Tobacco smoking

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Tobacco smoking is the practice where tobacco is burned and the vapors either tasted or inhaled.
The practice began as early as 5000–3000 BC.[1] Many civilizations burnt incense during
religious rituals, which was later adopted for pleasure or as a social tool.[2] Tobacco was
introduced to Eurasia in the late 16th century where it followed common trade routes. The
substance was met with frequent criticism, but became popular nonetheless.[3][4]

German scientists formally identified the link between smoking and lung cancer in the late 1920s
leading the first anti-smoking campaign in modern history. The movement failed to reach across
enemy lines during the Second World War, and quickly became unpopular thereafter.[5] In 1950,
health authorities again began to suggest a relationship between smoking and cancer.[6] Scientific
evidence mounted in the 1980s, which prompted political action against the practice. Rates of
consumption from 1965 onward in the developed world have either peaked or declined.[7]
However, they continue to climb in the developing world.[8]

Smoking is the most common method of consuming tobacco, and tobacco is the most common
substance smoked. The agricultural product is often mixed with other additives[9] and then
pyrolyzed. The resulting vapors are then inhaled and the active substances absorbed through the
alveoli in the lungs.[10] The active substances trigger chemical reactions in nerve endings which
heightens heart rate, memory, alertness,[11] and reaction time.[12] Dopamine and later endorphins
are released, which are often associated with pleasure.[13] As of 2000, smoking is practiced by
some 1.22 billion people. Men are more likely to smoke than women,[14] though the gender gap
declines with younger age.[15][16]

Many smokers begin during adolescence or early adulthood. Usually during the early stages,
smoking provides pleasurable sensations, serving 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 to continue.

Contents
[hide]

 1 History
o 1.1 Early use
o 1.2 Popularization
o 1.3 Social stigma
 2 Consumption
o 2.1 Methods
o 2.2 Physiology
o 2.3 Demographics
 3 Psychology
o 3.1 Takeup
o 3.2 Persistence
o 3.3 Patterns
 4 Impact
o 4.1 Economic
o 4.2 Health
o 4.3 Social
 5 Public policy
o 5.1 Taxation
o 5.2 Restrictions
o 5.3 Product safety
 6 Gateway drug theory
 7 Cessation
 8 See also
  9 References
 10 Bibliography
 11 External links

[edit] History
Main articles: History of tobacco and History of smoking

[edit] Early use

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

Smoking's history dates back to as early as 5000–3000 BC when the agricultural product began
to be cultivated in South America; consumption later evolved into burning the plant substance
either by accident or with intent of exploring other means of consumption.[1] The practice worked
its way into shamanistic rituals.[17][page  needed] Many ancient civilizations, such as the Babylonians,
Indians and Chinese, burnt incense as a part of religious rituals, as did the Israelites and the later
Catholic and Orthodox Christian churches. Smoking in the Americas probably had its origins in
the incense-burning ceremonies of shamans but was later adopted for pleasure or as a social tool.
[2]
The smoking of tobacco and various hallucinogenic drugs was used to achieve trances and to
come into contact with the spirit world.

Eastern North American tribes would carry large amounts of tobacco in pouches as a readily
accepted trade item and would often smoke it in pipes, either in defined ceremonies that were
considered sacred, or to seal a bargain,[18] and they would smoke it at such occasions in all stages
of life, even in childhood.[19][page  needed] It was believed that tobacco was a gift from the Creator and
that the exhaled tobacco smoke was capable of carrying one's thoughts and prayers to heaven.[20]

Apart from smoking, tobacco had a number of uses as medicine. As a pain killer it was used for
earache and toothache and occasionally as a poultice. Smoking was said by the desert Indians to
be a cure for colds, especially if the tobacco was mixed with the leaves of the small Desert Sage,
Salvia Dorrii, or the root of Indian Balsam or Cough Root, Leptotaenia multifida, the addition of
which was thought to be particularly good for asthma and tuberculosis.[21]

