were scientifically known, it was considered a filthy, harmful and immoral habit by some Christian preachers and social reformers. Tobacco was listed, along with drunkenness, gambling, cards, dancing and theater-going, in J.M. Judy's Questionable Amusements and Worthy Substitutes, which was published in 1904 by the Western Methodist Book Concern of Chicago. Judy wrote that "Tobacco dulls the mind. It does this not only by wasting the body, the physical basis of the mind, but it does it through habits of intellectual idleness, which the user of tobacco naturally forms. Whoever heard of a first-class loafer who did not eat the weed or burn it, or both?" In addition, he wrote, "Tobacco wastes the body" and "blunts the moral nature." But there was also the more direct concern that the poor would waste what little money they had on tobacco, instead of supporting their families, similar to a concern about alcohol in this era.

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 waste of time and saw the practice of people "borrowing" (pilfering) cigarettes from each other as morally questionable.

Most modern opposition to smoking, however, is based on moral arguments grounded on health concerns. Some public interest groups, usually described as "anti-smokers", are interested in controlling smoking through political means; many consist of former "reformed" smokers, doctors and others concerned about public health. The shift toward health-oriented moral concerns may be observed in Jewish approaches based on Jewish law (Halakha). For instance, when the link between smoking and health was still doubted, Rabbi Moses Feinstein wrote a responsum stating that smoking was permitted, though inadvisable. More recently, rabbinic responsa tend to argue that smoking is prohibited as self-endangerment under Jewish law and, moreover, smoking in indoor spaces should be a priori restricted as a type of damage to others. (See article on Jewish law and history on smoking.) Moral concerns about both 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 the divine. (Beyond religious ethics, Kantians also argue against self-injury as a necessary duty, consistent with the moral law or categorical imperative.)

For another take on the moral aspects of smoking, see David Krogh's book "Smoking: the Artificial Passion" (Freeman 1992). Freeman documents a strong case 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 shows how tobacco is not like alcohol or so-called controlled substances including marijuana a recreational drug. He shows how 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.

Krogh's analysis is unusual because it explains why workplaces prior to about 1980 actively encouraged smoking through the provision of ashtrays and vending machines and even today, smokers in nonsmoking offices are usually allowed generous breaks far in excess of nonsmokers. Krogh shows how cigarette smoking (unlike alcohol or marijuana, but perhaps like "speed" and "crystal meth") reconciles people to dull jobs by narrowing their physical, and hence psychological responses to fit within an expected range: not so depressed as to be subpar but not overenthusiastic or so angry as to cause fear in fellow employees.

This range is naturalized as normal but in fact all industrialized societies have had to train their lower-level cadres to dampen their response and it appears, given Krogh's narrative sociology, that smoking was morally neutral before about 1980 because it fulfilled this necessary function.

The zenith of smoking's moral approval in America was the Second World War and the postwar era where vast numbers of people had to operate technical apparatus while dampening down feelings of fear and despair which were normal given the facts of the war and subsequent period of "cold" war. But to the extent that since this era, metropolitan and developed countries had almost complete immunity from the immediacy of wartime conditions, smoking has probably fulfilled less of a socially necessary function in metropolitan societies...while in marginalized war zones it continues to enjoy positive approval.

As a narrative sociology, Krogh needs to be taken with a grain of salt. It may be that prior to modern restrictions on tobacco advertising, public relations was able to create the illusion that a harmful activity was morally neutral or even a mitzvah (Jewish commandment).

Passive smoking

Passive smoking (also known as environmental tobacco smoke (ETS), involuntary smoking or secondhand smoke) occurs when the exhaled and ambient smoke from one person's cigarette is inhaled by other people. Fritz Lickint was the first to use the German term passives rauchen (passive smoking) in 1939, while working for Hitler’s anti-tobacco league. In his 1200 page book Tabak und Organismus (Tobacco and the Organism) he describes numerous diseases. He knew already that tar was more hazardous than nicotine. From 1938, anti-smoking regulations began to be implemented by the Nazi regime in Germany. [7]

Non-smokers exposed to secondhand smoke are at risk for many of the health problems associated with direct smoking. In 1992, the Journal of the American Medical Association published a review of the evidence available from epidemiological and other studies regarding the relationship between secondhand smoke and heart disease and estimated that passive smoking was responsible for 35,000 to 40,000 deaths per year in the United States in the early 1980s. [8] Non-smokers living with smokers have about a 25 per cent increase in risk of death from heart attack and are also more likely to suffer a stroke, and some research suggests that risks to nonsmokers may be even greater than this estimate. One recent study in the British Medical Journal found that exposure to secondhand smoke increases the risk of heart disease among non-smokers by as much as 60 percent. [9] Passive smoking is especially risky for children and babies and can cause low birth weight babies, sudden infant death syndrome (SIDS), bronchitis and pneumonia, and middle ear infections. [10]

Some controversy has attended efforts to estimate the specific risk of lung cancer related to passive smoking. In 1993, the US Environmental Protection Agency (EPA) issued a report estimating that 3,000 lung cancer related deaths in the US were caused by passive smoking every year.

