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Tobacco smoking

2007 Schools Wikipedia Selection. Related subjects: Everyday life; Health and
medicine

   The cigarette is the most common method of smoking tobacco.
   Enlarge
   The cigarette is the most common method of smoking tobacco.

   Tobacco smoking, often referred to as "smoking", is the act of burning
   the dried or cured leaves of the tobacco plant and inhaling the smoke
   for pleasure or ritualistic purposes, or more commonly out of habit and
   to satisfy addiction. The practice was common among Native Americans of
   The Plains Indian religion, and was later introduced to the rest of the
   world by sailors following European exploration of the Americas.

   Tobacco smoke contains nicotine, an addictive 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 (which has a
   survival percentage of 16.4%), emphysema, and cardiovascular disease.
   Many countries regulate or restrict tobacco sales and advertising and
   require warnings be placed prominently on the product packaging. Many
   municipalities now ban smoking in a variety of public venues due to
   health impacts on non-smokers breathing second-hand smoke.

   While smoking is declining in many industrial nations due in part to
   these initiatives, smoking in sometimes less restrictive developing
   countries is rising and worldwide production and usage of tobacco is
   increasing.

History

   Tobacco smoking with pipes and cigars was common to many Native
   American cultures prior to the arrival of European explorers. The
   practice is depicted in early Mayan art dating back to around 1,500
   years ago. The Maya were also known to use tobacco as an all-purpose
   medicinal antidote, and the crop was widely believed to possess magical
   powers as its usage has been documented in ancient ceremonial
   sacrifices and divinations as well as in talismans.

   On October 12, 1492, Christopher Columbus was given 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 became the first
   recorded smoker outside the Americas. Throughout the 16th century, the
   habit of smoking was common mainly among sailors. Tobacco was
   introduced to England in the 1560s by the crew of Sir John Hawkins but
   did not begin making an impact on European society until the 1580s. The
   cigar became immensely popular in England during the late 1820s. In
   1828, the cigarette appeared in Spain and enjoyed immediate success but
   still remained less popular than both the cigar and pipe until the
   early 20th century when cheap mechanically manufactured cigarettes
   became standard.

   During World War I, it was typical for tobacco products to be included
   in military rations. Following the war, cigarette smoking was
   advertised as part of a glamorous, carefree lifestyle, and became
   socially acceptable for women. In the 1930s, Nazi medical and military
   leaders grew concerned with the possibility that tobacco might be
   hazardous to human health and their scientists were the first to
   confirm this link. In the United States, biologist Raymond Pearl
   demonstrated the negative health effects of tobacco smoking as early as
   1938. In the 1950s and 1960s, the medical community along with various
   governmental bodies, and Readers Digest magazine, began a campaign to
   reduce the degree of smoking by showing how it damaged public health.
   Although tobacco smoking in many regions of the world has dropped
   dramatically in recent years, worldwide tobacco production is still
   growing. Smoking rates continue to remain relatively high in some Asian
   countries.

Methods of smoking

   Various smoking equipment including different pipes.
   Enlarge
   Various smoking equipment including different pipes.

Cigarette

   A cigarette is a product manufactured from cured and cut tobacco
   leaves, which are rolled and/or stuffed into a paper-wrapped cylinder
   (generally less than 120 mm in length and 10 mm in diameter). The
   cigarette is lit, usually with a match or lighter at one end and
   allowed to burn for the purpose of inhalation of its smoke from the
   other (sometimes filtered) end, which is inserted in the mouth.
   Cigarettes are smoked by some with a cigarette holder. (See also Bidi).
   A cigarette contains over 4000 chemicals, over 60 of which increase the
   risk of cancer and other diseases in humans and animals.

Cigar

   A cigar is a tightly-rolled bundle of dried and fermented tobacco, one
   end of which is lit with a match or lighter so that it produces smoke
   that can be drawn into the mouth. This smoke is usually not inhaled,
   but rather 'puffed' out. 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 their shape, especially that of
   what is now called the perfecto.

   Cigar tobacco is grown in significant quantities in such nations as
   Brazil, Cameroon, Cuba, Dominican Republic, Honduras, Indonesia,
   Mexico, and Nicaragua. Cigars manufactured in Cuba have been considered
   to be without peer as shown in contemporary media occasionally.

Smoking pipe

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

   Pipes are made from a variety of materials (some obscure): briar,
   corncob, meerschaum, clay, wood, glass, gourd, bamboo, and various
   other materials, such as metal. Some pipes are carved by artists.

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

   Pipes can range from the very simple machine-made briar pipe to
   handmade and artful implements created by pipemakers which can be very
   expensive collector's items.

