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{{short description|Practice of burning tobacco and breathing the resulting smoke}}
{{Use dmy dates|date=April 2021}}
[[File:Surgeon General's warning cigarettes.jpg|thumb|Cigarettes and package with health warning]]
{{Tobacco}}
{{Smoking|expanded=tobacco}}
'''Tobacco smoking''' is the practice of burning [[tobacco]] and ingesting the resulting [[tobacco smoke|smoke]]. The smoke may be inhaled, as is done with [[cigarette]]s, or released from the mouth, as is generally done with [[Tobacco pipe|pipe]]s and [[cigar]]s. The practice is believed to have begun as early as 5000–3000 BC in [[Mesoamerica]] and [[South America]].<ref name="Gateley2004"/> Tobacco was introduced to [[Eurasia]] in the late 17th century by [[European colonisation of the Americas|European colonists]], where it followed common trade routes. The practice encountered criticism from its first import into the [[Western world]] onward but embedded itself in certain strata of several societies before becoming widespread upon the introduction of automated cigarette-rolling apparatus.<ref name="L&M"/><ref>{{Cite book|author1=West, Robert |author2=Shiffman, Saul|title=Fast Facts: Smoking Cessation|publisher=Health Press Ltd.|year=2007|isbn=978-1-903734-98-8|page=28}}</ref>
Smoking is the most common method of consuming tobacco, and tobacco is the most common substance smoked. The agricultural product is often mixed with additives<ref name ="WHOJeffreyWigand"/> and then combusted. The resulting smoke, which contains various active substances, the most significant of which is the addictive [[psychostimulant]] drug [[nicotine]] (a compound naturally found in tobacco), is absorbed through the [[Pulmonary alveolus|alveoli in the lungs]] or the [[oral mucosa]].<ref name="GilmanXun2004p318"/> Many substances in cigarette smoke, chiefly nicotine, [[Nicotinic agonist|trigger chemical reactions in nerve endings]], which heighten heart rate, alertness<ref name="PMID2498936"/> and reaction time, among other things.<ref name="WesnessWarburton1997"/> [[Dopamine]] and [[endorphin]]s are released, which are often associated with pleasure,<ref name="GilmanXun2004pp320-321">{{Harvnb|Gilman|Xun|2004|pp=320–321}}</ref> leading to [[addiction]].<ref>{{Cite journal |last=Benowitz |first=Neal L. |date=2009-02-01 |title=Pharmacology of Nicotine: Addiction, Smoking-Induced Disease, and Therapeutics |journal=Annual Review of Pharmacology and Toxicology |language=en |volume=49 |issue=1 |pages=57–71 |doi=10.1146/annurev.pharmtox.48.113006.094742 |pmid=18834313 |issn=0362-1642|pmc=2946180 }}</ref>
German scientists identified a link between smoking and [[lung cancer]] in the late 1920s, leading to the first [[anti-smoking campaign]] in modern history, albeit one truncated by the collapse of [[Nazi Germany]] at the end of [[World War II]].<ref name="NWC228"/> In 1950, British researchers demonstrated a clear relationship between smoking and cancer.<ref name="RichardHillyBMJ1954"/> Evidence continued to mount in the 1960s, which prompted political action against the practice. Rates of consumption since 1965 in the [[developed world]] have either peaked or declined.<ref name="RockEtAlCDC2006"/> However, they continue to climb in the developing world.<ref name="WHO2002FactSheet"/> As of 2008 to 2010, tobacco is used by about 49% of men and 11% of women aged 15 or older in fourteen low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam), with about 80% of this usage in the form of smoking.<ref>{{cite journal|last=Giovino|first=GA|author2=Mirza, SA; Samet, JM; Gupta, PC; Jarvis, MJ; Bhala, N; Peto, R; Zatonski, W; Hsia, J; Morton, J; Palipudi, KM; Asma, S; GATS Collaborative, Group|title=Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys.|journal=Lancet|date=18 August 2012|volume=380|issue=9842|pages =668–79|pmid=22901888|doi=10.1016/S0140-6736(12)61085-X|s2cid=12450625| issn = 0140-6736 }}</ref> The gender gap tends to be less pronounced in lower age groups.<ref name="WomenTobaccoChallenges5-6"/><ref name="2001SurgeonGeneralWomen47" /> According to the [[World Health Organization]], 8 million annual deaths are caused by tobacco smoking.<ref name="Tobacco">{{Cite web |title=Tobacco |url=https://www.who.int/news-room/fact-sheets/detail/tobacco |access-date=2024-02-24 |website=www.who.int |language=en}}</ref>
Many smokers begin during adolescence or early adulthood.<ref name=":0">{{Cite journal|last1=Chandrupatla|first1=Siddardha G.|last2=Tavares|first2=Mary|last3=Natto|first3=Zuhair S.|date=27 July 2017|title=Tobacco Use and Effects of Professional Advice on Smoking Cessation among Youth in India|journal=Asian Pacific Journal of Cancer Prevention|volume=18|issue=7|pages=1861–1867|doi=10.22034/APJCP.2017.18.7.1861|issn=2476-762X|pmid=28749122|pmc=5648391}}</ref> A 2009 study of first smoking experiences of seventh-grade students found out that the most common factor leading students to smoke is cigarette advertisements. Smoking by parents, siblings, and friends also encourages students to smoke.<ref name="The Lancet">{{cite journal|title=Tobacco smoking: why start?|journal=The Lancet|date=26 September 2009|volume=374|issue=9695|pages=1038|doi=10.1016/s0140-6736(09)61680-9|pmid=19782852|last1=The Lancet|s2cid=37513171}}</ref> During the early stages, a combination of perceived pleasure acting as [[positive reinforcement]] and desire to respond to social peer pressure may offset the unpleasant symptoms of initial use, which typically include nausea and coughing. After an individual has smoked for some years, the avoidance of [[nicotine withdrawal]] symptoms and [[negative reinforcement]] become the key motivations to continue.
==History==
{{Main|History of tobacco|History of smoking}}
===Use in ancient cultures===
[[File:Aztec feast 1.jpg|thumb|Aztec women are handed flowers and smoking tubes before eating at a banquet, [[Florentine Codex]], 16th century.]]
One archeological find raises the possibility of tobacco-smoking in the area of present-day Nevada about 12,000 years ago.<ref>
{{cite news
|last1 = Nuwer
|first1 = Rachel
|author-link1 = Rachel Nuwer
|editor-last1 = Stix
|editor-first1 = Gary
|editor-link1 = Gary Stix
|title = Mammoths Roamed when Humans Started Using Tobacco at Least 12,300 Years Ago
|url = https://www.scientificamerican.com/article/mammoths-roamed-when-humans-started-using-tobacco-at-least-12-300-years-ago/
|work = Scientific American
|publisher = Springer Nature
|publication-date = 11 October 2021
|access-date = 16 February 2025
|quote = [...] researchers [...] identified the charred remnants of four tobacco seeds. Radiocarbon dating of willow wood charcoal also recovered from the hearth revealed that the entire contents, including the seeds, were approximately 12,300 years old. [...] [Daron] Duke and his colleagues do not know in what manner the tobacco was used, but they believe it could have been smoked or put behind the lip and sucked.
}}
</ref>
Systematic tobacco use dates back to as early as 5000–3000 BC when the agricultural product began to be cultivated in Mesoamerica and South America; consumption later came to involve burning the plant substance, either by accident or with the intent of exploring other means of consumption.<ref name="Gateley2004">{{Cite book |last=Gately |first=Iain |title=Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization |url=https://books.google.com/books?id=x41jVocj05EC |access-date=22 March 2009 |orig-year=2003 |year=2004 |publisher=Diane |isbn=978-0-8021-3960-3 |pages=3–7 |archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114080723/https://books.google.com/books?id=x41jVocj05EC |url-status=live}}</ref> The practice worked its way into [[shamanism | shamanistic]] rituals.<ref name="Wilbert1993">{{Cite book |last=Wilbert |first=Johannes |title=Tobacco and Shamanism in South America |url=https://books.google.com/books?id=qPCuo4LkrIwC |access-date=22 March 2009 |date=28 July 1993 |publisher=Yale University Press |isbn=978-0-300-05790-4|archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114080724/https://books.google.com/books?id=qPCuo4LkrIwC |url-status=live}}</ref> Many ancient civilizations – such as the [[Babylonians]], the Indians, and the Chinese – burned incense during religious rituals. Smoking in the Americas probably had its origins in the incense-burning ceremonies of [[shamanism|shamans]] but was later adopted for pleasure or as a social tool.<ref name="Robicsek1979">{{Cite book|last=Robicsek|first= Francis|title=The Smoking Gods: Tobacco in Maya Art, History, and Religion| date=January 1979 |publisher=University of Oklahoma Press|isbn=978-0-8061-1511-5|page=30}}</ref> The smoking of tobacco and various hallucinogenic drugs was used to achieve trances and to come into contact with the spirit world.<ref name=Hallucinogenic_pre-Columbian>{{cite journal |title=Hallucinogenic drugs in pre-Columbian Mesoamerican cultures |volume=30 |issue=1 |pages=42–49 |author=F.J.Carod-Artal |date=1 July 2011 |journal=Neurología |doi=10.1016/j.nrleng.2011.07.010 |pmid=21893367 |doi-access=free }}</ref> Also, to stimulate respiration, [[tobacco smoke enema | tobacco-smoke enema]]s were used.<ref>{{Citation |doi = 10.2307/2843888 |last = Nordenskiold |first = Erland |title = The American Indian as an Inventor |jstor = 2843888 |journal = Journal of the Royal Anthropological Institute |volume = 59 |page=277 |year = 1929}}</ref>
Eastern North American tribes would carry large amounts of tobacco in pouches as a readily accepted trade item and would often smoke it in [[ceremonial pipe]]s, either in sacred ceremonies or to seal bargains.<ref>{{Cite book |first1=John Gottlieb Ernestus |last1=Heckewelder |author-link1=John Heckewelder |first2=William Cornelius |last2=Reichel |author-link2=William Cornelius Reichel |title=History, manners, and customs of the Indian nations who once inhabited Pennsylvania and the neighboring states |url=https://books.google.com/books?id=qPCuo4LkrIwC |format=PDF |access-date=22 March 2009 |orig-year=1876 |date=June 1971 |publisher=The Historical Society of Pennsylvania |isbn=978-0-405-02853-3 |page=149 |archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114080724/https://books.google.com/books?id=qPCuo4LkrIwC |url-status=live}}</ref> Adults as well as children enjoyed the practice.<ref>{{Cite book |last1=Diéreville |first2=John Clarence |last2=Webster |first3=Alice de Kessler Lusk|last3=Webster | url = https://books.google.com/books?id=oGdNnQEACAAJ | title = Relation of the voyage to Port Royal in Acadia or New France |year=1933 |publisher=The Champlain Society |quote=They smoke with excessive eagerness […] men, women, girls and boys, all find their keenest pleasure in this way}}</ref> It was believed that tobacco was a gift from the Creator{{cn|date=February 2025}} and that the exhaled tobacco smoke was capable of carrying one's thoughts and prayers to the [[Great Spirit]].<ref>{{Cite book |last=Gottsegen|first=Jack Jacob |title=Tobacco: A Study of Its Consumption in the United States |url=https://books.google.com/books?id=1uNCAAAAIAAJ&q=Tobacco:+A+Study+of+Its+Consumption+in+the+United+States |access-date=22 March 2009|year=1940|publisher=Pitman Publishing Company|page=107|postscript=>|archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114080757/https://books.google.com/books?id=1uNCAAAAIAAJ&q=Tobacco:+A+Study+of+Its+Consumption+in+the+United+States |url-status=live | quote = Smoke also provided another means of communication to the Great Spirit.}}</ref>
Apart from smoking, tobacco was used as medicine. As a pain killer, it was used for earache and toothache and occasionally as a [[poultice]]. [[Desert Indians]] regarded smoking as a cure for colds, especially if the tobacco was mixed with the leaves of the small [[Desert sage]], ''[[Salvia dorrii]]'', or the root of [[Balsam of Peru|Indian balsam]] or [[cough root]], ''Leptotaenia multifida'', the addition of which was thought to be particularly good for [[asthma]] and [[tuberculosis]].<ref>{{Cite book |last=Balls |first=Edward K. |title=Early Uses of California Plants |url=https://archive.org/details/earlyusesofcalif00ball |url-access=registration |quote=Early Uses of California Plants. |access-date=22 March 2009 |date=1 October 1962 |publisher=University of California Press |isbn=978-0-520-00072-8 |pages=[https://archive.org/details/earlyusesofcalif00ball/page/81 81]–85}}</ref>
===Popularization===
{{For|more about the commercial development of tobacco|History of commercial tobacco in the United States}}
[[File:Gentlemen Smoking and Playing Backgammon in a Tavern, Dirck Hals 1627.png|thumb|left|upright=1.05|''Gentlemen Smoking and Playing Backgammon in a Tavern'' by [[Dirck Hals]], 1627]]
