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Tobacco smoking

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A woman smoking a cigarette, the most common method of tobacco smoking

Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed to have begun as early as 5000–3000 BC in Mesoamerica and South America.[1] Tobacco was introduced to Eurasia in the late 17th century by European colonists, where it followed common trade routes. The practice encountered criticism from its first import into the Western world onwards but embedded itself in certain strata of a number of societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.[2][3]

Smoking is the most common method of consuming tobacco, and tobacco is the most common substance smoked. The agricultural product is often mixed with additives[4] and then combusted. The resulting smoke, which contains various active substances the most significant of which is the addictive psychostimulant drug nicotine (a compound naturally found in tobacco), is absorbed through the alveoli in the lungs or the oral mucosa.[5] Many substances in cigarette smoke, chiefly nicotine, trigger chemical reactions in nerve endings, which heighten heart rate, alertness[6] and reaction time, among other things.[7] Dopamine and endorphins are released, which are often associated with pleasure,[8] leading to addiction.[9]

German scientists identified a link between smoking and lung cancer in the late 1920s, leading to the first anti-smoking campaign in modern history, albeit one truncated by the collapse of Nazi Germany at the end of World War II.[10] In 1950, British researchers demonstrated a clear relationship between smoking and cancer.[11] Evidence continued to mount in the 1960s, which prompted political action against the practice. Rates of consumption since 1965 in the developed world have either peaked or declined.[12] However, they continue to climb in the developing world.[13] As of 2008 to 2010, tobacco is used by about 49% of men and 11% of women aged 15 or older in fourteen low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam), with about 80% of this usage in the form of smoking.[14] The gender gap tends to be less pronounced in lower age groups.[15][16] According to the World Health Organization, 8 million annual deaths are caused by tobacco smoking.[17]

Many smokers begin during adolescence or early adulthood.[18] A 2009 study of first smoking experiences of seventh-grade students found out that the most common factor leading students to smoke is cigarette advertisements. Smoking by parents, siblings and friends also encourages students to smoke.[19] During the early stages, a combination of perceived pleasure acting as positive reinforcement and desire to respond to social peer pressure may offset the unpleasant symptoms of initial use, which typically include nausea and coughing. After an individual has smoked for some years, the avoidance of nicotine withdrawal symptoms and negative reinforcement become the key motivations to continue.


Use in ancient cultures[edit]

Aztec women are handed flowers and smoking tubes before eating at a banquet, Florentine Codex, 16th century.

Smoking's history dates back to as early as 5000–3000 BC, when the agricultural product began to be cultivated in Mesoamerica and South America; consumption later evolved into burning the plant substance either by accident or with intent of exploring other means of consumption.[1] The practice worked its way into shamanistic rituals.[20] Many ancient civilizations – such as the Babylonians, the Indians, and the Chinese – burnt incense during religious rituals. Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure or as a social tool.[21] The smoking of tobacco and various hallucinogenic drugs was used to achieve trances and to come into contact with the spirit world.[22] Also, to stimulate respiration, tobacco smoke enemas were used.[23]

Eastern North American tribes would carry large amounts of tobacco in pouches as a readily accepted trade item and would often smoke it in ceremonial pipes, either in sacred ceremonies or to seal bargains.[24] Adults as well as children enjoyed the practice.[25] It was believed that tobacco was a gift from the Creator and that the exhaled tobacco smoke was capable of carrying one's thoughts and prayers to heaven.[26]

Apart from smoking, tobacco had uses as medicine. As a pain killer it was used for earache and toothache and occasionally as a poultice. Smoking was said by the desert Indians to be a cure for colds, especially if the tobacco was mixed with the leaves of the small Desert sage, Salvia dorrii, or the root of Indian balsam or cough root, Leptotaenia multifida, the addition of which was thought to be particularly good for asthma and tuberculosis.[27]


Gentlemen Smoking and Playing Backgammon in a Tavern by Dirck Hals, 1627

In 1612, six years after the settlement of Jamestown, Virginia, John Rolfe was credited as the first settler to successfully raise tobacco as a cash crop. The demand quickly grew as tobacco, referred to as "brown gold", revived the Virginia joint stock company from its failed gold expeditions.[28] In order to meet demands from the Old World, tobacco was grown in succession, quickly depleting the soil. This became a motivator to settle west into the unknown continent, and likewise an expansion of tobacco production.[29]

Frenchman Jean Nicot (from whose name the word nicotine is derived) introduced tobacco to France in 1560, and tobacco then spread to England. The first report of a smoking Englishman is of a sailor in Bristol in 1556, seen "emitting smoke from his nostrils".[2] Like tea, coffee and opium, tobacco was just one of many intoxicants that was originally used as a form of medicine.[30] Tobacco was introduced around 1600 by French merchants in what today is modern-day Gambia and Senegal. At the same time, caravans from Morocco brought tobacco to the areas around Timbuktu, and the Portuguese brought the commodity (and the plant) to southern Africa, establishing the popularity of tobacco throughout all of Africa by the 1650s.

Soon after its introduction to the Old World, tobacco came under frequent criticism from state and religious leaders. James VI and I, King of Scotland and England, produced the treatise A Counterblaste to Tobacco in 1604, and also introduced excise duty on the product. Murad IV, sultan of the Ottoman Empire 1623–40 was among the first to attempt a smoking ban by claiming it was a threat to public morals and health. The Chongzhen Emperor of China issued an edict banning smoking two years before his death and the overthrow of the Ming dynasty. Later, the Manchu rulers of the Qing dynasty, would proclaim smoking "a more heinous crime than that even of neglecting archery". In Edo period Japan, some of the earliest tobacco plantations were scorned by the shogunate as being a threat to the military economy by letting valuable farmland go to waste for the use of a recreational drug instead of being used to plant food crops.[31]

Bonsack's cigarette rolling machine, as shown on U.S. patent 238,640

Religious leaders have often been prominent among those who considered smoking immoral or outright blasphemous. In 1634, the Patriarch of Moscow forbade the sale of tobacco, and sentenced men and women who flouted the ban to have their nostrils slit and their backs flayed. Pope Urban VIII likewise condemned smoking on holy places in a papal bull of 1624. Despite some concerted efforts, restrictions and bans were largely ignored. When James I of England, a staunch smoking opponent and the author of A Counterblaste to Tobacco, tried to curb the new trend by enforcing a 4000% tax increase on tobacco in 1604 it was unsuccessful, as suggested by the presence of around 7,000 tobacco outlets in London by the early 17th century. From this point on for some centuries, several administrations withdrew from efforts at discouragement and instead turned tobacco trade and cultivation into sometimes lucrative government monopolies.[32][33]

By the mid-17th century most major civilizations had been introduced to tobacco smoking and in many cases had already assimilated it into the native culture, despite some continued attempts upon the parts of rulers to eliminate the practice with penalties or fines. Tobacco, both product and plant, followed the major trade routes to major ports and markets, and then on into the hinterlands. The English language term smoking appears to have entered currency in the late 18th century, before which less abbreviated descriptions of the practice such as drinking smoke were also in use.[2]

Growth in the US remained stable until the American Civil War in 1860s, when the primary agricultural workforce shifted from slavery to sharecropping. This, along with a change in demand, accompanied the industrialization of cigarette production as craftsman James Bonsack created a machine in 1881 to partially automate their manufacture.[34]

Social attitudes and public health[edit]

In 1912 and 1932 in Germany, anti-smoking groups, often associated with anti-liquor groups,[35] first published advocacy against the consumption of tobacco in the journal Der Tabakgegner (The Tobacco Opponent). In 1929, Fritz Lickint of Dresden, Germany, published a paper containing formal statistical evidence of a lung cancer–tobacco link. During the Great Depression Adolf Hitler condemned his earlier smoking habit as a waste of money,[36] and later with stronger assertions. This movement was further strengthened with Nazi reproductive policy as women who smoked were viewed as unsuitable to be wives and mothers in a German family.[37] In the 20th century, smoking was common. There were social events like the smoke night which promoted the habit.

The anti-tobacco movement in Nazi Germany did not reach across enemy lines during the Second World War, as anti-smoking groups quickly lost popular support. By the end of the Second World War, American cigarette manufacturers quickly reentered the German black market. Illegal smuggling of tobacco became prevalent,[38] and leaders of the Nazi anti-smoking campaign were silenced.[39] As part of the Marshall Plan, the United States shipped free tobacco to Germany; with 24,000 tons in 1948 and 69,000 tons in 1949.[38] Per capita yearly cigarette consumption in post-war Germany steadily rose from 460 in 1950 to 1,523 in 1963.[10] By the end of the 20th century, anti-smoking campaigns in Germany were unable to exceed the effectiveness of the Nazi-era climax in the years 1939–41 and German tobacco health research was described by Robert N. Proctor as "muted".[10]

A lengthy study conducted in order to establish the strong association necessary for legislative action (US cigarette consumption per person blue, male lung cancer rate brown)

In 1950, Richard Doll published research in the British Medical Journal showing a close link between smoking and lung cancer.[40] Beginning in December 1952, the magazine Reader's Digest published "Cancer by the Carton", a series of articles that linked smoking with lung cancer.[41]

In 1954, the British Doctors Study, a prospective study of some 40 thousand doctors for about 2.5 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related.[11] In January 1964, the United States Surgeon General's Report on Smoking and Health likewise began suggesting the relationship between smoking and cancer.[42]

As scientific evidence mounted in the 1980s, tobacco companies claimed contributory negligence as the adverse health effects were previously unknown or lacked substantial credibility. Health authorities sided with these claims up until 1998, from which they reversed their position. The Tobacco Master Settlement Agreement, originally between the four largest US tobacco companies and the attorneys general of 46 states, restricted certain types of tobacco advertisement and required payments for health compensation; which later amounted to the largest civil settlement in United States history.[43]

Social campaigns have been instituted in many places to discourage smoking, such as Canada's National Non-Smoking Week.

From 1965 to 2006, rates of smoking in the United States declined from 42% to 20.8%.[12] The majority of those who quit were professional, affluent men. Although the per-capita number of smokers decreased, the average number of cigarettes consumed per person per day increased from 22 in 1954 to 30 in 1978. This paradoxical event suggests that those who quit smoked less, while those who continued to smoke moved to smoke more light cigarettes.[44] The trend has been paralleled by many industrialized nations as rates have either leveled-off or declined. In the developing world, however, tobacco consumption continued to rise at 3.4% in 2002.[13] In Africa, smoking is in most areas considered to be modern, and many of the strong adverse opinions that prevail in the West receive much less attention.[45] Today Russia leads as the top consumer of tobacco followed by Indonesia, Laos, Ukraine, Belarus, Greece, Jordan, and China.[46]



Tobacco is an agricultural product processed from the fresh leaves of plants in the genus Nicotiana. The genus contains several species, of which Nicotiana tabacum is the most commonly grown. Nicotiana rustica follows second, containing higher concentrations of nicotine. The leaves are harvested and cured to allow the slow oxidation and degradation of carotenoids in tobacco leaf. This produces certain compounds in the tobacco leaves which can be attributed to sweet hay, tea, rose oil, or fruity aromatic flavors. Before packaging, the tobacco is often combined with other additives in order to increase the addictive potency, shift the product's pH, or improve the effects of smoke by making it more palatable. In the United States these additives are regulated to 599 substances.[4] The product is then processed, packaged, and shipped to consumer markets.