In 1998 Judge William Osteen vacated the study - declaring it null and void after extensively commentating on the shoddy way it was conducted. His decision was 92 pages long. In his judgment he stated:
"The record and EPA's explanations to the court make it clear that using standard methodology, EPA could not produce statistically significant results with its selected studies. Analysis conducted with a .05 significance level and 95% confidence level included relative risks of 1. Accordingly, these results did not confirm EPA's controversial a priori hypothesis. In order to confirm its hypothesis, EPA maintained its standard significance level but lowered the confidence interval to 90%. This allowed EPA to confirm its hypothesis by finding a relative risk of 1.19, albeit a very weak association. EPA's conduct raises several concerns besides whether a relative risk of 1.19 is credible evidence supporting a Group A classification. First, with such a weak showing, if even a fraction of Plaintiffs' allegations regarding study selection or methodology is true, EPA cannot show a statistically significant association between ETS and lung cancer."

He also stated:
"In this case, EPA publicly committed to a conclusion before research had begun; excluded industry by violating the Act's procedural requirements; adjusted established procedure and scientific norms to validate the Agency's public conclusion, and aggressively utilized the Act's authority to disseminate findings to establish a de facto regulatory scheme intended to restrict Plaintiffs, products and to influence public opinion. In conducting the ETS Risk Assessment, disregarded information and made findings on selective information; did not disseminate significant epidemiologic information; deviated from its Risk Assessment Guidelines; failed to disclose important findings and reasoning; and left significant questions without answers. EPA's conduct left substantial holes in the administrative record. While so doing, produced limited evidence, then claimed the weight of the Agency's research evidence demonstrated ETS causes cancer. Gathering all relevant information, researching, and disseminating findings were subordinate to EPA's demonstrating ETS a Group A carcinogen."

The Alexis de Tocqueville Institution, S. Fred Singer, and others aggressively attacked the EPA study as "junk science".

In 2002, a group of 29 experts from 12 countries convened by the Monographs Programme of the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) reviewed all significant published evidence related to tobacco smoking and cancer. It concluded its evaluation of the carcinogenic risks associated with involuntary smoking, with second-hand smoke also being classified as carcinogenic to humans.[11] An earlier WHO epidemiology study also found "weak evidence of a dose-response relationship between risk of lung cancer and exposure to spousal and workplace ETS" [12]. The fact that the evidence was described as "weak" has been interpreted by the tobacco industry and its supporters as evidence that the ETS-lung cancer link has been "disproven". More precisely, the "weakness" of the evidence stems from the fact that the risk of ETS for individuals is small relative to the very high risk of actually smoking, making it more difficult to quantify through epidemiology. In addition to epidemiology, moreover, several other types of scientific evidence (including animal experiments, chemical constituent analysis of ETS, and human metabolic studies) support the WHO and EPA conclusions.

Most experts believe that moderate, occasional exposure to secondhand smoke presents a low cancer risk to nonsmokers, but the risk is more likely to be significant if non-smokers work in an environment where cigarette smoke is prevalent.[citation needed] For this reason, many countries (such as Ireland) and jurisdictions (like New York State) now prohibit smoking in public buildings. Many office buildings contain specially ventilated smoking areas; some are required by law to provide them.

While the cancer risk of occasional exposure is low, there are several recent studies showing more immediate cardiovascular risk to exposure over as little as 30 minutes. This is particularly worrisome for those with compromised cardiovascular health, but even in healthy populations short-term exposure has rapid effects.

Effects on pets

A study conducted by the Tufts' School of Veterinary Medicine and the University of Massachusetts revealed that a cat living with a smoker is two times more likely to get feline lymphoma than one that's not. After five years living with a smoker, that rate increases to three times as likely. And, when there are two smokers in the home, the chances of getting feline lymphoma increases to four times as likely.

This indicates that the risk of developing cancer from second-hand smoke may be greater for cats than for humans, including children. One possible reason is that the cat receives the cancer-causing agents both by inhaling and by grooming.

