Tobacco smoking

Various smoking equipment including different pipes.

Tobacco smoking is the act of burning the dried leaves of the tobacco plant and inhaling the smoke. The practice was common to many Native American cultures and was introduced to the rest of the world by sailors following European exploration of the Americas. Tobacco smoke contains nicotine, a stimulant which temporarily improves alertness and memory, but also forms a strong physical and psychological chemical dependence (addiction). Medical research has determined that smoking is a major contributing factor towards many health problems, particularly lung cancer, emphysema, and cardiovascular disease. Many countries regulate or restrict tobacco sales and advertising, and many municipalities now ban smoking in a variety of public venues due to health impacts on non-smokers of breathing second-hand smoke.

History

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Tobacco plantation in Kentucky

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

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

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

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

Tobacco products were included in military rations during World War I.[2] After the war, cigarette smoking was portrayed in advertising as part of a glamorous carefree lifestyle, and became socially acceptable for women. In the 1930s Nazi medical and military leaders became concerned that tobacco might prove a hazard to human health, concluding that the "extraordinary rise in tobacco use" was "the single most important cause of the rising incidence of lung cancer," the first scientists to confirm this link. From 1933 to 1945 Germany had the world's strongest anti-smoking movement, with the full support of Adolf Hitler, who disapproved of smoking. He characterised tobacco as "the wrath of the Red Man against the White Man for having been given hard liquor." He also associated smoking, along with drinking, as affects of liberal decadence. Nazi propagandists even had a campaign to discourage smoking during pregnancy, which was medically progressive for its time. Germany's defeat in 1945 meant that its aggressive anti-tobacco movement declined. Hitler and the campaigners behind the movement were dead, had been silenced, or were later executed for crimes against humanity. Much of the science on the dangers of tobacco had been gathered through brutal experimentation on concentration camp prisoners. In the post-World War II period, German physician Knut-Olaf Haustein was known for his work studying the effects of tobacco smoking.

In the United States biologist Raymond Pearl had demonstrated the negative health affects of smoking tobacco as early as 1938. In the 1950s and 1960s, the medical community and government bodies, as well as Readers Digest magazine, began a campaign to reduce the degree of smoking by showing how it damaged public health. Filter-tip cigarettes, which reduce poisonous chemicals, were introduced and are now standard everywhere. Less potent brands were also introduced in the 1960s but did not satisfy smokers' cravings as well as traditional brands. The 1964 U.S. Surgeon General's Report, summarizing the findings of numerous medical research studies, was a major wake-up call, and led millions of Americans to quit, and tobacco commercials to be banned. In recent years tobacco smoking in many regions of the world has dramatically dropped, but remains extraordinarily high in regions such as the Asian Far East due to aggressive cigarette company marketing and lack of health education.

Methods of smoking

Cigarette

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A cigarette will burn to ash on one end.

Main article: Cigarette

A cigarette is a tobacco product manufactured out of cured and finely cut tobacco leaves, which are rolled or stuffed into a paper-wrapped cylinder (generally less than 120 mm in length and 10 mm in diameter). The cigarette is ignited at one end and allowed to smoulder for the purpose of inhalation of its smoke from the other (usually filtered) end, which is inserted in the mouth. They are sometimes smoked with a cigarette holder.

Cigar

Main article: Cigar

An airtight cigar storage tube and a guillotine-style cutter

A cigar is a tightly rolled bundle of dried and fermented tobacco, one end of which is ignited so that its smoke may be drawn into the smoker's mouth through the other end.

The word cigar is from the Spanish word cigarro, which the Oxford English Dictionary suggests is a variation on cigarra, Spanish for "cicada," due to its shape, especially that of what is now called the perfecto. Other sources have indicated that it may be derived from the Mayan word sikar, "tobacco."