Common methods of consuming tobacco include the following:

Field of tobacco organized in rows extending to the horizon.
Tobacco field in Intercourse, Pennsylvania
Powderly stripps hung vertically, slightly sun bleached.
Basma leaves curing in the sun at Pomak village of Xanthi, Thrace, Greece
Rectangular strips stacked in an open square box.
Processed tobacco pressed into flakes for pipe smoking
Beedis are thin South Asian cigarettes filled with tobacco flakes and wrapped in a tendu leaf tied with a string at one end. They produce higher levels of carbon monoxide, nicotine, and tar than cigarettes typical in the United States.[47][48]
Tendu Patta (Leaf) collection for Beedi industries
Cigars are tightly rolled bundles of dried and fermented tobacco which are ignited so that smoke may be drawn into the smoker's mouth. They are generally not inhaled because of the high alkalinity of the smoke, which can quickly become irritating to the trachea and lungs. The prevalence of cigar smoking varies depending on location, historical period, and population surveyed, and prevalence estimates vary somewhat depending on the survey method. The United States is the top consuming country by far, followed by Germany and the United Kingdom; the US and Western Europe account for about 75% of cigar sales worldwide.[49] As of 2005 it is estimated that 4.3% of men and 0.3% of women smoke cigars in the US.[50]
Cigarettes, French for "small cigar", are a product consumed through smoking and manufactured out of cured and finely cut tobacco leaves and reconstituted tobacco, often combined with other additives, which are then rolled or stuffed into a paper-wrapped cylinder.[4] Cigarettes are ignited and inhaled, usually through a cellulose acetate filter, into the mouth and lungs.

Hookah are a single or multi-stemmed (often glass-based) water pipe for smoking. Originally from India, the hookah was a symbol of pride and honor for the landlords, kings and other such high class people. Now, the hookah has gained immense popularity, especially in the Middle East. A hookah operates by water filtration and indirect heat. It can be used for smoking herbal fruits, tobacco, or cannabis.
Kretek are cigarettes made with a complex blend of tobacco, cloves and a flavoring "sauce". It was first introduced in the 1880s in Kudus, Java, to deliver the medicinal eugenol of cloves to the lungs. The quality and variety of tobacco play an important role in kretek production, from which kretek can contain more than 30 types of tobacco. Minced dried clove buds weighing about one-third of the tobacco blend are added to add flavoring. In 2004 the United States prohibited cigarettes from having a "characterizing flavor" of certain ingredients other than tobacco and menthol, thereby removing kretek from being classified as cigarettes.[51]
Pipe smoking
Pipe smoking is done with a tobacco pipe, typically consisting of a small chamber (the bowl) for the combustion of the tobacco to be smoked and a thin stem (shank) that ends in a mouthpiece (the bit). Shredded pieces of tobacco are placed into the chamber and ignited.
Roll-your-own or hand-rolled cigarettes, often called "rollies", "cigi" or "Roll-ups", are very popular particularly in European countries and the UK. These are prepared from loose tobacco, cigarette papers, and filters all bought separately. They are usually much cheaper than ready-made cigarettes and small contraptions can be bought making the process easier.
A vaporizer is a device used to sublimate the active ingredients of plant material. Rather than burning the herb, which produces potentially irritating, toxic, or carcinogenic by-products; a vaporizer heats the material in a partial vacuum so that the active compounds contained in the plant boil off into a vapor. This method is often preferable when medically administering the smoke substance, as opposed to directly pyrolyzing the plant material.


A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake

The active substances in tobacco, especially cigarettes, are administered by burning the leaves and inhaling the vaporized gas that results. This quickly and effectively delivers substances into the bloodstream by absorption through the alveoli in the lungs. The lungs contain some 300 million alveoli, which amounts to a surface area of over 70 m2 (about the size of a tennis court). This method is not completely efficient as not all of the smoke will be inhaled, and some amount of the active substances will be lost in the process of combustion, pyrolysis.[5] Pipe and Cigar smoke are not inhaled because of its high alkalinity, which are irritating to the trachea and lungs. However, because of its higher alkalinity (pH 8.5) compared to cigarette smoke (pH 5.3), non-ionized nicotine is more readily absorbed through the mucous membranes in the mouth.[52] Nicotine absorption from cigar and pipe, however, is much less than that from cigarette smoke.[53] Nicotine and cocaine activate similar patterns of neurons, which supports the existence of common substrates among these drugs.[54]

The absorbed nicotine mimics nicotinic acetylcholine which when bound to nicotinic acetylcholine receptors prevents the reuptake of acetylcholine thereby increasing that neurotransmitter in those areas of the body.[55] These nicotinic acetylcholine receptors are located in the central nervous system and at the nerve-muscle junction of skeletal muscles; whose activity increases heart rate, alertness,[6] and faster reaction times.[7] Nicotine acetylcholine stimulation is not directly addictive. However, since dopamine-releasing neurons are abundant on nicotine receptors, dopamine is released; and, in the nucleus accumbens, dopamine is associated with motivation causing reinforcing behavior.[56] Dopamine increase, in the prefrontal cortex, may also increase working memory.[57]

When tobacco is smoked, most of the nicotine is pyrolyzed. However, a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. There is also a formation of harmane (an MAO inhibitor) from the acetaldehyde in tobacco smoke. This may play a role in nicotine addiction, by facilitating a dopamine release in the nucleus accumbens as a response to nicotine stimuli.[58] Using rat studies, withdrawal after repeated exposure to nicotine results in less responsive nucleus accumbens cells, which produce dopamine responsible for reinforcement.[59]


Percentage of males smoking any tobacco product
Percentage of females smoking any tobacco product. Note that there is a difference between the scales used for males and the scales used for females.[46]

As of 2000, smoking was practiced by around 1.22 billion people. At current rates of 'smoker replacement' and market growth, this may reach around 1.9 billion in 2025.[60]

Smoking may be up to five times more prevalent among men than women in some communities,[60] although the gender gap usually declines with younger age.[15][16] In some developed countries smoking rates for men have peaked and begun to decline, while for women they continue to climb.[61]

As of 2002, about twenty percent of young teenagers (13–15) smoked worldwide. 80,000 to 100,000 children begin smoking every day, roughly half of whom live in Asia. Half of those who begin smoking in adolescent years are projected to go on to smoke for 15 to 20 years.[13] As of 2019 in the United States, roughly 800,000 high school students smoke.[62]

The World Health Organization (WHO) states that "Much of the disease burden and premature mortality attributable to tobacco use disproportionately affect the poor". Of the 1.22 billion smokers, 1 billion of them live in developing or transitional economies. Rates of smoking have leveled off or declined in the developed world.[63] In the developing world, however, tobacco consumption is rising by 3.4% per year as of 2002.[13]

The WHO in 2004 projected 58.8 million deaths to occur globally,[64] from which 5.4 million are tobacco-attributed,[65] and 4.9 million as of 2007.[66] As of 2002, 70% of the deaths are in developing countries.[66] As of 2017, smoking causes one in ten deaths worldwide, with half of those deaths in the US, China, India and Russia.[67]



Sigmund Freud, whose doctor assisted his suicide because of oral cancer caused by smoking[68]

Most smokers begin smoking during adolescence or early adulthood. Some studies also show that smoking can also be linked to various mental health complications.[69] Smoking has elements of risk-taking and rebellion, which often appeal to young people. [citation needed] The presence of peers that smoke and media featuring high-status models smoking may also encourage smoking. Because teenagers are influenced more by their peers than by adults [dubiousdiscuss], attempts by parents, schools, and health professionals at preventing people from trying cigarettes are often unsuccessful.[70][71]

Children of smoking parents are more likely to smoke than children with non-smoking parents. Children of parents who smoke are less likely to quit smoking.[18] One study found that parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked.[72] 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.[73]

Behavioural research generally indicates that teenagers begin their smoking habits due to peer pressure, and cultural influence portrayed by friends. However, one study found that direct pressure to smoke cigarettes played a less significant part in adolescent smoking, with adolescents also reporting low levels of both normative and direct pressure to smoke cigarettes.[74] Mere exposure to tobacco retailers may motivate smoking behaviour in adults.[75] A similar study suggested that individuals may play a more active role in starting to smoke than has previously been thought and that social processes other than peer pressure also need to be taken into account.[76] Another study's results indicated that peer pressure was significantly associated with smoking behavior across all age and gender cohorts, but that intrapersonal factors were significantly more important to the smoking behavior of 12- to 13-year-old girls than same-age boys. Within the 14- to 15-year-old age group, one peer pressure variable emerged as a significantly more important predictor of girls' than boys' smoking.[77] It is debated whether peer pressure or self-selection is a greater cause of adolescent smoking.

Psychologist Hans Eysenck (who later was questioned for nonplausible results [78] and unsafe publications[79][80]) developed a personality profile for the typical smoker. Extraversion is the trait that is most associated with smoking, and smokers tend to be sociable, impulsive, risk taking, and excitement seeking individuals.[81]


The reasons given by some smokers for this activity have been categorized as addictive smoking, pleasure from smoking, tension reduction/relaxation, social smoking, stimulation, habit/automatism, and handling. There are gender differences in how much each of these reasons contribute, with females more likely than males to cite tension reduction/relaxation, stimulation and social smoking.[82]

Some smokers argue that the depressant effect of smoking allows them to calm their nerves, often allowing for increased concentration. However, according to the Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, while higher doses have stimulant effect."[83]


A number of studies have established that cigarette sales and smoking follow distinct time-related patterns. For example, cigarette sales in the United States of America have been shown to follow a strongly seasonal pattern, with the high months being the months of summer, and the low months being the winter months.[84]

Similarly, smoking has been shown to follow distinct circadian patterns during the waking day—with the high point usually occurring shortly after waking in the morning, and shortly before going to sleep at night.[85]



Tobacco smoking is the leading cause of preventable death and a global public health concern.[86] There are 1.3 billion tobacco users in the world, as per latest data from WHO.[17] One person dies every six seconds from a tobacco related disease.[87]

head and torso of a male with internal organs shown and labels referring to the effects of tobacco smoking
Common adverse effects of tobacco smoking. The more common effects are in bold face.[88]

Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for heart attacks,[89][90] strokes,[91] chronic obstructive pulmonary disease (COPD),[92] idiopathic pulmonary fibrosis (IPF),[93] and emphysema.[92]

Smoking tobacco causes various types and subtypes of cancers[94] (particularly lung cancer, cancers of the oropharynx,[95] larynx,[95] and mouth,[95] esophageal and pancreatic cancer).[18] Using tobacco, especially together with alcohol, is a major risk factor for head and neck cancer. 72% of head and neck cancer cases are caused by using both alcohol and tobacco.[96] This rises to 89% when looking specifically at laryngeal cancer.[97]