In 1612, six years after the settlement of [[Jamestown, Virginia]], [[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", revived the [[Virginia joint stock company]] from its failed gold expeditions.<ref>{{Cite journal|last=Jordan|first=Ervin L. Jr.|title=Jamestown, Virginia, 1607–1907: An Overview|url=http://curry.edschool.virginia.edu/socialstudies/projects/jvc/overview.html|access-date=22 February 2009|publisher=University of Virginia|url-status=dead|archive-url=https://web.archive.org/web/20021017223417/http://curry.edschool.virginia.edu/socialstudies/projects/jvc/overview.html|archive-date=17 October 2002}}</ref> 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.<ref>{{Cite book|last=Kulikoff|first=Allan|title=Tobacco and Slaves: The Development of Southern Cultures in the Chesapeake|url=https://archive.org/details/tobaccoslavesdev0000kuli|url-access=registration|quote=Tobacco & Slaves: The Development of Southern Cultures in the Chesapeake.|access-date=22 March 2009|date=1 August 1986|publisher=The University of North Carolina Press|isbn=978-0-8078-4224-9}}</ref>
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".<ref name="L&M"/> Like tea, coffee, and opium, tobacco was just one of many intoxicants that were originally used as a form of medicine.<ref>{{Harvnb|Gilman|Xun|2004|p=38}}</ref> 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. [[James VI and I]], King of Scotland and England, produced the treatise ''[[A Counterblaste to Tobacco]]'' in 1604, and also introduced excise duty on the product. [[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 morals and health. The [[Chongzhen Emperor]] of China issued an edict banning smoking two years before his death and the overthrow of the [[Ming dynasty]]. Later, the [[Manchu people|Manchu]] rulers of the [[Qing dynasty]] 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.<ref name="Screech-Smoke">{{Harvnb|Gilman|Xun|2004|pp=92–99}}</ref>
[[File:Bonsack machine.png|thumb|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 flayed. Pope [[Urban VIII]] likewise condemned smoking in holy places in a papal bull of 1624. Despite some concerted efforts, restrictions and bans were largely ignored. When [[James I of England]], a staunch smoking opponent and the author of ''[[A Counterblaste to Tobacco]]'', tried to curb the new trend by enforcing a 4000% tax increase on tobacco in 1604 it was unsuccessful, as suggested by the presence of around 7,000 tobacco outlets in London by the early 17th century. From this point on, for some centuries, several administrations withdrew from efforts at discouragement and instead turned the tobacco trade and cultivation into sometimes lucrative government monopolies.<ref>{{Harvnb|Gilman|Xun|2004|pp=15–16}}</ref><ref>{{Cite journal|author=King James I of England|title=A Counterblaste to Tobacco|url=http://www.laits.utexas.edu/poltheory/james/blaste/|access-date=22 March 2009|date=16 April 2002|orig-year=1604|publisher=University of Texas at Austin|archive-date=18 May 2009|archive-url=https://web.archive.org/web/20090518062807/http://www.laits.utexas.edu/poltheory/james/blaste/|url-status=live}}</ref>
By the mid-17th century, most major civilizations had been introduced to tobacco smoking and, in many cases, had already assimilated it into the native culture, despite some continued attempts on the part of rulers to eliminate the practice with penalties or fines. Tobacco, both product and plant, followed the major trade routes to major ports and markets, and then into the hinterlands. The English language term ''smoking'' appears to have entered currency in the late 18th century, before which less abbreviated descriptions of the practice such as ''drinking smoke'' were also in use.<ref name="L&M">{{Cite book|first1=John|last1=Lloyd|first2=John|last2=Mitchinson|title=The Book of General Ignorance|date=25 July 2008|publisher=Harmony Books|isbn=978-0-307-39491-0|url=https://archive.org/details/bookofgeneralign00lloy}}</ref>
Growth in the US remained stable until the American Civil War in the 1860s when the primary agricultural workforce shifted from [[slavery]] to [[sharecropping]]. This, along with a change in demand, accompanied the industrialization of cigarette production as craftsman [[James Bonsack]] created a machine in 1881 to partially automate their manufacture.<ref name="Burns134-135">{{Cite book|last=Burns|first=Eric|title=The Smoke of the Gods: A Social History of Tobacco|url=https://books.google.com/books?id=cZfqS7vi9vEC&q=The+Smoke+of+the+Gods:+A+Social+History+of+Tobacco|access-date=22 March 2009|date=28 September 2006|publisher=Temple University Press|isbn=978-1-59213-480-9|pages=134–135|archive-date=14 January 2023|archive-url=https://web.archive.org/web/20230114080727/https://books.google.com/books?id=cZfqS7vi9vEC&q=The+Smoke+of+the+Gods:+A+Social+History+of+Tobacco|url-status=live}}</ref>
===Social attitudes and public health ===
{{globalize section|date=March 2024}}
In 1912 and 1932 in Germany, anti-smoking groups, often associated with anti-liquor groups,<ref name="NWC178">{{Harvnb|Proctor|2000|p=178}}</ref> first published advocacy against the consumption of tobacco in the journal ''Der Tabakgegner'' (The Tobacco Opponent). In 1929, [[Fritz Lickint]] of Dresden, Germany, published a paper containing formal [[Statistics|statistical]] evidence of a lung cancer–tobacco link. During the [[Great Depression]], [[Adolf Hitler]] condemned his earlier smoking habit as a waste of money,<ref name="NWC219">{{Harvnb|Proctor|2000|p=219}}</ref> 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.<ref name="NWC187">{{Harvnb|Proctor|2000|p=187}}</ref> In the 20th century, smoking was common. Social events like the [[smoke night]] promoted the habit.
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,<ref name="NWC245">{{Harvnb|Proctor|2000|p=245}}</ref> and leaders of the Nazi anti-smoking campaign were silenced.<ref name="ADLNMPHP">{{cite journal |last1=Proctor |first1=Robert N. |title=Nazi Medicine and Public Health Policy |journal=Dimensions |year=1996 |volume=10 |issue=2 |url=http://www.adl.org/Braun/dim_14_1_nazi_med.asp |archive-url=https://archive.today/20121205091200/http://www.adl.org/Braun/dim_14_1_nazi_med.asp |archive-date=5 December 2012 |publisher=[[Anti-Defamation League]] |via=archived copy at [[archive.is]] |access-date=1 October 2018 |url-status=live }}</ref> 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.<ref name="NWC245"/> Per capita yearly cigarette consumption in [[History of Germany since 1945|post-war Germany]] steadily rose from 460 in 1950 to 1,523 in 1963.<ref name="NWC228">{{Harvnb|Proctor|2000|p=228}}</ref> 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".<ref name="NWC228"/>
[[File:Lung Cancer Incidece vers Cigarette Consumption.svg|thumb|A lengthy study conducted in order to establish the strong association necessary for legislative action (US cigarette consumption per person blue, male lung cancer rate brown)]]
In 1950, [[Richard Doll]] published research in the ''[[British Medical Journal]]'' showing a close link between smoking and [[lung cancer]].<ref>{{cite journal | last1 = Doll | first1 = R. | last2 = Hill | first2 = A. B. | title = Smoking and Carcinoma of the Lung | journal = British Medical Journal | volume = 2 | issue = 4682 | pages = 739–748 | date = 1 September 1950 | pmid = 14772469 | pmc = 2038856 | doi = 10.1136/bmj.2.4682.739 | issn = 0007-1447 }}</ref> Beginning in December 1952, the magazine ''[[Reader's Digest]]'' published "Cancer by the Carton", a series of articles that linked [[smoking]] with [[lung cancer]].<ref>{{Cite news |url=http://www.cnn.com/US/9705/tobacco/history/ |title=CNN Interactive |publisher=Cnn.com |access-date=22 June 2009 |archive-date=23 April 2009 |archive-url=https://web.archive.org/web/20090423205623/http://www.cnn.com/US/9705/tobacco/history/ |url-status=live }}</ref>
In 1954, the [[British Doctors Study]], a prospective study of some 40 thousand doctors for about 2.5 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related.<ref name="RichardHillyBMJ1954">{{cite journal | last1 = Doll | first1 = R. | last2 = Hill | first2 = B. | title = The mortality of doctors in relation to their smoking habits: a preliminary report: (Reprinted from Br Med J 1954:ii;1451-5) | journal = BMJ (Clinical Research Ed.) | volume = 328 | issue = 7455 | pages = 1529–1533; discussion 1533 | date = Jun 2004 | pmid = 15217868 | pmc = 437141 | doi = 10.1136/bmj.328.7455.1529 | issn = 0959-8138 }}</ref> In January 1964, the United States [[Surgeon General of the United States|Surgeon General]]'s Report on Smoking and Health likewise began suggesting the relationship between smoking and cancer.<ref>{{cite web|url= http://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/60|title= The Reports of the Surgeon General: The 1964 Report on Smoking and Health|work= Profiles in Science|publisher= [[United States National Library of Medicine]], [[National Institutes of Health]]|access-date= 10 October 2015|archive-date= 20 January 2016|archive-url= https://web.archive.org/web/20160120031958/http://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/60|url-status= dead}}</ref>
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.<ref name="WallStreetJournalTobaccoMastersSettlement">{{cite news|newspaper=[[Wall Street Journal]]|title=Forty-Six States Agree to Accept $206 Billion Tobacco Settlement|date=23 November 1998|author=Milo Geyelin}}</ref>
Social campaigns have been instituted in many places to discourage smoking, such as Canada's [[National Non-Smoking Week]].
From 1965 to 2006, rates of smoking in the United States declined from 42% to 20.8%.<ref name="RockEtAlCDC2006">{{Cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm|title=Cigarette Smoking Among Adults --- United States, 2006|access-date=1 January 2009|author=VJ Rock, MPH, A Malarcher, JW Kahende, K Asman, MSPH, C Husten, MD, R Caraballo|date=9 November 2007|publisher=United States Centers for Disease Control and Prevention|quote=In 2006, an estimated 20.8% (45.3 million) of U.S. adults[...]|archive-date=16 August 2019|archive-url=https://web.archive.org/web/20190816014306/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm|url-status=live}}</ref> 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 smoking smoked less, while those who continued to smoke moved to smoke more light cigarettes.<ref>{{Cite book|last=Hilton|first=Matthew|title=Smoking in British Popular Culture, 1800–2000: Perfect Pleasures|url=https://books.google.com/books?id=UjM8t6Ul73YC&q=Smoking+in+British+Popular+Culture|access-date=22 March 2009|date=4 May 2000|publisher=Manchester University Press|isbn=978-0-7190-5257-6|pages=229–241|archive-date=14 January 2023|archive-url=https://web.archive.org/web/20230114064553/https://books.google.com/books?id=UjM8t6Ul73YC&q=Smoking+in+British+Popular+Culture|url-status=live}}</ref> The trend has been paralleled by many industrialized nations as rates have either leveled-off or declined. In the [[developing world]], however, tobacco consumption continued to rise at 3.4% in 2002.<ref name="WHO2002FactSheet">{{Cite web|url=http://www.wpro.who.int/media_centre/fact_sheets/fs_20020528.htm|title=WHO/WPRO-Smoking Statistics|access-date=1 January 2009|date=28 May 2002|publisher=World Health Organization Regional Office for the Western Pacific|url-status=dead|archive-url=https://web.archive.org/web/20091108181404/http://www.wpro.who.int/media_centre/fact_sheets/fs_20020528.htm|archive-date=8 November 2009}}</ref> 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.<ref>{{Harvnb|Gilman|Xun|2004|pp=46–57}}</ref> In 2008, [[Russia]] (70.2%), [[Indonesia]] (65.3%), [[Belarus]] (63.6%), [[Ukraine]] (63.3%), [[Laos]] (62.5%), [[Greece]] (62.4%), [[Jordan]] (61.7%), [[Tonga]] (61.1%), [[China]] (60.8%), and [[North Korea]] (59.5%) were ranked the first by adjusted prevalence estimate of the percent of male population smoking tobacco.<ref name="MPOWER 2008 pp=267–288">{{harvnb|MPOWER|2008|pp=267–288}}</ref>
==Consumption==
===Methods===
{{Hatnote|For more about the production of the agricultural product, see [[Cultivation of tobacco]], [[Types 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 several species, of which ''[[Nicotiana tabacum]]'' is the most commonly grown. ''[[Nicotiana rustica]]'' follows second, containing higher concentrations of nicotine. The leaves are harvested and cured to allow the slow [[oxidation]] and degradation of [[carotenoid]]s in tobacco leaves. 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 to increase the addictive potency, shift the product's [[pH]], or improve the effects of smoke by making it more palatable. In the United States, these additives are regulated to [[List of additives in cigarettes|599 substances]].<ref name="WHOJeffreyWigand"/> The product is then processed, packaged, and shipped to consumer markets.