Cigar tobacco is grown in significant quantities in such nations as Brazil, Cameroon, Cuba, Dominican Republic, Honduras, Indonesia, Mexico, Nicaragua and the United States of America. Cigars manufactured in Cuba are widely considered to be without peer, although many experts believe that the best offerings from Honduras and Nicaragua rival those from Cuba. The Cuban reputation arises from both the unique characteristics of the Vuelta Abajo region in the Pinar del Río Province at the west of the island, where a microclimate allows for high-quality tobacco to be grown, and the skill of the Cuban cigar makers.

Smoking pipe

Main article: Smoking pipe

Tobacco pipe of briar wood

A smoking pipe is a device used for smoking combustible substances such as tobacco and cannabis. The smoking pipe typically consists of a small chamber (the bowl) for the 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, the most common being (in order of use): briar, corncob, meerschaum, African block meerschaum, clay, cherry, wood, glass, gourd, bamboo (as in the Japanese Kiseru), and various other materials, such as morta and metal. Many pipes are carved with a great deal of artistry.

Tobaccos used for smoking pipes are often carefully treated and blended to achieve flavour nuances not available in other tobacco products. Many of these are blends using staple ingredients of variously cured Burley and Virginia tobaccos which are enhanced by spice tobaccos, among them many Oriental or Balkan varietals, Latakia (a fire-cured spice tobacco of Cypriot or Syrian origin), Perique (uniquely grown in St. James Parish, Louisiana) or blends of Virginia and Burley tobaccos of African, Indian, or South American origins. Traditionally, many U.S. blends are made of American Burley with sweeteners and flavorings added to create an "aromatic" flavor, 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 artful blending with selected spice tobaccos only and careful, often historically-based, curing processes. Pipes can range from the very simple machine-made briar pipe to highly-prized handmade and artful implements created by renowned pipemakers which are often very expensive collector's items.

Many find that the enjoyment of smoking pipe tobacco is greatly increased by the wearing of specific, and preferably matching, smoking attire (see slippers and dressing gowns).

Hookah

Main article: Hookah

Closeup of a hookah of the type commonly used in Egypt. The green glass is the base, the pipe is the metallic tube above the base, the hose is the black and silver coil, and the bowl is hidden by a wind guard. A pair of tongs, for holding the coal during lighting, rest on the tray.

A hookah is a traditional Middle Eastern or South Asian device for smoking, which operates by water-filtration and indirect heat. It can be used for smoking many substances, such as tobacco, and herbal fruits. In many studies, it has been found to improve health conditions.

Factors that influence smoking behavior

Performance enhancement

Tobacco smoke contains nicotine, a stimulant, which increases the acetylcholine levels in the brain, temporary increasing memory and alertness.

Nicotine addiction

Nicotine, an element of tobacco smoke, is one of the most addictive substances that exists. It causes both physical and psychological dependence. According to the Henningfield and Benowitz Ratings, nicotine is more addictive than heroine, alcohol, cocaine, marijuana, and caffeine. Many smokers continue to use tobacco even though they wish they could stop. Most smokers use nicotine compulsively. About half of Canadians who currently smoke have tried to quit. McGill University health professor Jennifer O'Loughlin stated that nicotine addiction can occur as soon as five months after the start of smoking.

It is difficult to quit smoking due to the withdrawal symptoms which include depression, 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.

Tobacco advertising

Main article: Tobacco advertising

Before the 1970s, most tobacco advertising was legal in the United States and most European nations. In the United States, in the 1950s and 1960s, cigarette brands were frequently sponsors of television shows—most notably shows such as To Tell the Truth and I've Got a Secret. One of the most famous television jingles of the era came from an advertisement for Winston cigarettes. The slogan "Winston tastes good like a cigarette should!" proved to be catchy, and is still quoted today. Another popular slogan from the 1960s was "Us Tareyton smokers would rather fight than switch!," which was used to advertise Tareyton cigarettes.

However, many nations, including Russia, still allow billboards advertising tobacco use. Tobacco smoking is still advertised in special magazines, during sporting events, in gas stations and stores, and in more rare cases on television.

In the United States, it was well known that tobacco companies are marketing tobacco smoking to minors. 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".

Recently, some nations began anti-smoking advertisements to counter the effects of tobacco advertising.

