Tobacco smoking

From Wikipedia, the free encyclopedia

The neutrality of this article is disputed. Please see the discussion on the talk page.

Tobacco smoking is the act of burning the dried or cured leaves of the tobacco plant and inhaling the smoke for pleasure or ritualistic purposes, for self-medication, or out of habit and to satisfy addiction. The practice was common among Native Americans throughout North and South America, and was later introduced to the rest of the world via trade following European exploration of the Americas.

Tobacco smoke contains nicotine, an addictive stimulant. The effect of nicotine in first time or irregular users is an increase in alertness and memory, and mild euphoria. In chronic users, nicotine simply relieves the symptoms of nicotine withdrawal: confusion, restlessness, anxiety, insomnia, and dysphoria. Withdrawal symptoms in chronic users begin to appear approximately 30 minutes after every dose. Nicotine also disturbs metabolism and suppresses appetite.

Medical research has determined that chronic tobacco smoking is a major contributing factor towards many health problems, particularly lung cancer, emphysema, and cardiovascular disease.^[1][2] Many countries regulate or restrict tobacco sales and advertising and require warnings to be placed prominently on the product packaging. Many governments now restrict or ban smoking in a variety of public venues over concerns of second-hand smoke, and ostensibly to discourage tobacco use in general.

Contents 1 Methods of smoking 1.1 Cigarette 1.2 Cigar 1.3 Smoking pipe 1.4 Hookah 2 Health effects 2.1 History 2.2 Health risks of smoking 2.3 Passive smoking 2.4 Sudden infant death syndrome 2.5 Bodily functions and how they are affected 2.6 Physical and mental addiction 2.7 Smoking and depression 2.8 Health benefits of smoking 3 Effects of the habit and industry on society 3.1 Link between tobacco use and use of illicit drugs 3.2 Effect on healthcare costs 3.3 Peer pressure 3.4 Parental smoking 3.5 Smoking in movies and television 3.6 The use of smoking to project an image 3.7 Genetic connection 4 Opinions of society on smoking 4.1 Native Americans and smoking 4.2 Christianity and smoking (arguments against) 4.3 Mormonism and smoking (arguments against) 4.4 Judaism and smoking (arguments against) 5 Smoking cessation 6 Legal issues and regulation 6.1 Sale to minors 6.2 Taxation 6.3 Restrictions on cigarette advertising 6.4 Package warnings 6.5 Smoking bans 6.6 New Smoking Legislations in 2007 (Great Britain) 7 See also 8 Notes 9 References 10 Further reading 11 External links 11.1 History 11.2 Prevention and self help 11.3 Smokers' rights sites 11.4 Statistics and studies

[edit] Methods of smoking

[edit] Cigarette

Main article: Cigarette

A cigarette is a product manufactured from cured and cut tobacco leaves, which are rolled and/or stuffed into a paper-wrapped cylinder. The cigarette is lit, usually with a match or lighter at one end and allowed to burn for the purpose of inhalation of its smoke from the other (usually filtered) end, which is inserted in the mouth."Roll Ups" are also very popular, particularly in European countries; these are prepared from loose tobacco, cigarette papers and filters all bought separately by the consumer. Cigarettes are smoked by some with a cigarette holder. (See also Bidi). A cigarette contains over 4000 chemicals,^[3] over 60 of which are believed to increase the risk of cancer and other diseases in humans and animals. See List of additives in cigarettes

[edit] Cigar

Main article: Cigar

A cigar is a cylinder of tobacco rolled in tobacco leaves for smoking. They come in many shapes and sizes, the most common being the "Corona." The tobacco used is grown throughout the Caribbean in places such as the Dominican Republic, Jamaica, and Cuba. Many wrappers are from Connecticut. Cigars manufactured in Cuba have historically been considered to be without peer, though today many aficionados consider the relative quality of Cuban cigars has diminished with the Cuban government’s mismanagement of cigar production[2], as well as the increasing quality of non-Cuban cigars, such as the Punch, Bolivar and Padron labels.

[edit] Smoking pipe

Main article: Smoking pipe

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

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

Pipes can range from the very simple machine-made briar pipe to handmade and artful implements created by pipemakers which can be very expensive collector's items. The popularity of pipe smoking in Western countries has declined in recent years. However, it has also enjoyed a resurgence of late among younger and middle aged smokers who find its contemplative nature and age-transcendent status as "hobby not habit" to be both thoroughly enjoyable and stress-relieving. Due to the wide availability of high quality mass-produced and custom smoking pipes as well as a myriad of pipe tobaccos to suit any taste, the hobby is likely to persist for years to come despite growing anti-smoking sentiment.