[edit] Popularization

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

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

In 1612, six years after the settlement of Jamestown, John Rolfe was credited as the first settler
to successfully raise tobacco as a cash crop. The demand quickly grew as tobacco, referred to as
"brown gold", reviving the Virginia join stock company from its failed gold expeditions.[22] In
order to meet demands from the Old World, tobacco was grown in succession, quickly depleting
the soil. This became a motivator to settle west into the unknown continent, and likewise an
expansion of tobacco production.[23] Indentured servitude became the primary labor force up until
Bacon's Rebellion, from which the focus turned to slavery.[24] This trend abated following the
American revolution as slavery became regarded as unprofitable. However, the practice was
revived in 1794 with the invention of the cotton gin.[25][page  needed]

Frenchman Jean Nicot (from whose name the word nicotine is derived) introduced tobacco to
France in 1560, and tobacco then spread to England. The first report of a smoking Englishman is
of a sailor in Bristol in 1556, seen "emitting smoke from his nostrils".[3] Like tea, coffee and
opium, tobacco was just one of many intoxicants that was originally used as a form of medicine.
[26]
Tobacco was introduced around 1600 by French merchants in what today is modern-day
Gambia and Senegal. At the same time caravans from Morocco brought tobacco to the areas
around Timbuktu and the Portuguese brought the commodity (and the plant) to southern Africa,
establishing the popularity of tobacco throughout all of Africa by the 1650s.

Soon after its introduction to the Old World, tobacco came under frequent criticism from state
and religious leaders. Murad IV, sultan of the Ottoman Empire 1623-40 was among the first to
attempt a smoking ban by claiming it was a threat to public moral and health. The Chinese
emperor Chongzhen issued an edict banning smoking two years before his death and the
overthrow of the Ming dynasty. Later, the Manchu of the Qing dynasty, who were originally a
tribe of nomadic horse warriors, would proclaim smoking "a more heinous crime than that even
of neglecting archery". In Edo period Japan, some of the earliest tobacco plantations were
scorned by the shogunate as being a threat to the military economy by letting valuable farmland
go to waste for the use of a recreational drug instead of being used to plant food crops.[27]

Bonsack's cigarette rolling machine, as shown on U.S. patent 238,640.

Religious leaders have often been prominent among those who considered smoking immoral or
outright blasphemous. In 1634 the Patriarch of Moscow forbade the sale of tobacco and
sentenced men and women who flouted the ban to have their nostrils slit and their backs whipped
until skin came off their backs. The Western church leader Urban VII likewise condemned
smoking in a papal bull of 1642. Despite many concerted efforts, restrictions and bans were
almost universally ignored. When James I of England, a staunch anti-smoker and the author of a
A Counterblaste to Tobacco, tried to curb the new trend by enforcing a 4000% tax increase on
tobacco in 1604, it proved a failure, as London had some 7,000 tobacco sellers by the early 17th
century. Later, scrupulous rulers would realise the futility of smoking bans and instead turned
tobacco trade and cultivation into lucrative government monopolies.[28][29]

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

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

[edit] Social stigma

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

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

In Germany, anti-smoking groups, often associated with anti-liquor groups,[31] first published
advocacy against the consumption of tobacco in the journal Der Tabakgegner (The Tobacco
Opponent) in 1912 and 1932. In 1929, Fritz Lickint of Dresden, Germany, published a paper
containing formal statistical evidence of a lung cancer–tobacco link. During the Great depression
Adolf Hitler condemned his earlier smoking habit as a waste of money,[32] and later with stronger
assertions. This movement was further strengthened with Nazi reproductive policy as women
who smoked were viewed as unsuitable to be wives and mothers in a German family.[33]

The anti-tobacco movement in Nazi Germany did not reach across enemy lines during the
Second World War, as anti-smoking groups quickly lost popular support. By the end of the
Second World War, American cigarette manufacturers quickly reentered the German black
market. Illegal smuggling of tobacco became prevalent,[34] and leaders of the Nazi anti-smoking
campaign were silenced.[35] As part of the Marshall Plan, the United States shipped free tobacco
to Germany; with 24,000 tons in 1948 and 69,000 tons in 1949.[34] Per capita yearly cigarette
consumption in post-war Germany steadily rose from 460 in 1950 to 1,523 in 1963.[5] By the end
of the 20th century, anti-smoking campaigns in Germany were unable to exceed the effectiveness
of the Nazi-era climax in the years 1939–41 and German tobacco health research was described
by Robert N. Proctor as "muted".[5]
A lengthy study conducted in order to establish the strong association necessary for legislative
action.