Cigarette smoking increases the risk of Crohn's disease as well as the severity of the course of the disease.[98] It is also the number one cause of bladder cancer. Cigarette smoking has also been associated with sarcopenia, the age-related loss of muscle mass and strength.[99] The smoke from tobacco elicits carcinogenic effects on the tissues of the body that are exposed to the smoke.[89][100][94][101] Regular cigar smoking is known to carry serious health risks, including increased risk of developing various types and subtypes of cancers, respiratory diseases, cardiovascular diseases, cerebrovascular diseases, periodontal diseases, teeth decay and loss, and malignant diseases.[89][94][102][103]

Tobacco smoke is a complex mixture of over 7,000 toxic chemicals, 98 of which are associated with an increased risk of cardiovascular disease and 69 of which are known to be carcinogenic.[86] The most important chemicals causing cancer are those that produce DNA damage, since such damage appears to be the primary underlying cause of cancer.[104] The most carcinogenic compounds in cigarette smoke are acrolein,[105] formaldehyde,[106] acrylonitrile,[107] 1,3-butadiene,[108] acetaldehyde,[109] ethylene oxide,[110] and isoprene.[111] In addition to the aforementioned toxic chemicals, flavored tobacco contains flavorings which upon heating release toxic chemicals and carcinogens such as carbon monoxide (CO), polycyclic aromatic hydrocarbons (PAHs), furans, phenols, aldehydes (such as acrolein), and acids, in addition to nitrogenous carcinogens, alcohols, and heavy metals, all of which are dangerous to human health.[100][112][113][114][115] A comparison of 13 common hookah flavors found that melon flavors are the most dangerous, with their smoke containing four classes of hazards in high concentrations.[115]

The World Health Organization estimates that tobacco caused 8 million deaths in 2004[17] and 100 million deaths over the course of the 20th century.[116] Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide."[117] Although 70% of smokers state their intention to quit only 3–5% are actually successful in doing so.[118]

The probabilities of death from lung cancer before age 75 in the United Kingdom are 0.2% for men who never smoked (0.4% for women), 5.5% for male former smokers (2.6% in women), 15.9% for current male smokers (9.5% for women) and 24.4% for male "heavy smokers" defined as smoking more than 25 cigarettes per day (18.5% for women).[119] Tobacco smoke can combine with other carcinogens present within the environment in order to produce elevated degrees of lung cancer.

The risk of lung cancer decreases almost from the first day someone quits smoking and it drops by 50% after 10 years of smoking cessation.[17] Healthy cells that have escaped mutations grow and replace the damaged ones in the lungs. In the research dated December 2019, 40% of cells in former smokers looked like those of people who had never smoked.[120]

Rates of smoking have generally leveled-off or declined in the developed world. Smoking rates in the United States have dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults.[121] In the developing world, tobacco consumption is rising by 3.4% per year.[122]

Smoking alters the transcriptome of the lung parenchyma; the expression levels of a panel of seven genes (KMO, CD1A, SPINK5, TREM2, CYBB, DNASE2B, FGG) are increased in the lung tissue of smokers.[123]

Passive smoking is the inhalation of tobacco smoke by individuals who are not actively smoking. This smoke is known as second-hand smoke (SHS) or environmental tobacco smoke (ETS) when the burning end is present, and third-hand smoke after the burning end has been extinguished. Because of its negative implications, exposure to SHS has played a central role in the regulation of tobacco products. Six hundred thousand deaths were attributed to SHS in 2004. It also has been known to produce skin conditions such as freckles and dryness.[124]

Smokers are at greater risk of developing psychotic disorder.[125] Tobacco has also been described an anaphrodisiac due to its propensity for causing erectile dysfunction.[126] There is a correlation between tobacco smoking and a reduced risk of Parkinson's disease.[127][128]


In countries where there is a universally funded healthcare system, the government covers the cost of medical care for smokers who become ill through smoking in the form of increased taxes. Two broad debating positions exist on this front, the "pro-smoking" argument suggesting that heavy smokers generally do not live long enough to develop the costly and chronic illnesses which affect the elderly, reducing society's healthcare burden, and the "anti-smoking" argument suggests that the healthcare burden is increased because smokers get chronic illnesses younger and at a higher rate than the general population. Data on both positions has been contested. The Centers for Disease Control and Prevention published research in 2002 claiming that the cost of each pack of cigarettes sold in the United States was more than $7 in medical care and lost productivity.[129] The cost may be higher, with another study putting it as high as $41 per pack, most of which however is on the individual and his/her family.[130] This is how one author of that study puts it when he explains the very low cost for others: "The reason the number is low is that for private pensions, Social Security, and Medicare — the biggest factors in calculating costs to society — smoking actually saves money. Smokers die at a younger age and don't draw on the funds they've paid into those systems."[130] Other research demonstrates that premature death caused by smoking may redistribute Social Security income in unexpected ways that affect behavior and reduce the economic well-being of smokers and their dependents.[131] To further support this, whatever the rate of smoking consumption is per day, smokers have a greater lifetime medical cost on average compared to a non-smoker by an estimated $6000.[118] Between the cost for lost productivity and health care expenditures combined, cigarette smoking costs at least 193 billion dollars (Research also shows that smokers earn less money than nonsmokers[132]). As for secondhand smoke, the cost is over 10 billion dollars.[133]

By contrast, some non-scientific studies, including one conducted by Philip Morris in the Czech Republic called Public Finance Balance of Smoking in the Czech Republic[134] and another by the Cato Institute,[135] support the opposite position. Philip Morris has explicitly apologised for the former study, saying: "The funding and public release of this study which, among other things, detailed purported cost savings to the Czech Republic due to premature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptable disregard of basic human values. For one of our tobacco companies to commission this study was not just a terrible mistake, it was wrong. All of us at Philip Morris, no matter where we work, are extremely sorry for this. No one benefits from the very real, serious and significant diseases caused by smoking."[134]

Between 1970 and 1995, per-capita cigarette consumption in poorer developing countries increased by 67 percent, while it dropped by 10 percent in the richer developed world. Eighty percent of smokers now live in less developed countries. By 2030, the World Health Organization (WHO) forecasts that 10 million people a year will die of smoking-related illness, making it the single biggest cause of death worldwide, with the largest increase to be among women. WHO forecasts the 21st century's death rate from smoking to be ten times the 20th century's rate ("Washingtonian" magazine, December 2007).

The tobacco industry is known to be one of the largest global enterprises in the world. The six biggest tobacco companies made a combined profit of $35.1 billion (Jha et al., 2014) in 2010.[136]


Skull with a burning cigarette, by Vincent van Gogh

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean-Paul Sartre's Gauloises-brand cigarettes; Albert Einstein's, Douglas MacArthur's, Bertrand Russell's, and Bing Crosby's pipes; or the news broadcaster Edward R. Murrow's cigarette. Writers in particular seem to be known for smoking, for example, Cornell Professor Richard Klein's book Cigarettes are Sublime for the analysis, by this professor of French literature, of the role smoking plays in 19th and 20th century letters. The popular author Kurt Vonnegut addressed his addiction to cigarettes within his novels. British Prime Minister Harold Wilson was well known for smoking a pipe in public as was Winston Churchill for his cigars. Sherlock Holmes, the fictional detective created by Sir Arthur Conan Doyle, smoked a pipe, cigarettes, and cigars. The DC Vertigo comic book character John Constantine, created by Alan Moore, is synonymous with smoking, so much so that the first storyline by Preacher creator Garth Ennis centered around John Constantine contracting lung cancer. Professional wrestler James Fullington, while in character as "The Sandman", is a chronic smoker in order to appear "tough".

The problem of smoking at home is particularly difficult for women in many cultures (especially Arab cultures), where it may not be acceptable for a woman to ask her husband not to smoke at home or in the presence of her children. Studies have shown that pollution levels for smoking areas indoors are higher than levels found on busy roadways, in closed motor garages, and during fire storms.[clarification needed] Furthermore, smoke can spread from one room to another, even if doors to the smoking area are closed.[137]

The ceremonial smoking of tobacco, and praying with a sacred pipe, is a prominent part of the religious ceremonies of a number of Native American Nations. Sema, the Anishinaabe word for tobacco, is grown for ceremonial use and considered the ultimate sacred plant since its smoke is believed to carry prayers to the spirits. In most major religions, however, tobacco smoking is not specifically prohibited, although it may be discouraged as an immoral habit. Before the health risks of smoking were identified through controlled study, smoking was considered an immoral habit by certain Christian preachers and social reformers. The founder of the Latter Day Saint movement, Joseph Smith, recorded that on 27 February 1833, he received a revelation which discouraged tobacco use. This "Word of Wisdom" was later accepted as a commandment, and faithful Latter-day Saints abstain completely from tobacco.[138] Jehovah's Witnesses base their stand against smoking on the Bible's command to "clean ourselves of every defilement of flesh" (2 Corinthians 7:1). The Jewish Rabbi Yisrael Meir Kagan (1838–1933) was one of the first Jewish authorities to speak out on smoking. In Ahmadiyya Islam, smoking is highly discouraged, although not forbidden. During the month of fasting however, it is forbidden to smoke tobacco.[139] In the Baháʼí Faith, smoking tobacco is discouraged though not forbidden.[140]

Public policy[edit]

On 27 February 2005 the WHO Framework Convention on Tobacco Control, took effect. The FCTC is the world's first public health treaty. Countries that sign on as parties agree to a set of common goals, minimum standards for tobacco control policy, and to cooperate in dealing with cross-border challenges such as cigarette smuggling. Currently the WHO declares that 4 billion people will be covered by the treaty, which includes 168 signatories.[141] 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.


Many governments have introduced excise taxes on cigarettes in order to reduce the consumption of cigarettes. The World Health Organization finds that:[142]

The structure of tobacco excise taxes varies considerably across countries, with lower income countries more likely to rely more on ad valorem excises and higher income countries more likely to rely more on specific excise taxes, while many countries at all income levels use a mix of specific and ad valorem excises.

Tobacco excise tax systems are quite complex in several countries, where different tax rates are applied based on prices, product characteristics such as presence/absence of a filter or length, packaging, weight, tobacco content, and/or production or sales volume. These complex systems are difficult to administer, create opportunities for tax avoidance, and are less effective from a public health perspective.

Globally, cigarette excise taxes account for less than 45 percent of cigarette prices, on average, while all taxes applied to cigarettes account for just over half of half of price. Higher income countries levy higher taxes on tobacco products and these taxes account for a greater share of price, with both the absolute tax and share of price accounted for by tax falling as country incomes fall.

In 2002, the Centers for Disease Control and Prevention said that each pack of cigarettes[quantify] sold in the United States costs the nation more than $7 in medical care and lost productivity,[129] around $3400 per year per smoker. Another study by a team of health economists finds the combined price paid by their families and society is about $41 per pack of cigarettes.[143]

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.[144][145] Smoking is often cited[citation needed] as an example of an inelastic good, however, i.e. a large rise in price will only result in a small decrease in consumption.