A study by Colorado State University found that a dog that has exposure to a smoker in the home is 1.6 times more likely to develop lung cancer than a dog that is not exposed to a smoker. The study also found that skull shape had an effect on the estimated risk of lung cancer in dogs. Dogs with long noses (like German shepherds) have a higher risk for nasal cancer and dogs with short noses (like pugs) have a higher risk for lung cancer. This is because, in theory, a dog with a long nose has an extra filtering system in its nose, so it is more likely to develop nasal cancers, but because of this extra filtering system, tobacco smoke is less likely to reach its lungs and cause cancer there.

Legal issues & Regulation

In many countries (including the United States, New Zealand, Canada, and Australia), it is illegal to sell tobacco products to minors. In Britain it is illegal to sell tobacco products to people under the age of 16 (However in Scotland, MSP Duncan McNeil proposes to raise the age limit to 18 in an attempt to reduce underage smoking); in 47 of the 50 United States the minimum age is 18 (Alabama, Alaska, and Utah raised the age to 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 only adults can 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 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.

In Alberta, Canada, smoking is illegal for people under the age of 18. If caught by the police, a person is subject to seizure of cigarettes and possibly a C$100 fine.

Some countries also impose legal requirements on the packaging of tobacco products. For example in the countries of the European Union and Australia, cigarette packs must be prominently labeled with one of various statements such as "SMOKING KILLS" and the even more extreme "SMOKING KILLS IN A SLOW AND PAINFUL WAY", accompanied by an explanation of the statement. See Australian tobacco labeling regulations. Canada has also imposed labels upon cigarette packs warning smokers of the effects. These labels say things such as: Cigarettes Hurt Babies, Tobacco Kills, etc. and include 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.

Attention grabbing signs often mark locations where smoking is not permitted.

In addition, some jurisdictions impose restrictions on where smoking is allowed. According to the American Nonsmokers' Rights Foundation, as of April 2004, the US states of Delaware, New York, Massachusetts, Florida, California, Connecticut, Maine, and Utah prohibit smoking in restaurants. Delaware, New York, California, Connecticut, Massachusetts, and Maine also prohibit smoking in bars, except for designated smoking lounges. Similar restrictions have been proposed (though not yet implemented) for states such as Georgia, Oregon, New Jersey, Minnesota, Illinois, Maryland, and Colorado. Smoking has been banned in most workplaces and public buildings in the United States since the early 1990s.

In France, it is illegal to sell cigarettes to minors under 16. Also prohibited are automatic cigarette-vending machines, as well as tobacco advertisements (with narrow exceptions such as the windows of licensed tobacco sellers). Smoking is prohibited in all places accessible to the public or workers (including offices, shops, restaurants and bars) except in areas specifically designated for smokers; this law is however largely unenforced regarding smaller bars and restaurants.

From March 29, 2004, it became illegal in the Republic of Ireland to smoke in all enclosed places of work, with a very small number of exceptions. This included all bars and restaurants. Similar legislation came into force in Norway on June 1, 2004, New Zealand on December 10, 2004, Sweden on June 1, 2005 and will take effect in Scotland from 2006. In 2004, Bhutan became the first country in the world to ban smoking and the selling of Tobacco.

On 1 January 2005, the Australian state of Queensland imposed the strictest regulations of public smoking in Australia. New smoking regulations banned smoking 10 metres from a children's public playground, smoking on patrolled beaches, smoking within 4 metres from a non-residential building's entrance, and smoking at major sports stadiums. Strict laws were also imposed on smoking within eating and drinking venues. Television advertisements were shown by the government under the slogan "No Body Smokes Here Anymore".

On 14 March 2005 Bangladesh banned smoking in public places.

The Kingdom Of Bhutan has illegalized smoking.

Beginning February 28 2005, an international treaty, the WHO Framework Convention on Tobacco Control[13], will take effect. The deadline to be a full party to the treaty (and make decisions on implementation, financial and other matters) is November 8 2005. 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[14]. Amongst other steps, signatories are to put together legislation that will protect people from being exposed to second-hand smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

Recently some activists and officials have begun calling for a total ban on tobacco product sales and consumption altogether. see: smoking ban for more information.

Further reading

On the history of tobacco smoking

  • Iain Gately: La Diva Nicotina. The Story of How Tobacco Seduced the World (2001) (ISBN 0743208129).:

See also

External links

History

Prevention & Self help

Statistics & Studies

Notes

  1. Template:Fnb "Nicotine: A Powerful Addiction." Centers for Disease Control and Prevention. [16]
  2. 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
  3. 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.
  4. 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.
  5. ^ 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.
  6. ^ 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.
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