Richard Doll in 1950 published research in the British Medical Journal showing a close link
between smoking and lung cancer.[36] Four years later, in 1954 the British Doctors Study, a study
of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which the
government issued advice that smoking and lung cancer rates were related.[6] In 1964 the United
States Surgeon General's Report on Smoking and Health likewise began suggesting the
relationship between smoking and cancer.

As scientific evidence mounted in the 1980s, tobacco companies claimed contributory

negligence as the adverse health effects were previously unknown or lacked substantial
credibility. Health authorities sided with these claims up until 1998, from which they reversed
their position. The Tobacco Master Settlement Agreement, originally between the four largest
US tobacco companies and the Attorneys General of 46 states, restricted certain types of tobacco
advertisement and required payments for health compensation; which later amounted to the
largest civil settlement in United States history.[37]

From 1965 to 2006, rates of smoking in the United States declined from 42% to 20.8%.[7] The
majority of those who quit were professional, affluent men. Although the per-capita number of
smokers decreased, the average number of cigarettes consumed per person per day increased
from 22 in 1954 to 30 in 1978. This paradoxical event suggests that those who quit smoked less,
while those who continued to smoke moved to smoke more light cigarettes.[38] The trend has
been paralleled by many industrialized nations as rates have either leveled-off or declined. In the
developing world, however, tobacco consumption continues to rise at 3.4% in 2002.[8] In Africa,
smoking is in most areas considered to be modern, and many of the strong adverse opinions that
prevail in the West receive much less attention.[39] Today Russia leads as the top consumer of
tobacco followed by Indonesia, Laos, Ukraine, Belarus, Greece, Jordan, and China.[40]

[edit] Consumption
[edit] Methods

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

Tobacco is an agricultural product processed from the fresh leaves of plants in the genus
Nicotiana. The genus contains a number of species, however, Nicotiana tabacum is the
commonly grown. Nicotiana rustica follows as second containing higher concentrations of
nicotine. These leaves are harvested and cured to allow for the slow oxidation and degradation of
carotenoids in tobacco leaf. This produces certain compounds in the tobacco leaves which can be
attributed to sweet hay, tea, rose oil, or fruity aromatic flavors. Before packaging, the tobacco is
often combined with other additives in order to: enhance the addictive potency, shift the products
pH, or improve the effects of smoke by making it more palatable. In the United States these
additives are regulated to 599 substances.[9] The product is then processed, packaged, and
shipped to consumer markets. Means of consumption has greatly expanded in scope as new
methods of delivering the active substances with fewer by-products have encompassed or are
beginning to encompass:

Tobacco field in Intercourse, Pennsylvania.

Basma leaves curing in the sun at Pomak village of Xanthi, Thrace, Greece.

Processed tobacco pressed into long strips for shipping.