Common methods of consuming tobacco include the following:
{{multiple image
| align = right
| direction = vertical
| width = 180
| image1 = Patch of Tobacco (Nicotiana tabacum ) in a field in Intercourse, Pennsylvania..jpg
| alt1 = Field of tobacco organized in rows extending to the horizon.
| caption1 = Tobacco field in [[Intercourse, Pennsylvania]]
| image2 = Basma-tobacco-drying.jpg
| alt2 = Powderly stripps hung vertically, slightly sun bleached.
| caption2 = [[Tobacco leaves|Basma]] leaves curing in the sun at [[Pomak]] village of [[Xanthi]], Thrace, Greece
| image3 = DunhillLightFlake.jpg
| alt3 = Rectangular strips stacked in an open square box.
| caption3 = Processed tobacco pressed into flakes for pipe smoking
| total_width =
}}
;Beedi: [[Beedi]]s are thin South Asian cigarettes filled with tobacco flakes and wrapped in a tendu leaf tied with a string at one end. They produce higher levels of carbon monoxide, nicotine, and tar than cigarettes typical in the United States.<ref>{{Cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4836a2.htm|title=Bidi Use Among Urban Youth – Massachusetts, March–April 1999|access-date=14 February 2009|date=17 September 1999|publisher=Centers for Disease Control and Prevention|archive-date=11 February 2009|archive-url=https://web.archive.org/web/20090211061406/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4836a2.htm|url-status=live}}</ref><ref>{{cite journal | last1 = Pakhale | first1 = S. M. | last2 = Maru | first2 = G. B. | title = Distribution of major and minor alkaloids in tobacco, mainstream and sidestream smoke of popular Indian smoking products | journal = Food and Chemical Toxicology | volume = 36 | issue = 12 | pages = 1131–1138 | date = Dec 1998 | pmid = 9862656 | doi = 10.1016/S0278-6915(98)00071-4 | issn = 0278-6915 }}</ref>
[[File:Diospyros melanoxylon Tendu.jpg|thumb|Tendu Patta (Leaf) collection for Beedi industries]]
;Cigars: [[Cigar]]s are tightly rolled bundles of dried and fermented tobacco that are ignited so that smoke may be drawn into the smoker's mouth. They are generally not inhaled because of the high alkalinity of the smoke, which can quickly irritate 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.<ref name="Rarick">{{Cite journal|ssrn=1127582|author=Rarick CA|title=Note on the premium cigar industry|date=2 April 2008|doi=10.2139/ssrn.1127582 |s2cid=152340055 }}</ref> As of 2005 it is estimated that 4.3% of men and 0.3% of women smoke cigars in the US.<ref>{{Cite journal|journal=MMWR Morb Mortal Wkly Rep|year=2006|volume=55|issue=42|pages=1145–8|title=Tobacco use among adults—United States, 2005|vauthors=Mariolis P, Rock VJ, Asman K|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm|pmid=17065979|display-authors=etal|access-date=17 September 2017|archive-date=26 September 2017|archive-url=https://web.archive.org/web/20170926235944/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm|url-status=live}}</ref>
;Cigarettes: ''[[Cigarette]]s'', 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.<ref name="WHOJeffreyWigand">{{Cite web|url=http://www.jeffreywigand.com/WHOFinal.pdf|title=ADDITIVES, CIGARETTE DESIGN and TOBACCO PRODUCT REGULATION|access-date=14 February 2009|last=Wigand|first=Jeffrey S.|date=July 2006|publisher=Jeffrey Wigand|___location=Mt. Pleasant, MI 48804|archive-date=16 May 2011|archive-url=https://web.archive.org/web/20110516151158/http://www.jeffreywigand.com/WHOFinal.pdf|url-status=live}}<!-- RELIABLE ONLY FOR DEFINITION OF CIGARETTE --></ref> Cigarettes are ignited and inhaled, usually through a cellulose acetate filter, into the mouth and lungs.
{{anchor|French inhale}}
;Hookah: ''[[Hookah]]'' are a single or multi-stemmed (often glass-based) water pipe for smoking. Originally from India, the hookah was a symbol of pride and honor for the landlords, kings, and other such high-class people. Now, 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 (drug)|cannabis]].
;Kretek: ''[[Kretek]]'' are cigarettes made with a complex blend of tobacco, [[clove]]s 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 kretek can contain more than 30 types of tobacco. Minced dried clove buds, weighing about one-third 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 kretek from being classified as cigarettes.<ref>{{Cite press release|url=http://thomas.loc.gov/cgi-bin/bdquery/z?d108:SN02461:@@@D&summ2=m&|access-date=1 August 2007|publisher=Library of Congress|title=A bill to protect the public health by providing the Food and Drug Administration with certain authority to regulate tobacco products. (Summary)|date=20 May 2004|archive-date=4 September 2015|archive-url=https://web.archive.org/web/20150904081039/http://thomas.loc.gov/cgi-bin/bdquery/z?d108:SN02461:@@@D&summ2=m&|url-status=dead}}</ref>
;Pipe smoking: [[Pipe smoking]] is done with a tobacco pipe, typically consisting 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.
;Roll-your-own: [[Roll-your-own cigarette|Roll-your-own]] or hand-rolled cigarettes, often called "rollies", "cigi" or "Roll-ups", are very popular, particularly in Europe. These are prepared from loose tobacco, cigarette papers, and filters, all bought separately. They are usually much cheaper than ready-made cigarettes, and small contraptions can be purchased, making the process easier.
;Vaporizer: A [[vaporizer (cannabis)|vaporizer]] is a device used to sublimate the active ingredients of plant material. Rather than burning the herb, which produces potentially irritating, toxic, or [[carcinogen]]ic 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. This method is often preferable when medically administering the smoke substance, as opposed to directly pyrolyzing the plant material.
===Physiology===
{{See also|Chain smoking}}
[[File:Blood nicotine graph.jpg|thumb|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, are administered by burning the leaves and inhaling the vaporized gas that results. This quickly and effectively delivers substances into the bloodstream by [[absorption (pharmacology)|absorption]] through the [[Pulmonary alveolus|alveoli]] in the lungs. The lungs contain some 300 million alveoli, which amounts to a surface area of over 70 m<sup>2</sup> (about the size of a tennis court). This method is not completely efficient 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]].<ref name="GilmanXun2004p318">{{Harvnb|Gilman|Xun|2004|p=318}}</ref> Pipe and Cigar smoke are not inhaled because of their high [[alkalinity]], which is irritating to the [[Vertebrate trachea|trachea]] and lungs. However, because of its higher alkalinity (pH 8.5) compared to cigarette smoke (pH 5.3), non-ionized nicotine is more readily absorbed through the [[mucous membranes]] in the mouth.<ref>{{cite journal | last1 = Turner | first1 = JA | last2 = Sillett | first2 = RW | last3 = McNicol | first3 = MW | title = Effect of cigar smoking on carboxyhemoglobin and plasma nicotine concentrations in primary pipe and cigar smokers and ex-cigarette smokers | journal = British Medical Journal | volume = 2 | issue = 6099 | pages = 1387–9 | year = 1977 | pmid = 589225 | pmc = 1632361 | doi = 10.1136/bmj.2.6099.1387 }}</ref> Nicotine absorption from cigar and pipe, however, is much less than that from cigarette smoke.<ref>{{cite journal | last1 = Armitage | first1 = A. K. | last2 = Turner | first2 = D. M. | title = Absorption of Nicotine in Cigarette and Cigar Smoke through the Oral Mucosa | journal = Nature | volume = 226 | issue = 5252 | pages = 1231–1232 | year = 1970 | pmid = 5422597 | doi = 10.1038/2261231a0 | bibcode = 1970Natur.226.1231A | s2cid = 4208650 }}</ref> Nicotine and cocaine activate similar patterns of neurons, which supports the existence of common [[Enzyme substrate|substrates]] among these drugs.<ref>{{cite journal | last1 = Pich | first1 = E. M. | last2 = Pagliusi | first2 = S. R. | last3 = Tessari | first3 = M. | last4 = Talabot-Ayer | first4 = D. | last5 = Hooft Van Huijsduijnen | first5 = R. | last6 = Chiamulera | first6 = C. | title = Common neural substrates for the addictive properties of nicotine and cocaine | journal = Science | volume = 275 | issue = 5296 | pages = 83–86 | year = 1997 | pmid = 8974398 | doi = 10.1126/science.275.5296.83 | s2cid = 5923174 }}</ref>
The absorbed [[nicotine]] mimics nicotinic acetylcholine, which when bound to [[nicotinic acetylcholine receptor]]s prevents the reuptake of [[acetylcholine]] thereby increasing that [[neurotransmitter]] in those areas of the body.<ref name="WonnacottPMID9023878">{{cite journal | last1 = Wonnacott | first1 = S. | title = Presynaptic nicotinic ACh receptors | journal = Trends in Neurosciences | volume = 20 | issue = 2 | pages = 92–8| year = 1997 | pmid = 9023878 | doi = 10.1016/S0166-2236(96)10073-4 | s2cid = 42215860 }}</ref> These nicotinic acetylcholine receptors are located in the central nervous system and at the nerve-muscle junction of skeletal muscles; whose activity increases heart rate, alertness,<ref name="PMID2498936">{{cite journal | last1 = Parrott | first1 = A. C. | last2 = Winder | first2 = G. | title = Nicotine chewing gum (2 mg, 4 mg) and cigarette smoking: comparative effects upon vigilance and heart rate | journal = Psychopharmacology | volume = 97 | issue = 2 | pages = 257–261 | year = 1989 | pmid = 2498936 | doi = 10.1007/BF00442260 | s2cid = 4842374 }}</ref> and faster reaction times.<ref name="WesnessWarburton1997">{{cite journal | last1 = Parkin | first1 = C. | last2 = Fairweather | first2 = D. B. | last3 = Shamsi | first3 = Z. | last4 = Stanley | first4 = N. | last5 = Hindmarch | first5 = I. | title = The effects of cigarette smoking on overnight performance | journal = Psychopharmacology | volume = 136 | issue = 2 | pages = 172–178 | year = 1998 | pmid = 9551774 | doi = 10.1007/s002130050553 | s2cid = 22962937 }}</ref> Nicotine acetylcholine stimulation is not directly addictive. However, since dopamine-releasing neurons are abundant on nicotine receptors, dopamine is released; and, in the [[nucleus accumbens]], dopamine is associated with motivation causing [[reinforcing]] behavior.<ref>{{cite journal | last1 = Pontieri | first1 = F. E. | last2 = Tanda | first2 = G. | last3 = Orzi | first3 = F. | last4 = Di Chiara | first4 = G. D. | title = Effects of nicotine on the nucleus accumbens and similarity to those of addictive drugs | journal = Nature | volume = 382 | issue = 6588 | pages = 255–257 | year = 1996 | pmid = 8717040 | doi = 10.1038/382255a0 | bibcode = 1996Natur.382..255P | s2cid = 4338516 }}</ref> Dopamine increase, in the [[Prefrontal Cortex Basal Ganglia Working Memory|prefrontal cortex]], may also increase [[working memory]].<ref>{{cite journal | last1 = Guinan | first1 = M. E. | last2 = Portas | first2 = M. R. | last3 = Hill | first3 = H. R. | title = The candida precipitin test in an immunosuppressed population | journal = Cancer | volume = 43 | issue = 1 | pages = 299–302 | year = 1979 | pmid = 761168 | doi = 10.1002/1097-0142(197901)43:1<299::AID-CNCR2820430143>3.0.CO;2-D | s2cid = 45096870 }}</ref>
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 [[Harmala alkaloids|harmane]] (an [[MAO inhibitor]]) from the acetaldehyde in tobacco smoke. This may play a role in nicotine addiction by facilitating a dopamine release in the [[nucleus accumbens]] as a response to nicotine stimuli.<ref>{{cite journal | last1 = Talhout | first1 = R. | last2 = Opperhuizen | first2 = A. | last3 = Van Amsterdam | first3 = J. G. C. | title = Role of acetaldehyde in tobacco smoke addiction | journal = European Neuropsychopharmacology | volume = 17 | issue = 10 | pages = 627–636 | date = Oct 2007 | pmid = 17382522 | doi = 10.1016/j.euroneuro.2007.02.013 | s2cid = 25866206 | issn = 0924-977X }}</ref> Using rat studies, withdrawal after repeated exposure to nicotine results in less responsive nucleus accumbens cells, which produce dopamine responsible for [[reinforcement]].<ref>{{cite journal | last1 = Shoaib | first1 = M. | last2 = Lowe | first2 = A. | last3 = Williams | first3 = S. | title = Imaging localised dynamic changes in the nucleus accumbens following nicotine withdrawal in rats | journal = NeuroImage | volume = 22 | issue = 2 | pages = 847–854 | year = 2004 | pmid = 15193614 | doi = 10.1016/j.neuroimage.2004.01.026 | s2cid = 43544025 }}</ref>