The actual effectivness of tobacco advertisement is widely debated. According to an essay by Henry Saffer, public health experts say that tobacco advertising increases cigarette consumption, but there is a significant empirical literature that finds little or no effect of tobacco advertising on smoking.

Peer pressure

Many anti-smoking organizations say that teenagers begin their smoking habits due to peer pressure. 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. A similar study showed suggests 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. 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. It is debated whether peer pressure or self-selection is a greater cause of adolescent smoking.

Ethnic and cultural influences

Smoking is more popular in some cultures than in others. One study found that in the United States, white youths reported the highest rates of lifetime, current, and persistent smoking, and initiated smoking at a significantly earlier age than African-Americans and Hispanics. In the United States, 33.4% of American Indians and Alaskan Natives smoke, 22.2% of whites smoke, 20.2% of African americans smoke, 15.0% of Hispanics smoke, and only 11.3% of Asian Americans smoke. Local cultures play a significant role in the smoking prevalnce in the region. Utah, a predominantly Mormon state, has a smoking rate of 12 percent, while Kentucky, which is the second largest tobacco producing state and whose state economy is the most tobacco dependent , has a 31 percent smoking rate. In Europe, smoking is more popular than it is in the United States. In Germany, 35% of the population smokes, and in Russia, 39% of the population smokes (63% of all males smoke). In the United States, the smoking rate is 22.1%.

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. 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.

Smoking in movies

Exposure to smoking in movies has been linked with adolescent smoking initiation in cross-sectional studies. 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. Despite the declining tobacco use in the society, the incidence of smoking in 2002 movies was nearly the same as in 1950 movies.

The use of smoking to project an image

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean Paul Sartre's Gauloise-brand cigarettes, Bertrand Russell's pipe, or the news broadcaster Edward R. Murrow's cigarette. Writers in particular seemed to be known for smoking; see, for example, Richard Klein's book Cigarettes are Sublime for the analysis, by this Cornell University professor of French literature, of the role smoking plays in 19th and 20th century letters. British Prime Minister Harold Wilson was well known for smoking a pipe in public.

Smoking and depression

Data from multiple studies suggest that depression plays a role in cigarette smoking. A history of regular smoking was observed more frequently among individuals who had experienced 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. Another study found that the average lifetime daily cigarette consumption was strongly related to lifetime prevalence and to prospectively assessed 1-year prevalence of major depression. 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 full blown major depression. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. The neurotransmitter systems affected by cigarette smoke mirror the neurotransmitter pathways are also 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.

Genetic connection

It is inconclusive if smoking is influenced by genetic factors; one 1990 study posited that 52% of the variance in smoking behaviour is attributable to heritable factors, with the the other half were a function of the environment.

Health effects

Main article: Health effects of tobacco smoking

Health risks of smoking

Because of their nicotine addiction, many smokers are unable to cease smoking despite their knowledge of ill health effects.

The health effects of tobacco smoking are related to direct tobacco smoking, as well as passive smoking, inhalation of environmental or secondhand tobacco smoke. A 50 year study of over thirty thousand British physicians showed that nonsmokers lived about 10 more years than the smokers. 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 43% -- nearly three times greater. 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.

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, Indiana would reduce its infant mortality rate (12th highest in the country) by 9%. Tobacco smoke reduces the delivery of oxygen to the fetus through the presence of carbon monoxide, cyanide, and aromatic hydrocarbons. Nicotine and other substances in tobacco smoke cause reduction in placental blood flow, creating further reductions in oxygen delivery as well as reductions in nutrients to the unborn baby. Secondhand smoke exposure during pregnancy produces twice the risk of low birth weight babies. Smoking is the single largest modifiable risk factor in intrauterine growth retardation.

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

The incidence of lung cancer is highly correlated with smoking.

A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired.

Nicotine is a powerful, addictive stimulant and is one of the main factors leading to the continued tobacco smoking. Although the amount of nicotine inhaled with tobacco smoke is quite small (most of the substance is destroyed by the heat) it is still sufficient to cause physical and/or psychological dependence.