[edit] Hookah

A hookah is a traditional Middle Eastern or South Asian device for smoking, which operates by water-filtration and indirect heat. Hookah smoking is most popular in the Middle East, and is a niche market in most other places. In Muslim countries, where cannabis products smoking occupies a social niche analogous to that of alcohol drinking in the West, hookahs are sometimes loaded with hashish or opium. In the Far East opium and cannabis are also the most traditional drugs used, in direct commercial competition with tobacco from the West.^{[citation needed]}

Typically, tobacco is smoked from a hookah by placing exotic, richly flavored tobaccos in the smoking bowl, covering it with foil, and placing a coal on top of the foil. This keeps the tobacco from burning, and allows it to bake. The resulting vapors are further cooled by the hookah water, resulting in a moist, warm smoke and a delicious aroma even for those not enjoying direct smoke. The Al-Waha, Al Fakher, and Nakhla tobacco companies compete for market share in the Middle East by producing increasingly luxurious flavored tobaccos for use in the hookah. Currently available flavors include the traditional apple, grape, double apple, orange, strawberry, cherry, mango, vanilla, and melon flavors; as well as the modern cola, coconut, cappuccino, and banana milk flavors.

Popular myth suggests that hookah smoking is considered to be safer than other forms of smoking. However, water is not effective for removing all relevant toxins, e.g. the carcinogenic aromatic hydrocarbons are not water-soluble. Several serious negative health effects are linked to hookah smoking and studies indicate that it is likely to be more harmful to health than cigarettes, due in part to the volume of smoke inhaled. One study found hookah smoke to be both clastogenic and genotoxic for human beings,^[4] while another study showed that the CO hazard is as high with hookah smoking as with cigarette smoking.^[5] In addition to the cancer risk, there is some risk of infectious disease resulting from pipe sharing, and other risks associated to the common addition of other psychoactive drugs to the tobacco.^[6]

[edit] Health effects

Main article: Health effects of tobacco smoking

[edit] History

As the use of tobacco became popular in Europe, some people became concerned about its possible ill effects on the health of its users. One of the first was King James I of Great Britain. In 1604, he wrote "A Counterblaste to Tobacco" in which he asked his subjects^[7]

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

In 1761, English doctor John Hill published "Cautions against the Immoderate Use of Snuff" in which he warned snuff users that they were vulnerable to cancers of the nose,^[8][9] though Smith, a tobacco user himself, reportedly wrote it to strike at his tobacconist, who had angered him, and later retracted the report.^{[citation needed]} In 1795, American Samuel Thomas von Soemmering reported on cancers of the lip in pipe smokers.^[9] In 1912, American Dr. Isaac Adler was the first to strongly suggest that lung cancer is related to smoking.^[10] In 1929, Fritz Lickint of Dresden, Germany, published a formal statistical evidence of a lung cancer–tobacco link, based on a study showing that lung cancer sufferers were likely to be smokers.^[11] Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less).^[11]

In 1950, Dr. Richard Doll published research in a 1950 issue of the British Medical Journal showing a close link between smoking and lung cancer.^[12] In 1964, Luther L. Terry, M.D., Surgeon General of the United States, released the report of the Surgeon General's Advisory Committee on Smoking and Health. It was based on over 7000 scientific articles that linked tobacco use with cancer and other diseases. This report led to laws requiring warning labels on tobacco products and to restrictions on tobacco advertisements.^{[citation needed]} From this time, Americans became much more aware of the dangers of tobacco and its use in the United States began to decline.^{[citation needed]} By 2004, nearly half of all Americans who had ever smoked had quit (CDC 2004).^[13] In the 1950s, manufacturers began adding filter tips to cigarettes to remove some of the tar and nicotine as they were smoked. "Safer", "less potent" cigarette brands were also introduced. They were so popular that, as of 2004, half of Americans preferred them^[14] in spite the fact that the idea of a "safer" cigarette is a myth. Cigarettes that offer, "low tar and nicotine" simply cause the smoker to smoke more or to inhale more deeply to get the same level of nicotine. According to The Federal Government’s National Cancer Institute (NCI), light cigarettes provide no benefit to smoker's health.^[15][16]

[edit] Health risks of smoking

The health effects of tobacco smoking are related to direct tobacco smoking, as well as passive smoking, inhalation of environmental or secondhand tobacco smoke.^[17] A 50 year study of over thirty thousand British physicians showed that nonsmokers lived about 10 more years than the smokers.^{[citation needed]} For those born between 1920 and 1929 the standardized mortality rate between the ages of 35 and 69 for nonsmokers was 15% and for smokers was 45% —nearly three times as great.^[18] Claims that personalities of smokers account for these differences are not convincing in light of the fact that the heavy smokers were about 25 times more likely to die of lung cancer or chronic obstructive pulmonary disease than the nonsmokers.^[18]. Smoking is responsible for 87% of lung cancer deaths.^[17]

