Smoking in culture

      Smoking has been accepted into culture, in various art forms, and has developed many distinct, and often conflicting or mutually exclusive, meanings depending on time, place and the practitioners of smoking. Pipe smoking, until recently one of the most common forms of smoking, is today often associated with solemn contemplation, old age and is often considered quaint and archaic. Cigarette smoking, which did not begin to become widespread until the late 19th century, has more associations of modernity and the faster pace of the industrialized world. Cigars have been, and still are, associated with masculinity, power and is an iconic image associated with the stereotypical capitalist. Smoking in public has for a long time been something reserved for men and when done by women has been associated with promiscuity. In Japan during the Edo period, prostitutes and their clients would often approach one another under the guise of offering a smoke and the same was true for 19th century Europe.
                                                                                   Art

An Apothecary Smoking in an Interior by Adriaen van Ostade, oil on panel, 1646.

     The earliest depictions of smoking can be found on Classical Mayan pottery from around the 9th century. The art was primarily religious in nature and depicted deities or rulers smoking early forms of cigarettes.Soon after smoking was introduced outside of the Americas it began appearing in painting in Europe and Asia. The painters of the Dutch Golden Age were among the first to paint portraits of people smoking and still lifes of pipes and tobacco. For southern European painters of the 17th century, a pipe was much too modern to include in the preferred motifs inspired by mythology from Greek and Roman antiquity. At first smoking was considered lowly and was associated with peasants.Many early paintings were of scenes set in taverns or brothels. Later, as the Dutch Republic rose to considerable power and wealth, smoking became more common amongst the affluent and portraits of elegant gentlemen tastefully raising a pipe appeared. Smoking represented pleasure, transience and the briefness of earthly life as it, quite literally, went up in smoke. Smoking was also associated with representations of both the sense of smell and that of taste.

      In the 18th century smoking became far more sparse in painting as the elegant practice of taking snuff became popular. Smoking a pipe was again relegated to portraits of lowly commoners and country folk and the refined sniffing of shredded tobacco followed by sneezing was rare in art. When smoking appeared it was often in the exotic portraits influenced by Orientalism. Many proponents of post-colonial theory controversially believe this portrayal was a means of projecting an image of European superiority over its colonies and a perception of the male dominance of a feminized Orient.[citation needed] They believe the theme of the exotic and alien “Other” escalated in the 19th century, fueled by the rise in popularity of ethnology during the Enlightenment.

Skull with a Burning Cigarette by Vincent van Gogh, oil on canvas, 1885.

In the 19th century smoking was common as a symbol of simple pleasures; the pipe smoking “noble savage”, solemn contemplation by Classical Roman ruins, scenes of an artists becoming one with nature while slowly toking a pipe. The newly empowered middle class also found a new dimension of smoking as a harmless pleasure enjoyed in smoking saloons and libraries. Smoking a cigarette or a cigar would also become associated with the bohemian, someone who shunned the conservative middle class values and displayed his contempts for conservatism. But this was a pleasure that was to be confined to a male world; women smokers were associated with prostitution and was not considered an activity in which proper ladies should involve themselves. It was not until the turn of the century that smoking women would appear in paintings and photos, giving a chic and charming impression. Impressionists like Vincent van Gogh, who was a pipe smoker himself, would also begin to associate smoking with gloom and fin-du-siècle fatalism.

     While the symbolism of the cigarette, pipe and cigar respectively were consolidated in the late 19th century, it was not until the 20th century that artists began to use it fully; a pipe would stand for thoughtfulness and calm; the cigarette symbolized modernity, strength and youth, but also nervous anxiety; the cigar was a sign of authority, wealth and power. The decades following World War II, during the apex of smoking when the practice had still not come under fire by the growing anti-smoking movement, a cigarette casually tucked between the lips represented the young rebel, epitomized in actors like Marlon Brando and James Dean or mainstays of advertising like the Marlboro Man. It was not until the 1970s when the negative aspects of smoking began to appear; the unhealthy lower-class loser, reeking of cigarette smoke and lack of motivation and drive, especially in art inspired or commissioned by anti-smoking campaigns.

                                                                                  Film

Film star and iconic smoker Humphrey Bogart.

          Ever since the era of silent films, smoking has had a major part in film symbolism. In the hard boiled film noir crime thrillers, cigarette smoke often frames characters and is frequently used to add an aura of mystique or even nihilism. One of the forerunners of this symbolism can be seen in Fritz Lang’s Weimar era Dr Mabuse, der Spieler, 1922 (Dr Mabuse, the Gambler), where men mesmerized by card playing smoke cigarettes while gambling. Women smokers in film were also early on associated with a type of sensuous and seductive sexuality, most notably personified by German film star Marlene Dietrich. Similarly, actors like Humphrey Bogart and Audrey Hepburn have been closely identified with their smoker persona and some of their most famous portraits and roles have involved a thick mist of cigarette smoke. Hepburn often enhanced the glamour with a cigarette holder, most notably in the film Breakfast at Tiffany’s. Smoking could also be used as a means to subvert censorship, as two cigarettes burning unattended in an ashtray was often used to ‘suggest’ sexual activity.

