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Tobacco smoking

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Tobacco smoking is the practice where tobacco is burned and the vapors either tasted or inhaled.The practice began as early as 50003000 BC.[1] Many civilizations burnt incense duringreligious rituals, which was later adopted for pleasure or as a social tool.[2] Tobacco was

introduced to Eurasia in the late 16th century where it followed common trade routes. Thesubstance was met with frequent criticism, but became popular nonetheless.[3][4]

German scientists formally identified the link between smoking and lung cancer in the late 1920sleading the first anti-smoking campaign in modern history. The movement failed to reach acrossenemy lines during the Second World War, and quickly became unpopular thereafter.[5] In 1950,health authorities again began to suggest a relationship between smoking and cancer.[6] Scientificevidence mounted in the 1980s, which prompted political action against the practice. Rates of


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consumption from 1965 onward in the developed world have either peaked or declined.[7]However, they continue to climb in the developing world.[8]

Smoking is the most common method of consuming tobacco, and tobacco is the most commonsubstance smoked. The agricultural product is often mixed with other additives[9] and then

pyrolyzed. The resulting vapors are then inhaled and the active substances absorbed through thealveoli in the lungs.[10] The active substances trigger chemical reactions in nerve endings whichheightens heart rate, memory, alertness,[11] and reaction time.[12]Dopamine and laterendorphinsare released, which are often associated with pleasure.

[13]As of 2000, smoking is practiced by

some 1.22 billion people. Men are more likely to smoke than women,[14] though the gender gapdeclines with younger age.[15][16]

Many smokers begin during adolescence orearly adulthood. Usually during the early stages,smoking provides pleasurable sensations, serving as a source ofpositive reinforcement. After anindividual has smoked for many years, the avoidance ofwithdrawal symptoms and negativereinforcement become the key motivations to continue.

Contents

[hide]

y 1 Historyo 1.1 Early useo 1.2 Popularizationo 1.3 Social stigma

y 2 Consumptiono 2.1 Methodso 2.2 Physiologyo 2.3 Demographics

y 3 Psychologyo 3.1 Takeupo 3.2 Persistenceo 3.3 Patterns

y 4 Impacto 4.1 Economico 4.2 Healtho 4.3 Social

y 5 Public policyo 5.1 Taxationo 5.2 Restrictionso 5.3 Product safety

y 6 Gateway drug theoryy 7 Cessationy 8 See alsoy 9 Referencesy 10 Bibliography


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y 11 External links

[edit] History

Main articles: History of tobacco and History of smoking

[edit] Early use

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

Smoking's history dates back to as early as 50003000 BC when the agricultural product began

to be cultivated in South America; consumption later evolved into burning the plant substanceeither by accident or with intent of exploring other means of consumption.[1] The practiceworked its way into shamanistic rituals.[17][page needed] Many ancient civilizations, such as theBabylonians, Indians and Chinese, burnt incense as a part of religious rituals, as did the Israelitesand the later Catholic and Orthodox Christian churches. Smoking in the Americas probably hadits origins in the incense-burning ceremonies ofshamans but was later adopted for pleasure or asa social tool.[2] The smoking of tobacco and various hallucinogenic drugs was used to achievetrances and to come into contact with the spirit world.

Eastern North American tribes would carry large amounts of tobacco in pouches as a readilyaccepted trade item and would often smoke it inpipes, either in defined ceremonies that were

considered sacred, or to seal a bargain,[18] and they would smoke it at such occasions in all stagesof life, even in childhood.[19][page needed] It was believed that tobacco was a gift from the Creatorand that the exhaled tobacco smoke was capable of carrying one's thoughts and prayers toheaven.[20]

Apart from smoking, tobacco had a number of uses as medicine. As a pain killer it was used forearache and toothache and occasionally as a poultice. Smoking was said by the desert Indians tobe a cure for colds, especially if the tobacco was mixed with the leaves of the small Desert Sage,


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Salvia Dorrii, or the root of Indian Balsam or Cough Root,Leptotaenia multifida, the addition ofwhich was thought to be particularly good for asthma and tuberculosis.[21]

[edit] Popularization

For more about the commercial development of tobacco, see History of commercial tobacco inthe United States.

Gentlemen Smoking and Playing Backgammon in an Interiorby Dirck Hals, 1627.