===Demographics===
{{Main|Prevalence of tobacco use}}
{{Multiple image
| direction = vertical
| align = right
| image1 = Male Smoking by Country.png
| image2 = Female Smoking by Country.png
| width = 200
| caption1 = Percentage of '''males''' smoking any tobacco product
| caption2 = Percentage of '''females''' smoking any tobacco product. Note that there is a difference between the scales used for males and the scales used for females.<ref name="MPOWER 2008 pp=267–288"/>
}}
As of 2000, smoking was practiced by around 1.22 billion people. At current rates of 'smoker replacement' and market growth, this may reach around 1.9 billion in 2025.<ref name="HNPGuindonBoisclair13-16">{{Cite journal|first1=G. Emmanuel|last1=Guindon|first2=David|last2=Boisclair|title=Past, current and future trends in tobacco use|url=http://www1.worldbank.org/tobacco/pdf/Guindon-Past,%20current-%20whole.pdf|access-date=22 March 2009|year=2003|publisher=The International Bank for Reconstruction and Development / The World Bank|___location=Washington DC|pages=13–16|archive-url=https://web.archive.org/web/20090318003729/http://www1.worldbank.org/tobacco/pdf/Guindon-Past,%20current-%20whole.pdf|archive-date=18 March 2009|url-status=dead}}</ref>
Smoking may be up to five times more prevalent among men than women in some communities,<ref name="HNPGuindonBoisclair13-16"/> although the gender gap usually declines with younger age.<ref name="WomenTobaccoChallenges5-6">{{Cite web|url=https://www.who.int/tobacco/media/en/WomenMonograph.pdf|archive-url=https://web.archive.org/web/20031128122821/http://www.who.int/tobacco/media/en/WomenMonograph.pdf|url-status=dead|archive-date=28 November 2003|title=Women and the Tobacco Epidemic: Challenges for the 21st Century|access-date=2 January 2009|author=The World Health Organization, and the Institute for Global Tobacco Control, Johns Hopkins School of Public Health|year=2001|publisher=World Health Organization|pages=5–6}}</ref><ref name="2001SurgeonGeneralWomen47">{{Cite web|url=https://www.cdc.gov/tobacco/data_statistics/sgr/2001/|title=Surgeon General's Report—Women and Smoking|access-date=3 January 2009|year=2001|publisher=Centers for Disease Control and Prevention|page=47|archive-date=10 July 2009|archive-url=https://web.archive.org/web/20090710040912/http://www.cdc.gov/tobacco/data_statistics/sgr/2001/|url-status=live}}</ref> In some developed countries smoking rates for men have peaked and begun to decline, while for women they continue to climb.<ref>{{Cite journal|first1=Richard|last1=Peto|first2=Alan D|last2=Lopez|first3=Jillian|last3=Boreham|first4=Michael|last4=Thun|title=Mortality from Smoking in Developed Countries 1950–2000: indirect estimates from national vital statistics|url=http://www.ctsu.ox.ac.uk/~tobacco/SMK_All_PAGES.pdf|access-date=22 March 2009|year=2006|publisher=Oxford University Press|page=9|url-status=dead|archive-url=https://web.archive.org/web/20050224232603/http://www.ctsu.ox.ac.uk/~tobacco/SMK_All_PAGES.pdf|archive-date=24 February 2005}}</ref>
As of 2002, about twenty percent of young teenagers (13–15) smoked worldwide. 80,000 to 100,000 children begin smoking every day, roughly half of whom live in Asia. Half of those who start smoking in [[adolescent]] years are projected to go on to smoke for 15 to 20 years.<ref name="WHO2002FactSheet"/> As of 2019 in the United States, roughly 800,000 high school students smoke.<ref>Tobaccofreekids.org/problem/tol-s</ref>
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. Smoking rates have leveled off or declined in the [[developed world]].<ref>{{cite journal | title = Cigarette smoking among adults and trends in smoking cessation – United States, 2008 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 58 | issue = 44 | pages = 1227–1232 | year = 2009 | pmid = 19910909 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm | format = Full free text | author1 = Centers for Disease Control and Prevention (CDC) | access-date = 17 September 2017 | archive-date = 16 September 2017 | archive-url = https://web.archive.org/web/20170916142331/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm | url-status = live }}</ref> In the [[developing world]], however, tobacco consumption is rising by 3.4% per year as of 2002.<ref name="WHO2002FactSheet"/>
The WHO in 2004 projected 58.8 million deaths to occur globally,<ref name="WHO2004GBD8">{{harvnb|GBD|2008|p=8}}</ref> from which 5.4 million are tobacco-attributed,<ref>{{harvnb|GBD|2008|p=23}}</ref> and 4.9 million as of 2007.<ref name="WHO2007FactSheet">{{Cite web|url=http://www.wpro.who.int/media_centre/fact_sheets/fs_20070529.htm|title=WHO/WPRO-Tobacco Fact sheet|access-date=1 January 2009|date=29 May 2007|publisher=World Health Organization Regional Office for the Western Pacific|url-status=dead|archive-url=https://web.archive.org/web/20090207100241/http://www.wpro.who.int/media_centre/fact_sheets/fs_20070529.htm|archive-date=7 February 2009}}</ref> As of 2002, 70% of the deaths are in developing countries.<ref name="WHO2007FactSheet"/> As of 2017, smoking causes one in ten deaths worldwide, with half of those deaths in the US, China, India and Russia.<ref>{{Cite news|url=https://www.bbc.com/news/health-39510728|title=Smoking causes one in 10 deaths worldwide, study shows|date=6 April 2017|work=BBC News|access-date=11 April 2017|language=en-GB|archive-date=10 April 2017|archive-url=https://web.archive.org/web/20170410231718/http://www.bbc.com/news/health-39510728|url-status=live}}</ref>
==Psychology==
===Takeup===
[[File:Sigmund Freud, by Max Halberstadt (cropped).jpg|thumb|upright|[[Sigmund Freud]], whose doctor [[Sigmund Freud#Death|assisted his suicide]] because of [[oral cancer]] caused by smoking<ref name=Gay>{{Cite book| last=Gay| first= Peter| year=1988| title=Freud: A Life for Our Time| url=https://archive.org/details/freudlifeforourt00gayp| url-access=registration| ___location=New York |pages=[https://archive.org/details/freudlifeforourt00gayp/page/650 650]–651|isbn=978-0-393-32861-5|publisher= W. W. Norton & Company |author-link=Peter Gay}}</ref>]]
Most smokers begin smoking during adolescence or early adulthood. Some studies also show that smoking can be linked to various mental health complications.<ref>{{cite journal |author1=Patton G. C. |author2=Hibbert M. |author3=Rosier M. J. |author4=Carlin J. B. |author5=Caust J. |author6=Bowes G. | year = 1996 | title = Is smoking associated with depression and anxiety in teenagers? | journal = American Journal of Public Health | volume = 86 | issue = 2| pages = 225–230 | pmc=1380332 | pmid=8633740 | doi=10.2105/ajph.86.2.225}}</ref> Smoking has elements of risk-taking and rebellion, which often appeal to young people. {{citation needed|date=July 2023}} The presence of peers who smoke and media featuring high-status models smoking may also encourage smoking. Because teenagers are influenced more by their peers than by adults {{dubious|date=July 2023}}, attempts by parents, schools, and health professionals at preventing people from trying cigarettes are often unsuccessful.<ref name="StantonSilva1992">{{cite journal | last1 = Stanton | first1 = W. | last2 = Silva | first2 = P. A. | title = A longitudinal study of the influence of parents and friends on children's initiation of smoking | journal = Journal of Applied Developmental Psychology | volume = 13 | issue = 4 | pages = 423–434 | year = 1992 | doi = 10.1016/0193-3973(92)90010-F }}</ref><ref>{{Cite book|last1=Harris|first1=Judith Rich|last2=Pinker|first2=Steven|title=The nurture assumption: why children turn out the way they do|url=https://books.google.com/books?id=9GQlA_l-TQ0C&q=The+nurture+assumption:+Why+children+turn+out+the+way+they+do|access-date=22 March 2009|date=4 September 1998|publisher=Simon and Schuster|isbn=978-0-684-84409-1|archive-date=14 January 2023|archive-url=https://web.archive.org/web/20230114080750/https://books.google.com/books?id=9GQlA_l-TQ0C&q=The+nurture+assumption:+Why+children+turn+out+the+way+they+do|url-status=live}}</ref>
Children with smoking parents are more likely to smoke than children with non-smoking parents. Children of parents who smoke are less likely to quit smoking.<ref name=":0" /> One study found that parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked.<ref>{{cite journal | last1 = Chassin | first1 = L. | last2 = Presson | first2 = C. | last3 = Rose | first3 = J. | last4 = Sherman | first4 = S. J. | last5 = Prost | first5 = J. | title = Parental Smoking Cessation and Adolescent Smoking | journal = Journal of Pediatric Psychology | volume = 27 | issue = 6 | pages = 485–496 | year = 2002 | pmid = 12177249 | doi = 10.1093/jpepsy/27.6.485 | doi-access = free }}</ref> 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 a lower likelihood of trying smoking for both middle and high school students.<ref>{{cite journal | last1 = Proescholdbell | first1 = R. J. | last2 = Chassin | first2 = L. | last3 = MacKinnon | first3 = D. P. | title = Home smoking restrictions and adolescent smoking | journal = Nicotine & Tobacco Research | volume = 2 | issue = 2 | pages = 159–167 | year = 2000 | doi = 10.1080/713688125 | pmid = 11072454 | s2cid = 8749779 }}</ref>
Behavioural research generally indicates 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 played a less significant part in adolescent smoking, with [[adolescent]]s also reporting low levels of both [[Norm (sociology)|normative]] and direct pressure to smoke cigarettes.<ref>{{cite journal | last1 = Urberg | first1 = K. | last2 = Shyu | first2 = S. J. | last3 = Liang | first3 = J. | title = Peer influence in adolescent cigarette smoking | journal = Addictive Behaviors | volume = 15 | issue = 3 | pages = 247–255 | year = 1990 | pmid = 2378284 | doi = 10.1016/0306-4603(90)90067-8 }}</ref> Mere exposure to tobacco retailers may motivate smoking behaviour in adults.<ref>{{Cite book|title=Review: Tobacco outlet density|last=Bharatula|first=Arun|year=2016|___location=Melbourne|url=https://drive.google.com/open?id=0B-e8wYlugBcUTFQ4TnRkenBkVW8}}{{Dead link|date=November 2018 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> A similar study suggested that individuals may play a more active role in starting to smoke than has previously been thought and that social processes other than peer pressure also need to be taken into account.<ref>{{Cite journal|vauthors=Michell L, West P |title=Peer pressure to smoke: the meaning depends on the method|volume=11|issue=1|pages=39–49|year=1996|doi=10.1093/her/11.1.39|journal=Health Education Research|doi-access=free}}</ref> Another study's results indicated 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- to 13-year-old girls than same-age boys. Within the 14- to 15-year-old age group, one peer pressure variable emerged as a significantly more important predictor of girls' than boys' smoking.<ref>{{cite journal | last1 = Barber | first1 = J. | last2 = Bolitho | first2 = F. | last3 = Bertrand | first3 = L. | title = The Predictors of Adolescent Smoking | journal = Journal of Social Service Research | volume = 26 | issue = 1 | pages = 51–66| year = 1999 | doi = 10.1300/J079v26n01_03 }}</ref> It is debated whether peer pressure or [[self-selection]] is a greater cause of adolescent smoking.