Since World War II, smoking has gradually become less frequent on screen as the obvious health hazards of smoking have become more widely known. With the anti-smoking movement gaining greater respect and influence, conscious attempts not to show smoking on screen are now undertaken in order to avoid encouraging smoking or giving it positive associations, particularly for family films. Smoking on screen is more common today among characters who are portrayed as anti-social or even criminal.
Literature

       Just as in other types of fiction, smoking has had an important place in literature and smokers are often portrayed as characters with great individuality, or outright eccentrics, something typically personified in one of the most iconic smoking literary figures of all, Sherlock Holmes. Other than being a frequent part of short stories and novels, smoking has spawned endless eulogies, praising its qualities and affirming the author’s identity as a devoted smoker. Especially during the late 19th century and early 20th century, a panoply of books with titles like Tobacco: Its History and associations (1876), Cigarettes in Fact and Fancy (1906) and Pipe and Pouch: The Smokers Own Book of Poetry (1905) were written in the UK and the US. The titles were written by men for other men and contained general tidbits and poetic musings about the love for tobacco and all things related to it, and frequently praised the refined bachelor’s life. The Fragrant Weed: Some of the Good Things Which Have been Said or Sung about Tobacco, published in 1907, contained, among many others, the following lines from the poem A Bachelor’s Views by Tom Hall that were typical of the attitude in many of the books:

The cover of My Lady Nicotine: A Study in Smoke (1896) by J.M. Barrie, otherwise best known for his play Peter Pan.“ So let us drink
To her, – but think
Of him who has to keep her;
And sans a wife
Let’s spend our life
In bachelordom, – it’s cheaper. ”


     These works were all published in an era before the cigarette had become the dominant form of tobacco consumption and pipes, cigars and chewing tobacco were still commonplace. Many of the books were published in novel packaging that would attract the learned smoking gentleman. Pipe and Pouch came in a leather bag resembling a tobacco pouch and Cigarettes in Fact and Fancy (1901) came bound in leather, packaged in an imitation cardboard cigar box. By the late 1920s, the publication of this type of literature largely abated and was only sporadically revived in the later 20th century.
Music

       There have been few examples of tobacco in music in early modern times, though there are occasional signs of influence in pieces such as Johann Sebastian Bach’s Edifying Thoughts of a Tobacco-Smoker.However, from the early 20th century and onwards smoking has been closely associated with popular music. Jazz was from early on closely intertwined with the smoking that was practiced in the venues where it was played, such as bars, dance halls, jazz clubs and even brothels. The rise of jazz coincided with the expansion of the modern tobacco industry, and in the United States also contributed to the spread of cannabis. The latter went under names like “tea”, “muggles” and “reefer” in the jazz community and was so influential in the 1920s and 30s that it found its way into songs composed at the time such as Louis Armstrong’s Muggles Larry Adler’s Smoking Reefers and Don Redman’s Chant of The Weed. The popularity of marijuana among jazz musicians remained high until the 1940s and 50s, when it was partially replaced by the use of heroin.

      Another form of modern popular music that has been closely associated with cannabis smoking is reggae, a style of music that originated in Jamaica in the late 1950s and early 60s. Cannabis, or ganja, is believed to have been introduced to Jamaica in the mid-19th century by Indian immigrant labor and was primarily associated with Indian workers until it was appropriated by the Rastafari movement in the middle of the 20th century. The Rastafari considered cannabis smoking to be a way to come closer to God, or Jah, an association that was greatly popularized by reggae icons such as Bob Marley and Peter Tosh in the 1960s and 70s.

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Smoking Physiology

                                                    Smoking Physiology

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

     Inhaling the vaporized gas form of substances into the lungs is a quick and very effective way of delivering drugs into the bloodstream (as the gas diffuses directly into the pulmonary vein, then into the heart and from there to the brain) and affects the user within less than a second of the first inhalation. The lungs consist of several million tiny bulbs called alveoli that altogether have an area of over 70 m² (about the area of a tennis court). This can be used to administer useful medical as well as recreational drugs such as aerosols, consisting of tiny droplets of a medication, or as gas produced by burning plant material with a psychoactive substance or pure forms of the substance itself. Not all drugs can be smoked, for example the sulphate derivative that is most commonly inhaled through the nose, though purer free base forms of substances can, but often require considerable skill in administering the drug properly. The method is also somewhat inefficient since not all of the smoke will be inhaled.The inhaled substances trigger chemical reactions in nerve endings in the brain due to being similar to naturally occurring substances such as endorphins and dopamines, which are associated with sensations of pleasure. The result is what is usually referred to as a “high” that ranges between the mild stimulus caused by nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines.
Inhaling smoke into the lungs, no matter the substance, has adverse effects on one’s health. The incomplete combustion produced by burning plant material, like tobacco or cannabis, produces carbon monoxide, which impairs the ability of blood to carry oxygen when inhaled into the lungs. There are several other toxic compounds in tobacco that constitute serious health hazards to long-term smokers from a whole range of causes; vascular abnormalities such as stenosis, lung cancer, heart attacks, strokes, impotence, low birth weight of infants born by smoking mothers. 8% of long-term smokers develop the characteristic set of facial changes known to doctors as smoker’s face.
Psychology

     Most tobacco smokers begin during adolescence or early adulthood. Smoking has elements of risk-taking and rebellion, which often appeal to young people. The presence of high-status models and peers may also encourage smoking. Because teenagers are influenced more by their peers than by adults,[36] attempts by parents, schools, and health professionals at preventing people from trying cigarettes are often unsuccessful.