Many nations have implemented some form of tobacco taxation. As of 1997, Denmark had the highest cigarette tax burden of $4.02 per pack. Taiwan only had a tax burden of $0.62 per pack. The federal government of the United States charges $1.01 per pack.[146]

Cigarette taxes vary widely from state to state in the United States. For example, Missouri has a cigarette tax of only 17 cents per pack, the nation's lowest, while New York has the highest cigarette tax in the U.S.: $4.35 per pack. In Alabama, Illinois, Missouri, New York City, Tennessee, and Virginia, counties and cities may impose an additional limited tax on the price of cigarettes.[147] Sales taxes are also levied on tobacco products in most jurisdictions.

In the United Kingdom, as of April 2023, a packet of 20 cigarettes has a tax added of 16.5% of the retail price plus £5.89.[148] The UK has a significant black market for tobacco, and it has been estimated by the tobacco industry that 27% of cigarette and 68% of handrolling tobacco consumption is non-UK duty paid (NUKDP).[149]

In Australia total taxes account for 62.5% of the final price of a packet of cigarettes (2011 figures). These taxes include federal excise or customs duty and Goods and Services Tax.[150]


An enclosed smoking area in a Japanese train station. Notice the air vent on the roof.

In June 1967, the US Federal Communications Commission ruled that programmes broadcast on a television station which discussed smoking and health were insufficient to offset the effects of paid advertisements that were broadcast for five to ten minutes each day. In April 1970, the US Congress passed the Public Health Cigarette Smoking Act banning the advertising of cigarettes on television and radio starting on 2 January 1971.[151]

The Tobacco Advertising Prohibition Act 1992 expressly prohibited almost all forms of Tobacco advertising in Australia, including the sponsorship of sporting or other cultural events by cigarette brands.

All tobacco advertising and sponsorship on television has been banned within the European Union since 1991 under the Television Without Frontiers Directive (1989).[152] This ban was extended by the Tobacco Advertising Directive, which took effect in July 2005 to cover other forms of media such as the internet, print media, and radio. The directive does not include advertising in cinemas and on billboards or using merchandising – or tobacco sponsorship of cultural and sporting events which are purely local, with participants coming from only one Member State[153] as these fall outside the jurisdiction of the European Commission. However, most member states have transposed the directive with national laws that are wider in scope than the directive and cover local advertising. A 2008 European Commission report concluded that the directive had been successfully transposed into national law in all EU member states, and that these laws were well implemented.[154]

Some countries also impose legal requirements on the packaging of tobacco products. For example, in the countries of the European Union, Turkey, Australia[155] and South Africa, cigarette packs must be prominently labeled with the health risks associated with smoking.[156] Canada, Australia, Thailand, Iceland and Brazil have also imposed labels upon cigarette packs warning smokers of the effects, and they include graphic images of the potential health effects of smoking. Cards are also inserted into cigarette packs in Canada. There are sixteen of them, and only one comes in a pack. They explain different methods of quitting smoking. Also, in the United Kingdom, there have been a number of graphic NHS advertisements, one showing a cigarette filled with fatty deposits, as if the cigarette is symbolizing the artery of a smoker.

Some countries have also banned advertisement at point of sale. United Kingdom and Ireland have limited the advertisement of tobacco at retailers.[157][158] This includes storing of cigarettes behind a covered shelf not visible to the public. They do however allow some limited advertising at retailers. Norway has a complete ban of point of sale advertising.[159] This includes smoking products and accessories. Implementing these policies can be challenging, all of these countries experienced resistance and challenges from the tobacco industry.[160][161][162] The World Health Organization recommends the complete ban of all types of advertisement or product placement, including at vending machines, at airports and on internet shops selling tobacco.[163] The evidence is as yet unclear as to the effect of such bans.  

Many countries have a smoking age. In many countries, including the United States, most European Union member states, New Zealand, Canada, South Africa, Israel, India,[18] Brazil, Chile, Costa Rica and Australia, it is illegal to sell tobacco products to minors and in the Netherlands, Austria, Belgium, Denmark and South Africa it is illegal to sell tobacco products to people under the age of 18. On 1 September 2007 the minimum age to buy tobacco products in Germany rose from 16 to 18, as well as in the United Kingdom where on 1 October 2007 it rose from 16 to 18.[164] Underlying such laws is the belief that people should make an informed decision regarding the risks of tobacco use. These laws have a lax enforcement in some nations and states. In China, Turkey, and many other countries usually a child will have little problem buying tobacco products, because they are often told to go to the store to buy tobacco for their parents.

Several countries such as Ireland, Latvia, Estonia, the Netherlands, Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore, Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United Kingdom, Slovenia, Turkey and Malta have legislated against smoking in public places, often including bars and restaurants. Restaurateurs have been permitted in some jurisdictions to build designated smoking areas (or to prohibit smoking). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars. In provinces of Canada, smoking is illegal in indoor workplaces and public places, including bars and restaurants. As of 31 March 2008 Canada has introduced a smoke-free law in all public places, as well as within 10 metres of an entrance to any public place. In Australia, smoke-free laws vary from state to state. In New Zealand and Brazil, smoking is restricted in enclosed public places including bars, restaurants and pubs. Hong Kong restricted smoking on 1 January 2007 in the workplace, public spaces such as restaurants, karaoke rooms, buildings, and public parks (bars which do not admit minors were exempt until 2009). In Romania smoking is illegal in trains, metro stations, public institutions (except where designated, usually outside) and public transport. In Germany, in addition to smoking bans in public buildings and transport, an anti-smoking ordinance for bars and restaurants was implemented in late 2007. A study by the University of Hamburg (Ahlfeldt and Maennig 2010) demonstrates that the smoking ban had, if any, only short run effects on bar and restaurant revenues. In the medium and long run no negative effect was measurable. The results suggest either that the consumption in bars and restaurants is not affected by smoking bans in the long run or that negative revenue effects by smokers are compensated by increasing revenues through non-smokers.[165]

Ignition safety[edit]

An indirect public health problem posed by cigarettes is that of accidental fires, usually linked with consumption of alcohol. Enhanced combustion using nitrates was traditionally used but cigarette manufacturers have been silent on this subject claiming at first that a safe cigarette was technically impossible, then that it could only be achieved by modifying the paper. Roll your own cigarettes contain no additives and are fire safe. Numerous fire safe cigarette designs have been proposed, some by tobacco companies themselves, which would extinguish a cigarette left unattended for more than a minute or two, thereby reducing the risk of fire. Among American tobacco companies, some have resisted this idea, while others have embraced it. RJ Reynolds was a leader in making prototypes of these cigarettes in 1983[166] and will make all of their U.S. market cigarettes to be fire-safe by 2010.[167] Phillip Morris is not in active support of it.[168] Lorillard (purchased by RJ Reynolds), the US' 3rd-largest tobacco company, seems to be ambivalent.[168]

Health warnings[edit]

Individual cigarettes in Canada now carry warnings such as "poison in every puff" and "cigarettes cause impotence" in what the government says is an effort to make it "virtually impossible to avoid health warnings altogether".[169]

Gateway drug theory[edit]

The relationship between tobacco and other drug use has been well-established, however the nature of this association remains unclear. The two main theories are the phenotypic causation (gateway) model and the correlated liabilities model. The causation model argues that smoking is a primary influence on future drug use,[170] while the correlated liabilities model argues that smoking and other drug use are predicated on genetic or environmental factors.[171] One study published by the NIH found that tobacco use may be linked to cocaine addiction and marijuana use. The study stated that 90% of adults who used cocaine had smoked cigarettes before (this was for people ages 18–34). This study could support the gateway drug theory.[172]


Quitting smoking often involves advice from physicians or social workers,[18] cold turkey, nicotine replacement therapy, contingent vouchers,[173] antidepressants, vaping,[174] hypnosis, self-help (mindfulness meditation),[175] and support groups.

In the United States, about 70% of smokers would like to quit smoking, and 50% report having made an attempt to do so in the past year.[176] Without support, 1% of smokers will successfully quit smoking each year. Physician advice to quit smoking increases the rate to 3% per year.[177] Adding first‐line smoking cessation medications (and some behavioral help), increased quit rates to around 20% of smokers in a year.[178] For cessation of smoking, public participation in health campaigns are important. In Nepal, cardiologist Om Murti Anil has launched smokers are not selfish campaign on the occasion of valentines day. He is using social media to motivate people to sacrifice their smoking habits as gift to their loved ones .[179]

See also[edit]