Psychologist [[Hans Eysenck]] (who was later questioned for implausible results
<ref name="Pelosi2019">{{cite journal |last1=Pelosi |first1=Anthony J. |title=Personality and fatal diseases: Revisiting a scientific scandal |journal=Journal of Health Psychology |volume=24 |issue=4 |year=2019 |pages=421–439 |issn=1359-1053 |doi=10.1177/1359105318822045|pmid=30791726 |pmc=6712909 }}</ref> and unsafe publications<ref name="Enquiry">{{cite web |title=King's College London enquiry into publications authored by Professor Hans Eysenck with Professor Ronald Grossarth-Maticek |url=https://retractionwatch.com/wp-content/uploads/2019/10/HE-Enquiry.pdf |date=October 2019 |access-date=13 January 2020 |archive-date=5 November 2022 |archive-url=https://web.archive.org/web/20221105133943/https://retractionwatch.com/wp-content/uploads/2019/10/HE-Enquiry.pdf |url-status=live }}</ref><ref name="Hawkes">Nigel Hawkes (2019), [https://www.bmj.com/content/bmj/367/bmj.l5899.full.pdf Works by eminent psychologist who doubted smoking caused cancer are "unsafe," finds inquiry] {{Webarchive|url=https://web.archive.org/web/20230104001110/https://www.bmj.com/content/367/bmj.l5899 |date=4 January 2023 }}</ref>) 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.<ref>{{Cite book|first1=Hans J. |last1=Eysenck |first2=Stuart |last2=Brody |title=Smoking, health and personality |date=November 2000 |publisher=Transaction |isbn=978-0-7658-0639-0 }}</ref>
===Persistence===
The reasons given by some smokers for this activity have been 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 contributes, with females more likely than males to cite ''tension reduction/relaxation'', ''stimulation'' and ''social smoking''.<ref>{{cite journal | last1 = Berlin | first1 = I. | last2 = Singleton | first2 = E. G. | last3 = Pedarriosse | first3 = A. M. | last4 = Lancrenon | first4 = S. | last5 = Rames | first5 = A. | last6 = Aubin | first6 = H. J. | last7 = Niaura | first7 = R. | title = The Modified Reasons for Smoking Scale: factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers | journal = Addiction | volume = 98 | issue = 11 | pages = 1575–1583 | year = 2003 | pmid = 14616184 | doi = 10.1046/j.1360-0443.2003.00523.x }}</ref>
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 the effect it has at any time is likely 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 a stimulant effect."<ref>{{Cite journal|title=Nicotine|url=http://www.ch.ic.ac.uk/rzepa/mim/drugs/html/nicotine_text.htm|access-date=22 March 2009|publisher=Imperial College London|archive-date=14 July 2009|archive-url=https://web.archive.org/web/20090714142449/http://www.ch.ic.ac.uk/rzepa/mim/drugs/html/nicotine_text.htm|url-status=live}}</ref>
===Patterns===
Several 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 summer months and the low months being the winter months.<ref>{{cite journal | last1 = Chandra | first1 = S. | last2 = Chaloupka | first2 = F. J. | title = Seasonality in cigarette sales: patterns and implications for tobacco control | journal = Tobacco Control | volume = 12 | issue = 1 | pages = 105–107 | year = 2003 | pmid = 12612375 | pmc = 1759100 | doi = 10.1136/tc.12.1.105 }}</ref>
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.<ref>{{cite journal | last1 = Chandra | first1 = S. | last2 = Shiffman | first2 = S. | last3 = Scharf | first3 = M. | last4 = Dang | first4 = Q. | last5 = Shadel | first5 = G. | title = Daily smoking patterns, their determinants, and implications for quitting | journal = [[Experimental and Clinical Psychopharmacology]] | volume = 15 | issue = 1 | pages = 67–80 | date = Feb 2007 | pmid = 17295586 | doi = 10.1037/1064-1297.15.1.67 | issn = 1064-1297 }}</ref>
==Effects==
===Health===
{{Main|Health effects of tobacco}}
{{see also|Polycyclic aromatic hydrocarbons}}
[[File:Adverse effects of tobacco smoking.svg|thumb|alt=head and torso of a male with internal organs shown and labels referring to the effects of tobacco smoking|Common adverse effects of tobacco smoking. The more common effects are in boldface.<ref>{{Cite book|first1=Vinay|last1=Kumar|first2=Abul K.|last2=Abbas|first3=Nelson|last3=Fausto|first4=Richard|last4=Mitchell|title=Robbins Basic Pathology|edition=8th|date=18 May 2007|publisher=W.B. Saunders|___location=Philadelphia|isbn=978-1-4160-2973-1|page=288, Figure 8–6|chapter=Chapter 8: Environmental and Nutritional Diseases}}</ref>]]
[[File:Cancer Take Warning (21870574025).jpg|thumb|Cancer prevention poster from New Zealand]]
Tobacco smoking is the [[Leading causes of preventable death|leading cause of preventable death]] and a global [[public health]] concern.<ref name="Kalkhoran2018">{{cite journal |last1=Kalkhoran |first1=S |last2=Benowitz |first2=NL |last3=Rigotti |first3=AN |date=August 2018 |title=Prevention and Treatment of Tobacco Use: JACC Health Promotion Series |url=https://www.onlinejacc.org/content/72/9/1030 |journal=[[Journal of the American College of Cardiology]] |publisher=[[Elsevier]] for the [[American College of Cardiology]] |volume=72 |issue=9 |pages=1030–45 |doi=10.1016/j.jacc.2018.06.036 |doi-access=free |issn=1558-3597 |pmc=6261256 |pmid=30139432 |s2cid=52077567 |access-date=1 August 2020 |archive-date=9 August 2020 |archive-url=https://web.archive.org/web/20200809153506/https://www.onlinejacc.org/content/72/9/1030 |url-status=live }}</ref> There are 1.3 billion tobacco users in the world, as per latest data from WHO.<ref name="Tobacco"/> One person dies every six seconds from a tobacco related disease.<ref>{{Cite web|url=http://www.ash.org/|title=ASH > Action on Smoking & Health|website=www.ash.org|access-date=16 November 2016|date=2 August 2012|archive-date=19 November 2016|archive-url=https://web.archive.org/web/20161119054152/http://ash.org/|url-status=live}}</ref>
Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for [[Myocardial infarction|heart attacks]],<ref name="Harm Reduct. J.">{{cite journal |last1=Rodu |first1=B |last2=Plurphanswat |first2=N |date=January 2021 |title=Mortality among male cigar and cigarette smokers in the USA |url=https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-020-00446-4.pdf |url-status=live |journal=[[Harm Reduction Journal]] |publisher=[[BioMed Central]] |volume=18 |issue=7 |page=7 |doi=10.1186/s12954-020-00446-4 |doi-access=free |issn=1477-7517 |lccn=2004243422 |pmc=7789747 |pmid=33413424 |s2cid=230800394 |archive-url=https://web.archive.org/web/20210826115030/https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-020-00446-4.pdf |archive-date=26 August 2021 |access-date=28 August 2021}}</ref><ref name="Am. J. Public Health">{{cite journal |last1=Nonnemaker |first1=J |last2=Rostron |first2=B |last3=Hall |first3=P |last4=MacMonegle |first4=A |last5=Apelberg |first5=B |date=September 2014 |title=Mortality and Economic Costs From Regular Cigar Use in the United States, 2010 |editor-last=Morabia |editor-first=A |editor-link=Alfredo Morabia |journal=[[American Journal of Public Health]] |publisher=[[American Public Health Association]] |volume=104 |issue=9 |pages=e86–e91 |doi=10.2105/AJPH.2014.301991 |eissn=1541-0048 |issn=0090-0036 |pmc=4151956 |pmid=25033140 |s2cid=207276270}}</ref> [[stroke]]s,<ref name="Expert Rev. Cardiovasc Ther.">{{cite journal |last1=Shah |first1=RS |last2=Cole |first2=JW |date=July 2010 |title=Smoking and stroke: the more you smoke the more you stroke |journal=[[Expert Review of Cardiovascular Therapy]] |publisher=[[Informa]] |volume=8 |issue=7 |pages=917–932 |doi=10.1586/erc.10.56 |issn=1744-8344 |pmc=2928253 |pmid=20602553 |s2cid=207215548}}</ref> [[chronic obstructive pulmonary disease]] (COPD),<ref name="IJERPH 2009">{{cite journal |last=Laniado-Laborín |first=Rafael |date=January 2009 |title=Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century |journal=[[International Journal of Environmental Research and Public Health]] |publisher=[[MDPI]] |volume=6 |issue=1: ''Smoking and Tobacco Control'' |doi=10.3390/ijerph6010209 |pages=209–224 |doi-access=free |issn=1660-4601 |pmc=2672326 |pmid=19440278 |s2cid=19615031 }}</ref> [[idiopathic pulmonary fibrosis]] (IPF),<ref name="Pulm Med.">{{cite journal |last1=Oh |first1=CK |last2=Murray |first2=LA |last3=Molfino |first3=NL |date=February 2012 |title=Smoking and Idiopathic Pulmonary Fibrosis |journal=[[Pulmonary Medicine (journal)|Pulmonary Medicine]] |publisher=[[Hindawi (publisher)|Hindawi Publishing Corporation]] |volume= 2012|issue= |pages=808260 |doi=10.1155/2012/808260 |issn=2090-1844 |pmc=3289849 |pmid=22448328 |s2cid=14090263|doi-access=free }}</ref> and [[emphysema]].<ref name="IJERPH 2009" />
Smoking tobacco causes various types and subtypes of [[cancer]]s<ref name="J. Natl. Cancer Inst.">{{cite journal |last1=Thun |first1=Michael J. |last2=Jacobs |first2=Eric J. |last3=Shapiro |first3=Jean A. |date=February 2000 |title=Cigar Smoking in Men and Risk of Death From Tobacco-Related Cancers |url=https://academic.oup.com/jnci/article/92/4/333/2624751 |url-status=live |editor-last=Ganz |editor-first=Patricia A. |editor-link=Patricia A. Ganz |journal=[[Journal of the National Cancer Institute]] |publisher=[[Oxford University Press]] |volume=92 |issue=4 |pages=333–337 |doi=10.1093/jnci/92.4.333 |doi-access=free |eissn=1460-2105 |issn=0027-8874 |pmid=10675383 |s2cid=7772405 |archive-url=https://web.archive.org/web/20210421095250/https://academic.oup.com/jnci/article/92/4/333/2624751 |archive-date=21 April 2021 |access-date=28 August 2021}}</ref> (particularly [[lung cancer]], [[Oropharyngeal cancer|cancers of the oropharynx]],<ref name="StatPearls 2020">{{cite book |vauthors=Anjum F, Zohaib J |title=Definitions |chapter=Oropharyngeal Squamous Cell Carcinoma |date=4 December 2020 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK563268/ |place=Treasure Island (FL) |publisher=StatPearls Publishing |edition=Updated |id=Bookshelf ID: NBK563268 |doi=10.32388/G6TG1L |pmid=33085415 |s2cid=229252540 |via=[[NCBI]] |access-date=7 February 2021 |archive-date=11 June 2021 |archive-url=https://web.archive.org/web/20210611150638/https://www.ncbi.nlm.nih.gov/books/NBK563268/ |url-status=live }}</ref> [[Laryngeal cancer|larynx]],<ref name="StatPearls 2020" /> and [[Oral cancer|mouth]],<ref name="StatPearls 2020" /> [[Esophageal cancer|esophageal]] and [[pancreatic cancer]]).<ref name=":0" /> Using tobacco, especially together with [[Alcohol (drug)|alcohol]], is a major risk factor for [[head and neck cancer]]. 72% of head and neck cancer cases are caused by using both alcohol and tobacco.<ref name=":6">{{Cite journal |last1=Gormley |first1=Mark |last2=Creaney |first2=Grant |last3=Schache |first3=Andrew |last4=Ingarfield |first4=Kate |last5=Conway |first5=David I. |date=2022-11-11 |title=Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors |journal=British Dental Journal |language=en |volume=233 |issue=9 |pages=780–786 |doi=10.1038/s41415-022-5166-x |issn=0007-0610 |pmc=9652141 |pmid=36369568}}</ref> This rises to 89% when looking specifically at [[laryngeal cancer]].<ref>{{Cite journal |last1=Hashibe |first1=Mia |last2=Brennan |first2=Paul |last3=Chuang |first3=Shu-chun |last4=Boccia |first4=Stefania |last5=Castellsague |first5=Xavier |last6=Chen |first6=Chu |last7=Curado |first7=Maria Paula |last8=Dal Maso |first8=Luigino |last9=Daudt |first9=Alexander W. |last10=Fabianova |first10=Eleonora |last11=Fernandez |first11=Leticia |last12=Wünsch-Filho |first12=Victor |last13=Franceschi |first13=Silvia |last14=Hayes |first14=Richard B. |last15=Herrero |first15=Rolando |date=2009-02-01 |title=Interaction between Tobacco and Alcohol Use and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium |journal=Cancer Epidemiology, Biomarkers & Prevention |language=en |volume=18 |issue=2 |pages=541–550 |doi=10.1158/1055-9965.EPI-08-0347 |issn=1055-9965 |pmc=3051410 |pmid=19190158}}</ref>