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     Psychologists such as Hans Eysenck have 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. Although personality and social factors may make people likely to smoke, the actual habit is a function of operant conditioning. During the early stages, smoking provides pleasurable sensations (because of its action on the dopamine system) and thus serves as a source of positive reinforcement. After an individual has smoked for many years, the avoidance of withdrawal symptoms and negative reinforcement become the key motivations. Although smoking tobacco has long been seen as a universally addictive trait, it has been proven statistically that people take a varying amount of time to become dependent on the drug nicotine. In fact, the graph showing percentage of the “population showing addictive behaviour” vs “amount of nicotine taken” levels off before reaching 100% of the population, showing that a proportion of people never become dependant on nicotine at all.


     However, because people who smoke are engaging in an activity that has negative effects on health, they tend to rationalize their behavior. In other words, they develop convincing, if not necessarily logical, reasons why smoking is acceptable for them to do. For example, a smoker could justify his or her behavior by concluding that everyone dies and so cigarettes do not actually change anything. Or a person could believe that smoking relieves stress or has other benefits that justify its risks. Smokers who need a cigarette first thing in the morning will often quote the positive effects, but will not accept that they awake feeling below normal levels of happiness (lower levels of dopamine) and merely smoke to return themselves to a “normal” level of happiness (“normal” level of dopamine).
Smoking and I.Q.

     According to a study of more than 20,000 Israeli military recruits that was published in 2010, smokers have a lower I.Q. than non-smokers. Those who never smoked had an average I.Q. of 101, while those who smoked more than one pack per day had an average I.Q. of 90.[38]
Social effects
For more details on this topic, see Prevalence of tobacco consumption.

                                 Smoking any tobacco product, %, Males

     Smoking, primarily of tobacco, is an activity that is practiced by some 1.1 billion people, and up to 1/3 of the adult population.[40] The image of the smoker can vary considerably, but is very often associated, especially in fiction, with individuality and aloofness. Even so, smoking of both tobacco and cannabis can be a social activity which serves as a reinforcement of social structures and is part of the cultural rituals of many and diverse social and ethnic groups. Many smokers begin smoking in social settings and the offering and sharing of a cigarette is often an important rite of initiation or simply a good excuse to start a conversation with strangers in many settings; in bars, night clubs, at work or on the street. Lighting a cigarette is often seen as an effective way of avoiding the appearance of idleness or mere loitering. For adolescents, it can function as a first step out of childhood or as an act of rebellion against the adult world. Also, smoking can be seen as a sort of camaraderie. It has been shown that even opening a packet of cigarettes, or offering a cigarette to other people, can increase the level of dopamine (the “happy feeling”) in the brain, and it is doubtless that people who smoke form relationships with fellow smokers, in a way that only proliferates the habit, particularly in countries where smoking inside public places has been made illegal. Other than recreational drug use, it can be used to construct identity and a development of self-image by associating it with personal experiences connected with smoking. The rise of the modern anti-smoking movement in the late 19th century did more than create awareness of the hazards of smoking; it provoked reactions of smokers against what was, and often still is, perceived as an assault on personal freedom and has created an identity among smokers as rebels or outcasts, apart from non-smokers:“ There is a new Marlboro land, not of lonesome cowboys, but of social-spirited urbanites, united against the perceived strictures of public health. ”



     The importance of tobacco to soldiers was early on recognized as something that could not be ignored by commanders. By the 17th century allowances of tobacco were a standard part of the naval rations of many nations and by World War I cigarette manufacturers and governments collaborated in securing tobacco and cigarette allowances to soldiers in the field. It was asserted that regular use of tobacco while under duress would not only calm the soldiers, but allow them to withstand greater hardship. Until the mid-20th century, the majority of the adult population in many Western nations were smokers and the claims of anti-smoking activists were met with much skepticism, if not outright contempt. Today the movement has considerably more weight and evidence of its claims, but a considerable proportion of the population remains steadfast smokers.
Health effects of tobacco
Main article: Health effects of tobacco

     Tobacco-related diseases are some of the biggest killers in the world today and are cited as one of the biggest causes of premature death in industrialized countries. In the United States some 500,000 deaths per year are attributed to smoking-related diseases and a recent study estimated that as much as 1/3 of China’s male population will have significantly shortened life-spans due to smoking.

     Male and female smokers lose an average of 13.2 and 14.5 years of life, respectively.

At least half of all lifelong smokers die earlier as a result of smoking.

      The risk of dying from lung cancer before age 85 is 22.1% for a male smoker and 11.9% for a female current smoker, in the absence of competing causes of death. The corresponding estimates for lifelong nonsmokers are a 1.1% probability of dying from lung cancer before age 85 for a man of European descent, and a 0.8% probability for a woman.