In 1612, six years after the settlement of Jamestown, John Rolfe was credited as the first settlerto successfully raise tobacco as a cash crop. The demand quickly grew as tobacco, referred to as"brown gold", reviving the Virginia join stock company from its failed gold expeditions.[22] Inorder to meet demands from the Old World, tobacco was grown in succession, quickly depletingthe soil. This became a motivator to settle west into the unknown continent, and likewise anexpansion of tobacco production.[23]Indentured servitude became the primary labor force upuntil Bacon's Rebellion, from which the focus turned to slavery.[24] This trend abated followingthe American revolution as slavery became regarded as unprofitable. However, the practice was

revived in 1794 with the invention of the cotton gin.[25][page needed]

Frenchman Jean Nicot (from whose name the word nicotine is derived) introduced tobacco toFrance in 1560, and tobacco then spread to England. The first report of a smoking Englishman isof a sailor in Bristol in 1556, seen "emitting smoke from his nostrils".[3] Like tea, coffee andopium, tobacco was just one of many intoxicants that was originally used as a form ofmedicine.[26] Tobacco was introduced around 1600 by French merchants in what today ismodern-day Gambia and Senegal. At the same time caravans from Morocco brought tobacco tothe areas around Timbuktu and the Portuguese brought the commodity (and the plant) tosouthern 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 stateand religious leaders. Murad IV, sultan of the Ottoman Empire 1623-40 was among the first toattempt a smoking ban by claiming it was a threat to public moral and health. The ChineseemperorChongzhen issued an edict banning smoking two years before his death and theoverthrow of the Ming dynasty. Later, the Manchu of the Qing dynasty, who were originally atribe of nomadic horse warriors, would proclaim smoking "a more heinous crime than that evenof neglecting archery". In Edo period Japan, some of the earliest tobacco plantations were


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scorned by the shogunate as being a threat to the military economy by letting valuable farmlandgo to waste for the use of a recreational drug instead of being used to plant food crops.[27]

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 oroutright blasphemous. In 1634 the Patriarch of Moscow forbade the sale of tobacco andsentenced men and women who flouted the ban to have their nostrils slit and their backs whippeduntil skin came off their backs. The Western church leaderUrban VII likewise condemnedsmoking in a papal bull of 1642. Despite many concerted efforts, restrictions and bans werealmost universally ignored. When James I of England, a staunch anti-smoker and the author of a

A Counterblaste to Tobacco, tried to curb the new trend by enforcing a 4000% tax increase ontobacco in 1604, it proved a failure, as London had some 7,000 tobacco sellers by the early 17thcentury. Later, scrupulous rulers would realise the futility of smoking bans and instead turnedtobacco trade and cultivation into lucrative government monopolies.[28][29]

By the mid-17th century every major civilization had been introduced to tobacco smoking and inmany cases had already assimilated it into the native culture, despite the attempts of many rulersto eliminate the practice with harsh penalties or fines. Tobacco, both product and plant, followedthe major trade routes to major ports and markets, and then on into the hinterlands. The Englishlanguage termsmokingwas coined in the late 18th century; before then the practice was calleddrinking smoke.[3][page needed]

Growth remained stable until the American Civil War in 1860s, when the primary labor forceshifted from slavery to share cropping. This, along with a change in demand, lead to theindustrialization of tobacco production with the cigarette. James Bonsack, a craftsman, in 1881produce a machine to speed the production in cigarettes.[30]

[edit] Social stigma

For more about the social stigma, see Anti-smoking movement.


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A Nazi anti-smoking ad titled "The chain-smoker" saying "He does not devour it [the cigarette],it devours him"

In Germany, anti-smoking groups, often associated with anti-liquor groups,[31] first publishedadvocacy against the consumption of tobacco in the journalDer Tabakgegner(The TobaccoOpponent) in 1912 and 1932. In 1929, Fritz Lickint of Dresden, Germany, published a paper

containing formal statistical evidence of a lung cancertobacco link. During the Great depressionAdolf Hitlercondemned his earlier smoking habit as a waste of money,[32] and later with strongerassertions. This movement was further strengthened with Nazi reproductive policy as womenwho smoked were viewed as unsuitable to be wives and mothers in a German family.

[33]

The anti-tobacco movement in Nazi Germany did not reach across enemy lines during theSecond World War, as anti-smoking groups quickly lost popular support. By the end of theSecond World War, American cigarette manufacturers quickly reentered the German blackmarket. Illegal smuggling of tobacco became prevalent,[34] and leaders of the Nazi anti-smokingcampaign were silenced.

[35]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.[34] Per capita yearly cigarette

consumption inpost-war Germany steadily rose from 460 in 1950 to 1,523 in 1963.[5] By the endof the 20th century, anti-smoking campaigns in Germany were unable to exceed the effectivenessof the Nazi-era climax in the years 193941 and German tobacco health research was describedby Robert N. Proctoras "muted".[5]


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A lengthy study conducted in order to establish the strong association necessary for legislativeaction.