Beedi 
Bidis smoke produce higher levels of carbon monoxide, nicotine, and tar than cigarettes
typical in the United States.[41][42]
Cigars 
Cigars are tightly rolled bundles of dried and fermented tobacco which are ignited so that
smoke may be drawn into the smoker's mouth. They are generally not inhaled because the
high alkalinity of the smoke, which can quickly become irritating to the trachea and
lungs. The prevalence of cigar smoking varies depending on location, historical period,
and population surveyed, and prevalence estimates vary somewhat depending on the
survey method. The United States is the top consuming country by far, followed by
 Germany and the United Kingdom; the US and Western Europe account for about 75% of
cigar sales worldwide.[43] As of 2005 it is estimated that 4.3% of men and 0.3% of women
smoke cigars.[44]
Cigarettes 
Cigarettes, French for "small cigar", are a product consumed through smoking and
manufactured out of cured and finely cut tobacco leaves and reconstituted tobacco, often
combined with other additives, which are then rolled or stuffed into a paper-wrapped
cylinder.[9] Cigarettes are ignited and inhaled, usually through a cellulose acetate filter,
into the mouth and lungs.
Electronic cigarette 
Electronic cigarettes is an alternative to tobacco smoking, although no tobacco is
consumed. It is a battery-powered device that provides inhaled doses of nicotine by
delivering a vaporized propylene glycol/nicotine solution. Many legislation and public
health investigations are currently pending in many countries due to its relatively recent
emergence.
Hookah 
Hookah are a single or multi-stemmed (often glass-based) water pipe for smoking.
Originally from India, the hookah has gained immense popularity, especially in the
Middle East. A hookah operates by water filtration and indirect heat. It can be used for
smoking herbal fruits, tobacco, or cannabis.
Kreteks 
Kreteks are cigarettes made with a complex blend of tobacco, cloves and a flavoring
"sauce". It was first introduced in the 1880s in Kudus, Java, to deliver the medicinal
eugenol of cloves to the lungs. The quality and variety of tobacco play an important role
in kretek production, from which kreteks can contain more than 30 types of tobacco.
Minced dried clove buds weighing about 1/3 of the tobacco blend are added to add
flavoring. In 2004 the United States prohibited cigarettes from having a "characterizing
flavor" of certain ingredients other than tobacco and menthol, thereby removing Kreteks
from being classified as cigarettes.[45]
Passive smoking 
Passive smoking is the involuntary consumption of smoked tobacco. Second-hand smoke
(SHS) is the consumption where the burning end is present, environmental tobacco
smoke (ETS) or third-hand smoke is the consumption of the smoke that remains after the
burning end has been extinguished. Because of its negative implications, this form of
consumption has played a central role in the regulation of tobacco products.
Pipe smoking 
Pipe smoking typically consists of a small chamber (the bowl) for the combustion of the
tobacco to be smoked and a thin stem (shank) that ends in a mouthpiece (the bit).
Shredded pieces of tobacco are placed into the chamber and ignited. Tobaccos for
smoking in pipes are often carefully treated and blended to achieve flavour nuances not
available in other tobacco products.
Roll-Your-Own 
Roll-Your-Own or hand-rolled cigarettes, often called 'rollies', are very popular
particularly in European countries. These are prepared from loose tobacco, cigarette
papers and filters all bought separately. They are usually much cheaper to make.
Vaporizer 
 A vaporizer is a device used to sublimate the active ingredients of plant material. Rather
than burning the herb, which produces potentially irritating, toxic, or carcinogenic by-
products; a vaporizer heats the material in a partial vacuum so that the active compounds
contained in the plant boil off into a vapor. Medical administration of a smoke substance
often prefer this method as to directly pyrolyzing the plant material.

[edit] Physiology

See also: Chain smoking

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

The active substances in tobacco, especially cigarettes, is administered by burning the leaves and
inhaling the vaporized gas that results. This quickly and effectively delivers substances into the
bloodstream by absorption through the alveoli in the lungs. The lungs contain some 300 million
alveoli, which amounts to a surface area of over 70 m2 (about the size of a tennis court). This
method is inefficient as not all of the smoke will be inhaled, and some amount of the active
substances will be lost in the process of combustion, pyrolysis.[10] Pipe and Cigar smoke are not
inhaled because of its high alkalinity, which are irritating to the trachea and lungs. However,
because of its higher alkalinity (pH 8.5) compared to cigarette smoke (pH 5.3), unionized
nicotine is more readily absorbed through the mucous membranes in the mouth.[46] Nicotine
absorption from cigar and pipe, however, is much less than that from cigarette smoke.[47]

The inhaled substances trigger chemical reactions in nerve endings. The cholinergic receptors are
often triggered by the naturally occurring neurotransmitter acetylcholine. Acetylcholine and
Nicotine express chemical similarities, which allows Nicotine to trigger the receptor as well.[48]
These nicotinic acetylcholine receptors takes are located in the central nervous system and at the
nerve-muscle junction of skeletal muscles; whose activity increases heart rate, alertness,[11] and
faster reaction times.[12] Nicotine acetylcholine stimulation is not directly addictive. However,
since dopamine-releasing neurons are abundant on nicotine receptors, dopamine is released.[49]
This release of dopamine, which is associated with pleasure, is reinforcing and may also increase
working memory.[13][50] Nicotine and cocaine activate similar patterns of neurons, which supports
the idea that common substrates among these drugs.[51]

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. There is also a
formation of harmane (a MAO inhibitor) from the acetaldehyde in tobacco smoke. This seems to
play an important role in nicotine addiction—probably by facilitating a dopamine release in the
nucleus accumbens as a response to nicotine stimuli.[52] Using rat studies, withdrawal after
repeated exposure to nicotine results in less responsive nucleus accumbens cells, which produce
dopamine responsible for reinforcement.[53]