  1. ^ a b Gately, Iain (2004) [2003]. Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization. Diane. pp. 3–7. ISBN 978-0-8021-3960-3. Archived from the original on 14 January 2023. Retrieved 22 March 2009.
  2. ^ a b c Lloyd, John; Mitchinson, John (25 July 2008). The Book of General Ignorance. Harmony Books. ISBN 978-0-307-39491-0.
  3. ^ West, Robert; Shiffman, Saul (2007). Fast Facts: Smoking Cessation. Health Press Ltd. p. 28. ISBN 978-1-903734-98-8.
  4. ^ a b c Wigand, Jeffrey S. (July 2006). "ADDITIVES, CIGARETTE DESIGN and TOBACCO PRODUCT REGULATION" (PDF). Mt. Pleasant, MI 48804: Jeffrey Wigand. Archived (PDF) from the original on 16 May 2011. Retrieved 14 February 2009.{{cite web}}: CS1 maint: location (link)
  5. ^ a b Gilman & Xun 2004, p. 318
  6. ^ a b Parrott, A. C.; Winder, G. (1989). "Nicotine chewing gum (2 mg, 4 mg) and cigarette smoking: comparative effects upon vigilance and heart rate". Psychopharmacology. 97 (2): 257–261. doi:10.1007/BF00442260. PMID 2498936. S2CID 4842374.
  7. ^ a b Parkin, C.; Fairweather, D. B.; Shamsi, Z.; Stanley, N.; Hindmarch, I. (1998). "The effects of cigarette smoking on overnight performance". Psychopharmacology. 136 (2): 172–178. doi:10.1007/s002130050553. PMID 9551774. S2CID 22962937.
  8. ^ Gilman & Xun 2004, pp. 320–321
  9. ^ Benowitz, Neal L. (1 February 2009). "Pharmacology of Nicotine: Addiction, Smoking-Induced Disease, and Therapeutics". Annual Review of Pharmacology and Toxicology. 49 (1): 57–71. doi:10.1146/annurev.pharmtox.48.113006.094742. ISSN 0362-1642. PMC 2946180. PMID 18834313.
  10. ^ a b c Proctor 2000, p. 228
  11. ^ a b Doll, R.; Hill, B. (June 2004). "The mortality of doctors in relation to their smoking habits: a preliminary report: (Reprinted from Br Med J 1954:ii;1451-5)". BMJ (Clinical Research Ed.). 328 (7455): 1529–1533, discussion 1533. doi:10.1136/bmj.328.7455.1529. ISSN 0959-8138. PMC 437141. PMID 15217868.
  12. ^ a b VJ Rock, MPH, A Malarcher, JW Kahende, K Asman, MSPH, C Husten, MD, R Caraballo (9 November 2007). "Cigarette Smoking Among Adults --- United States, 2006". United States Centers for Disease Control and Prevention. Archived from the original on 16 August 2019. Retrieved 1 January 2009. In 2006, an estimated 20.8% (45.3 million) of U.S. adults[...]{{cite web}}: CS1 maint: multiple names: authors list (link)
  13. ^ a b c d "WHO/WPRO-Smoking Statistics". World Health Organization Regional Office for the Western Pacific. 28 May 2002. Archived from the original on 8 November 2009. Retrieved 1 January 2009.
  14. ^ Giovino, GA; Mirza, SA; Samet, JM; Gupta, PC; Jarvis, MJ; Bhala, N; Peto, R; Zatonski, W; Hsia, J; Morton, J; Palipudi, KM; Asma, S; GATS Collaborative, Group (18 August 2012). "Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys". Lancet. 380 (9842): 668–79. doi:10.1016/S0140-6736(12)61085-X. PMID 22901888. S2CID 12450625.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ a b The World Health Organization, and the Institute for Global Tobacco Control, Johns Hopkins School of Public Health (2001). "Women and the Tobacco Epidemic: Challenges for the 21st Century" (PDF). World Health Organization. pp. 5–6. Archived from the original (PDF) on 28 November 2003. Retrieved 2 January 2009.{{cite web}}: CS1 maint: multiple names: authors list (link)
  16. ^ a b "Surgeon General's Report—Women and Smoking". Centers for Disease Control and Prevention. 2001. p. 47. Archived from the original on 10 July 2009. Retrieved 3 January 2009.
  17. ^ a b c d "Tobacco". www.who.int. Retrieved 24 February 2024.
  18. ^ a b c d e Chandrupatla, Siddardha G.; Tavares, Mary; Natto, Zuhair S. (27 July 2017). "Tobacco Use and Effects of Professional Advice on Smoking Cessation among Youth in India". Asian Pacific Journal of Cancer Prevention. 18 (7): 1861–1867. doi:10.22034/APJCP.2017.18.7.1861. ISSN 2476-762X. PMC 5648391. PMID 28749122.
  19. ^ The Lancet (26 September 2009). "Tobacco smoking:why start?". The Lancet. 374 (9695): 1038. doi:10.1016/s0140-6736(09)61680-9. PMID 19782852. S2CID 37513171.
  20. ^ Wilbert, Johannes (28 July 1993). Tobacco and Shamanism in South America. Yale University Press. ISBN 978-0-300-05790-4. Archived from the original on 14 January 2023. Retrieved 22 March 2009.
  21. ^ Robicsek, Francis (January 1979). The Smoking Gods: Tobacco in Maya Art, History, and Religion. University of Oklahoma Press. p. 30. ISBN 978-0-8061-1511-5.
  22. ^ F.J.Carod-Artal (1 July 2011). "Hallucinogenic drugs in pre-Columbian Mesoamerican cultures". Neurología. 30 (1): 42–49. doi:10.1016/j.nrleng.2011.07.010. PMID 21893367.
  23. ^ Nordenskiold, Erland (1929), "The American Indian as an Inventor", Journal of the Royal Anthropological Institute, 59: 277, doi:10.2307/2843888, JSTOR 2843888
  24. ^ Heckewelder, John Gottlieb Ernestus; Reichel, William Cornelius (June 1971) [1876]. History, manners, and customs of the Indian nations who once inhabited Pennsylvania and the neighboring states (PDF). The Historical society of Pennsylvania. p. 149. ISBN 978-0-405-02853-3. Archived from the original on 14 January 2023. Retrieved 22 March 2009.
  25. ^ Diéreville; Webster, John Clarence; Webster, Alice de Kessler Lusk (1933). "Relation of the voyage to Port Royal in Acadia or New France". The Champlain Society. They smoke with excessive eagerness […] men, women, girls and boys, all find their keenest pleasure in this way {{cite journal}}: Cite journal requires |journal= (help)
  26. ^ Gottsegen, Jack Jacob (1940). "Tobacco: A Study of Its Consumption in the United States". Pitman Publishing Company: 107. Archived from the original on 14 January 2023. Retrieved 22 March 2009> {{cite journal}}: Cite journal requires |journal= (help)
  27. ^ Balls, Edward K. (1 October 1962). Early Uses of California Plants. University of California Press. pp. 81–85. ISBN 978-0-520-00072-8. Retrieved 22 March 2009. Early Uses of California Plants.
  28. ^ Jordan, Ervin L. Jr. "Jamestown, Virginia, 1607–1907: An Overview". University of Virginia. Archived from the original on 17 October 2002. Retrieved 22 February 2009. {{cite journal}}: Cite journal requires |journal= (help)
  29. ^ Kulikoff, Allan (1 August 1986). Tobacco and Slaves: The Development of Southern Cultures in the Chesapeake. The University of North Carolina Press. ISBN 978-0-8078-4224-9. Retrieved 22 March 2009. Tobacco & Slaves: The Development of Southern Cultures in the Chesapeake.
  30. ^ Gilman & Xun 2004, p. 38
  31. ^ Gilman & Xun 2004, pp. 92–99
  32. ^ Gilman & Xun 2004, pp. 15–16
  33. ^ King James I of England (16 April 2002) [1604]. "A Counterblaste to Tobacco". University of Texas at Austin. Archived from the original on 18 May 2009. Retrieved 22 March 2009. {{cite journal}}: Cite journal requires |journal= (help)
  34. ^ Burns, Eric (28 September 2006). The Smoke of the Gods: A Social History of Tobacco. Temple University Press. pp. 134–135. ISBN 978-1-59213-480-9. Archived from the original on 14 January 2023. Retrieved 22 March 2009.
  35. ^ Proctor 2000, p. 178
  36. ^ Proctor 2000, p. 219
  37. ^ Proctor 2000, p. 187
  38. ^ a b Proctor 2000, p. 245
  39. ^ Proctor, Robert N. (1996). "Nazi Medicine and Public Health Policy". Dimensions. 10 (2). Anti-Defamation League. Archived from the original on 5 December 2012. Retrieved 1 October 2018 – via archived copy at archive.is.
  40. ^ Doll, R.; Hill, A. B. (1 September 1950). "Smoking and Carcinoma of the Lung". British Medical Journal. 2 (4682): 739–748. doi:10.1136/bmj.2.4682.739. ISSN 0007-1447. PMC 2038856. PMID 14772469.
  41. ^ "CNN Interactive". Cnn.com. Archived from the original on 23 April 2009. Retrieved 22 June 2009.
  42. ^ "The Reports of the Surgeon General: The 1964 Report on Smoking and Health". Profiles in Science. United States National Library of Medicine, National Institutes of Health. Archived from the original on 20 January 2016. Retrieved 10 October 2015.
  43. ^ Milo Geyelin (23 November 1998). "Forty-Six States Agree to Accept $206 Billion Tobacco Settlement". Wall Street Journal.
  44. ^ Hilton, Matthew (4 May 2000). Smoking in British Popular Culture, 1800–2000: Perfect Pleasures. Manchester University Press. pp. 229–241. ISBN 978-0-7190-5257-6. Archived from the original on 14 January 2023. Retrieved 22 March 2009.
  45. ^ Gilman & Xun 2004, pp. 46–57
  46. ^ a b MPOWER 2008, pp. 267–288
  47. ^ "Bidi Use Among Urban Youth – Massachusetts, March–April 1999". Centers for Disease Control and Prevention. 17 September 1999. Archived from the original on 11 February 2009. Retrieved 14 February 2009.
  48. ^ Pakhale, S. M.; Maru, G. B. (December 1998). "Distribution of major and minor alkaloids in tobacco, mainstream and sidestream smoke of popular Indian smoking products". Food and Chemical Toxicology. 36 (12): 1131–1138. doi:10.1016/S0278-6915(98)00071-4. ISSN 0278-6915. PMID 9862656.
  49. ^ Rarick CA (2 April 2008). "Note on the premium cigar industry". doi:10.2139/ssrn.1127582. S2CID 152340055. SSRN 1127582. {{cite journal}}: Cite journal requires |journal= (help)
  50. ^ Mariolis P, Rock VJ, Asman K, et al. (2006). "Tobacco use among adults—United States, 2005". MMWR Morb Mortal Wkly Rep. 55 (42): 1145–8. PMID 17065979. Archived from the original on 26 September 2017. Retrieved 17 September 2017.
  51. ^ "A bill to protect the public health by providing the Food and Drug Administration with certain authority to regulate tobacco products. (Summary)" (Press release). Library of Congress. 20 May 2004. Archived from the original on 4 September 2015. Retrieved 1 August 2007.
  52. ^ Turner, JA; Sillett, RW; McNicol, MW (1977). "Effect of cigar smoking on carboxyhemoglobin and plasma nicotine concentrations in primary pipe and cigar smokers and ex-cigarette smokers". British Medical Journal. 2 (6099): 1387–9. doi:10.1136/bmj.2.6099.1387. PMC 1632361. PMID 589225.