[[Cigarette]] smoking increases the risk of [[Crohn's disease]] as well as the severity of the course of the disease.<ref>Inflamm Bowel Dis. May 2009, P. Seksik, I Nion-Larmurier</ref> It is also the number one cause of [[bladder cancer]]. Cigarette smoking has also been associated with [[sarcopenia]], the age-related loss of muscle mass and strength.<ref>{{cite journal |vauthors=Rom O, Kaisari S, Aizenbud D, Reznick AZ |year=2013 |title=Cigarette smoke and muscle catabolism in C2 myotubes |journal=Mech Ageing Dev. |volume=134 |issue=1–2 |pages=24–34 |pmid=23262287 |doi=10.1016/j.mad.2012.11.004 |s2cid=322153}}</ref> The smoke from tobacco elicits carcinogenic effects on the tissues of the body that are exposed to the smoke.<ref name="Harm Reduct. J." /><ref name="Cancer Epidemiol. Biomark. Prev.">{{cite journal |last1=Etemadi |first1=Arash |last2=Blount |first2=Benjamin C. |last3=Calafat |first3=Antonia M. |last4=Chang |first4=Cindy M. |last5=De Jesus |first5=Victor R. |last6=Poustchi |first6=Hossein |last7=Wang |first7=Lanqing |last8=Pourshams |first8=Akram |last9=Shakeri |first9=Ramin |last10=Shiels |first10=Meredith S. |last11=Inoue-Choi |first11=Maki |last12=Ambrose |first12=Bridget K. |last13=Christensen |first13=Carol H. |last14=Wang |first14=Baoguang |last15=Ye |first15=Xiaoyun |last16=Murphy |first16=Gwen |last17=Feng |first17=Jun |last18=Xia |first18=Baoyun |last19=Sosnoff |first19=Connie S. |last20=Boffetta |first20=Paolo |last21=Brennan |first21=Paul |last22=Bhandari |first22=Deepak |last23=Kamangar |first23=Farin |last24=Dawsey |first24=Sanford M. |last25=Abnet |first25=Christian C. |last26=Freedman |first26=Neal D. |last27=Malekzadeh |first27=Reza |date=February 2019 |title=Urinary Biomarkers of Carcinogenic Exposure among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study |journal=[[Cancer Epidemiology, Biomarkers & Prevention]] |publisher=[[American Association for Cancer Research]] |volume=28 |issue=2 |pages=337–347 |doi=10.1158/1055-9965.EPI-18-0743 |eissn=1538-7755 |issn=1055-9965 |pmc=6935158 |pmid=30622099 |s2cid=58560832}}</ref><ref name="J. Natl. Cancer Inst." /><ref>Dreyer, L et al. (1997) Tobacco Smoking. APMIS Inc.</ref> Regular [[cigar]] smoking is known to carry [[Health effects of tobacco|serious health risks]], including increased risk of developing various types and subtypes of [[cancer]]s, [[respiratory disease]]s, [[cardiovascular disease]]s, [[cerebrovascular disease]]s, [[periodontal disease]]s, [[Tooth decay|teeth decay]] and [[Tooth loss|loss]], and [[malignant disease]]s.<ref name="Harm Reduct. J." /><ref name="J. Natl. Cancer Inst." /><ref name="BMC Publ. Health">{{cite journal |last1=Chang |first1=Cindy M. |last2=Corey |first2=Catherine G. |last3=Rostron |first3=Brian L. |last4=Apelberg |first4=Benjamin J. |date=April 2015 |title=Systematic review of cigar smoking and all-cause and smoking-related mortality |url=https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-015-1617-5.pdf |url-status=live |journal=[[BMC Public Health]] |publisher=[[BioMed Central]] |volume=15 |issue=390 |page=390 |doi=10.1186/s12889-015-1617-5 |doi-access=free |issn=1471-2458 |pmc=4408600 |pmid=25907101 |s2cid=16482278 |archive-url=https://web.archive.org/web/20210316053609/https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-015-1617-5.pdf |archive-date=16 March 2021 |access-date=5 September 2021}}</ref><ref name="J. Periodontol.">{{cite journal |last1=Albandar |first1=Jasim M. |last2=Adensaya |first2=Margo R. |last3=Streckfus |first3=Charles F. |last4=Winn |first4=Deborah M. |date=December 2000 |title=Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss |journal=[[Journal of Periodontology]] |publisher=[[American Academy of Periodontology]] |volume=71 |issue=12 |pages=1874–1881 |doi=10.1902/jop.2000.71.12.1874 |issn=0022-3492 |pmid=11156044 |s2cid=11598500}}</ref>
Tobacco smoke is a complex mixture of over 7,000 [[Toxicant|toxic chemicals]], 98 of which are associated with an increased risk of cardiovascular disease and 69 of which are known to be [[carcinogen]]ic.<ref name="Kalkhoran2018" /> The most important chemicals [[Carcinogenesis|causing cancer]] are those that produce DNA damage, since such damage appears to be the primary underlying cause of cancer.<ref name="pmid18403632">{{cite journal |vauthors=Kastan MB |title=DNA damage responses: mechanisms and roles in human disease: 2007 G.H.A. Clowes Memorial Award Lecture |journal=Mol. Cancer Res. |volume=6 |issue=4 |pages=517–24 |year=2008 |pmid=18403632 |doi=10.1158/1541-7786.MCR-08-0020 |doi-access=free }}</ref> The most [[Carcinogenesis|carcinogenic]] compounds in cigarette smoke are [[acrolein]],<ref name="pmid20158384">{{cite journal |vauthors=Liu XY, Zhu MX, Xie JP |title=Mutagenicity of acrolein and acrolein-induced DNA adducts |journal=Toxicol. Mech. Methods |volume=20 |issue=1 |pages=36–44 |year=2010 |pmid=20158384 |doi=10.3109/15376510903530845 |s2cid=8812192 }}</ref> [[formaldehyde]],<ref name="pmid11971987">{{cite journal |vauthors=Speit G, Merk O |title=Evaluation of mutagenic effects of formaldehyde in vitro: detection of crosslinks and mutations in mouse lymphoma cells |journal=Mutagenesis |volume=17 |issue=3 |pages=183–7 |year=2002 |pmid=11971987 |doi= 10.1093/mutage/17.3.183|doi-access=free }}</ref> [[acrylonitrile]],<ref name="pmid19546159">{{cite journal |vauthors=Pu X, Kamendulis LM, Klaunig JE |title=Acrylonitrile-induced oxidative stress and oxidative DNA damage in male Sprague-Dawley rats |journal=Toxicol. Sci. |volume=111 |issue=1 |pages=64–71 |year=2009 |pmid=19546159 |pmc=2726299 |doi=10.1093/toxsci/kfp133 }}</ref> [[1,3-butadiene]],<ref name="pmid21602187">{{cite journal |vauthors=Koturbash I, Scherhag A, Sorrentino J, Sexton K, Bodnar W, Swenberg JA, Beland FA, Pardo-Manuel Devillena F, Rusyn I, Pogribny IP |title=Epigenetic mechanisms of mouse interstrain variability in genotoxicity of the environmental toxicant 1,3-butadiene |journal=Toxicol. Sci. |volume=122 |issue=2 |pages=448–56 |year=2011 |pmid=21602187 |pmc=3155089 |doi=10.1093/toxsci/kfr133 }}</ref> [[acetaldehyde]],<ref name="pmid21604744">{{cite journal |vauthors=Garcia CC, Angeli JP, Freitas FP, Gomes OF, de Oliveira TF, Loureiro AP, Di Mascio P, Medeiros MH |title=[13C2]-Acetaldehyde promotes unequivocal formation of 1,N2-propano-2'-deoxyguanosine in human cells |journal=J. Am. Chem. Soc. |volume=133 |issue=24 |pages=9140–3 |year=2011 |pmid=21604744 |doi=10.1021/ja2004686 |url=https://figshare.com/articles/_sup_13_sup_C_sub_2_sub_Acetaldehyde_Promotes_Unequivocal_Formation_of_1_i_N_i_sup_2_sup_Propano_2_deoxyguanosine_in_Human_Cells/2639098 |access-date=1 December 2019 |archive-date=6 November 2020 |archive-url=https://web.archive.org/web/20201106102427/https://figshare.com/articles/_sup_13_sup_C_sub_2_sub_Acetaldehyde_Promotes_Unequivocal_Formation_of_1_i_N_i_sup_2_sup_Propano_2_deoxyguanosine_in_Human_Cells/2639098 |url-status=live |url-access=subscription }}</ref> [[ethylene oxide]],<ref name="pmid19477295">{{cite journal |vauthors=Tompkins EM, McLuckie KI, Jones DJ, Farmer PB, Brown K |title=Mutagenicity of DNA adducts derived from ethylene oxide exposure in the pSP189 shuttle vector replicated in human Ad293 cells |journal=Mutat. Res. |volume=678 |issue=2 |pages=129–37 |year=2009 |pmid=19477295 |doi=10.1016/j.mrgentox.2009.05.011 |bibcode=2009MRGTE.678..129T }}</ref> and [[isoprene]].<ref name="pmid17317274">{{cite journal |vauthors=Fabiani R, Rosignoli P, De Bartolomeo A, Fuccelli R, Morozzi G |title=DNA-damaging ability of isoprene and isoprene mono-epoxide (EPOX I) in human cells evaluated with the comet assay |journal=Mutat. Res. |volume=629 |issue=1 |pages=7–13 |year=2007 |pmid=17317274 |doi=10.1016/j.mrgentox.2006.12.007 |bibcode=2007MRGTE.629....7F }}</ref> In addition to the aforementioned toxic chemicals, [[flavored tobacco]] contains flavorings which upon heating release toxic chemicals and carcinogens such as [[carbon monoxide]] (CO), [[polycyclic aromatic hydrocarbons]] (PAHs), [[Polychlorinated dibenzofurans|furans]], [[phenols]], [[aldehydes]] (such as [[acrolein]]), and acids, in addition to nitrogenous [[carcinogens]], [[alcohols]], and [[Heavy metals#Toxicity|heavy metals]], all of which are dangerous to human health.<ref name="Cancer Epidemiol. Biomark. Prev." /><ref name="Arterioscler. Thromb. Vasc. Biol.">{{cite journal |last1=Alarabi |first1=A. B. |last2=Karim |first2=Z. A. |last3=Alshbool |first3=F. Z. |last4=Khasawneh |first4=F. T. |last5=Hernandez |first5=Keziah R. |last6=Lozano |first6=Patricia A. |last7=Montes Ramirez |first7=Jean E. |last8=Rivera |first8=José O. |date=February 2020 |title=Short-Term Exposure to Waterpipe/Hookah Smoke Triggers a Hyperactive Platelet Activation State and Increases the Risk of Thrombogenesis |journal=[[Arteriosclerosis, Thrombosis, and Vascular Biology]] |publisher=[[Lippincott Williams & Wilkins]] |volume=40 |issue=2 |pages=335–349 |doi=10.1161/ATVBAHA.119.313435 |doi-access=free |issn=1079-5642 |pmc=7000176 |pmid=31941383 |s2cid=210335103 }}</ref><ref name="Ann. Am. Thorac. Soc.">{{cite journal |last1=Patel |first1=Mit P. |last2=Khangoora |first2=Vikramjit S. |last3=Marik |first3=Paul E. |date=October 2019 |title=A Review of the Pulmonary and Health Impacts of Hookah Use |journal=[[Annals of the American Thoracic Society]] |publisher=[[American Thoracic Society]] |volume=16 |issue=10 |pages=1215–1219 |doi=10.1513/AnnalsATS.201902-129CME |doi-access=free |issn=2325-6621 |pmid=31091965 |s2cid=155103502 }}</ref><ref name="Environ. Health Prev. Med.">{{cite journal |last1=Qasim |first1=Hanan |last2=Alarabi |first2=A. B. |last3=Alzoubi |first3=K. H. |last4=Karim |first4=Z. A. |last5=Alshbool |first5=F. Z. |last6=Khasawneh |first6=F. T. |date=September 2019 |title=The effects of hookah/waterpipe smoking on general health and the cardiovascular system |url=https://environhealthprevmed.biomedcentral.com/track/pdf/10.1186/s12199-019-0811-y.pdf |url-status=live |journal=[[Environmental Health and Preventive Medicine]] |publisher=[[BioMed Central]] |volume=24 |issue=58 |page=58 |doi=10.1186/s12199-019-0811-y |doi-access=free |issn=1347-4715 |pmc=6745078 |pmid=31521105 |bibcode=2019EHPM...24...58Q |s2cid=202570973 |archive-url=https://web.archive.org/web/20210424161857/https://environhealthprevmed.biomedcentral.com/track/pdf/10.1186/s12199-019-0811-y.pdf |archive-date=24 April 2021 |access-date=8 September 2021}}</ref><ref name="Farag">{{Cite journal| doi = 10.1038/s41598-018-35368-6| pmid = 30451904| pmc = 6242864| issn = 2045-2322| volume = 8| issue = 1| pages = 17028| last1 = Farag| first1 = Mohamed A.| last2 = Elmassry| first2 = Moamen M.| last3 = El-Ahmady| first3 = Sherweit H.| title = The characterization of flavored hookahs aroma profile and in response to heating as analyzed via headspace solid-phase microextraction (SPME) and chemometrics| journal = Scientific Reports| date = 2018-11-19| bibcode = 2018NatSR...817028F}}</ref> A comparison of 13 common [[hookah]] flavors found that melon flavors are the most dangerous, with their smoke containing four classes of hazards in high concentrations.<ref name="Farag" />
The [[World Health Organization]] estimates that tobacco caused 8 million deaths in 2004<ref name="Tobacco"/> and 100 million deaths over the 20th century.<ref name=WHO2>[https://wayback.archive-it.org/all/20080910041812/http://www.who.int/entity/tobacco/mpower/mpower_report_prevalence_data_2008.pdf WHO Report on the Global Tobacco Epidemic, 2008]</ref> 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."<ref name="fn1">"[https://www.cdc.gov/tobacco/quit_smoking/you_can_quit/nicotine.htm Nicotine: A Powerful Addiction] {{webarchive|url=https://web.archive.org/web/20090501011931/http://www.cdc.gov/tobacco/quit_smoking/you_can_quit/nicotine.htm |date=1 May 2009 }}." Centers for Disease Control and Prevention.</ref> Although 70% of smokers state their intention to quit, only 3–5% are successful.<ref name="Barendregt, J. J. 1997"/>
The probabilities of death from lung cancer before age 75 in the United Kingdom are 0.2% for men who never smoked (0.4% for women), 5.5% for male former smokers (2.6% in women), 15.9% for current male smokers (9.5% for women) and 24.4% for male "heavy smokers" defined as smoking more than 25 cigarettes per day (18.5% for women).<ref>{{cite journal |author1=Peto Richard |author2=Darby Sarah |author3=Deo Harz | year = 2000 | title = Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies | journal = [[The BMJ]] | volume = 321 | issue = 7257| pages = 323–329 | doi = 10.1136/bmj.321.7257.323 | pmid=10926586 | pmc=27446|display-authors=etal}}</ref> Tobacco smoke can combine with other carcinogens present within the environment to produce elevated degrees of lung cancer.