[edit] Demographics

Main article: Prevalence of tobacco consumption

Percentage of females smoking any tobacco product

Percentage of males smoking any tobacco product. Note that there is a difference between the
scales used for females and the scales used for males.[40]

As of 2000, smoking is practiced by 1.22 billion people. Assuming no change in prevalence it is

predicted that 1.45 billion people will smoke in 2010 and 1.5 to 1.9 billion in 2025. Assuming
that prevalence will decrease at 1% a year and that there will be a modest increase of income of
2%, it is predicted the number of smokers will stand at 1.3 billion in 2010 and 2025.[14]

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

As of 2002, about twenty percent of young teens (13–15) smoke worldwide. From which 80,000
to 100,000 children begin smoking every day—roughly half of which live in Asia. Half of those
who begin smoking in adolescent years are projected to go on to smoke for 15 to 20 years.[8]

The World Health Organization (WHO) states that "Much of the disease burden and premature
mortality attributable to tobacco use disproportionately affect the poor". Of the 1.22 billion
smokers, 1 billion of them live in developing or transitional economies. Rates of smoking have
leveled off or declined in the developed world.[55] In the developing world, however, tobacco
consumption is rising by 3.4% per year as of 2002.[8]

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

Sigmund Freud, whose doctor assisted his suicide because of oral cancer caused by smoking[59]

Most 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, attempts by parents, schools, and health professionals at preventing people from trying
cigarettes are unsuccessful.[60][61]

Children of smoking parents are more likely to smoke than children with non-smoking parents.
One study found that parental smoking cessation was associated with less adolescent smoking,
except when the other parent currently smoked.[62] A current study tested the relation 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.[63]

Many anti-smoking organizations claim that teenagers begin their smoking habits due to peer
pressure, and cultural influence portrayed by friends. 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.[64]
A similar study showed that individuals play a more active role in starting to smoke than has
previously been acknowledged and that social processes other than peer pressure need to be
taken into account.[65] Another study's results revealed that peer pressure was significantly
associated with smoking behavior across all age and gender cohorts, but that intrapersonal
factors were significantly more important to the smoking behavior of 12–13 year-old girls than
same-age boys. Within the 14–15 year-old age group, one peer pressure variable emerged as a
significantly more important predictor of girls' than boys' smoking.[66] It is debated whether peer
pressure or self-selection is a greater cause of adolescent smoking.
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.[67] 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.

[edit] Persistence

Because they are engaging in an activity that has negative effects on health, people who smoke
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.

The reasons given by smokers for this activity are broadly categorized as addictive smoking,
pleasure from smoking, tension reduction/relaxation, social smoking, stimulation,
habit/automatism, and handling. There are gender differences in how much each of these reasons
contribute, with females more likely than males to cite tension reduction/relaxation, stimulation
and social smoking.[68]

Some smokers argue that the depressant effect of smoking allows them to calm their nerves,
often allowing for increased concentration. However, according to the Imperial College London,
"Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the 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, while higher doses have
stimulant effect."[69]

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

[edit] Patterns

A number of studies have established that cigarette sales and smoking follow distinct time-
related patterns. For example, cigarette sales in the United States of America have been shown to
follow a strongly seasonal pattern, with the high months being the months of summer, and the
low months being the winter months.[70]

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

[edit] Impact
[edit] Economic

See also: Tobacco industry

In countries where there is a public health system, society covers the cost of medical care for
smokers who become ill through in the form of increased taxes. Two arguments exist on this
front, the "pro-smoking" argument suggesting that heavy smokers generally don't live long
enough to develop the costly and chronic illnesses which affect the elderly, reducing society's
healthcare burden. The "anti-smoking" argument suggests that the healthcare burden is increased
because smokers get chronic illnesses younger and at a higher rate than the general population.