Lung cancer rates are linked to the number of people who smoke. It is noted that an increase in deaths from lung cancer appeared 20 years after an increase in cigarette consumption. The damage a continuing smoker does to their lungs can take up to 20 years before its physical manifestation in lung cancer. Women began smoking later than men, so the rise in death rate amongst women did not appear until later. More men than women smoke. More men than women die of lung cancer. The male lung cancer death rate decreased in 1975 — roughly 20 years after the fall in cigarette consumption in men. Fall in consumption in women also began in 1975 but by 1991 had not manifested in a decrease in lung cancer related mortalities amongst women.^[19]

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

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

The carcinogenity of tobacco smoke is not explained by nicotine, which is not carcinogenic or mutagenic. Rather, any partially burnt material, tobacco or not, contains polycyclic aromatic hydrocarbons, particularly benzopyrene. The mechanism of their carcinogenity is well-known: oxidation produces an epoxide, which binds to DNA covalently and permanently distorts it. DNA damage is the cause of cancer, because if the poison damages the cellular apoptosis system severely enough, the injured cell cannot kill itself and becomes a cancer cell. The poison is not specific, so whether the cancer-causing damage is done is determined by random chance. In this respect, the mechanism of carcinogenicity closely resembles that of mustard gas, aflatoxin and other DNA alkylating agents.^{[citation needed]}

Tobacco smoke also contains various carcinogens other than polynuclear aromatic hydrocarbons, such as traces of radioactive elements. For example, smoke from tobacco grown with phosphate fertilizers contains polonium 210^[20] Some researchers have estimated that polonium 210 carries a cancer risk of 4 per 10000 smokers^{[21][this source's reliability may need verification]}, while others have estimated the mortality rate to be 18 per million.^[22]

The carcinogenity is aggravated by the delivery of the carcinogens, namely direct inhalation. Radioactive and carcinogenic particles would not find their way by itself to the lungs, but a smoker inhales them repeatedly over a long period of time.

All smoke contains very fine particulates. They are able to penetrate the alveolar wall into the blood and their effects on the heart are observable in a short time.^{[citation needed]}

A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting disease is half that of a smoker.^{[citation needed]}

Nicotine is a powerful, addictive stimulant and is one of the main factors leading to the continued tobacco smoking. Although the amount of nicotine inhaled with tobacco smoke is quite small (most of the substance is destroyed by the heat) it is still sufficient to cause physical and/or psychological dependence.^{[citation needed]} However, smokers usually ignore these facts and trade health risk for other qualities such as enjoyment and satisfied addictions.^{[citation needed]} These smokers often think of the benefits of smoking rather than the downsides. Some smokers claim that the depressant effect of smoking allows them to "calm their nerves", often allowing for increased concentration. This, however, is only partly true. According to the Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, whilst higher doses have stimulant effect."^[23] The health risks of smoking are not uniform across all smokers. Risks vary according to amount of cigarettes smoked, with those who smoke more cigarettes at greater risk. Light smoking is a health risk. According to the Canadian Lung Association, tobacco kills between 40,000–45,000 Canadians per year, more than the total number of deaths from AIDS, traffic accidents, suicide, murder, fires and accidental poisoning.^[24][25] However, the number of deaths related to smoking may be exaggerated because it is difficult to determine whether smoking actually caused the terminal illness.

[edit] Passive smoking

Main article: Passive smoking

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

It is confirmed that, in adults, secondhand smoke causes lung cancer, nasal sinus cancer, breast cancer in younger women, heart disease, heart attacks, and asthma induction. Secondhand smoke is also known to harm children, infants and reproductive health through acute lower respiratory tract illness, asthma induction and exacerbation, chronic respiratory symptoms, middle ear infection, lower birth weight babies, and Sudden Infant Death Syndrome.^[26] In a study released February 12, 2007 warning signs for cardiovascular disease are higher in people exposed to secondhand tobacco smoke, adding to the link between "passive smoke" and heart disease. "Our study provides further evidence to suggest low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease," said Dr. Andrea Venn of University of Nottingham in Britain, lead author of the study.^[27]

In June 2006, US Surgeon General Richard H. Carmona called the evidence of the effects of passive smoke "indisputable" and said "The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and non-smoking adults.".^[28] Passive smoking is one of the key issues that have led to introduction of smoking bans, particularly in workplaces.