  53. ^ Armitage, A. K.; Turner, D. M. (1970). "Absorption of Nicotine in Cigarette and Cigar Smoke through the Oral Mucosa". Nature. 226 (5252): 1231–1232. Bibcode:1970Natur.226.1231A. doi:10.1038/2261231a0. PMID 5422597. S2CID 4208650.
  54. ^ Pich, E. M.; Pagliusi, S. R.; Tessari, M.; Talabot-Ayer, D.; Hooft Van Huijsduijnen, R.; Chiamulera, C. (1997). "Common neural substrates for the addictive properties of nicotine and cocaine". Science. 275 (5296): 83–86. doi:10.1126/science.275.5296.83. PMID 8974398. S2CID 5923174.
  55. ^ Wonnacott, S. (1997). "Presynaptic nicotinic ACh receptors". Trends in Neurosciences. 20 (2): 92–8. doi:10.1016/S0166-2236(96)10073-4. PMID 9023878. S2CID 42215860.
  56. ^ Pontieri, F. E.; Tanda, G.; Orzi, F.; Di Chiara, G. D. (1996). "Effects of nicotine on the nucleus accumbens and similarity to those of addictive drugs". Nature. 382 (6588): 255–257. Bibcode:1996Natur.382..255P. doi:10.1038/382255a0. PMID 8717040. S2CID 4338516.
  57. ^ Guinan, M. E.; Portas, M. R.; Hill, H. R. (1979). "The candida precipitin test in an immunosuppressed population". Cancer. 43 (1): 299–302. doi:10.1002/1097-0142(197901)43:1<299::AID-CNCR2820430143>3.0.CO;2-D. PMID 761168. S2CID 45096870.
  58. ^ Talhout, R.; Opperhuizen, A.; Van Amsterdam, J. G. C. (October 2007). "Role of acetaldehyde in tobacco smoke addiction". European Neuropsychopharmacology. 17 (10): 627–636. doi:10.1016/j.euroneuro.2007.02.013. ISSN 0924-977X. PMID 17382522. S2CID 25866206.
  59. ^ Shoaib, M.; Lowe, A.; Williams, S. (2004). "Imaging localised dynamic changes in the nucleus accumbens following nicotine withdrawal in rats". NeuroImage. 22 (2): 847–854. doi:10.1016/j.neuroimage.2004.01.026. PMID 15193614. S2CID 43544025.
  60. ^ a b Guindon, G. Emmanuel; Boisclair, David (2003). "Past, current and future trends in tobacco use" (PDF). Washington DC: The International Bank for Reconstruction and Development / The World Bank: 13–16. Archived from the original (PDF) on 18 March 2009. Retrieved 22 March 2009. {{cite journal}}: Cite journal requires |journal= (help)
  61. ^ Peto, Richard; Lopez, Alan D; Boreham, Jillian; Thun, Michael (2006). "Mortality from Smoking in Developed Countries 1950–2000: indirect estimates from national vital statistics" (PDF). Oxford University Press: 9. Archived from the original (PDF) on 24 February 2005. Retrieved 22 March 2009. {{cite journal}}: Cite journal requires |journal= (help)
  62. ^ Tobaccofreekids.org/problem/tol-s
  63. ^ Centers for Disease Control and Prevention (CDC) (2009). "Cigarette smoking among adults and trends in smoking cessation – United States, 2008" (Full free text). MMWR. Morbidity and Mortality Weekly Report. 58 (44): 1227–1232. PMID 19910909. Archived from the original on 16 September 2017. Retrieved 17 September 2017.
  64. ^ GBD 2008, p. 8
  65. ^ GBD 2008, p. 23
  66. ^ a b "WHO/WPRO-Tobacco Fact sheet". World Health Organization Regional Office for the Western Pacific. 29 May 2007. Archived from the original on 7 February 2009. Retrieved 1 January 2009.
  67. ^ "Smoking causes one in 10 deaths worldwide, study shows". BBC News. 6 April 2017. Archived from the original on 10 April 2017. Retrieved 11 April 2017.
  68. ^ Gay, Peter (1988). Freud: A Life for Our Time. New York: W. W. Norton & Company. pp. 650–651. ISBN 978-0-393-32861-5.
  69. ^ Patton G. C.; Hibbert M.; Rosier M. J.; Carlin J. B.; Caust J.; Bowes G. (1996). "Is smoking associated with depression and anxiety in teenagers?". American Journal of Public Health. 86 (2): 225–230. doi:10.2105/ajph.86.2.225. PMC 1380332. PMID 8633740.
  70. ^ Stanton, W.; Silva, P. A. (1992). "A longitudinal study of the influence of parents and friends on children's initiation of smoking". Journal of Applied Developmental Psychology. 13 (4): 423–434. doi:10.1016/0193-3973(92)90010-F.
  71. ^ Harris, Judith Rich; Pinker, Steven (4 September 1998). The nurture assumption: why children turn out the way they do. Simon and Schuster. ISBN 978-0-684-84409-1. Archived from the original on 14 January 2023. Retrieved 22 March 2009.
  72. ^ Chassin, L.; Presson, C.; Rose, J.; Sherman, S. J.; Prost, J. (2002). "Parental Smoking Cessation and Adolescent Smoking". Journal of Pediatric Psychology. 27 (6): 485–496. doi:10.1093/jpepsy/27.6.485. PMID 12177249.
  73. ^ Proescholdbell, R. J.; Chassin, L.; MacKinnon, D. P. (2000). "Home smoking restrictions and adolescent smoking". Nicotine & Tobacco Research. 2 (2): 159–167. doi:10.1080/713688125. PMID 11072454. S2CID 8749779.
  74. ^ Urberg, K.; Shyu, S. J.; Liang, J. (1990). "Peer influence in adolescent cigarette smoking". Addictive Behaviors. 15 (3): 247–255. doi:10.1016/0306-4603(90)90067-8. PMID 2378284.
  75. ^ Bharatula, Arun (2016). Review: Tobacco outlet density. Melbourne.{{cite book}}: CS1 maint: location missing publisher (link)[permanent dead link]
  76. ^ Michell L, West P (1996). "Peer pressure to smoke: the meaning depends on the method". Health Education Research. 11 (1): 39–49. doi:10.1093/her/11.1.39.
  77. ^ Barber, J.; Bolitho, F.; Bertrand, L. (1999). "The Predictors of Adolescent Smoking". Journal of Social Service Research. 26 (1): 51–66. doi:10.1300/J079v26n01_03.
  78. ^ Pelosi, Anthony J. (2019). "Personality and fatal diseases: Revisiting a scientific scandal". Journal of Health Psychology. 24 (4): 421–439. doi:10.1177/1359105318822045. ISSN 1359-1053. PMC 6712909. PMID 30791726.
  79. ^ "King's College London enquiry into publications authored by Professor Hans Eysenck with Professor Ronald Grossarth-Maticek" (PDF). October 2019. Archived (PDF) from the original on 5 November 2022. Retrieved 13 January 2020.
  80. ^ Nigel Hawkes (2019), Works by eminent psychologist who doubted smoking caused cancer are "unsafe," finds inquiry Archived 4 January 2023 at the Wayback Machine
  81. ^ Eysenck, Hans J.; Brody, Stuart (November 2000). Smoking, health and personality. Transaction. ISBN 978-0-7658-0639-0.
  82. ^ Berlin, I.; Singleton, E. G.; Pedarriosse, A. M.; Lancrenon, S.; Rames, A.; Aubin, H. J.; Niaura, R. (2003). "The Modified Reasons for Smoking Scale: factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers". Addiction. 98 (11): 1575–1583. doi:10.1046/j.1360-0443.2003.00523.x. PMID 14616184.
  83. ^ "Nicotine". Imperial College London. Archived from the original on 14 July 2009. Retrieved 22 March 2009. {{cite journal}}: Cite journal requires |journal= (help)
  84. ^ Chandra, S.; Chaloupka, F. J. (2003). "Seasonality in cigarette sales: patterns and implications for tobacco control". Tobacco Control. 12 (1): 105–107. doi:10.1136/tc.12.1.105. PMC 1759100. PMID 12612375.
  85. ^ Chandra, S.; Shiffman, S.; Scharf, M.; Dang, Q.; Shadel, G. (February 2007). "Daily smoking patterns, their determinants, and implications for quitting". Experimental and Clinical Psychopharmacology. 15 (1): 67–80. doi:10.1037/1064-1297.15.1.67. ISSN 1064-1297. PMID 17295586.
  86. ^ a b Kalkhoran, S; Benowitz, NL; Rigotti, AN (August 2018). "Prevention and Treatment of Tobacco Use: JACC Health Promotion Series". Journal of the American College of Cardiology. 72 (9). Elsevier for the American College of Cardiology: 1030–45. doi:10.1016/j.jacc.2018.06.036. ISSN 1558-3597. PMC 6261256. PMID 30139432. S2CID 52077567. Archived from the original on 9 August 2020. Retrieved 1 August 2020.
  87. ^ "ASH > Action on Smoking & Health". www.ash.org. 2 August 2012. Archived from the original on 19 November 2016. Retrieved 16 November 2016.
  88. ^ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Mitchell, Richard (18 May 2007). "Chapter 8: Environmental and Nutritional Diseases". Robbins Basic Pathology (8th ed.). Philadelphia: W.B. Saunders. p. 288, Figure 8–6. ISBN 978-1-4160-2973-1.
  89. ^ a b c Rodu, B; Plurphanswat, N (January 2021). "Mortality among male cigar and cigarette smokers in the USA" (PDF). Harm Reduction Journal. 18 (7). BioMed Central: 7. doi:10.1186/s12954-020-00446-4. ISSN 1477-7517. LCCN 2004243422. PMC 7789747. PMID 33413424. S2CID 230800394. Archived (PDF) from the original on 26 August 2021. Retrieved 28 August 2021.
  90. ^ Nonnemaker, J; Rostron, B; Hall, P; MacMonegle, A; Apelberg, B (September 2014). Morabia, A (ed.). "Mortality and Economic Costs From Regular Cigar Use in the United States, 2010". American Journal of Public Health. 104 (9). American Public Health Association: e86–e91. doi:10.2105/AJPH.2014.301991. eISSN 1541-0048. ISSN 0090-0036. PMC 4151956. PMID 25033140. S2CID 207276270.
  91. ^ Shah, RS; Cole, JW (July 2010). "Smoking and stroke: the more you smoke the more you stroke". Expert Review of Cardiovascular Therapy. 8 (7). Informa: 917–932. doi:10.1586/erc.10.56. ISSN 1744-8344. PMC 2928253. PMID 20602553. S2CID 207215548.
  92. ^ a b Laniado-Laborín, Rafael (January 2009). "Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century". International Journal of Environmental Research and Public Health. 6 (1: Smoking and Tobacco Control). MDPI: 209–224. doi:10.3390/ijerph6010209. ISSN 1660-4601. PMC 2672326. PMID 19440278. S2CID 19615031.
  93. ^ Oh, CK; Murray, LA; Molfino, NL (February 2012). "Smoking and Idiopathic Pulmonary Fibrosis". Pulmonary Medicine. 2012. Hindawi Publishing Corporation: 808260. doi:10.1155/2012/808260. ISSN 2090-1844. PMC 3289849. PMID 22448328. S2CID 14090263.
  94. ^ a b c Thun, Michael J.; Jacobs, Eric J.; Shapiro, Jean A. (February 2000). Ganz, Patricia A. (ed.). "Cigar Smoking in Men and Risk of Death From Tobacco-Related Cancers". Journal of the National Cancer Institute. 92 (4). Oxford University Press: 333–337. doi:10.1093/jnci/92.4.333. eISSN 1460-2105. ISSN 0027-8874. PMID 10675383. S2CID 7772405. Archived from the original on 21 April 2021. Retrieved 28 August 2021.