Hookah

   A hookah is a traditional Middle Eastern or South Asian device for
   smoking, which operates by water-filtration and indirect heat. Hookah
   smoking is most popular in the Middle East, and is a niche market in
   most other places.

   Popular myth suggests that hookah smoking is considered to be safer
   than other forms of smoking due to water-filtration. However, several
   serious negative health effects are still linked to hookah smoking and
   studies indicate that it is likely to be more harmful to health than
   cigarettes, due in part to the volume of smoke inhaled. One study found
   hookah smoke to be both clastogenic and genotoxic for human beings,
   while another study showed that the CO hazard is as high with hookah
   smoking as with cigarette smoking. In addition to the cancer risk,
   there is some risk of infectious disease resulting from pipe sharing,
   and other harm caused by any addition of alcohol or psychoactive drugs
   to the tobacco.

Health effects

History

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

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

   In 1761, English doctor John Hill published "Cautions against the
   Immoderate Use of Snuff" in which he warned snuff users that they were
   vulnerable to cancers of the nose. In 1795, American Samuel Thomas von
   Soemmering reported on cancers of the lip in pipe smokers. In 1912,
   American Dr. Isaac Adler was the first to strongly suggest that lung
   cancer is related to smoking. In 1929, Fritz Lickint of Dresden,
   Germany, published the first formal statistical evidence of a lung
   cancer–tobacco link, based on a study showing that lung cancer
   sufferers were likely to be smokers. Lickint also argued that tobacco
   use was the best way to explain the fact that lung cancer struck men
   four or five times more often than women (since women smoked much less)
   (Borio 2006).

   In 1950, Dr. Richard Doll published research in a 1950 issue of the
   British Medical Journal showing a close link between smoking and lung
   cancer. In 1964, Luther L. Terry, M.D., Surgeon General of the United
   States, released the report of the Surgeon General's Advisory Committee
   on Smoking and Health. It was based on over 7000 scientific articles
   that linked tobacco use with cancer and other diseases. This report led
   to laws requiring warning labels on tobacco products and to
   restrictions on tobacco advertisements. From this time, Americans
   became much more aware of the dangers of tobacco and its use in the
   United States began to decline. By 2004, nearly half of all Americans
   who had ever smoked had quit (CDC 2004). In the 1950s, manufactureres
   began adding filter tips to cigarettes to remove some of the tar and
   nicotine as they were smoked. Safer, less potent cigarette brands were
   also introduced, however, they were unpopular, since smokers found
   these did not satisfy their nicotine craving as well as conventional
   brands.

Health risks of smoking

   Because of their nicotine addiction, many smokers find it difficult to
   cease smoking despite their knowledge of ill health effects.
   Enlarge
   Because of their nicotine addiction, many smokers find it difficult 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.

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

   The United States' Centers for Disease Control and Prevention describes
   tobacco use as "the single most important preventable risk to human
   health in developed countries and an important cause of premature death
   worldwide". Twenty-four percent of pregnant women in Indiana smoke
   cigarettes. If they didn’t smoke, it is estimated by one source that
   Indiana would reduce its infant mortality rate (12th highest in the
   country) by 9%. 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 carcinogenity of tobacco smoke is not explained by nicotine, which
   is not carcinogenic or mutagenic. Rather, any partially burnt material,
   tobacco or not, contains polycyclic aromatic hydrocarbons, particularly
   benzopyrene. The mechanism of their carcinogenity is well-known:
   oxidation produces an epoxide, which binds to DNA covalently and
   permanently distorts it. DNA damage is the cause of cancer.
   The incidence of lung cancer is highly correlated with smoking.
   Enlarge
   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. A year after quitting, the risk of contracting disease is
   half that of a smoker.

   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. This, however, is only
   partly true. According to the Imperial College London, "Nicotine seems
   to provide both a stimulant and a depressant effect, and it is likely
   that the effect it has at any time is determined by the mood of the
   user, the environment and the circumstances of use. Studies have
   suggested that low doses have a depressant effect, whilst higher doses
   have stimulant effect." 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 between 40,000-45,000 Canadians per year,
   more than the total number of deaths from AIDS, traffic accidents,
   suicide, murder, fires and accidental poisoning. However, the number of
   deaths related to smoking may be exaggerated because it is difficult to
   determine whether smoking actually caused the terminal illness.

Passive smoking

   This photo illustrates smoke in a pub, a common complaint from those
   concerned with passive smoking
   Enlarge
   This photo illustrates smoke in a pub, a common complaint from those
   concerned with passive smoking

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

   It is confirmed that, in adults, secondhand smoke causes lung cancer,
   nasal sinus cancer, breast cancer in younger women, heart disease,
   heart attacks, and asthma induction. Secondhand smoke is also known to
   harm children, infants and reproductive health through acute lower
   respiratory tract illness, asthma induction and exacerbation, chronic
   respiratory symptoms, middle ear infection, lower birth weight babies,
   and Sudden Infant Death Syndrome.