Smoking one cigarette a day results in a risk of heart disease that is halfway between that of a smoker and a non-smoker. The non-linear dose response relationship is explained by smoking’s effect on platelet aggregation.

Among the diseases and afflictions that can be caused by smoking are vascular stenosis, lung cancer, heart attacks and chronic obstructive pulmonary disease.

      Many governments are trying to deter people from smoking with anti-smoking campaigns in mass media stressing the harmful long-term effects of smoking. Passive smoking, or secondhand smoking, which affects people in the immediate vicinity of smokers, is a major reason for the enforcement of smoking bans. This is a law enforced to stop individuals smoking in indoor public places, such as bars, pubs and restaurants. The idea behind this is to discourage smoking by making it more inconvenient, and to stop harmful smoke being present in enclosed public spaces. A common concern among legislators is to discourage smoking among minors and many states have passed laws against selling tobacco products to underage customers. Many developing countries have not adopted anti-smoking policies, leading some to call for anti-smoking campaigns and further education to explain the negative effects of ETS (Environmental Tobacco Smoke) in developing countries.

     Despite the many bans, European countries still hold 18 of the top 20 spots, and according to the ERC, a market research company, the heaviest smokers are from Greece, averaging 3,000 cigarettes per person in 2007.[53] Rates of smoking have leveled off or declined in the developed world but continue to rise in developing countries. Smoking rates in the United States have dropped by half from 1965 to 2006, falling from 42% to 20.8% in adults.

      The effects of addiction on society vary considerably between different substances that can be smoked and the indirect social problems that they cause, in great part because of the differences in legislation and the enforcement of narcotics legislation around the world. Though nicotine is a highly addictive drug, its effects on cognition are not as intense or noticeable as other drugs such as, cocaine, amphetamines or any of the opiates (including heroin and morphine). As tobacco is also not an illegal drug, there is no black market with high risks and high prices for consumers.

                             Smoking is a risk factor in Alzheimer’s Disease.
                                                                     Economics

       Estimates from the Campaign for Tobacco-Free Kids claim that smokers cost the U.S. economy $97.6 billion a year in lost productivity, and that an additional $96.7 billion is spent on public and private health care combined.This is over 1% of the gross domestic product. A male smoker in the United States that smokes more than one pack a day can expect an average increase of $19,000 just in medical expenses over the course of his lifetime. A U.S. female smoker that also smokes more than a pack a day can expect an average of $25,800 additional healthcare costs over her lifetime. These costs must be offset against the extra tax revenue that smoking provides.