The composition of environmental tobacco smoke (ETS) is similar to fossil fuel combustion products that contribute to air pollution, and has been shown to be responsible for indoor particulate matter (PM) levels far exceeding official outdoor limits.^[29]

[edit] Sudden infant death syndrome

Main article: Sudden infant death syndrome

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

[edit] Bodily functions and how they are affected

Tobacco smoke contains nicotine, a stimulant. Nicotine acts as an agonist, that attaches to nicotinic acetylcholine receptor sites in the brain. Some of these receptors regulate respiration, heart rate, memory, alertness, and muscle movement, therefore these bodily functions are affected by smoking.^{[citation needed]}

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

Recent evidence has shown that smoking tobacco causes increases in dopamine levels in the brain, and lowers the levels of monoamine oxidase (MAO) found in the brain that naturally stops the levels of dopamine becoming too high, this causes the promotion of abnormally high levels of dopamine similar to those experienced by heroin and cocaine addicts and users. Smokers have feelings of pleasure and reward when they smoke due to this chemical imbalance created.^[30] One study found that smokers exhibit better reaction-time and memory performance as they tire, compared to non-smokers.^[31]

[edit] Physical and mental addiction

Nicotine, an element of tobacco smoke, is one of the most addictive substances that exists. When tobacco is smoked, most of the nicotine is pyrolyzed; a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. According to studies by Henningfield and Benowitz, nicotine is more addictive than cannabis and caffeine but of a lesser potential for somatic dependency than ethanol, cocaine and heroin. A study by Perrine concludes that nicotine's potential for psychological dependency exceeds all other studied drugs^[32] - even ethanol, an extremely physically addictive substance with a severe withdrawal that can be fatal. Many smokers use nicotine compulsively. About half of Canadians who currently smoke have tried to quit.^[33] McGill University health professor Jennifer O'Loughlin stated that nicotine addiction can occur as soon as five months after the start of smoking.^[34]

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

[edit] Smoking and depression

Data from multiple studies suggest that depression plays a role in cigarette smoking.^[35] A history of regular smoking was observed more frequently among individuals who had experienced a major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis.^[36] Another study found that the average lifetime daily cigarette consumption was strongly related to lifetime prevalence, and to prospectively assessed one year prevalence of major depression.^[37] People with major depression are also much less likely to quit due to the increased risk of experiencing mild to severe states of depression, including a major depressive episode.^[38] Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse.^[39] The neurotransmitter systems affected by cigarette smoke mirror the neurotransmitter pathways that are thought to be involved in the biological mechanisms of depression, and the use of antidepressants as adjuvants to smoking-cessation treatment can enhance cessation success rates.^[40]

[edit] Health benefits of smoking

While smoking is synonymous with damaging one's health, a few marginal health benefits have been observed in smokers, reducing their risk of several diseases. It should be noted that the increased risk of terminal illness from habitual smoking is still widely believed to outweigh the benefits and should not be taken as evidence that smoking is healthful or beneficial overall.

Several types of "Smoker’s Paradoxes",^[41] i.e. cases where smoking appears to have specific beneficial effects, have been observed; often the actual mechanism remains undetermined. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI).^[41] Risk of ulcerative colitis has been frequently shown to be reduced by smokers on a dose-dependent basis; the effect is eliminated if the individual stops smoking.^[42][43] Smoking appears to interfere with development of Kaposi's sarcoma,^[44] breast cancer among women carrying the very high risk BRCA gene,^[45] preeclampsia,^[46] and atopic disorders such as allergic asthma.^[47] A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an anti-inflammatory agent and interfering with the disease process.^[48]

It has been said that smoking can reduce the amount of tics a Tourette Syndrome sufferer has.

A large body of evidence suggests that the risks of neurological diseases such as Parkinson's disease or Alzheimer's disease might be twice as high for non-smokers than for smokers.^[49] Many such papers regarding Alzheimer's disease^[50] and Parkinson's Disease^[51] have been published. A plausible explanation for these cases may be the effect of nicotine, a cholinergic stimulant, decreasing the levels of acetylcholine in the smoker's brain; Parkinson's disease occurs when the effect of dopamine is less than that of acetylcholine. Opponents counter by noting that consumption of pure nicotine may be as beneficial as smoking without the risk.