However, smokers usually ignore these facts and trade health risk for other qualities such as enjoyment and satisfied addictions. These smokers often think of the benefits of smoking rather than the downsides. Some smokers claim that the depressant effect of smoking allows them to "calm their nerves", often allowing for increased concentration.

The health risks of smoking are not uniform across all smokers but vary according to amount of cigarettes smoked, with those who smoke more cigarettes at greater risk, although light smoking is still a health risk.

According to the Canadian Lung Association, tobacco kills more than 40,000-45,000 Canadians per year, more than the total number of deaths from AIDS, traffic accidents, suicide, murder, fires and accidental poisoning. However, the number of deaths related to smoking may be exaggerated because it is difficult to determine whether smoking actually caused the terminal illness.

Purported health benefits of smoking

Ulcerative colitis is twice as common in non-smokers as in smokers. The nicotine in tobacco smoke acts as an anti-inflammatory agent.

Also, it is thought that the risks of Parkinson's disease or Alzheimer's disease may be significantly lower for smokers than for non-smokers though this idea has not been definitively proven. According to previous epidemiological studies, cigarette smokers are 50% less likely to have PD or AD than are age- and gender-matched nonsmokers. One explanation given for this effect is the fact that nicotine allegedly increases the levels of acetylcholine in the smoker's brain. Parkinson's disease consequently occurs when the effect of dopamine is less than that of acetylcholine. Another explanation may simply be that smokers die before they reach the age at which the onset of Parkinson's disease occurs. However, nicotine, a cholinergic stimulant, is the only substance in tobacco smoke which has those positive effects, and the consumption of pure nicotine would likely be more beneficial than smoking.

More recent evidence has challenged the earlier epidemiological studies on methodological grounds. A prospective Rotterdam Study found that the incidence of Alzheimer's disease is more than double for smokers as compared to non-smokers 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.

Passive smoking

Main article: Passive smoking

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

It was confirmed that, in adults, secondhand smoke causes lung cancer, nasal sinus cancer, breast cancer in younger women, heart disease, heart attacks, and asthma induction. Second-hand 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.

In June 2006, US Surgeon General Richard H. Carmona called the evidence against passive smoke "indisputable" and said "The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and non-smoking adults." . Passive smoking is one of the key issues that have lead 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.

Smoking cessation

Main article: Smoking cessation

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The Easy Way to Stop Smoking by Allen Carr, a famous book teaching smoking cessation

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

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

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 13 7848 in Australia). In addition, there are many self-help books on the market, such as those by Allen Carr and David Marks.

Opinions on smoking

Native Americans and smoking

Communal smoking of a sacred tobacco pipe was a common ritual of many Native American tribes, and was considered a sacred part of their religion. Sema, the Anishnabe word for tobacco, was grown for ceremonial use and considered the ultimate sacred plant since its smoke was believed to carry prayers to the heavens. Smoking was chiefly done after the evening meal, in the sweathouse, and before going to sleep. 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.

Christianity and smoking (arguments against)

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

Moral concerns about self-injury are also prevalent in Catholic medical ethics on the grounds that people ought to be responsible stewards of the body as a gift from God; the stewardship argument is also used among Protestant groups as an argument against smoking.

Mormonism and smoking (arguments against)

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

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

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

Judaism and smoking (arguments against)

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

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

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

Other opinions on smoking

Much opposition to smoking is based on arguments grounded on alleged unethical corporate practices of the tobacco industry and public health concerns. Many public interest groups are interested in controlling smoking-induced problems through political means, and mostly consist of former smokers, health professionals, corporate responsibility advocates, school and community-based organizations, and environmental groups.

David Krogh argues for tobacco's uniqueness as a drug and accounts for the fact that in the past, many moralists who disapproved of "recreational" drugs approved of tobacco.

Krogh's book argues that tobacco is not like alcohol or so-called controlled substances, including marijuana, and that smokers use tobacco to normalize their feelings within the narrow band necessary for functioning within an industrial society, where energy levels have to be carefully rationed according to expectations.