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Tobacco Public policy

     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. 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. Taxation See also: Cigarette taxes in the United States Many governments have introduced excise taxes on cigarettes in order to reduce the consumption of cigarettes. 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, over $2000 per year per smoker. Another study by a team of health economists finds the combined price paid by their families and society is about $41 per pack of cigarettes. 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. Smoking is often cited as an example of an inelastic good, however, i.e. a large rise in price will only result in a small decrease in consumption. Many nations have implemented some form of tobacco taxation. As of 1997, Denmark had the highest cigarette tax burden of $4.02 per pack. Taiwan only had a tax burden of $0.62 per pack. Currently, the average price and excise tax on cigarettes in the United States is well below those in many other industrialized nations. Cigarette taxes vary widely from state to state in the United States. For example, South Carolina has a cigarette tax of only 7 cents per pack, the nation’s lowest, while Rhode Island has the highest cigarette tax in the U.S.: $3.46 per pack. In Alabama, Illinois, Missouri, New York City, Tennessee, and Virginia, counties and cities may impose an additional limited tax on the price of cigarettes. In the United Kingdom, a packet of 20 cigarettes typically costs between £4.25 and £5.50 depending on the brand purchased and where the purchase was made.The UK has a strong black market for cigarettes which has formed as a result of the high taxation, and it is estimated 27% of cigarette and 68% of handrolling tobacco consumption was non-UK duty paid (NUKDP). Restrictions An enclosed smoking area in a Japanese train station. Note air ventilation. Main articles: Tobacco advertising, Tobacco packaging warning messages, Smoking ban, and Smoking ban in private vehicles In June 1967, the Federal Communications Commission ruled that programs broadcast on a television station that discussed smoking and health were insufficient to offset the effects of paid advertisements that were broadcast for five to ten minutes each day. In April 1970, Congress passed the Public Health Cigarette Smoking Act banning the advertising of cigarettes on television and radio starting on January 2, 1971. The Tobacco Advertising Prohibition Act 1992 expressly prohibited almost all forms of Tobacco advertising in Australia, including the sponsorship of sporting or other cultural events by cigarette brands. All tobacco advertising and sponsorship on television has been banned within the European Union since 1991 under the Television Without Frontiers Directive (1989) This ban was extended by the Tobacco Advertising Directive, which took effect in July 2005 to cover other forms of media such as the internet, print media, and radio. The directive does not include advertising in cinemas and on billboards or using merchandising – or tobacco sponsorship of cultural and sporting events which are purely local, with participants coming from only one Member State as these fall outside the jurisdiction of the European Commission. However, most member states have transposed the directive with national laws that are wider in scope than the directive and cover local advertising. A 2008 European Commission report concluded that the directive had been successfully transposed into national law in all EU member states, and that these laws were well implemented. 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 labeled with the health risks associated with smoking. Canada, Australia, Thailand, Iceland and Brazil have also imposed labels upon cigarette packs warning smokers of the effects, and they include graphic images of the potential health effects of smoking. Cards are also inserted into cigarette packs in Canada. There are sixteen of them, and only one comes in a pack. They explain different methods of quitting smoking. Also, in the United Kingdom, there have been a number of graphic NHS advertisements, one showing a cigarette filled with fatty deposits, as if the cigarette is symbolising the artery of a smoker. Many countries have a smoking age, In many countries, including the United States, most European Union member states, New Zealand, Canada, South Africa, Israel, India, Brazil, Chile, Costa Rica and Australia, it is illegal to sell tobacco products to minors and in the Netherlands, Austria, Belgium, Denmark and South Africa it is illegal to sell tobacco products to people under the age of 16. On September 1, 2007 the minimum age to buy tobacco products in Germany rose from 16 to 18, as well as in Great Britain where on October 1, 2007 it rose from 16 to 18. Underlying such laws is the belief that people should make an informed decision regarding the risks of tobacco use. These laws have a lax enforcement in some nations and states. In China, Turkey, and many other countries usually a child will have little problem buying tobacco products, because they are often told to go to the store to buy tobacco for their parents. Several countries such as Ireland, Latvia, Estonia, the Netherlands, France, Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore, Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United Kingdom, Slovenia and Malta have legislated against smoking in public places, often including bars and restaurants. Restaurateurs have been permitted in some jurisdictions to build designated smoking areas (or to prohibit smoking). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars. In provinces of Canada, smoking is illegal in indoor workplaces and public places, including bars and restaurants. As of March 31, 2008 Canada has introduced a smoking ban in all public places, as well as within 10 meters of an entrance to any public place. In Australia, smoking bans vary from state to state. Currently, Queensland has total bans within all public interiors (including workplaces, bars, pubs and eateries) as well as patrolled beaches and some outdoor public areas. There are, however, exceptions for designated smoking areas. In Victoria, smoking is banned in train stations, bus stops and tram stops as these are public locations where second hand smoke can affect non-smokers waiting for public transport, and since July 1, 2007 is now extended to all indoor public places. In New Zealand and Brazil, smoking is banned in enclosed public places mainly bars, restaurants and pubs. Hong Kong banned smoking on January 1, 2007 in the workplace, public spaces such as restaurants, karaoke rooms, buildings, and public parks. Bars serving alcohol who do not admit under-18s have been exempted till 2009. In Romania smoking is illegal in trains, metro stations, public institutions (except where designated, usually outside) and public transportation. Product safety An indirect public health problem posed by cigarettes is that of accidental fires, usually linked with consumption of alcohol. Numerous cigarette designs have been proposed, some by tobacco companies themselves, which would extinguish a cigarette left unattended for more than a minute or two, thereby reducing the risk of fire. Among American tobacco companies, some have resisted this idea, while others have embraced it. RJ Reynolds was a leader in making prototypes of these cigarettes in 1983 and will make all of their U.S. market cigarettes to be fire-safe by 2010. Phillip Morris is not in active support of it. Lorillard, the nation’s third largest tobacco company, seems to be ambivalent. Gateway drug theory Main articles: Tobacco and other drugs and Gateway drug theory The relationship between tobacco and other drug use has been well-established, however the nature of this association remains unclear. The two main theories are the phenotypic causation (gateway) model and the correlated liabilities model. The causation model argues that smoking is a primary influence on future drug use,[100] while the correlated liabilities model argues that smoking and other drug use are predicated on genetic or environmental factors. Cessation Main article: Smoking cessation Smoking cessation, referred to as “quitting” is the action leading towards abstinence of tobacco smoking. There are a number of methods such as cold turkey, nicotine replacement therapy, antidepressants, hypnosis, self-help, and support groups.

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History cigarettes

     A reproduction of a carving from the temple at Palenque, Mexico, depicting a Mayan priest smoking from a smoking tube.

     The earliest forms of cigarettes have been attested in Central America around the 9th century in the form of reeds and smoking tubes. The Maya, and later the Aztecs, smoked tobacco and various psychoactive drugs in religious rituals and frequently depicted priests and deities smoking on pottery and temple engravings. The cigarette, and the cigar, were the most common method of smoking in the Caribbean, Mexico and Central and South America until recent times.

     The South and Central American cigarette used various plant wrappers; when it was brought back to Spain, maize wrappers were introduced, and by the seventeenth century, fine paper. The resulting product was called papelate and is documented in Goya’s paintings La Cometa, La Merienda en el Manzanares, and El juego de la pelota a pala (18th century).

     By 1830, the cigarette had crossed into France, where it received the name cigarette; and in 1845, the French state tobacco monopoly began manufacturing them.

     In the George Bizet opera Carmen, which was set in Spain in the 1830s, the title character Carmen was at first a worker in a cigarette factory.

      In the English-speaking world, the use of tobacco in cigarette form became increasingly popular during and after the Crimean War, when British soldiers began emulating their Ottoman Turkish comrades and Russian enemies.This was helped by the development of tobaccos that are suitable for cigarette use, and by the development of the Egyptian cigarette export industry.