Other Alzheimer's studies, however, challenge these epidemiological studies on methodological grounds.^[52] A prospective Rotterdam Study found that the incidence of Alzheimer's disease is more than double for smokers as compared to non-smokers^[53] and the Honolulu Heart Program (a longitudinal cohort study) also found more than twice the risk for Alzheimer's disease among medium and heavy smokers as compared to non-smokers.^[54]

The negative correlation between smoking and Parkinson's disease is recognized but causality has not been established. The relationship may be artifact (observational) based on clusters of behavioral and personality differences in the pre-Parkinsonian population versus the smoking population.^[55]

Considering the high rates of physical sickness and deaths among persons suffering from schizophrenia^{[citation needed]}, one of smoking's most burdensome short term benefits is its temporary effect to improve alertness and cognitive functioning in that disease.^[56] It has been postulated that the mechanism of this effect is that schizophrenics have a disturbance of nicotinic receptor functioning.^[57]

[edit] Effects of the habit and industry on society

[edit] Link between tobacco use and use of illicit drugs

Cigarettes and alcohol are considered a “gateway drug.” A 1994 report from the Center on Addiction and Substance Abuse at Columbia University states that there is a consistent relationship between the use of cigarettes and alcohol and the subsequent use of cannabis. Cigarettes, alcohol and cannabis use and the subsequent use of illicit drugs like cocaine is also linked, regardless of the age, sex, ethnicity or race of the individuals involved. Children 12 to 17 years old who smoke are nineteen times more likely to use cocaine. This may also be affected by each individual person's personality and or attitude toward their life style. Some people are more inclined to take risks or to engage in potentially harmful behaviors than others and these people are sometimes more inclined to smoke cigarettes or do other drugs. The reason that so many people that do drugs start off with cigarettes, alcohol and/or marijuana is because those three are the cheapest and most accessable. Many people belive that the U.S. and other governments use the "gateway drug" theory to justify their prohibition of marijuana. There are many people that smoke marijuana and/or cigarettes without ever becoming addicted or even trying other drugs. The 1994 report also found that when younger children use these gateway drugs, the more often they use them, the more likely they are to use cocaine, heroin, hallucinogens and other illicit drugs. The report concludes that the data is already robust enough to make a strong case to step up efforts to prevent childhood use of cigarettes, alcohol and cannabis and to take firm steps to reduce children’s access to these gateway drugs.^[58]

People who abuse drugs are likely to be cigarette smokers also. More than two-thirds of drug abusers are regular tobacco smokers, a rate more than double of that in the general population. NIDA researchers have found that craving for nicotine also increases craving for illicit drugs among drug abusers who smoke tobacco, and this suggests that smokers in drug rehabilitation programs may be less successful than nonsmokers in staying off drugs.^[59]

[edit] Effect on healthcare costs

In countries where there is a public health system, society pays for the medical care of smokers who become ill through increased taxes. Two arguments exist on this front, the "pro-smoking" argument suggesting that heavy smokers generally don't live long enough to develop the costly and chronic illnesses which affect the elderly, reducing society's healthcare burden. 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 is limited, although 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.^[60] The cost may be higher, with another study putting it as high as $41 per pack.^[61]

By contrast, some non-scientific studies, including one conducted by Philip Morris in the Czech Republic^[62] and another by the CATO institute,^[63] support the opposite position. Neither study was peer-reviewed nor published in a scientific journal, and the CATO institute have received funding from tobacco companies in the past. Philip Morris have 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."^[62] For example, Reynolds American Inc. used the Joe Camel cartoon character to advertise Camel cigarettes. Other brands such as Virginia Slims targeted women with slogans like "You've Come a Long Way Baby".

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

The actual effectiveness of tobacco advertisement is widely documented. According to an opinion piece by Henry Saffer, public health experts say that tobacco advertising increases cigarette consumption and there is significant empirical literature that finds a significant effect of tobacco advertising on smoking, especially in children.^{[64][65][66][67][68][69][70][71]}

[edit] Peer pressure

Many anti-smoking organizations claim 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 did not play a significant part in adolescent smoking. In that study, adolescents also reported low levels of both normative and direct pressure to smoke cigarettes.^[72] A similar study showed that individuals play a more active role in starting to smoke than has previously been acknowledged and that social processes other than peer pressure need to be taken into account.^[73] Another study's results revealed that peer pressure was significantly associated with smoking behavior across all age and gender cohorts, but that intrapersonal factors were significantly more important to the smoking behavior of 12–13 year-old girls than same-age boys. Within the 14–15 year-old age group, one peer pressure variable emerged as a significantly more important predictor of girls' than boys' smoking.^[74] It is debated whether peer pressure or self-selection is a greater cause of adolescent smoking. It is arguable that the reverse of peer-pressure is true, when the majority of peers do not smoke and ostracize those who do.