Kantians, however, argue against self-injury as a necessary duty, consistent with the moral law or categorical imperative.

Legal issues and regulation

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The health warnings on a British cigarette pack

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. Amongst other steps, signatories are to put together legislation that will eliminate secondhand smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

Sale to minors

In many countries, including the United States, New Zealand, Canada, South Africa, Brazil and Australia, it is illegal to sell tobacco products to minors. In the United Kingdom, Austria and South Africa it is illegal to sell tobacco products to people under the age of 16. In 46 of the 50 United States, the minimum age is 18, except for Alabama, Alaska, New Jersey, and Utah where the legal age is 19. Some countries have also legislated against giving tobacco products to (i.e. buying for) minors, and even against minors engaging in the act of smoking. Underlying such laws is the belief that people should make an informed decision regarding the risks of tobacco use. 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.

Taxation

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Cigarettes have become very expensive in places that want to reduce the amount of smoking in public; pictured is the cost of a carton of cigarettes in New Jersey

Many governments have introduced excise taxes on cigarettes in order to reduce the consumpttion 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. 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.

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. Currently, the average price and excise tax on cigarettes in the United States is well below those of most other industrialized nations.

The cigarette taxes vary from state to state in the United States. For example, South Carolina has a cigarette taxes of only 7 cents per pack, while Rhode Island has a cigarette tax of 246 cents 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.

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

Some nations are reluctant to increase tobacco taxes because they fear the reduction of tobacco tax revenues and smuggling.

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 prohibits tobacco advertising in any form, with a very small number of exceptions (some international sporting events are excepted, but these exceptions will be revoked in 2006). Other countries have legislated particularly against advertising that appears to target minors.

Package warnings

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

Smoking bans

Main article: Smoking ban

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

Some jurisdictions impose restrictions on where smoking is allowed. Several European countries such as the Republic of Ireland, Norway, Sweden, Italy, Spain and Scotland have legislated against smoking in public places, often including bars and restaurants. Similar bans will also take effect in the rest of the UK at various intervals (Northern Ireland from April 2007, England from summer 2007 and Wales at a similar time). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars.

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

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
• List of tobacco-related deaths
• Pack year
• Smoking culture
• Smoking fetish

References

• Joint Committee on Smoking and Health. Smoking and health: physician responsibility; a statement of the Joint Committee on Smoking and Health. Chest 1995; 198:201- 208
• Boffetta, P., Agudo, A., Ahrens, W., Benhamou, E., Benhamou, S., Darby, S.C., Ferro, G., Fortes, C., Gonzalez, C.A., Jockel, K.H., Krauss, M., Kreienbrock, L., Kreuzer, M., Mendes, A., Merletti, F., Nyberg, F., Pershagen, G., Pohlabeln, H., Riboli, E., Schmid, G., Simonato, L., Tredaniel, J., Whitley, E., Wichmann, H.E., Saracci, R. 1998. Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J. Natl. Cancer Inst. 90:1440-1450.
• Osvaldo P. Almeida, Gary K. Hulse, David Lawrence and Leon Flicker, "Smoking as a risk factor for Alzheimer's disease: contrasting evidence from a systematic review of case-control and cohort studies," Addiction, Volume 97, Issue 1, Page 15 - January 2002.

Further reading

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

External links

History

• Vintage Celebrity Smoking Ads
• The Tobacco Timeline by Gene Borio
• "Legacy Tobacco Documents Library (LTDL)". Retrieved November 8. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help) 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

Prevention and self help

• WHYQUIT.COM A great 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
• Stop Smoking Tips and Quit Smoking Help
• NHS UK website on giving up smoking
• The Quitline (Australia - Victoria)
• The Health Consequences of Involuntary Exposure to Tobacco Smoke

Smokers' rights sites

• Forces International
• SmokersClub International
• An Article on Protection of Cigar Smoking in Britain

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”
• Tobacco Smoke and Involuntary Smoking, Summary of Data Reported and Evaluation 2004 by the IARC.
• 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
• Smoking behaviour among university students
• Collection of Anti-Smoking TV Commercials