     The widespread smoking of cigarettes in the Western world is largely a 20th century phenomenon – at the start of the century the per capita annual consumption in the USA was 54 cigarettes (equivalent to less than 0.5% of the population smoking more than 100 cigarettes per year), and consumption there peaked at 4,259 per capita in 1965. At that time about 50% of men and 33% of women smoked (defined as smoking more than 100 cigarettes per year). By 2000, consumption had fallen to 2,092 per capita, corresponding to about 30% of men and 22% of women smoking more than 100 cigarettes per year, and by 2006 per capita consumption had declined to 1,691;implying that about 21% of the population smoked 100 cigarettes or more per year.

     During World War I and World War II, cigarettes were rationed to soldiers. During the second half of the 20th century, the adverse health effects of cigarettes started to become widely known and text-only health warnings became commonplace on cigarette packets. The United States has not yet implemented graphical cigarette warning labels, which are considered a more effective method to communicate to the public the dangers of cigarette smoking. Canada, Australia, and New Zealand, however, have both textual warnings and graphic visual images displaying, among other things, the damaging effects tobacco use has on the human body.

     The cigarette has evolved much since its conception; for example, the thin bands that travel transverse to the “axis of smoking” (thus forming circles along the length of the cigarette) are alternate sections of thin and thick paper to facilitate effective burning when being drawn, and retard burning when at rest. Synthetic particulate filters remove some of the tar before it reaches the smoker.
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Cigarettes – smoking

     The cigarette, a paper-wrapped roll of delicately cut tobacco, has been smoked by humans for centuries. The inhaling and exhaling of fumes of burning plant material was first introduced by the Aztecs who smoked a hollow reed or cane tube filled with tobacco, and by other natives of Mexico, Central America,and parts of South America who rolled the crushed tobacco leaves in corn (maize) husks or other vegetable wrappers. Often used in ceremonials by the American Indians, the ritual of smoking has continued throughout history. While itwas the cigar that Spanish conquistadors brought back from the New World that gained popularity as a symbol of wealth, the early 16th century found beggars in Seville fashioning the first cigarettes from discarded cigar butts which they shredded and rolled in scraps of paper (Spanish papeletes) to allow the poor man an opportunity to smoke his cigarrillos (Spanish for”little cigars”). As these gained respect, use of the little cigars traveledto Italy and Portugal in the 18th century, and Portuguese traders carried them to the Eastern Mediterranean and Russia. It was only during the NapoleonicWars that the French named them cigarettes. While another generation of French and British troops fought during the Crimean war forty years later, the cigarette was gaining popularity in the United States.
     In 1880, James A. Bonsack ended the need to hand roll and paste the cigarettewith his invention of the cigarette machine. A U.S. patent was granted for the machine that fed tobacco onto a continuous strip of paper and was automatically formed, pasted, closed, and cut to lengths by a rotary cutting knife. In 1883, the Bonsack machine was imported to England and the cigarette industry soon developed in several European countries throughout the next few years.The first half of the twentieth century found an enormous growth of cigarette smokers as improvements in cultivation and processing lessened the acid content in smoking tobacco, making it easier to inhale. Typically a man’s vice,cigarettes soon found their way into the hands of women throughout Europe andthe United States in the 1920s.


     Health hazards, such as lung cancer, emphysema, and heart disease, were not associated with cigarette smoking until the 1950s and ’60s when medical evidence proved the correlation. It was during this time that smoking of cigaretteswas discouraged by certain nations, particularly the United Kingdom and theUnited States. In addition to a campaign that encouraged cigarettes with filter tips and the production of milder tobaccos, the early ’70s saw the demiseof tobacco advertising on television. The United States stopped their television advocacy of cigarettes in January 1971. Canada ended their advertising in1972, and West Germany followed suit by the end of the same year. Major American tobacco companies reached an agreement in April 1971 that required a health warning in other types of advertising, which subsequently became law. Another vehicle used to discourage the smoker was increased taxation of cigarettes during the late 20th century. The 1980s brought about the prohibition or restriction of smoking in public buildings and private sector businesses in the United States and several other countries. Although predictions of ill health and limitations to their use have taken priority, ironically, cigarettes continue to gain in popularity among men, women, and the very young.
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The World Health Organization (WHO) has named tobacco one of the greatest public health threats of the twenty-first century. As of 1999, more than one billion people worldwide smoke, and 3.5 million people are expected to die fromcauses directly related to tobacco use. This death rate is expected to rise to 10 million by the year 2030. Seventy percent of these deaths will occur indeveloping countries where the proportion of smokers is growing, particularlyamong women. Calling tobacco “a global threat,” WHO says these figures do not include the enormous physical, emotional, and economic costs associated with disease and disability caused by tobacco use.

     In the United States alone, 25.2 million men, 23.2 million women, and 4.1 million teens between 12 and 17 years of age, smoke. Every day, more than threemillion youths under the age of 18 begin smoking. The gruesome statistics show that more than five million children alive today will die prematurely because, as adolescents, they decided to use tobacco. Nationally, one in five of all deaths are related to tobacco use. It kills more than 430,000 people everyyear–more than AIDS, alcohol, drugs abuse, automobile accidents, murders, suicides, and fires combined. Five million years of potential life is lost every year due to premature death caused by tobacco use, medical costs total more than $50 billion annually, and indirect cost another $50 billion.