[edit] Parental smoking

Children of smoking parents are more likely to smoke than children with non-smoking parents. One study found that parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked.^[75] 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.^[76]

[edit] Smoking in movies and television

Exposure to smoking in movies has been linked with adolescent smoking initiation in cross-sectional studies.^[77][78] Hollywood movies tend to have a high incidence of smoking behavior. According to a study of movies created between 1988 and 1997, eighty-seven percent of these movies portrayed various tobacco use, with an average of 5 occurrences per film. R-rated movies had the greatest number of occurrences and were most likely to feature major characters using tobacco.^[79] Despite the declining tobacco use in the society, the incidence of smoking in 2002 movies was nearly the same as in 1950 movies.^[80]

There have been moves to reduce the depiction of protagonists smoking in television shows, especially those aimed at children. For example, Ted Turner took steps to remove or edit scenes that depict characters smoking in cartoons such as Tom and Jerry, The Flintstones and Scooby-Doo,^[81] which are shown on his Cartoon Network and Boomerang television channels.

[edit] The use of smoking to project an image

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean Paul Sartre's Gauloise-brand cigarettes, Bertrand Russell's pipe, or the news broadcaster Edward R. Murrow's cigarette. Writers in particular seemed to be known for smoking; see, for example, 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 addresses 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 also smoked a pipe, besides injecting himself with cocaine, "to keep his overactive brain occupied during the dull London days, when nothing happened". 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, centred 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".

[edit] Genetic connection

Smoking is influenced by genetic factors; one 1990 study posited that 52% of the variance in smoking behaviour is attributable to heritable factors, while the other half were a function of the environment.^[82]

[edit] Opinions of society on smoking

[edit] Native Americans and smoking

Communal smoking of a sacred tobacco pipe is a common ritual of many Native American tribes, and was considered a sacred part of their religion. Sema, the Anishinaabe word for tobacco, was grown for ceremonial use and considered the ultimate sacred plant since its smoke was believed to carry prayers to the heavens.^[83] Smoking was chiefly done after the evening meal, in the sweathouse, and before going to sleep.^[84] The tobacco used during these rituals varies widely in potency — the Nicotiana rustica species used in South America, for instance, has up to twice the nicotine content of the common North American N. tabacum. Many Native American tribes operate tobacco stores, including on the Internet, where they are usually exempt from taxes and therefore can sell products cheaper than non-Native American dealers.

[edit] Christianity and smoking (arguments against)

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

Moral concerns about self-injury are also prevalent in Catholic medical ethics on the grounds that people ought to be responsible stewards of the body as a gift from God; the stewardship argument is also used among Protestant groups as an argument against smoking. However, smoking is seldom considered a formal sin in Catholicism and many lay, vowed, and ordained faithful smoke.

[edit] Mormonism and smoking (arguments against)

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

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

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

[edit] Judaism and smoking (arguments against)

Main article: Jewish law and history on smoking

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

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

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

The verse for this prohibition is a general verse stating that one should watch their health - "ונשמרתם מאד, לנפשתיכם" [Vi'nish'martem Me'od Li'naf'sho'tey'chem] Deut. 04:15 "And you shall watch yourselves very well..."

[edit] Smoking cessation

Main article: Smoking cessation

Many of tobacco's health effects can be minimised through smoking cessation. The British doctors study^[85] showed that those who stopped smoking before they reached 30 years of age lived almost as long as those who never smoked. It is also possible to reduce the risks by reducing the frequency of smoking and by proper diet and exercise. Some research has indicated that some of the damage caused by smoking tobacco can be moderated with the use of antioxidants.

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

Peer support can be helpful, such as that provided by support groups and telephone quitlines.(eg., 1-800-QuitNow in the US, 0800 169 0169 in the UK, and 131 848 in Australia). In addition, there are many self-help books on the market, such as The Stop Smoking Secret by Mark Jordan, and books by Allen Carr and David Marks.

[edit] Legal issues and regulation

On February 28, 2005, an international treaty, the WHO Framework Convention on Tobacco Control, took effect. The FCTC is the world's first public health treaty. Countries that sign on as parties agree to a set of common goals, minimum standards for tobacco control policy, and to cooperate in dealing with cross-border challenges such as cigarette smuggling. Currently the WHO declares that 4 billion people will be covered by the treaty, which includes 168 signatories.^[86] 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.