Data on both positions is limited. The Centers for Disease Control and Prevention published
research in 2002 claiming that the cost of each pack of cigarettes sold in the United States was
more than $7 in medical care and lost productivity.[72] The cost may be higher, with another study
putting it as high as $41 per pack, most of which however is on the individual and his/her family.
[73]
This is how one author of that study puts it when he explains the very low cost for others:
"The reason the number is low is that for private pensions, Social Security, and Medicare — the
biggest factors in calculating costs to society — smoking actually saves money. Smokers die at a
younger age and don't draw on the funds they've paid into those systems."[73]

By contrast, some non-scientific studies, including one conducted by Philip Morris in the Czech
Republic[74] and another by the Cato Institute,[75] support the opposite position. Philip Morris has
explicitly apologised for the former study, saying: "The funding and public release of this study
which, among other things, detailed purported cost savings to the Czech Republic due to
premature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptable
disregard of basic human values. For one of our tobacco companies to commission this study
was not just a terrible mistake, it was wrong. All of us at Philip Morris, no matter where we
work, are extremely sorry for this. No one benefits from the very real, serious and significant
diseases caused by smoking."[74]

Between 1970 an 1995, per-capita cigarette consumption in poorer developing countries

increased by 67 percent, while it dropped by 10 percent in the richer developed world. Eighty
percent of smokers now live in less developed countries. By 2030, the World Health
Organization (WHO) forecasts that 10 million people a year will die of smoking-related illness,
making it the single biggest cause of death worldwide, with the largest increase to be among
women. WHO forecasts' the 21st century's death rate from smoking to be ten times the 20th
century's rate. ("Washingtonian" magazine, December 2007).

[edit] Health

Main article: Health effects of tobacco

Common adverse effects of tobacco smoking. The more common effects are in bold face.[76]

Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being
a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD),
emphysema, and cancer (particularly lung cancer, cancers of the larynx and mouth, and
pancreatic cancer). Cigarette smoking increases the risk of Crohn's disease as well as the severity
of the course of the disease. [77] It is also the number one cause of bladder cancer.

The World Health Organization estimate that tobacco caused 5.4 million deaths in 2004[78] and
100 million deaths over the course of the 20th century.[79] Similarly, 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."[80]

Rates of smoking have leveled off or declined in the developed world. Smoking rates in the
United States have dropped by half from 1965 to 2006 falling from 42% to 20.8% in adults.[81] In
the developing world, tobacco consumption is rising by 3.4% per year.[82]

[edit] Social

See also: Tobacco advertising and Religious views on smoking

Famous smokers of the past used cigarettes or pipes as part of their image, such as Jean Paul
Sartre's Gauloise-brand cigarettes; Albert Einstein's, Kiana Lee Rosch's, Douglas MacArthur's,
Bertrand Russell's, and Bing Crosby's pipes; 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. The popular author
Kurt Vonnegut addressed his addiction to cigarettes within his novels. 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 smoked a
pipe, cigarettes, and cigars, besides injecting himself with cocaine, "to keep his overactive brain
occupied during the dull London days, when nothing happened". The DC Vertigo comic book
character, John Constantine, created by Alan Moore, is synonymous with smoking, so much so
that the first storyline by Preacher creator, Garth Ennis, centered around John Constantine
contracting lung cancer. Professional wrestler James Fullington, while in character as "The
Sandman", is a chronic smoker in order to appear "tough".

The ceremonial smoking of tobacco, and praying with a sacred pipe, is a prominent part of the
religious ceremonies of a number of Native American Nations. Sema, the Anishinaabe word for
tobacco, is grown for ceremonial use and considered the ultimate sacred plant since its smoke
was believed to carry prayers to the heavens. In most major religions, however, tobacco smoking
is not specifically prohibited, although it may be discouraged as an immoral habit. Before the
health risks of smoking were identified through controlled study, smoking was considered an
immoral habit by certain Christian preachers and social reformers. The founder of the Latter Day
Saint movement, Joseph Smith, Jr, recorded that on February 27, 1833, he received a revelation
which discouraged tobacco use. This "Word of Wisdom" was later accepted as a commandment,
and faithful Latter-day Saints abstain completely from tobacco.[83] Jehovah's Witnesses base their
stand against smoking on the Bible's command to "clean ourselves of every defilement of flesh"
(2 Corinthians 7:1). The Jewish Rabbi Yisrael Meir Kagan (1838–1933) was one of the first
Jewish authorities to speak out on smoking. In the Bahá'í Faith, smoking tobacco is discouraged
though not forbidden.[84