     Of the 4,000 or more different chemicals present in cigarette smoke, 60 are known to cause cancer and others to cause cellular genetic mutations that canlead to cancer. Cigarette smoke contains nicotine–a highly addictive chemical–tars, nitrosamines, and polycyclic hydrocarbons, all of which are carcinogenic. It also contains carbon monoxide which, when inhaled, interferes with transportation and utilization of oxygen throughout the body.     Cigarette smoke is called mainstream smoke when inhaled directly from a cigarette. Sidestream smoke is smoke emitted from the burning cigarette and exhaled by the smoker. Sidestream smoke is also called environmental tobacco smoke(ETS) or secondhand smoke. Inhalation of ETS is known as passive smoking. In1993, the Environmental Protection Agency (EPA) classified ETS as a Group A (known human) carcinogen–the grouping reserved for the most dangerous carcinogens. By 1996, the Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) found that nine out of 10 non-smoking Americans are regularly exposed to ETS. A study by the American Heart Association reported in 1997 that women regularly exposed to ETS have a 91% greater risk ofheart attack and those exposed occasionally a 58% greater risk–rates whichare believed to apply equally to men. The EPA estimates that, annually, ETS is responsible for more than 3,000 lung cancer deaths, 35,000-62,000 deaths from heart attacks, and lower respiratory tract infections (such as bronchitis[300,000 cases annually] and asthma [400,000 existing cases]), and middle earinfections in children.     ETS may be more carcinogenic than mainstream smoke as it contains higher amounts of carcinogenic materials with smaller particles. These smaller particlesare more likely to lodge in the lungs than the larger particles in mainstream smoke. Researchers found that no safe threshold exists for exposure to ETS.With this information, many municipal governments and workplaces have bannedcigarette smoking altogether.     Scientific evidence has proven that smoking can cause cancer of the lung, larynx, esophagus, mouth, and bladder; cardiovascular disease; chronic lung ailments; coronary heart disease; and stroke. It also prohibits the healing of peptic ulcers, in addition to promoting recurrence of the condition. Smokelesstobacco has equally deadly consequences. When cigarette smoke is inhaled, thelarge surface area of the lung tissues and alveoli quickly absorb the chemical components and nicotine. Within one minute of inhaling, the chemicals in the smoke are distributed by the bloodstream to the brain, heart, kidneys, liver, lungs, gastrointestinal tract, muscle, and fat tissue. In pregnant women,cigarette smoke crosses the placenta and may effect fetal growth.Cardiovascular disease, or diseases of the blood vessels and heart, includesstroke, heart attack, peripheral vascular disease, and aortic aneurysm. In 1990 in the United States, one fifth of all deaths due to cardiovascular disease were linked to smoking. Specifically, 179,820 deaths from general cardiovascular disease, 134,235 deaths from heart disease, and 23,281 deaths from cerebrovascular disease (stroke) were directly linked to smoking. In addition, researchers have noted a strong dose-response relationship between the durationand extent of smoking and the death rate from heart disease in men under 65.The more one smokes, the more one is likely to develop heart disease. Researchers have also seen a similar trend in women.          Cigarette smoking leads to cardiovascular disease in a number of ways. Smoking damages the inside of the blood vessels, initiating changes that lead to atherosclerosis, a disease characterized by blood vessel blockage. It also causes the coronary arteries (that supply the heart muscle with oxygen) to constrict, increasing vulnerability of the heart to heart attack (when heart muscledies as a result of lack of oxygen) and cardiac arrest (when the heart stopsbeating). Smoking also raises the levels of low-density lipoproteins (the so-called “bad” cholesterol) in the blood, and lowers the levels of high-density lipoproteins (the so-called “good” cholesterol), a situation that has beenlinked to atherosclerosis. Finally, smoking increases the risk of stroke by 1.5 to 3 times the risk for nonsmokers.     Smoking causes 85% of all lung cancers, and 14% of all cancers–among them cancers of the mouth, pharynx (throat), larynx (voice-box), esophagus, stomach,pancreas, cervix, kidney, ureter, and bladder. More than 171,500 new diagnoses were expected in 1998. Other environmental factors add to the carcinogenicqualities of tobacco. For example, alcohol consumption combined with smokingaccounts for three-quarters of all oral and pharyngeal cancers. Also, persons predisposed genetically to certain cancers may develop cancer more quicklyif they smoke. Only 14% of lung cancer patients survive five years after diagnosis.     Smoking is the leading cause of lung disease in the United States. Among thedirect causes of death are pneumonia, influenza, bronchitis, emphysema, and chronic airway obstruction. Smoking increases mucus production in the airwaysand deadens the respiratory cilia, the tiny hairs that sweep debris out fromthe lungs. Without the action of the cilia, bacteria and inhaled particles from cigarette smoke are free to damage the lungs.     In the smaller airways of the lungs–the tiny bronchioles that branch off from the larger bronchi–chronic inflammation is present in smokers which causesairway to constrict causing cough, mucus production, and shortness of breath. Eventually, this inflammation can lead to chronic obstructive pulmonary disease (COPD), a condition in which oxygen absorption by the lungs is greatly reduced, severely limiting the amount of oxygen transported to body tissues.     For the 40 years prior to 1987, breast cancer was the leading cause of cancerdeath among women in the United States. In 1987, lung cancer took the lead.As well as increased risk of cancer and cardiovascular disease, women smokersare at increased risk of osteoporosis (a disease in which bones become brittle and vulnerable to breakage), cervical cancer, and decreased fertility. Pregnant women have increased risk for spontaneous abortion, premature separation of the placenta from the uterine wall (a life-threatening complication formother and fetus), placenta previa (in which the placenta implants much lowerin the uterus than normal, which may lead to hemorrhage), bleeding during pregnancy, and premature rupture of the placental membranes (which can lead toinfection). Infants born to women who smoke during pregnancy are at increasedrisk for low birth weight (18,600 cases annually), and other developmental problems. In men, smoking lowers testosterone levels, and appears to increasemale infertility.     Numerous other health problems are caused by smoking such as poor circulationin the extremities due to constricted blood vessels. This not only leads toconstantly cold hands and feet; it often requires amputation of the lower extremities. Smoking also deadens the taste buds and the receptors in the nasalepithelium, interfering with the senses of taste and smell, and may also contribute to periodontal disease.