[edit] Sale to minors

In many countries, including the United States, the European Union member states, New Zealand, Canada, South Africa, Brazil and Australia, it is illegal to sell tobacco products to minors. In the United Kingdom, The Netherlands, Austria, Denmark and South Africa it is illegal to sell tobacco products to people under the age of 16. In 46 of the 50 United States, the minimum age is 18, except for Alabama, Alaska, New Jersey, and Utah where the legal age is 19 (also in the Suffolk and Nassau Counties of Long Island, New York). Some countries have also legislated against giving tobacco products to (i.e. buying for) minors, and even against minors engaging in the act of smoking. Underlying such laws is the belief that people should make an informed decision regarding the risks of tobacco use. These laws have a lax enforcement in some nations and states. In other regions, cigarettes are still sold to minors because the fines for the violation are lower or comparable to the profit made from the sales to minors. However 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.

[edit] Taxation

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

In 2002, the Centers for Disease Control and Prevention said that each pack of cigarettes sold in the United States costs the nation more than $7 in medical care and lost productivity.^[87] 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.^[88]

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.^[89][90]

Many nations have implemented some form of tobacco taxation. As of 1997, Denmark had the highest cigarette tax burden of $4.02 per pack. Taiwan only had a tax burden of $0.62 per pack. Currently, the average price and excise tax on cigarettes in the United States is well below those in many other industrialized nations.^[91]

The cigarette taxes vary from state to state in the United States. For example, South Carolina has a cigarette tax of only 7 cents per pack, while Rhode Island has a cigarette tax of $2.46 per pack. In Alabama, Illinois, Missouri, New York City, Tennessee, and Virginia, counties and cities may impose an additional limited tax on a price of cigarettes.^[92]

Due to the high taxation, the price of an average pack of cigarettes in New Jersey is $6.35,^[93] which is still less than the approximated external cost of a pack of cigarettes.

The average price in New York City has exceeded $7 per pack.

In Australia, which has a very high rate of tobacco taxation, the average price of a standard pack (25) is AUD$11.50.

In the United Kingdom, a packet of cigarettes typically costs around £5.50 (approx $10.70). The UK has a strong black market for cigarettes which has formed as a result of the high taxation, and it is estimated that one third of all cigarettes smoked in the country avoid UK taxes.

Some nations are reluctant to increase tobacco taxes because they fear the reduction of tobacco tax revenues and increase in smuggling.(thus reducing the small amount of money they take in and increasing difficulties in funding anti-smoking campaigns).

[edit] Restrictions on cigarette advertising

Several Western countries have also put restrictions on cigarette advertising. In the United States, all television advertising of tobacco products has been prohibited since 1971. In Australia, the Tobacco Advertising Prohibition Act 1992^[94] prohibits tobacco advertising in any form, with a very small number of exceptions (some international sporting events are excepted, but these exceptions were revoked in 2006). Other countries have legislated particularly against advertising that appears to target minors .

[edit] Package warnings

Main article: Tobacco packaging warning signs

Some countries also impose legal requirements on the packaging of tobacco products. For example in the countries of the European Union, Turkey, Australia^[95] and South Africa, cigarette packs must be prominently labelled with the health risks associated with smoking.^[96] Canada, Australia and Brazil have also imposed labels upon cigarette packs warning smokers of the effects, and they include graphic images of the potential health effects of smoking. Cards are also inserted into cigarette packs in Canada. There are sixteen of them, and only one comes in a pack. They explain different methods of quitting smoking. Also, in the United Kingdom, there have been a number of graphic NHS advertisements, one showing a cigarette filled with fatty deposits, as if the cigarette is symbolising the artery of a smoker.

Currently in Australia, almost 70% of the cigarette packet (Including 1/3 of the front, the whole back and both sides) are covered in either graphic imagery or health factoids. These warnings depict images of the effects of smoking (gangrene, children in hospital from passive smoking and browned teeth), name/number of chemicals and annual death rates. Incredibly graphic television ads accompany them, involving a doctor amputating a foot and smokers struggling to breathe in hospital. Since then, the number of smokers has been reduced by one quarter.^[97]

[edit] Smoking bans

Main article: Smoking ban

Some jurisdictions impose restrictions on where smoking is allowed. Several European countries such as the Republic of Ireland, Finland, Norway, Sweden, Italy, Lithuania, Spain and Scotland have legislated against smoking in public places, often including bars and restaurants. Restauranters have been obligated to build designated smoking areas (or to prohibit smoking). Similar bans will also take effect in the rest of the UK at various intervals (Northern Ireland and Wales from 02 April 2007, and England from 01 July 2007). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars. In Canada smoking is illegal in bars and restaurants in certain provinces. In Australia, smoking bans vary from state to state. Currently, Queensland has the strictest laws, with total bans within all public interiors (including workplaces, bars, pubs and eateries) as well as patrolled beaches and some outside public areas. There are, however, exceptions for designated smoking areas. In New Zealand smoking is banned in enclosed public places mainly bars and pubs. Hong Kong banned smoking on the 1st of January 2007 in the workplace, public spaces such as restaurants, karaoke rooms, buildings, and public parks. Bars serving alcohol who do not admit under 18's have been exempted till 2009. In Romania smoking is illegal in trains, metro stations, public institutions(except where designated, usually outside) and public transportation.