Richard Doll in 1950 published research in the British Medical Journal showing a close linkbetween smoking and lung cancer.[36] Four years later, in 1954 the British Doctors Study, a study

of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which thegovernment issued advice that smoking and lung cancer rates were related.[6] In 1964 the UnitedStates Surgeon General's Report on Smoking and Health likewise began suggesting therelationship between smoking and cancer.

As scientific evidence mounted in the 1980s, tobacco companies claimed contributorynegligence as the adverse health effects were previously unknown or lacked substantialcredibility. Health authorities sided with these claims up until 1998, from which they reversedtheir position. The Tobacco Master Settlement Agreement, originally between the four largestUS tobacco companies and the Attorneys General of 46 states, restricted certain types of tobaccoadvertisement and required payments for health compensation; which later amounted to the

largest civil settlement in United States history.

[37]

From 1965 to 2006, rates of smoking in the United States declined from 42% to 20.8%.[7] Themajority of those who quit were professional, affluent men. Although the per-capita number ofsmokers decreased, the average number of cigarettes consumed per person per day increasedfrom 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.[38] The trend hasbeen paralleled by many industrialized nations as rates have either leveled-off or declined. In thedeveloping world, however, tobacco consumption continues to rise at 3.4% in 2002.[8] In Africa,smoking is in most areas considered to be modern, and many of the strong adverse opinions thatprevail in the West receive much less attention.[39] Today Russia leads as the top consumer of

tobacco followed by Indonesia, Laos, Ukraine, Belarus, Greece, Jordan, and China.

[40]

[edit] Consumption

[edit] Methods

For more about the production of the argicultural product, see Types of tobacco, Cultivation oftobacco, Curing of tobacco, and Tobacco products

Tobacco is an agricultural product processed from the fresh leaves of plants in the genusNicotiana. The genus contains a number of species, however, Nicotiana tabacum is the

commonly grown. Nicotiana rustica follows as second containing higher concentrations ofnicotine. These leaves are harvested and cured to allow for the slow oxidation and degradation ofcarotenoids in tobacco leaf. This produces certain compounds in the tobacco leaves which can beattributed to sweet hay, tea, rose oil, or fruity aromatic flavors. Before packaging, the tobacco isoften combined with other additives in order to: enhance the addictive potency, shift the productspH, or improve the effects of smoke by making it more palatable. In the United States theseadditives are regulated to 599 substances.[9] The product is then processed, packaged, andshipped to consumer markets. Means of consumption has greatly expanded in scope as new


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methods of delivering the active substances with fewer by-products have encompassed or arebeginning to encompass:

Tobacco field in Intercourse, Pennsylvania.

Basma leaves curing in the sun at Pomakvillage ofXanthi, Thrace, Greece.

Processed tobacco pressed into long strips for shipping.

BeediBidis smoke produce higher levels of carbon monoxide, nicotine, and tar than cigarettes

typical in the United States.

[41][42]

CigarsCigars are tightly rolled bundles of dried and fermented tobacco which are ignited so thatsmoke may be drawn into the smoker's mouth. They are generally not inhaled because thehigh alkalinity of the smoke, which can quickly become irritating to the trachea andlungs. The prevalence of cigar smoking varies depending on location, historical period,and population surveyed, and prevalence estimates vary somewhat depending on thesurvey method. The United States is the top consuming country by far, followed by


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Germany and the United Kingdom; the US and Western Europe account for about 75% ofcigar sales worldwide.[43] As of 2005 it is estimated that 4.3% of men and 0.3% ofwomen smoke cigars.

[44]

CigarettesCigarettes, French for "small cigar", are a product consumed through smoking and

manufactured out of cured and finely cut tobacco leaves and reconstituted tobacco, oftencombined with other additives, which are then rolled or stuffed into a paper-wrappedcylinder.[9] Cigarettes are ignited and inhaled, usually through a cellulose acetate filter,into the mouth and lungs.

Electronic cigaretteElectronic cigarettes is an alternative to tobacco smoking, although no tobacco isconsumed. It is a battery-powered device that provides inhaled doses of nicotine bydelivering a vaporized propylene glycol/nicotine solution. Many legislation and publichealth investigations are currently pending in many countries due to its relatively recentemergence.

Hookah

Hookah are a single or multi-stemmed (often glass-based) water pipe for smoking.Originally from India, the hookah has gained immense popularity, especially in theMiddle East. A hookah operates by water filtration and indirect heat. It can be used forsmoking herbal fruits, tobacco, or cannabis.