The risk of lung cancer decreases almost from the first day someone [[Smoking cessation|quits smoking]], and it drops by 50% after 10 years of smoking cessation.<ref name="Tobacco"/> Healthy cells that have escaped mutations grow and replace the damaged ones in the lungs. In the research dated December 2019, 40% of cells in former smokers resembled those of individuals who had never smoked.<ref>{{Cite journal|url=https://www.nature.com/articles/s41586-020-1961-1.epdf?referrer_access_token=0VDMQ0H4-f91dB5uqJjJftRgN0jAjWel9jnR3ZoTv0OKOcOePhUj_ZiBqhIKPHMESOIlMBgsq7AHooGU3FzfjdfYjURebC16Qb6V0cVfg19HvLQ2KS7pbx-MJiyBfwaKhmIHSH11XX1xKNkHeU5h60nkqCpwMmPuxyXblOVPEt4hZhf8_B_huSwZQXpra5y0PHnEzjNdkO683sRXKDMHkQ%3D%3D&tracking_referrer=www.bbc.com|title=Tobacco smoking and somatic mutations in human bronchial epithelium|journal=Nature|year=2020|doi=10.1038/s41586-020-1961-1|last1=Yoshida|first1=Kenichi|last2=Gowers|first2=Kate H. C.|last3=Lee-Six|first3=Henry|last4=Chandrasekharan|first4=Deepak P.|last5=Coorens|first5=Tim|last6=Maughan|first6=Elizabeth F.|last7=Beal|first7=Kathryn|last8=Menzies|first8=Andrew|last9=Millar|first9=Fraser R.|last10=Anderson|first10=Elizabeth|last11=Clarke|first11=Sarah E.|last12=Pennycuick|first12=Adam|last13=Thakrar|first13=Ricky M.|last14=Butler|first14=Colin R.|last15=Kakiuchi|first15=Nobuyuki|last16=Hirano|first16=Tomonori|last17=Hynds|first17=Robert E.|last18=Stratton|first18=Michael R.|last19=Martincorena|first19=Iñigo|last20=Janes|first20=Sam M.|last21=Campbell|first21=Peter J.|volume=578|issue=7794|pages=266–272|pmid=31996850|pmc=7021511|bibcode=2020Natur.578..266Y|access-date=30 January 2020|archive-date=12 August 2021|archive-url=https://web.archive.org/web/20210812225040/https://www.nature.com/articles/s41586-020-1961-1.epdf?referrer_access_token=0VDMQ0H4-f91dB5uqJjJftRgN0jAjWel9jnR3ZoTv0OKOcOePhUj_ZiBqhIKPHMESOIlMBgsq7AHooGU3FzfjdfYjURebC16Qb6V0cVfg19HvLQ2KS7pbx-MJiyBfwaKhmIHSH11XX1xKNkHeU5h60nkqCpwMmPuxyXblOVPEt4hZhf8_B_huSwZQXpra5y0PHnEzjNdkO683sRXKDMHkQ%3D%3D&tracking_referrer=www.bbc.com|url-status=live}}</ref>
Rates of smoking have generally leveled off or declined in the developed world. Smoking rates in the United States have dropped by half from 1965 to 2006, from 42% to 20.8% in adults.<ref>{{cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm#fig|title=Cigarette Smoking Among Adults --- United States, 2006|access-date=29 February 2016|archive-date=16 August 2019|archive-url=https://web.archive.org/web/20190816014306/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm#fig|url-status=live}}</ref> In the developing world, tobacco consumption is rising by 3.4% per year.<ref>{{Cite web|url=https://www.who.int/westernpacific|archiveurl=https://web.archive.org/web/20091108181404/http://www.wpro.who.int/media_centre/fact_sheets/fs_20020528.htm|url-status=dead|title=WHO Western Pacific | World Health Organization|archivedate=8 November 2009|website=www.who.int}}</ref>
Smoking alters the [[transcriptome]] of the lung [[parenchyma]]; the expression levels of a panel of seven genes (KMO, CD1A, SPINK5, TREM2, CYBB, DNASE2B, FGG) are increased in the lung tissue of smokers.<ref name="pmid31506599">{{cite journal | vauthors = Pintarelli G, Noci S, Maspero D, Pettinicchio A, Dugo M, De Cecco L, Incarbone M, Tosi D, Santambrogio L, Dragani TA, Colombo F | title = Cigarette smoke alters the transcriptome of non-involved lung tissue in lung adenocarcinoma patients | journal = Scientific Reports | volume = 9 | issue = 1 | article-number = 13039 | date = September 2019 | pmid = 31506599 | pmc = 6736939 | doi = 10.1038/s41598-019-49648-2 | bibcode = 2019NatSR...913039P }}</ref>
[[Passive smoking]] is the inhalation of tobacco smoke by individuals who are not actively smoking. This smoke is known as second-hand smoke (SHS) or environmental tobacco smoke (ETS) when the burning end is present, and [[third-hand smoke]] after the burning end has been extinguished. Because of its negative implications, exposure to SHS has played a central role in the regulation of tobacco products. Six hundred thousand deaths were attributed to SHS in 2004. It has also been known to produce skin conditions such as freckles and dryness.<ref name="lancet-2nd-burden">[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61388-8/abstract Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries] {{Webarchive|url=https://web.archive.org/web/20101129160423/http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61388-8/abstract |date=29 November 2010 }} 26 November 2010</ref>
Smokers are at greater risk of developing [[psychotic disorder]].<ref>{{cite journal|last1=Gurillo|first1=Pedro|last2=Jauhar|first2=Sameer|last3=Murray|first3=Robin M|last4=MacCabe|first4=James H|title=Does tobacco use cause psychosis? Systematic review and meta-analysis|journal=The Lancet Psychiatry|date=July 2015|doi=10.1016/S2215-0366(15)00152-2|pmid=26249303|volume=2|issue=8|pages=718–725|pmc=4698800}}</ref> Tobacco has also been described an [[anaphrodisiac]] due to its propensity for causing [[erectile dysfunction]].<ref>{{cite journal | author = Nicolosi Alfredo | display-authors = etal | year = 2003 | title = Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction | url = https://www.arca.fiocruz.br/handle/icict/9868 | journal = Urology | volume = 61 | issue = 1 | pages = 201–206 | doi = 10.1016/s0090-4295(02)02102-7 | pmid = 12559296 | access-date = 16 July 2019 | archive-date = 8 March 2021 | archive-url = https://web.archive.org/web/20210308094050/https://www.arca.fiocruz.br/handle/icict/9868 | url-status = live | doi-access = free }}<!--https://www.arca.fiocruz.br/handle/icict/9868--></ref> There is a correlation between tobacco smoking and a reduced risk of [[Parkinson's disease]].<ref>{{cite journal | vauthors = Ma C, Liu Y, Neumann S, Gao X | title = Nicotine from cigarette smoking and diet and Parkinson disease: a review | journal = Translational Neurodegeneration | volume = 6 | article-number = 18 | date = 2017 | pmid = 28680589 | pmc = 5494127 | doi = 10.1186/s40035-017-0090-8 | doi-access = free }}</ref><ref>{{cite journal |vauthors=Dorsey ER, Sherer T, Okun MS, Bloem BR |title=The Emerging Evidence of the Parkinson Pandemic |journal=J Parkinsons Dis |volume=8 |issue=s1 |pages=S3–8 |date=2018 |pmid=30584159 |pmc=6311367 |doi=10.3233/JPD-181474 |type=Review}}</ref>
===Economic===
{{See also|Tobacco industry}}
In countries where there is a [[universal healthcare|universally funded healthcare]] system, the government covers the cost of medical care for smokers who become ill through smoking in the form of increased taxes. Two broad debating positions exist on this front, the "pro-smoking" argument suggests that heavy smokers generally do not live long enough to develop the costly and chronic illnesses that affect the elderly, reducing society's healthcare burden, and 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 has been contested. The [[Centers for Disease Control and Prevention]] published research in 2002 claiming that the cost of each [[Cigarette pack|pack]] of cigarettes sold in the United States was more than $7 in medical care and lost productivity.<ref name="query.nytimes.com">{{cite news|url=https://query.nytimes.com/gst/fullpage.html?sec=health&res=9D02E1DA173CF931A25757C0A9649C8B63|title=Cigarettes Cost U.S. $7 Per Pack Sold, Study Says|work=The New York Times|date=12 April 2002|access-date=29 February 2016|archive-date=13 February 2008|archive-url=https://web.archive.org/web/20080213200803/http://query.nytimes.com/gst/fullpage.html?sec=health&res=9D02E1DA173CF931A25757C0A9649C8B63|url-status=live}}</ref> 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.<ref name="Familycost">{{cite web|url=https://www.usatoday.com/news/health/2004-11-26-smoking-costs_x.htm|title=USATODAY.com – Study: Cigarettes cost families, society $41 per pack|website=[[USA Today]]|access-date=29 February 2016|archive-date=24 May 2011|archive-url=https://web.archive.org/web/20110524020626/http://www.usatoday.com/news/health/2004-11-26-smoking-costs_x.htm|url-status=live}}</ref> 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."<ref name="Familycost"/> Other research demonstrates that premature death caused by smoking may redistribute Social Security income in unexpected ways that affect behavior and reduce the economic well-being of smokers and their dependents.<ref>{{Cite web |url=http://www.frbatlanta.org/filelegacydocs/erq307_ArmourPitts.pdf |title=Smoking: Taxing Health and Social Security |website=www.frbatlanta.org |access-date=2023-05-20 |archive-date=19 October 2012 |archive-url=https://web.archive.org/web/20121019202914/http://www.frbatlanta.org/filelegacydocs/erq307_ArmourPitts.pdf |language=en |first1=Brian S. |last1=Armour |first2=M. Melinda |last2=Pitts |date=2007 |publisher=[[Federal Reserve Bank of Atlanta]]}}</ref> To further support this, whatever the rate of smoking consumption is per day, smokers have a greater lifetime medical cost on average compared to a non-smoker by an estimated $6000.<ref name="Barendregt, J. J. 1997">{{cite journal | author = Barendregt J. J., Bonneux L., van der Maas P. J. | year = 1997 | title = The health care costs of smoking | url = https://repub.eur.nl/pub/59780/NEJM199710093371506.pdf | journal = New England Journal of Medicine | volume = 337 | issue = 15 | pages = 1052–1057 | doi = 10.1056/NEJM199710093371506 | pmid = 9321534 | hdl = 1765/59780 | hdl-access = free | access-date = 20 April 2018 | archive-date = 8 October 2022 | archive-url = https://web.archive.org/web/20221008003406/https://repub.eur.nl/pub/59780/NEJM199710093371506.pdf | url-status = live }}</ref> Between the cost for lost productivity and health care expenditures combined, cigarette smoking costs at least 193 billion dollars (Research also shows that smokers earn less money than nonsmokers<ref>{{Cite web |url=http://www.frbatlanta.org/documents/pubs/wp/wp1303.pdf |title=''Even One Is Too Much: The Economic Consequences of Being a Smoker'', Federal Reserve Bank of Atlanta, January 2013 |access-date=11 July 2013 |archive-date=26 November 2013 |archive-url=https://web.archive.org/web/20131126010513/http://www.frbatlanta.org/documents/pubs/wp/wp1303.pdf |url-status=dead }}</ref>). As for secondhand smoke, the cost is over 10 billion dollars.<ref>"Costs and Expenditures". Smoking and Tobacco. Centers for Disease Control and Prevention. Web. 20 January 2013. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/ {{Webarchive|url=https://web.archive.org/web/20110925123149/http://www.cdc.gov/tobacco/data%5Fstatistics/fact%5Fsheets/fast%5Ffacts/ |date=25 September 2011 }}</ref>
By contrast, some non-scientific studies, including one conducted by [[Philip Morris International|Philip Morris]] in the [[Czech Republic]] called ''[[Public Finance Balance of Smoking in the Czech Republic]]''<ref name="Czechonomics">{{Cite web|title=Public Finance Balance of Smoking in the Czech Republic|url=http://www.mindfully.org/Industry/Philip-Morris-Czech-Study.htm|url-status=dead|archive-url=https://web.archive.org/web/20060719015727/http://www.mindfully.org/Industry/Philip-Morris-Czech-Study.htm|archive-date=19 July 2006}}</ref> and another by the [[Cato Institute]],<ref>{{Cite web|title=Snuff the Facts|url=http://www.cato.org/dailys/1-16-98.html|url-status=dead|archive-url=https://web.archive.org/web/20061220145455/http://www.cato.org/dailys/1-16-98.html|archive-date=20 December 2006}}</ref> support the opposite position. Philip Morris has explicitly apologized 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."<ref name="Czechonomics"/>
Between 1970 and 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 being 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).
The tobacco industry is one of the largest global enterprises. The six largest tobacco companies earned a combined profit of $35.1 billion (Jha et al., 2014) in 2010.<ref>{{Cite web|url=http://dcp-3.org/sites/default/files/resources/NEJM%20Tobacco%20Tax.pdf|title=Global Effects of Smoking, of Quitting, and of Taxing Tobacco|access-date=2 May 2018|archive-date=27 November 2021|archive-url=https://web.archive.org/web/20211127145439/https://dcp-3.org/sites/default/files/resources/NEJM%20Tobacco%20Tax.pdf|url-status=live}}</ref>
===Social===
{{See also|Tobacco advertising|Religious views on smoking}}
[[File:Skull with a Burning Cigarette.jpg|thumb|''Skull with a burning cigarette'', by [[Vincent van Gogh]]]]
Famous smokers of the past used cigarettes or pipes as part of their image, such as [[Jean-Paul Sartre]]'s [[Gauloises]]-brand cigarettes; [[Albert Einstein]]'s, [[Douglas MacArthur]]'s, [[Bertrand Russell]]'s, and [[Bing Crosby]]'s pipes; or the news broadcaster [[Edward R. Murrow]]'s cigarette. Writers in particular seem to be known for smoking, for example, [[Cornell University|Cornell]] Professor Richard Klein's book ''[[Cigarettes Are Sublime|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 cigarette addiction in 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. The [[DC Comics|DC]] [[Vertigo Comics|Vertigo]] comic book character [[John Constantine]], created by [[Alan Moore]], is synonymous with smoking, so much so that the first storyline by [[Preacher (comics)|''Preacher'']] creator [[Garth Ennis]] centered around John Constantine contracting lung cancer. [[Professional wrestling|Professional wrestler]] [[The Sandman (wrestler)|James Fullington]], while in character as "The Sandman", is a chronic smoker to appear "tough".