   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.

Sudden infant death syndrome

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

Bodily functions and how they are affected

   Tobacco smoke contains nicotine, a stimulant. Nicotine acts as an
   inhibitor (or block), that attaches to cholinergic receptors (receptors
   for acetylcholine) in the brain that are usually used to control
   respiration, heart rate, memory, alertness, and muscle movement. As
   such all are affected by smoking. Normally, acetylcholine (a similar,
   naturally present healthy neurochemical) would attach to the receptors,
   however nicotine interferes in this natural biological process and
   attaches to the receptors instead and blocks them.

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

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

Physical & Mental addiction

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

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

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 a major depressive
   disorder at some time in their lives than among individuals who had
   never experienced major depression or among individuals with no
   psychiatric diagnosis. Another study found that the average lifetime
   daily cigarette consumption was strongly related to lifetime
   prevalence, and to prospectively assessed one year prevalence of major
   depression. People with major depression are also much less likely to
   quit due to the increased risk of experiencing mild to severe states of
   depression, including a major depressive episode. 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 that are thought to be involved in the
   biological mechanisms of depression, and the use of antidepressants as
   adjuvants to smoking-cessation treatment can enhance cessation success
   rates.

Health benefits of smoking

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

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

   Other studies, however, challenge these 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.

Smoking: Effects of the habit and industry on society

Link Between Tobacco use and use of Illicit drugs.

   Cigarettes along with alcohol and marijuana are considered a “ gateway
   drug.” A 1994 report from the Centre on Addiction and Substance Abuse
   at Columbia University states that there is a consistent relationship
   between the use of cigarettes and alcohol and the subsequent use of
   marijuana. Cigarettes, alcohol and marijuana use and the subsequent use
   of illicit drugs like cocaine is also linked, regardless of the age,
   sex, ethnicity or race of the individuals involved. Children 12 to 17
   years old who smoke are nineteen times more likely to use cocaine. The
   1994 report also found that the younger children are when they use
   these gateway drugs and the more often they use them, the more likely
   they are to use cocaine, heroin, hallucinogens and other illicit drugs.
   The report concludes that the data is already robust enough to make a
   strong case to step up efforts to prevent childhood use of cigarettes,
   alcohol and marijuana and to take firm steps to reduce children’s
   access to these gateway drugs.

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

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.

   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 believed by many 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".

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

   The actual effectivness of tobacco advertisement is widely debated.
   According to an opinion piece 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 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
   behaviour 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.

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 and television

   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 behaviour. 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.

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

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, Lord of the Rings' Gandalf, or the news broadcaster
   Edward R. Murrow's cigarette. Writers in particular seemed to be known
   for smoking; see, for example, Cornell Professor Richard Klein's book
   Cigarettes are Sublime for the analysis, by this professor of French
   literature, of the role smoking plays in 19th and 20th century letters.
   British Prime Minister Harold Wilson was well known for smoking a pipe
   in public as was Winston Churchill for his cigars. Sherlock Holmes, the
   fictional detective created by Sir Arthur Conan Doyle also smoked a
   pipe.

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, while the other half were a function
   of the environment.

Opinions of society 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 Anishinaabe word for tobacco, was grown for
   ceremonial use and considered the ultimate sacred plant since its smoke
   was believed to carry prayers to the heavens. 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 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, an anti-smoking advocate.
   Enlarge
   The Jewish leader Rabbi Yisrael Meir Kagan, an anti-smoking advocate.

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

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

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 (a smoker) 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 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.

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.

   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.

Legal issues and regulation

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

Sale to minors

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

Taxation

   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
   Enlarge
   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 consumption of cigarettes. Money collected from the
   cigarette taxes are frequently used to pay for tobacco use prevention
   programs, therefore making it a method of internalizing external costs.

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

   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.

   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 $2.46 per pack. In Alabama,
   Illinois, Missouri, New York City, Tennessee, and Virginia, counties
   and cities may impose an additional limited tax on a price of
   cigarettes.

   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 increase in 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

   The health warnings on a British cigarette pack
   Enlarge
   The health warnings on a British cigarette pack

   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.

   Currently in Australia, new package warnings are in place on labels.
   These warnings depict images of the affects of smoking (Gangrene,
   Children in hospital from passive smoking and browned teeth). Since
   then, the number of smokers have nearly cut down by one quarter.

Smoking bans

   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 and Wales from 02 April 2007, and England from summer 2007). In
   the United States, many states prohibit smoking in restaurants, and
   some also prohibit smoking in bars. In New Zealand and Australia
   smoking is banned in all public places, including bars and restaurants.

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

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