  95. ^ a b c Anjum F, Zohaib J (4 December 2020). "Oropharyngeal Squamous Cell Carcinoma". Definitions (Updated ed.). Treasure Island (FL): StatPearls Publishing. doi:10.32388/G6TG1L. PMID 33085415. S2CID 229252540. Bookshelf ID: NBK563268. Archived from the original on 11 June 2021. Retrieved 7 February 2021 – via NCBI.
  96. ^ Gormley, Mark; Creaney, Grant; Schache, Andrew; Ingarfield, Kate; Conway, David I. (11 November 2022). "Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors". British Dental Journal. 233 (9): 780–786. doi:10.1038/s41415-022-5166-x. ISSN 0007-0610. PMC 9652141. PMID 36369568.
  97. ^ Hashibe, Mia; Brennan, Paul; Chuang, Shu-chun; Boccia, Stefania; Castellsague, Xavier; Chen, Chu; Curado, Maria Paula; Dal Maso, Luigino; Daudt, Alexander W.; Fabianova, Eleonora; Fernandez, Leticia; Wünsch-Filho, Victor; Franceschi, Silvia; Hayes, Richard B.; Herrero, Rolando (1 February 2009). "Interaction between Tobacco and Alcohol Use and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium". Cancer Epidemiology, Biomarkers & Prevention. 18 (2): 541–550. doi:10.1158/1055-9965.EPI-08-0347. ISSN 1055-9965. PMC 3051410. PMID 19190158.
  98. ^ Inflamm Bowel Dis. May 2009, P. Seksik, I Nion-Larmurier
  99. ^ Rom O, Kaisari S, Aizenbud D, Reznick AZ (2013). "Cigarette smoke and muscle catabolism in C2 myotubes". Mech Ageing Dev. 134 (1–2): 24–34. doi:10.1016/j.mad.2012.11.004. PMID 23262287. S2CID 322153.
  100. ^ a b Etemadi, Arash; Blount, Benjamin C.; Calafat, Antonia M.; Chang, Cindy M.; De Jesus, Victor R.; Poustchi, Hossein; Wang, Lanqing; Pourshams, Akram; Shakeri, Ramin; Shiels, Meredith S.; Inoue-Choi, Maki; Ambrose, Bridget K.; Christensen, Carol H.; Wang, Baoguang; Ye, Xiaoyun; Murphy, Gwen; Feng, Jun; Xia, Baoyun; Sosnoff, Connie S.; Boffetta, Paolo; Brennan, Paul; Bhandari, Deepak; Kamangar, Farin; Dawsey, Sanford M.; Abnet, Christian C.; Freedman, Neal D.; Malekzadeh, Reza (February 2019). "Urinary Biomarkers of Carcinogenic Exposure among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study". Cancer Epidemiology, Biomarkers & Prevention. 28 (2). American Association for Cancer Research: 337–347. doi:10.1158/1055-9965.EPI-18-0743. eISSN 1538-7755. ISSN 1055-9965. PMC 6935158. PMID 30622099. S2CID 58560832.
  101. ^ Dreyer, L et al. (1997) Tobacco Smoking. APMIS Inc.
  102. ^ Chang, Cindy M.; Corey, Catherine G.; Rostron, Brian L.; Apelberg, Benjamin J. (April 2015). "Systematic review of cigar smoking and all-cause and smoking-related mortality" (PDF). BMC Public Health. 15 (390). BioMed Central: 390. doi:10.1186/s12889-015-1617-5. ISSN 1471-2458. PMC 4408600. PMID 25907101. S2CID 16482278. Archived (PDF) from the original on 16 March 2021. Retrieved 5 September 2021.
  103. ^ Albandar, Jasim M.; Adensaya, Margo R.; Streckfus, Charles F.; Winn, Deborah M. (December 2000). "Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss". Journal of Periodontology. 71 (12). American Academy of Periodontology: 1874–1881. doi:10.1902/jop.2000.71.12.1874. ISSN 0022-3492. PMID 11156044. S2CID 11598500.
  104. ^ Kastan MB (2008). "DNA damage responses: mechanisms and roles in human disease: 2007 G.H.A. Clowes Memorial Award Lecture". Mol. Cancer Res. 6 (4): 517–24. doi:10.1158/1541-7786.MCR-08-0020. PMID 18403632.
  105. ^ Liu XY, Zhu MX, Xie JP (2010). "Mutagenicity of acrolein and acrolein-induced DNA adducts". Toxicol. Mech. Methods. 20 (1): 36–44. doi:10.3109/15376510903530845. PMID 20158384. S2CID 8812192.
  106. ^ Speit G, Merk O (2002). "Evaluation of mutagenic effects of formaldehyde in vitro: detection of crosslinks and mutations in mouse lymphoma cells". Mutagenesis. 17 (3): 183–7. doi:10.1093/mutage/17.3.183. PMID 11971987.
  107. ^ Pu X, Kamendulis LM, Klaunig JE (2009). "Acrylonitrile-induced oxidative stress and oxidative DNA damage in male Sprague-Dawley rats". Toxicol. Sci. 111 (1): 64–71. doi:10.1093/toxsci/kfp133. PMC 2726299. PMID 19546159.
  108. ^ Koturbash I, Scherhag A, Sorrentino J, Sexton K, Bodnar W, Swenberg JA, Beland FA, Pardo-Manuel Devillena F, Rusyn I, Pogribny IP (2011). "Epigenetic mechanisms of mouse interstrain variability in genotoxicity of the environmental toxicant 1,3-butadiene". Toxicol. Sci. 122 (2): 448–56. doi:10.1093/toxsci/kfr133. PMC 3155089. PMID 21602187.
  109. ^ Garcia CC, Angeli JP, Freitas FP, Gomes OF, de Oliveira TF, Loureiro AP, Di Mascio P, Medeiros MH (2011). "[13C2]-Acetaldehyde promotes unequivocal formation of 1,N2-propano-2'-deoxyguanosine in human cells". J. Am. Chem. Soc. 133 (24): 9140–3. doi:10.1021/ja2004686. PMID 21604744. Archived from the original on 6 November 2020. Retrieved 1 December 2019.
  110. ^ Tompkins EM, McLuckie KI, Jones DJ, Farmer PB, Brown K (2009). "Mutagenicity of DNA adducts derived from ethylene oxide exposure in the pSP189 shuttle vector replicated in human Ad293 cells". Mutat. Res. 678 (2): 129–37. doi:10.1016/j.mrgentox.2009.05.011. PMID 19477295.
  111. ^ Fabiani R, Rosignoli P, De Bartolomeo A, Fuccelli R, Morozzi G (2007). "DNA-damaging ability of isoprene and isoprene mono-epoxide (EPOX I) in human cells evaluated with the comet assay". Mutat. Res. 629 (1): 7–13. doi:10.1016/j.mrgentox.2006.12.007. PMID 17317274.
  112. ^ Alarabi, A. B.; Karim, Z. A.; Alshbool, F. Z.; Khasawneh, F. T.; Hernandez, Keziah R.; Lozano, Patricia A.; Montes Ramirez, Jean E.; Rivera, José O. (February 2020). "Short-Term Exposure to Waterpipe/Hookah Smoke Triggers a Hyperactive Platelet Activation State and Increases the Risk of Thrombogenesis". Arteriosclerosis, Thrombosis, and Vascular Biology. 40 (2). Lippincott Williams & Wilkins: 335–349. doi:10.1161/ATVBAHA.119.313435. ISSN 1079-5642. PMC 7000176. PMID 31941383. S2CID 210335103.
  113. ^ Patel, Mit P.; Khangoora, Vikramjit S.; Marik, Paul E. (October 2019). "A Review of the Pulmonary and Health Impacts of Hookah Use". Annals of the American Thoracic Society. 16 (10). American Thoracic Society: 1215–1219. doi:10.1513/AnnalsATS.201902-129CME. ISSN 2325-6621. PMID 31091965. S2CID 155103502.
  114. ^ Qasim, Hanan; Alarabi, A. B.; Alzoubi, K. H.; Karim, Z. A.; Alshbool, F. Z.; Khasawneh, F. T. (September 2019). "The effects of hookah/waterpipe smoking on general health and the cardiovascular system" (PDF). Environmental Health and Preventive Medicine. 24 (58). BioMed Central: 58. Bibcode:2019EHPM...24...58Q. doi:10.1186/s12199-019-0811-y. ISSN 1347-4715. PMC 6745078. PMID 31521105. S2CID 202570973. Archived (PDF) from the original on 24 April 2021. Retrieved 8 September 2021.
  115. ^ a b Farag, Mohamed A.; Elmassry, Moamen M.; El-Ahmady, Sherweit H. (19 November 2018). "The characterization of flavored hookahs aroma profile and in response to heating as analyzed via headspace solid-phase microextraction (SPME) and chemometrics". Scientific Reports. 8 (1): 17028. Bibcode:2018NatSR...817028F. doi:10.1038/s41598-018-35368-6. ISSN 2045-2322. PMC 6242864. PMID 30451904.
  116. ^ WHO Report on the Global Tobacco Epidemic, 2008
  117. ^ "Nicotine: A Powerful Addiction Archived 1 May 2009 at the Wayback Machine." Centers for Disease Control and Prevention.
  118. ^ a b Barendregt J. J., Bonneux L., van der Maas P. J. (1997). "The health care costs of smoking" (PDF). New England Journal of Medicine. 337 (15): 1052–1057. doi:10.1056/NEJM199710093371506. hdl:1765/59780. PMID 9321534. Archived (PDF) from the original on 8 October 2022. Retrieved 20 April 2018.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  119. ^ Peto Richard; Darby Sarah; Deo Harz; et al. (2000). "Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies". The BMJ. 321 (7257): 323–329. doi:10.1136/bmj.321.7257.323. PMC 27446. PMID 10926586.
  120. ^ Yoshida, Kenichi; Gowers, Kate H. C.; Lee-Six, Henry; Chandrasekharan, Deepak P.; Coorens, Tim; Maughan, Elizabeth F.; Beal, Kathryn; Menzies, Andrew; Millar, Fraser R.; Anderson, Elizabeth; Clarke, Sarah E.; Pennycuick, Adam; Thakrar, Ricky M.; Butler, Colin R.; Kakiuchi, Nobuyuki; Hirano, Tomonori; Hynds, Robert E.; Stratton, Michael R.; Martincorena, Iñigo; Janes, Sam M.; Campbell, Peter J. (2020). "Tobacco smoking and somatic mutations in human bronchial epithelium". Nature. 578 (7794): 266–272. Bibcode:2020Natur.578..266Y. doi:10.1038/s41586-020-1961-1. PMC 7021511. PMID 31996850. Archived from the original on 12 August 2021. Retrieved 30 January 2020.
  121. ^ "Cigarette Smoking Among Adults --- United States, 2006". Archived from the original on 16 August 2019. Retrieved 29 February 2016.
  122. ^ "WHO Western Pacific | World Health Organization". www.who.int. Archived from the original on 8 November 2009.
  123. ^ Pintarelli G, Noci S, Maspero D, Pettinicchio A, Dugo M, De Cecco L, Incarbone M, Tosi D, Santambrogio L, Dragani TA, Colombo F (September 2019). "Cigarette smoke alters the transcriptome of non-involved lung tissue in lung adenocarcinoma patients". Scientific Reports. 9 (1): 13039. Bibcode:2019NatSR...913039P. doi:10.1038/s41598-019-49648-2. PMC 6736939. PMID 31506599.
  124. ^ Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries Archived 29 November 2010 at the Wayback Machine 26 November 2010
  125. ^ Gurillo, Pedro; Jauhar, Sameer; Murray, Robin M; MacCabe, James H (July 2015). "Does tobacco use cause psychosis? Systematic review and meta-analysis". The Lancet Psychiatry. 2 (8): 718–725. doi:10.1016/S2215-0366(15)00152-2. PMC 4698800. PMID 26249303.
  126. ^ Nicolosi Alfredo; et al. (2003). "Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction". Urology. 61 (1): 201–206. doi:10.1016/s0090-4295(02)02102-7. PMID 12559296. Archived from the original on 8 March 2021. Retrieved 16 July 2019.
  127. ^ Ma C, Liu Y, Neumann S, Gao X (2017). "Nicotine from cigarette smoking and diet and Parkinson disease: a review". Translational Neurodegeneration. 6: 18. doi:10.1186/s40035-017-0090-8. PMC 5494127. PMID 28680589.
