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Tobacco smoking

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Tobacco smoking is the act of smoking tobacco products, especially cigarettes and cigars. Tobacco smoking is considered a significant cause of human health problems, especially cancer and other disorders affecting the lungs.

The practice of smoking tobacco originated as a ritual practice among American Indians in North America, to which tobacco is native. It was adopted by many Europeans following the colonization of the Americas. Today, it is widespread throughout the world; according to the World Health Organization, it is most common in East Asia, where as many as two-thirds of all adult males smoke tobacco. [1] Because of concern over the health hazards of smoking, it has declined in recent years in the United States and Western Europe.

Tobacco may be smoked in several forms, the most common being the cigarette, the cigar, and pipe tobacco. Cigarette smoking is by far the most common. Pipes and cigars are less common, and are used almost exclusively by men.

In the case of cigarette smoking, for most smokers it also involves the inhalation of the smoke into the lungs. Tobacco smoke contains nicotine, which can form a strong physical and/or psychological dependence. According to the U.S. Centers for Disease Control and Prevention (CDC), "nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine" [2] . Dependence is strongest when tobacco smoke is inhaled into the lungs and increases with quantity and speed of nicotine absorption.

Lighting the tobacco is usually done with a lighter or match. One of the most common favors asked from a stranger is for a light; it is also done as a pretext to start a conversation. Some smokers consider smoking to be a relaxing, pleasurable, social activity. Some tobacco hobbyists may view the risks of smoking as balanced by its rewards.



Tobacco smoking, using both pipes and cigars, was long common to many Native American cultures of the Americas. It is depicted in the art of the Classic era Maya civilization of some 1,500 years ago.

With the arrival of the Europeans in the New World late in the 15th century, tobacco smoking was brought to Europe, and from there gradually spread to the rest of the world.

The cigarette was less common than the cigar or the smoking pipe until the early 20th century, when cheap mechanically made cigarettes became common.

Health effects

It has been scientifically established that "tobacco use is the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide".1

The main health risks in tobacco smoking pertain to diseases of the respiratory tract (particularly lung cancer) and also to diseases of the cardiovascular system, in particular smoking being a major risk factor for a myocardial infarction (heart attack). Cancers of the larynx and tongue are also important causes of mortality and morbidity.

Cigar and pipe smokers tend to inhale less smoke than cigarette smokers, so their risk of lung cancer is lower but is still several times higher than the risk for nonsmokers. Pipe and cigar smokers are also at risk for cancers of the oral cavity, larynx (voice box), or esophagus. Cancer of the mouth and jaw is also a risk for people who chew tobacco rather than smoke it.

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 steadily although gradually decrease as the damage to their body is repaired.

Diseases linked to smoking tobacco cigarettes include:

There are around 3000 chemicals found in tobacco smoke. Below are chemicals of known or supected carcinogenicity:

  • Carcinogenic:
  • Probably carcinogenic to humans:
    • Acrylonitrile
    • Benzo[a]anthracene
    • Benzo[α]pyrene
    • 1,3-Butadiene
    • Dibenz(a,h)anthracene
    • N-Nitrosodiethylamine
    • N-Nitrosodimethylamine
  • Possibly carcinogenic to humans:
    • Acetaldehyde
    • Benzo[b]fluoranthene
    • Benzo[j]fluoranthene
    • Benzo[k]fluoranthene
    • Dibenz[a,h]acridine
    • Dibenz[a,j]acridine
    • 7H-Dibenz[c,g]carbazole
    • Dibenzo(a,i)pyrene
    • Dibenzo(a,I)pyrene
    • 1,1-Dimethylhydrazine
    • Hydrazine
    • Indeno[1,2,3-cd]pyrene
    • Lead
    • 5-Methylchrysene
    • 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)
    • 2-Nitropropane
    • N-Nitrosodiethanolamine
    • N-Nitrosomethylethylamine
    • N-Nitrosomorpholine
    • N'-Nitrosonornicotine (NNN)
    • N-Nitrosopyrrolidine
    • Quinoline
    • iv ortho-Toluidine
    • Urethane (Ethyl Carbamate)

Tobacco has also been alleged to have some positive health effects. Most notably, some studies have found that patients with Alzheimer's Disease are less likely to have smoked than the general population, which has been interpreted to suggest that smoking offers some protection against Alzheimer. However, the research in this area is limited and the results are mixed. Some studies show that smoking increases the risk of Alzheimer's Disease. A recent review of the available scientific literature concluded that the apparent decrease in Alzheimer risk may be simply due to the fact that smokers tend to die before reaching the age at which Alzheimer normally occurs. "Differential mortality is always likely to be a problem where there is a need to investigate the effects of smoking in a disorder with very low incidence rates before age 75 years, which is the case of Alzheimer's disease", it stated, noting that smokers are only half as likely as non-smokers to survive to the age of 80. [3]

Smoking is more prevalent among the mentally ill than among the general population, and it has been theorized that nicotine may have a calming effect that alleviates some negative symptoms of psychiatric illnesses. Here, too, medical evidence is limited, and known therapeutic drugs are better suited than cigarettes for treatment of mental illness. Other studies have found that smoking is associated with slightly reduced incidence of endometrial cancer, hypertension during pregnancy, Parkinson's disease, and ulcerative colitis, but these possible health benefits are small compared to the much larger health risks with which smoking has been conclusively linked.