     In 1992, the Surgeon General of the United States declared nicotine to be asaddictive as cocaine. An article published in the December 17, 1997 issue ofthe Journal of the National Cancer Institute stated nicotine addictionrates are higher than for alcohol or cocaine–that of all people trying onlyone cigarette, 33-50% will ultimately become addicted. The article concludedthat simply knowing the harmful effects of tobacco is insufficient to help people kick the addiction and that behavioral intervention and support methodssimilar to those applied in alcohol and drug addictions appear to be most helpful.

     The physical effects of cigarette smoke include several neurological responses that, in turn, stimulate emotional responses. When serotonin, a neurotransmitter (substances in the brain used by cells to transmit nerve impulses) is released, a person feels more alert. Nicotine stimulates serotonin release. Soon, however, serotonin release becomes sluggish without the boost from nicotine and the smoker becomes dependent on nicotine to prompt the release of serotonin. Other neurotransmitters released in response to nicotine include dopamine, opioids (naturally-occurring pain-killing substances), and various hormones, all of which have powerful effects on the brain where addiction occurs.
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     In 1998, scientists found a defective gene which makes the metabolism of nicotine difficult. The normal gene produces a liver enzyme needed to break downnicotine. The defective gene, found in about 20% of nonsmokers, may lessen the likelihood of nicotine addiction.

     In 1999, researchers discovered a version of a gene which increases the levels of dopamine in the brain. Because nicotine stimulates the release of dopamine, researchers believe the new-found gene may reduce the individual’s desireto “pump up” dopamine production with nicotine.

     Quitting smoking significantly lowers the risk of cancer and cardiovascular disease. In fact, the risk of lung cancer decreases from 18.83 at 1-4 years after quitting, to 7.73 at 5-9 years, to below 5 at 10-19 years, to 2.1 at 20-plus years. The risk of lung cancer for nonsmokers is 1. In 1997, the U.S. government’s Agency for Health Care Policy and Research (AHCPR) reported that for every one of the 46 million American smokers, there was an ex-smoker who had successfully quit the habit.

     Weight gain is a common side effect of quitting, since smoking interferes with pancreatic function and carbohydrate metabolism, leading to a lower body weight in some people. However, not all people experience this lowered body weight from smoking, thus, not all people who quit gain weight. Taste buds and smell are reactivated in nonsmokers, which may lead to increased food intake.

      About 80% of people who quit relapse within the first two weeks. Less than 3%of smokers become non-smokers annually. Nicotine gum and patches, which maintain a steady level of nicotine in the blood without the tar and carbon monoxide found in cigarettes, have been met with some success but are more successful when combined with other support programs. Other nicotine replacement products include a nasal spray and inhaler. The newest option for smokers who want to quit is the anti-smoking pill bupropion hydrochloride, also known as Zyban. This medication, which is used as an antidepressant and gained approvalby the FDA in 1997, seems to reduce nicotine withdrawal symptoms and the urgeto smoke without the use of any nicotine. Researchers now believe that smoking may be linked to depression, the withdrawal symptom causing most people who quit to begin again.

     In 1998, a $206 billion settlement from tobacco companies to 46 states included a ban on all outdoor advertising of tobacco products. The American Heart Association estimates that 4.1 million teenagers aged 12 through 17 years aresmokers. A study conducted by the National Household Survey on Drug Abuse indicates that if the smoking trend among young people continues, approximately5 million persons under 18 years old will die eventually from a smoking attributable disease. In 1999, the CDC appropriated more than $80 million to curtail tobacco use among young people. Coordinated education and prevention programs through schools have lowered the onset of smoking by 37% in seventh-gradestudents alone. By educating today’s youth to the dangers of tobacco use, adults of tomorrow will have longer, healthier, more productive lives.

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