KreteksKreteks 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 medicinaleugenol of cloves to the lungs. The quality and variety of tobacco play an important rolein kretek production, from which kreteks can contain more than 30 types of tobacco.Minced dried clove buds weighing about 1/3 of the tobacco blend are added to addflavoring. In 2004 the United States prohibited cigarettes from having a "characterizingflavor" of certain ingredients other than tobacco and menthol, thereby removing Kreteksfrom being classified as cigarettes.[45]

Passive smokingPassive smoking is the involuntary consumption of smoked tobacco. Second-hand smoke(SHS) is the consumption where the burning end is present, environmental tobaccosmoke (ETS) or third-hand smoke is the consumption of the smoke that remains after theburning end has been extinguished. Because of its negative implications, this form ofconsumption has played a central role in the regulation of tobacco products.

Pipe smokingPipe smoking typically consists of a small chamber (the bowl) for the combustion of thetobacco 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. Tobaccos forsmoking in pipes are often carefully treated and blended to achieve flavour nuances notavailable in other tobacco products.

Roll-Your-OwnRoll-Your-Own or hand-rolled cigarettes, often called 'rollies', are very popularparticularly in European countries. These are prepared from loose tobacco, cigarettepapers and filters all bought separately. They are usually much cheaper to make.

Vaporizer


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formation ofharmane (a MAO inhibitor) from the acetaldehyde in tobacco smoke. This seems toplay an important role in nicotine addictionprobably by facilitating a dopamine release in thenucleus accumbens as a response to nicotine stimuli.

[52]Using rat studies, withdrawal after

repeated exposure to nicotine results in less responsive nucleus accumbens cells, which producedopamine responsible forreinforcement.[53]

[edit] Demographics

Main article: Prevalence of tobacco consumption

Percentage offemales smoking any tobacco product

Percentage ofmales smoking any tobacco product. Note that there is a difference between thescales used for females and the scales used for males.

[40]

As of 2000, smoking is practiced by 1.22 billion people. Assuming no change in prevalence it ispredicted that 1.45 billion people will smoke in 2010 and 1.5 to 1.9 billion in 2025. Assumingthat prevalence will decrease at 1% a year and that there will be a modest increase of income of2%, it is predicted the number of smokers will stand at 1.3 billion in 2010 and 2025.[14]

Smoking is generally five times higher among men than women,[14] however the gender gapdeclines with younger age.[15][16] In developed countries smoking rates for men have peaked andhave begun to decline, however for women they continue to climb.[54]

As of 2002, about twenty percent of young teens (1315) smoke worldwide. From which 80,000to 100,000 children begin smoking every dayroughly half of which live in Asia. Half of thosewho begin smoking in adolescent years are projected to go on to smoke for 15 to 20 years.[8]

The World Health Organization (WHO) states that "Much of the disease burden and prematuremortality 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 haveleveled off or declined in the developed world.[55] In the developing world, however, tobaccoconsumption is rising by 3.4% per year as of 2002.[8]

The WHO in 2004 projected 58.8 million deaths to occur globally,[56] from which 5.4 million aretobacco-attributed,[57] and 4.9 million as of 2007.[58] As of 2002, 70% of the deaths are indeveloping countries.

[58]


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[edit] Psychology

[edit] Takeup

Sigmund Freud, whose doctor assisted his suicide because oforal cancercaused by smoking[59]

Most smokers begin during adolescence or early adulthood. Smoking has elements of risk-takingand rebellion, which often appeal to young people. The presence of high-status models and peersmay also encourage smoking. Because teenagers are influenced more by their peers than byadults, attempts by parents, schools, and health professionals at preventing people from tryingcigarettes are unsuccessful.[60][61]

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.[62] A current study tested the relation ofadolescent smoking to rules regulating where adults are allowed to smoke in the home. Resultsshowed that restrictive home smoking policies were associated with lower likelihood of tryingsmoking for both middle and high school students.[63]

Many anti-smoking organizations claim that teenagers begin their smoking habits due to peerpressure, and cultural influence portrayed by friends. However, one study found that directpressure 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.[64]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 betaken into account.[65] Another study's results revealed thatpeer pressure was significantlyassociated with smoking behavior across all age and gender cohorts, but that intrapersonalfactors were significantly more important to the smoking behavior of 1213 year-old girls thansame-age boys. Within the 1415 year-old age group, one peer pressure variable emerged as asignificantly more important predictor of girls' than boys' smoking.[66] It is debated whether peerpressure orself-selection is a greater cause of adolescent smoking.