Smoking cessation

Also see main article smoking cessation

A team of British scientists headed by Richard Doll carried out a longitudal study of 34,439 medical specialists from 1951 to 2001, generally called the "British doctors study" [4] . The study demonstrated that smoking decreased life expectancy by 10 years and that almost half of the smokers died from smoking (cancer, heart disease, and stroke). About 5,900 of the study participants are still alive and only 134 of them still smoke.

Many of tobacco's health effects can be minimised through smoking cessation. The same longitudal 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 help 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.

Smoking and cardiovascular disease

anti smoking video ad
anti smoking video ad
Smoking also increases the chance of heart disease. Several ingredients of tobacco lead to the narrowing of blood vessels, increasing the likelihood of a blockage, and thus a heart attack or stroke. According to a study by an international team of researchers, people under 40 are five times more likely to have a heart attack if they smoke [5] .

Other tobacco chemicals lead to high blood pressure. Also, some chemicals may damage the inside of arteries, for example making it possible for cholesterol to adhere to the artery wall, possibly leading to a heart attack.

Play anti-smoking ad video (length 1m45s) A visual depiction of the process and effects of smoking. Picture on the right: still taken from the video anti smoking produced (and hosted) by django media.

Nicotine and addiction

Nicotine is a powerful 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 . The amount of nicotine absorbed by the body from smoking depends on many factors, including the type of tobacco, whether the smoke is inhaled, and whether a filter is used. On average it takes about seven seconds for the substance to reach the brain. Although nicotine does play a role in acute episodes of some diseases, including stroke, impotence, and heart disease, it does not contribute to the most serious, longer term afflictions, such as cancer or emphysema, which are caused mostly by the products of the smoldering combustion process. This has enabled development of various nicotine delivery systems, such as the nicotine patch or nicotine gum , that can satisfy the addictive craving by delivering nicotine without the harmful combustion byproducts. This can help the heavily dependent smoker to quit gradually, whie discontinuing further damage to health.

Moral aspects

Communal smoking of a sacred tobacco pipe was a universal ritual through Native America. Native Americans considered tobacco a sacred part of their religion. It was grown for ceremonial use and considered the ultimate sacred plant. Tobacco smoke was believed to carry prayers to the heavens.

In more modern times, even before the health risks of smoking were scientifically known, it was considered a filthy, harmful and immoral habit by some Christian preachers and social reformers. Tobacco was listed, along with drunkenness, gambling, cards, dancing and theater-going, in J.M. Judy's Questionable Amusements and Worthy Substitutes, which was published in 1904 by the Western Methodist Book Concern of Chicago. Judy wrote that "Tobacco dulls the mind. It does this not only by wasting the body, the physical basis of the mind, but it does it through habits of intellectual idleness, which the user of tobacco naturally forms. Whoever heard of a first-class loafer who did not eat the weed or burn it, or both?" In addition, he claimed, "Tobacco wastes the body" and "blunts the moral nature." But there was also the more direct concern that the poor would waste what little money they had on tobacco, instead of supporting their families, similar to a concern about alcohol in this era.

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 waste of time and saw the practice of people "borrowing" (pilfering) cigarettes from each other as morally questionable.

Most modern opposition to smoking, however, is based on health concerns rather than moral judgments.

Passive smoking

Passive smoking (also known as environmental tobacco smoke (ETS), involuntary smoking or secondhand smoke) occurs when the exhaled and ambient smoke from one person's cigarette is inhaled by other people. The US Environmental Protection Agency (EPA) in 1993 issued a report estimating that 3,000 lung cancer related deaths in the US were caused by passive smoking every year. Tobacco industry lobbyists, such as the Alexis de Tocqueville Institution, and many researchers, such as S. Fred Singer, aggressively attacked the EPA study as "junk science." In 2002, a group of 29 experts from 12 countries convened by the Monographs Programme of the International Agency for Research on Cancer (IARC) of the World Health Organization reviewed all significant published evidence related to tobacco smoking and cancer. It concluded its evaluation of the carcinogenic risks associated with involuntary smoking, with second-hand smoke also being classified as carcinogenic to humans.[6] An earlier WHO epidemiology study also found "weak evidence of a dose-response relationship between risk of lung cancer and exposure to spousal and workplace ETS".[7];90/19/1440 The fact that the evidence was described as "weak" has been interpreted by the tobacco industry and its supporters as evidence that the ETS-lung cancer link has been "disproven." More precisely, the "weakness" of the evidence stems from the fact that the risk of ETS for individuals is small relative to the very high risk of actually smoking, making it more difficult to quantify through epidemiology. Most experts believe that moderate, occasional exposure to secondhand smoke presents a low risk to nonsmokers, but a growing body of research suggests that risks to nonsmokers may be detectable. One recent study in the British Medical Journal found that exposure to secondhand smoke increases the risk of heart disease among non-smokers by as much as 60 percent. [8]

In addition to epidemiology, moreover, several other types of scientific evidence (including animal experiments, chemical constituent analysis of ETS, and human metabolic studies) support the WHO and EPA conclusions.