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

[edit] New Smoking Legislations in 2007 (Great Britain)

As of April 2nd 2007, Wales will initiate a complete smoking ban in enclosed public places, followed by England on July 1st 2007. A similar ban has been in place in Scotland since 26th March 2006. This includes pubs, clubs, restaurants, cinemas and all public transport. Contrary to some people's belief, you will still be able to smoke in open public places, such as railway platforms. The ban will have fines of £50 for people who smoke in restricted areas, and up to £2500 for people who fail to enforce the rules on their property, i.e. landlords.

As of October, the UK will also raise the smoking age from 16, which it has been for over 100 years, to 18, to bring it inline with the dangers of alcohol. It will apparently also make it easier for shop keepers to avoid selling to underage people.

[edit] See also

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

[edit] Notes

[edit] References

• Boffetta, P., Agudo, A., Ahrens, W., Benhamou, E., Benhamou, S., Darby, S.C., Ferro, G., Fortes, C., Gonzalez, C.A., Jockel, K.H., Krauss, M., Kreienbrock, L., Kreuzer, M., Mendes, A., Merletti, F., Nyberg, F., Pershagen, G., Pohlabeln, H., Riboli, E., Schmid, G., Simonato, L., Tredaniel, J., Whitley, E., Wichmann, H.E., Saracci, R. 1998. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J. Natl. Cancer Inst. 90:1440–1450.
• Borio, G., 2006. The Tobacco Timeline. Tobacco.org.
• Centers for Disease Control and Prevention (CDC). 2004. History of the 1964 Surgeon General's Report on Smoking and Health. [3]
• James I of England. 1604. A Counterblaste to Tobacco.
• Joint Committee on Smoking and Health. Smoking and health: physician responsibility; a statement of the Joint Committee on Smoking and Health. Chest 1995; 198:201–208
• Osvaldo P. Almeida, Gary K. Hulse, David Lawrence and Leon Flicker, "Smoking as a risk factor for Alzheimer's disease: contrasting evidence from a systematic review of case-control and cohort studies," Addiction, Volume 97, Issue 1, Page 15 - January 2002.
• Smoking cessation methods compared Smoking cessation methods compared. Smokingrelief.co.uk.

[edit] Further reading

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

[edit] External links

[edit] History

• Vintage Celebrity Smoking Ads
• The Tobacco Timeline by Gene Borio
• Legacy Tobacco Documents Library (LTDL). Retrieved on November 8, 2005. 7 million documents related to advertising, manufacturing, marketing, sales, and scientific research of tobacco products.
• CBC Digital Archives - Butting Out: The Slow Death of Smoking in Canada
• The Social History of Smoking, by G. L. Apperson, 1914, from Project Gutenberg

[edit] Prevention and self help

• IVEQUIT.COM - An advert free community site for smokers and non smokers
• SilkQuit.Org - A free quit smoking community site
• WHYQUIT.COM A resource for quitting
• Tobacco Information and Prevention Source (TIPS) from the U.S. Centers for Disease Control and Prevention
• 5-day plan for quitting from the U.S. Surgeon General
• ButtOut.ca - Stop Smoking Articles, News, and Facts
• NHS UK website on giving up smoking
• The Quitline (Australia - Victoria)
• The Health Consequences of Involuntary Exposure to Tobacco Smoke

[edit] Smokers' rights sites

• SmokersClub International
• An Article on Protection of Cigar Smoking in Britain
• My Choice Canada
• FOREST
• clearing the air
• Forces International
• New York Coalition Of Social Smokers
• C.L.A.S.H.
• 1964 Newspaper Article Congressman Tuck complaining about FTC's smoking rules

[edit] Statistics and studies

• Setting the Record Straight: Secondhand Smoke is a Preventable Health Risk
• New Surgeon General’s Report Focuses on the Effects of Secondhand Smoke
• Health Canada - Smoking Rates in Canada at Lowest Ever
• Total adult smokers by country
• Surgeon General's report on “The Health Effects of Secondhand Smoke”
• A summary of the IARC report by GreenFacts.
• Why Smokers Feel Good
• Smokers' blindness risk 'doubled' — BBC News
• Physicians for a Smoke-Free Canada
• Smoking behaviour among university students
• Collection of Anti-Smoking TV Commercials smoking is not kosher for passover