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Psychologists such as Hans Eysenckhave 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.

[67]Although, personality and social

factors may make people likely to smoke, the actual habit is a function ofoperant conditioning.During the early stages, smoking provides pleasurable sensations (because of its action on the

dopamine system) and thus serves as a source ofpositive reinforcement.

[edit] Persistence

Because they are engaging in an activity that has negative effects on health, people who smoketend to rationalize their behavior. In other words, they develop convincing, if not necessarilylogical reasons why smoking is acceptable for them to do. For example, a smoker could justifyhis or her behavior by concluding that everyone dies and so cigarettes do not actually changeanything. Or a person could believe that smoking relieves stress or has other benefits that justifyits risks.

The reasons given by smokers for this activity are broadly 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 reasonscontribute, with females more likely than males to cite tension reduction/relaxation,stimulationandsocial smoking.[68]

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 effectit has at any time is determined by the mood of the user, the environment and the circumstancesof use. Studies have suggested that low doses have a depressant effect, while higher doses have

stimulant effect."

[69]

The lack of deterrence by the deleterious health effects is a prototypical example ofoptimismbias.

[edit] Patterns

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 tofollow a strongly seasonal pattern, with the high months being the months of summer, and thelow months being the winter months.[70]

Similarly, smoking has been shown to follow distinct circadian patterns during the waking daywith the high point usually occurring shortly after waking in the morning, and shortly beforegoing to sleep at night.[71]

[edit] Impact


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[edit] Economic

See also: Tobacco industry

In countries where there is apublic health system, society covers the cost of medical care for

smokers who become ill through in the form of increased taxes. Two arguments exist on thisfront, the "pro-smoking" argument suggesting that heavy smokers generally don't live longenough to develop the costly and chronic illnesses which affect the elderly, reducing society'shealthcare burden. The "anti-smoking" argument suggests that the healthcare burden is increasedbecause smokers get chronic illnesses younger and at a higher rate than the general population.

Data on both positions is limited. The Centers for Disease Control and Prevention publishedresearch in 2002 claiming that the cost of eachpackof cigarettes sold in the United States wasmore than $7 in medical care and lost productivity.[72] The cost may be higher, with anotherstudy putting it as high as $41 per pack, most of which however is on the individual and his/herfamily.[73] 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. Smokersdie at a younger age and don't draw on the funds they've paid into those systems."[73]

By contrast, some non-scientific studies, including one conducted by Philip Morris in the CzechRepublic[74] and another by the Cato Institute,[75] support the opposite position. Philip Morris hasexplicitly apologised for the former study, saying: "The funding and public release of this studywhich, among other things, detailed purported cost savings to the Czech Republic due topremature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptabledisregard of basic human values. For one of our tobacco companies to commission this studywas 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 significantdiseases caused by smoking."[74]

Between 1970 an 1995, per-capita cigarette consumption in poorer developing countriesincreased by 67 percent, while it dropped by 10 percent in the richer developed world. Eightypercent of smokers now live in less developed countries. By 2030, the World HealthOrganization (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 amongwomen. WHO forecasts' the 21st century's death rate from smoking to be ten times the 20thcentury's rate. ("Washingtonian" magazine, December 2007).

[edit] Health

Main article: Health effects of tobacco


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character, John Constantine, created by Alan Moore, is synonymous with smoking, so much sothat the first storyline by Preachercreator, Garth Ennis, centered around John Constantinecontracting lung cancer. Professional wrestlerJames Fullington, while in character as "TheSandman", is a chronic smoker in order to appear "tough".

The ceremonial smoking of tobacco, and praying with a sacred pipe, is a prominent part of thereligious ceremonies of a number ofNative American Nations. Sema, the Anishinaabe word fortobacco, is grown for ceremonial use and considered the ultimate sacred plant since its smokewas believed to carry prayers to the heavens. In most major religions, however, tobacco smokingis not specifically prohibited, although it may be discouraged as an immoral habit. Before thehealth risks of smoking were identified through controlled study, smoking was considered animmoral habit by certain Christian preachers and social reformers. The founder of the Latter DaySaint movement, Joseph Smith, Jr, recorded that on February 27, 1833, he received a revelationwhich discouraged tobacco use. This "Word of Wisdom" was later accepted as a commandment,and faithful Latter-day Saints abstain completely from tobacco.[83] Jehovah's Witnesses base theirstand 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 (18381933) was one of the firstJewish authorities to speak out on smoking. In the Bah' Faith, smoking tobacco is discouragedthough not forbidden.

[84

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