Although the correlation between second-hand smoke and cancer continues to be inconclusive, risks to non-smokers, if any, would seem to be most likely to be significant if they work in an environment where cigarette smoke is prevalent. For this reason, many countries (such as Ireland) and jurisdictions (like New York State) now prohibit smoking in public buildings. Many office buildings contain specially ventilated smoking areas; some are required by law to provide them.

Effects on smokers

Smokers report a variety of physical and psychological effects from smoking tobacco. Those new to smoking will experience nausea, dizziness, and rapid heart beat. The negative symptoms will eventually vanish over time, with repeated use, as the body builds a tolerance to the nicotine. Nicotine is an unusual chemical because when absorbed slowly, it can act as a sedative and when absorbed quickly it can act as a stimulant. Pipe and cigar smokers usually experience more of the sedative/relaxation effect while cigarette smokers usually experience more of the stimulant effect.

In many respects, nicotine acts on the nervous system in a similar way to caffeine. Some writings have stated that smoking can also increase mental concentration. Most smokers say they enjoy smoking, which is part of the reason why many continue to do so even though they are aware of the health risks. Taste, smell, and visual enjoyment are also major contributions to the enjoyment of smoking, in addition to camaraderie with other smokers.

Experienced smokers, when denied access to nicotine, will often exhibit symptoms such as irritability, dry mouth, and rapid heart beat. Longer withdrawal can lead to insomnia and even mild depression. Smokers abstaining from nicotine for approximately ten to twenty days will, eventually, eliminate the chemical dependence, although the psychological dependence may linger for months or even many years. Unlike illicit drugs and alcohol, nicotine does not alter a smoker's motor skills, cognition, judgment, or language abilities.

Smokers wanting to quit (or temporarily abstain from) smoking can use a variety of nicotine-containing tobacco subsitutes to temporarily lessen the physical withdrawal symptoms, the most popular being nicotine gum and lozenges. Nicotine patches are also used for smoking cessation. Discussing the problem with supportive people can also be helpful. In addition, there are lots of self-help books on the market, for example those by Allen Carr.

Legal issues

In many countries (including the United States, New Zealand, Canada, and Australia), it is illegal to sell tobacco products to minors. In Britain it is illegal to sell tobacco products to people under the age of 16; in 47 of the 50 United States the minimum age is 18 (Alabama, Alaska, and Utah raised the age to 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 only adults can make an informed decision regarding the risks of tobacco use.

Several Western countries have also put restrictions on cigarette advertising. In the United States, all television advertising of tobacco products is 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.

Some countries also impose legal requirements on the packaging of tobacco products. For example in the countries of the European Union and Australia, cigarette packs must be prominently labeled with one of various statements such as "SMOKING KILLS" and "SMOKING IS ADDICTIVE", accompanied by an explanation of the statement. See Australian tobacco labeling regulations . Canada has also imposed labels upon cigarette packs warning smokers of the effects. These labels say things such as: Cigarettes Hurt Babies, Tobacco Kills, etc. 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.

In addition, some jurisdictions impose restrictions on where smoking is allowed. According to the American Nonsmokers' Rights Foundation , as of April 2004, the US states of Delaware, New York, Florida, California, Connecticut, Maine, and Utah prohibit smoking in restaurants. Delaware, New York, California, Connecticut, and Maine also prohibit smoking in bars. Similar restrictions have been proposed (though not yet implemented) for states such as Oregon, New Jersey, Minnesota, Illinois, Maryland, and Colorado.

From March 29, 2004, it became illegal in the Republic of Ireland to smoke in most enclosed places of work. This included all bars and restaurants. Similar legislation came into force in New Zealand on December 10, 2004 and will take effect in Scotland from 2006. In 2004, Bhutan became the first country in the world to ban smoking and the selling of Tobacco.

Beginning February 28, 2005, an international treaty, the WHO Framework Convention on Tobacco Control, will take 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.

Recently some activists and officials have begun calling for a total ban on tobacco product sales and consumption altogether. see: smoking ban for more information.

See also

External link

  • Smoking Prevention Strategies for Urban and Minority Youth


  1. 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
  2. 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.
  3. 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.

Last updated: 05-03-2005 09:00:33