  128. ^ Dorsey ER, Sherer T, Okun MS, Bloem BR (2018). "The Emerging Evidence of the Parkinson Pandemic". J Parkinsons Dis (Review). 8 (s1): S3–8. doi:10.3233/JPD-181474. PMC 6311367. PMID 30584159.
  129. ^ a b "Cigarettes Cost U.S. $7 Per Pack Sold, Study Says". The New York Times. 12 April 2002. Archived from the original on 13 February 2008. Retrieved 29 February 2016.
  130. ^ a b "USATODAY.com – Study: Cigarettes cost families, society $41 per pack". USA Today. Archived from the original on 24 May 2011. Retrieved 29 February 2016.
  131. ^ Armour, Brian S.; Pitts, M. Melinda (2007). "Smoking: Taxing Health and Social Security" (PDF). www.frbatlanta.org. Federal Reserve Bank of Atlanta. Archived from the original (PDF) on 19 October 2012. Retrieved 20 May 2023.
  132. ^ "Even One Is Too Much: The Economic Consequences of Being a Smoker, Federal Reserve Bank of Atlanta, January 2013" (PDF). Archived from the original (PDF) on 26 November 2013. Retrieved 11 July 2013.
  133. ^ "Costs and Expenditures". Smoking and Tobacco. Centers for Disease Control and Prevention. Web. 20 January 2013. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/ Archived 25 September 2011 at the Wayback Machine
  134. ^ a b "Public Finance Balance of Smoking in the Czech Republic". Archived from the original on 19 July 2006.
  135. ^ "Snuff the Facts". Archived from the original on 20 December 2006.
  136. ^ "Global Effects of Smoking, of Quitting, and of Taxing Tobacco" (PDF). Archived (PDF) from the original on 27 November 2021. Retrieved 2 May 2018.
  137. ^ Mostafa RM. Dilemma of women's passive smoking. Ann Thorac Med [serial online] 2011 [cited 2011 Mar 29];6:55-6. Available from: http://www.thoracicmedicine.org/text.asp?2011/6/2/55/78410 Archived 2 June 2018 at the Wayback Machine
  138. ^ Church of Jesus Christ of Latter-day Saints (2009). "Obey the Word of Wisdom". Basic Beliefs – The Commandments. Archived from the original on 4 September 2015. Retrieved 15 October 2009.
  139. ^ "Why is smoking not strictly forbidden in Islam?". Archived from the original on 3 May 2014. Retrieved 2 May 2014.
  140. ^ Smith, Peter (2000). "smoking". A concise encyclopedia of the Bahá'í Faith. Oxford: Oneworld Publications. pp. 323. ISBN 978-1-85168-184-6.
  141. ^ "WHO | Updated status of the WHO Framework Convention on Tobacco Control". 17 November 2004. Archived from the original on 17 November 2004. Retrieved 12 December 2021.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  142. ^ "Archived copy" (PDF). www.who.int. Archived from the original (PDF) on 12 December 2019. Retrieved 15 January 2022.{{cite web}}: CS1 maint: archived copy as title (link)
  143. ^ "26, 2004-smoking-costs_x.htm Study: Cigarettes cost families, society $41 per pack". USA Today.
  144. ^ "Reducing Tobacco Use". Archived from the original on 21 February 2016. Retrieved 29 February 2016.
  145. ^ Hyland, A.; Bauer, J. E.; Li, Q.; Abrams, S. M.; Higbee, C.; Peppone, L.; Cummings, K. M. (2005). "Higher cigarette prices influence cigarette purchase patterns". Tobacco Control. 14 (2): 86–92. doi:10.1136/tc.2004.008730. PMC 1748009. PMID 15791017.
  146. ^ "TTB – Tax Audit Division – Tax and Fee Rates". Archived from the original on 26 February 2016. Retrieved 29 February 2016.
  147. ^ Helen C. Alvarez (28 March 2014). "You and Cigarettes". Archived from the original on 4 March 2016. Retrieved 29 February 2016.
  148. ^ "Tax on shopping and services". GOV.UK. Archived from the original on 24 November 2022. Retrieved 1 April 2023.
  149. ^ "Tobacco Smuggling & Crossborder Shopping " Tobacco Manufacturers' Association". Archived from the original on 8 September 2008. Retrieved 29 February 2016.
  150. ^ Scollo, Michelle (2008). "13.2 Tobacco taxes in Australia" Archived 24 October 2022 at the Wayback Machine. Tobacco in Australia. Cancer Council Victoria. Retrieved 29 July 2010.
  151. ^ "History of Tobacco Regulation*". Archived from the original on 16 June 2010. Retrieved 29 February 2016.
  152. ^ "Phil Taylor's Papers " Index". Archived from the original on 12 February 2012. Retrieved 29 February 2016.
  153. ^  European Union – Tobacco advertising ban takes effect July 31  Archived 24 January 2011 at the Wayback Machine
  154. ^ "Report on the implementation of the EU Tobacco Advertising Directive" (PDF). Archived (PDF) from the original on 5 September 2011. Retrieved 4 August 2008.
  155. ^ Tobacco – Health warnings Australian Government Department of Health and Ageing. Retrieved 29 August 2008
  156. ^ Public Health at a Glance – Tobacco Pack Information
  157. ^ Scottish Government, St Andrew's House (21 January 2013). "Tobacco Display Ban Guidance". www2.gov.scot. Archived from the original on 27 November 2019. Retrieved 27 November 2019.
  158. ^ "Guidance on the display and pricing of tobacco products in Northern Ireland | Department of Health". Health. 25 August 2015. Archived from the original on 27 November 2019. Retrieved 27 November 2019.
  159. ^ Norwegian Government (1996). "Act No. 14 of March 9th, 1973 Relating to Prevention of the Harmful Effects of Tobacco (The Tobacco Control Act)" (PDF). Archived from the original (PDF) on 18 March 2017. Retrieved 27 November 2019.
  160. ^ "WHO | Norway: Prohibition on the visible display of tobacco products at the points of sale". WHO. Archived from the original on 13 February 2020. Retrieved 27 November 2019.
  161. ^ "Imperial Tobacco take fight against cigarette display ban to Supreme". The Independent. 12 November 2012. Archived from the original on 21 June 2022. Retrieved 27 November 2019.
  162. ^ Carrell, Severin; correspondent, Scotland (12 December 2012). "Scotland to ban cigarette displays in shops after court challenge fails". The Guardian. ISSN 0261-3077. Archived from the original on 27 November 2019. Retrieved 27 November 2019.
  163. ^ World Health Organization (2017). "Evidence brief: Tobacco point-of-sale display bans" (PDF). WHO. Archived from the original (PDF) on 27 November 2019. Retrieved 27 November 2019.
  164. ^ "Tobacco Sales Law". Archived from the original on 23 November 2010. Retrieved 29 February 2016.
  165. ^ Ahlfeldt, G., Maennig, W. (2010), Impact of non-smoking ordinances on hospitality revenues: The case of Germany, in Journal of Economics and Statistics, 230(5), 506–521; preliminary version in: Hamburg Contemporary Discussion Papers N° 26, http://www.uni-hamburg.de/economicpolicy/hced.html Archived 23 May 2016 at the Wayback Machine.
  166. ^ "NFPA applauds Reynolds American Inc". Archived from the original on 1 March 2013. Retrieved 29 February 2016.
  167. ^ "NFPA" (PDF). Archived from the original (PDF) on 20 November 2007. Retrieved 29 February 2016.
  168. ^ a b "Coalition for Fire-Safe Cigarettes". Archived from the original on 16 August 2011. Retrieved 29 February 2016.
  169. ^ Lindeman, Tracey (1 August 2023). "'Poison in every puff': Canada puts health warnings on individual cigarettes". The Guardian. ISSN 0261-3077. Retrieved 8 August 2023.
  170. ^ C. Merrill, J.; Kleber, H. D.; Shwartz, M.; Liu, H.; Lewis, S. R. (1999). "Cigarettes, alcohol, marijuana, other risk behaviors, and American youth". Drug and Alcohol Dependence. 56 (3): 205–212. doi:10.1016/S0376-8716(99)00034-4. PMID 10529022.
  171. ^ Swan, G. C.; Carmelli, D.; Rosenman, R. H.; Fabsitz, R. R.; Christian, J. C. (1990). "Smoking and alcohol consumption in adult male twins: genetic heritability and shared environmental influences" (Free full text). Journal of Substance Abuse. 2 (1): 39–50. doi:10.1016/S0899-3289(05)80044-6. ISSN 0899-3289. PMID 2136102. Archived from the original on 4 July 2016. Retrieved 7 April 2016.
  172. ^ "Why Nicotine is a Gateway Drug". National Institutes of Health (NIH). 22 May 2015. Archived from the original on 11 April 2020. Retrieved 20 April 2020.
  173. ^ Rohsenow, Damaris J.; Martin, Rosemarie A.; Tidey, Jennifer W.; Colby, Suzanne M.; Monti, Peter M. (2017). "Treating Smokers in Substance Treatment With Contingent Vouchers, Nicotine Replacement and Brief Advice Adapted for Sobriety Settings". Journal of Substance Abuse Treatment. 72: 72–79. doi:10.1016/j.jsat.2016.08.012. PMC 5154824. PMID 27658756.
  174. ^ "Vaping to quit smoking - NHS". nhs.uk. 20 September 2022. Archived from the original on 21 June 2023. Retrieved 13 June 2023.
  175. ^ Tang, Yi-Yuan; Tang, Rongxiang; Posner, Michael I. (2016). "Mindfulness meditation improves emotion regulation and reduces drug abuse". Drug and Alcohol Dependence. 163: S13–S18. doi:10.1016/j.drugalcdep.2015.11.041. PMID 27306725.
  176. ^ Centers for Disease Control Prevention (CDC) (November 2011). "Quitting smoking among adults—United States, 2001–2010". MMWR. Morbidity and Mortality Weekly Report. 60 (44): 1513–9. PMID 22071589. Archived from the original on 3 January 2023. Retrieved 9 May 2015.
  177. ^ Brunetta PG, Kroon L (2022). "Smoking Cessation". In Broaddus C, Ernst JD, King, TE, et al. (eds.). Murray & Nadel's Textbook of Respiratory Medicine (7 ed.). Elsevier. pp. 900–909.
  178. ^ Rosen, Laura J.; Galili, Tal; Kott, Jeffrey; Goodman, Mark; Freedman, Laurence S. (January 2018). "Diminishing benefit of smoking cessation medications during the first year: a meta-analysis of randomized controlled trials". Addiction. 113 (5). Wiley-Blackwell on behalf of the Society for the Study of Addiction: 805–816. doi:10.1111/add.14134. ISSN 0965-2140. PMC 5947828. PMID 29377409. S2CID 4764039.
  179. ^ "Family First: Dr. Anil's Love-Infused Anti-Smoking Initiative". GorakhaPatra. Retrieved 5 February 2024.


  • Frieden, Thomas R. et al. The Health Consequences of Smoking: 50 Years of Progress: A Report of the Surgeon General (2014) online

External links[edit]