The problem of smoking at home is challenging for women in many cultures (especially Arab cultures), where it may not be acceptable for a woman to ask her husband not to smoke at home or in the presence of her children. Studies have shown that pollution levels for smoking areas indoors are higher than levels found on busy roadways, in closed motor garages, and during firestorms.{{clarify|date=October 2012}} Furthermore, smoke can spread from one room to another, even if doors to the smoking area are closed.<ref>Mostafa RM. Dilemma of women's passive smoking. Ann Thorac Med [serial online] 2011 [cited 2011 Mar 29];6:55-6. Available from: http://www.thoracicmedicine.org/text.asp?2011/6/2/55/78410 {{Webarchive|url=https://web.archive.org/web/20180602122116/http://www.thoracicmedicine.org/text.asp?2011%2F6%2F2%2F55%2F78410 |date=2 June 2018 }}</ref>
The ceremonial smoking of tobacco and praying with a [[Ceremonial pipe|sacred pipe]] is a prominent part of the religious ceremonies of several [[Native Americans in the United States|Native American]] Nations. ''Sema'', the [[Anishinaabe]] word for tobacco, is grown for ceremonial use and is considered the ultimate sacred plant since its smoke is believed to carry prayers to the spirits. 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 studies, smoking was considered an immoral habit by certain Christian preachers and social reformers. The founder of the [[Latter Day Saint movement]], [[Joseph Smith]], recorded that on 27 February 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.<ref>{{Cite web | author = Church of Jesus Christ of Latter-day Saints | year = 2009 | title = Obey the Word of Wisdom | url = http://www.e-sheesh.com/obey-the-word-of-wisdom.html | work = Basic Beliefs – The Commandments | access-date = 15 October 2009 | archive-url = https://web.archive.org/web/20150904081039/http://www.e-sheesh.com/obey-the-word-of-wisdom.html | archive-date = 4 September 2015 | url-status = dead | df = dmy-all }}</ref> 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 [[Ahmadiyya Islam]], smoking is highly discouraged, although not forbidden. During the month of [[Ramadhan|fasting]] however, it is forbidden to smoke tobacco.<ref>{{cite web |url=http://www.alislam.org/v/6071.html |title=Why is smoking not strictly forbidden in Islam? |access-date=2 May 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140503005236/http://www.alislam.org/v/6071.html |archive-date=3 May 2014 }}</ref> In the [[Baháʼí Faith]], smoking tobacco is discouraged though not forbidden.<ref name="oneworld">{{Cite encyclopedia|last=Smith|first=Peter|encyclopedia=A concise encyclopedia of the Bahá'í Faith|title=smoking|year=2000|publisher=Oneworld Publications|___location=Oxford|isbn=978-1-85168-184-6|pages=[https://archive.org/details/conciseencyclope0000smit/page/323 323]|url=https://archive.org/details/conciseencyclope0000smit/page/323}}</ref>
==Public policy==
{{See also|Tobacco politics}}
On 27 February 2005, 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.<ref>{{Cite web|url=http://www.who.int/tobacco/framework/countrylist/en/|title=WHO | Updated status of the WHO Framework Convention on Tobacco Control|date=17 November 2004|access-date=12 December 2021|archive-date=17 November 2004|archive-url=https://web.archive.org/web/20041117032449/http://www.who.int/tobacco/framework/countrylist/en/|url-status=bot: unknown}}</ref> 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.
==
{{See also|Cigarette taxes in the United States}}
{{Taxation}}
Many governments have introduced [[excise tax]]es on cigarettes to reduce the consumption of cigarettes, alongside generating tax revenue. The [[World Health Organization]] finds that:<ref>{{cite web |url=https://www.who.int/tobacco/economics/1globalregionaloverview.pdf?ua=1 |title=Archived copy |website=www.who.int |access-date=15 January 2022 |archive-url=https://web.archive.org/web/20191212192622/https://www.who.int/tobacco/economics/1globalregionaloverview.pdf?ua=1 |archive-date=12 December 2019 |url-status=dead}}</ref>
{{Blockquote|The structure of tobacco excise taxes varies considerably across countries, with lower income countries more likely to rely more on ''ad valorem'' excises and higher income countries more likely to rely more on specific excise taxes, while many countries at all income levels use a mix of specific and ''ad valorem'' excises.
Tobacco excise tax systems are quite complex in several countries, where different tax rates are applied based on prices, and product characteristics such as the presence/absence of a filter or length, packaging, weight, tobacco content, and/or production or sales volume. These complex systems are difficult to administer, create opportunities for tax avoidance, and are less effective from a public health perspective.
Globally, cigarette excise taxes account for less than 45 percent of cigarette prices, on average, while all taxes applied to cigarettes account for just over half of the price. Higher-income countries levy higher taxes on tobacco products, and these taxes account for a greater share of the price, with both the absolute tax and share of price accounted for by tax falling as country incomes fall.}}
In 2002, the [[Centers for Disease Control and Prevention]] said that each [[Cigarette pack|pack]] of cigarettes{{quantify|date=August 2018}} sold in the United States costs the nation more than $7 in medical care and lost productivity,<ref name="query.nytimes.com"/> around $3400 per year per smoker. Another study by a team of health economists finds that the combined price paid by their families and society is about $41 per pack of cigarettes.<ref>{{Cite web|url=https://www.usatoday.com/news/health/November|title=26, 2004-smoking-costs_x.htm Study: Cigarettes cost families, society $41 per pack|website=[[USA Today]] }}</ref>
Substantial scientific evidence confirms that higher cigarette prices result in lower overall cigarette consumption. Most studies indicate that a 10% price increase reduces 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.<ref>{{cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr4916a1.htm|title=Reducing Tobacco Use|access-date=29 February 2016|archive-date=21 February 2016|archive-url=https://web.archive.org/web/20160221224729/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4916a1.htm|url-status=live}}</ref><ref>{{cite journal|title=Higher cigarette prices influence cigarette purchase patterns|journal=Tobacco Control|volume=14|issue=2|pages=86–92|doi=10.1136/tc.2004.008730|pmid=15791017|pmc=1748009|year=2005|last1=Hyland|first1=A.|last2=Bauer|first2=J. E.|last3=Li|first3=Q.|last4=Abrams|first4=S. M.|last5=Higbee|first5=C.|last6=Peppone|first6=L.|last7=Cummings|first7=K. M.}}</ref> While smoking is sometimes given as an example of an [[Elasticity (economics)|inelastic good]]{{Citation needed|date=April 2013}}, it is elastic in poorer and middle-wealth nations, and even in wealthier nations price increases do affect consumption, if not at the same rate as more elastic goods.<ref>{{Cite journal|last1=Nargis|first1=Nigar|last2=Stoklosa|first2=Michal|last3=Shang|first3=Ce|last4=Drope|first4=Jeffrey|title=Price, Income, and Affordability as the Determinants of Tobacco Consumption: A Practitioner's Guide to Tobacco Taxation|journal=Nicotine & Tobacco Research|volume=23|issue=1|pages=40–47|date=January 2021|url=https://doi.org/10.1093/ntr/ntaa134|access-date=18 September 2024|doi=10.1093/ntr/ntaa134|pmid=32697827 |pmc=7789936}}</ref> That is to say, a large rise in price will only result in a small decrease in consumption.
Many nations have implemented some form of tobacco taxation. As of 1997, Denmark had the highest cigarette tax burden of $4.02 per pack. Taiwan only had a tax burden of $0.62 per pack. The federal government of the United States charges $1.01 per pack.<ref>{{cite web|url=http://www.ttb.gov/tax_audit/atftaxes.shtml|title=TTB – Tax Audit Division – Tax and Fee Rates|access-date=29 February 2016|archive-url=https://web.archive.org/web/20160226182839/http://www.ttb.gov/tax_audit/atftaxes.shtml|archive-date=26 February 2016|url-status=dead}}</ref>
Cigarette taxes vary widely from state to state in the United States. For example, [[Missouri]] has a cigarette tax of only 17 cents per pack, the nation's lowest, while [[New York (state)|New York]] has the highest cigarette tax in the U.S.: $4.35 per pack. In Alabama, Illinois, Missouri, New York City, Tennessee, and Virginia, counties and cities may impose an additional limited tax on the price of cigarettes.<ref>{{cite web|url=http://you-and-cigarettes.blogspot.com/2014/03/cigarette-prices-in-usa.html|title=You and Cigarettes|author=Helen C. Alvarez|access-date=29 February 2016|date=28 March 2014|archive-date=4 March 2016|archive-url=https://web.archive.org/web/20160304131233/http://you-and-cigarettes.blogspot.com/2014/03/cigarette-prices-in-usa.html|url-status=live}}</ref> Sales taxes are also levied on tobacco products in most jurisdictions.
In the United Kingdom, {{As of|2023|04|lc=y|post=,}} a packet of 20 cigarettes has a tax added of 16.5% of the retail price plus £5.89.<ref>{{Cite web|url=https://www.gov.uk/tax-on-shopping/alcohol-tobacco|title=Tax on shopping and services|website=GOV.UK|access-date=1 April 2023|archive-date=24 November 2022|archive-url=https://web.archive.org/web/20221124193737/https://www.gov.uk/tax-on-shopping/alcohol-tobacco|url-status=live}}</ref> The UK has a significant [[black market]] for tobacco, and it has been estimated by the tobacco industry that 27% of cigarette and 68% of handrolling tobacco consumption is non-UK duty paid (NUKDP).<ref>{{cite web|url=http://www.the-tma.org.uk/tobacco-smuggling.aspx|title=Tobacco Smuggling & Crossborder Shopping " Tobacco Manufacturers' Association|access-date=29 February 2016|url-status=dead|archive-url=https://web.archive.org/web/20080908075123/http://www.the-tma.org.uk/tobacco-smuggling.aspx|archive-date=8 September 2008}}</ref>
In Australia, total taxes account for 62.5% of the final price of a packet of cigarettes (2011 figures). These taxes include federal excise or customs duty and [[Goods and Services Tax (Australia)|Goods and Services Tax]].<ref>Scollo, Michelle (2008). [http://www.tobaccoinaustralia.org.au/chapter-13-taxation/13-2-tobacco-taxes-in-australia "13.2 Tobacco taxes in Australia"] {{Webarchive|url=https://web.archive.org/web/20221024225928/https://www.tobaccoinaustralia.org.au/chapter-13-taxation/13-2-tobacco-taxes-in-australia |date=24 October 2022 }}. Tobacco in Australia. Cancer Council Victoria. Retrieved 29 July 2010.</ref>
===Restrictions===
{{Main|Tobacco advertising|Tobacco packaging warning messages|Plain tobacco packaging|Smoking ban}}
[[File:Smoking area.JPG|thumb|An enclosed smoking area in a Japanese train station. Notice the air vent on the roof.]]
In June 1967, the US [[Federal Communications Commission]] ruled that programs broadcast on a television station that discussed smoking and health were insufficient to offset the effects of paid advertisements that were broadcast for five to ten minutes each day. In April 1970, the US Congress passed the [[Public Health Cigarette Smoking Act]] banning the advertising of cigarettes on [[television]] and [[radio]] starting on 2 January 1971.<ref>{{cite web|url=http://www.druglibrary.org/Schaffer/LIBRARY/studies/nc/nc2b.htm|title=History of Tobacco Regulation*|access-date=29 February 2016|archive-date=16 June 2010|archive-url=https://web.archive.org/web/20100616014106/http://druglibrary.org/schaffer/LIBRARY/studies/nc/nc2b.htm|url-status=live}}</ref>
The Tobacco Advertising Prohibition Act 1992 expressly prohibited almost all forms of Tobacco advertising in Australia, including the sponsorship of sporting or other cultural events by cigarette brands.
All tobacco advertising and sponsorship on television has been banned within the European Union since 1991 under the Television Without Frontiers Directive (1989).<ref>{{cite web|url=http://ics.leeds.ac.uk/papers/vp01.cfm?outfit=ks&folder=4&paper=11|title=Phil Taylor's Papers " Index|access-date=29 February 2016|archive-date=12 February 2012|archive-url=https://web.archive.org/web/20120212192340/http://ics.leeds.ac.uk/papers/vp01.cfm?outfit=ks&folder=4&paper=11|url-status=live}}</ref> This ban was extended by the Tobacco Advertising Directive, which took effect in July 2005 to cover other forms of media such as the internet, print media, and radio. The directive does not include advertising in cinemas and on billboards or using merchandising – or tobacco sponsorship of cultural and sporting events that are purely local, with participants coming from only one Member State<ref>[http://www.deljpn.ec.europa.eu/home/news_en_newsobj1270.php European Union – Tobacco advertising ban takes effect July 31 ] {{webarchive|url=https://web.archive.org/web/20110124001102/http://www.deljpn.ec.europa.eu/home/news_en_newsobj1270.php |date=24 January 2011 }}</ref> as these fall outside the jurisdiction of the [[European Commission]]. However, most member states have transposed the directive with national laws that are wider in scope than the directive and cover local advertising. A 2008 European Commission report concluded that the directive had been successfully transposed into national law in all EU member states and that these laws were well implemented.<ref>{{Cite web|url=http://ec.europa.eu/health/ph_determinants/life_style/Tobacco/Documents/com_20080520_en.pdf|title=Report on the implementation of the EU Tobacco Advertising Directive|access-date=4 August 2008|archive-date=5 September 2011|archive-url=https://web.archive.org/web/20110905043008/http://ec.europa.eu/health/ph_determinants/life_style/Tobacco/Documents/com_20080520_en.pdf|url-status=live}}</ref>
[[File:Apr2024. Cigarette dispenser in Canoa Quebrada, state of Ceará, Brazil. 07.jpg|thumb|left|A cigarette dispenser in [[Canoa Quebrada]], Brazil selling individual cigarettes for [[Brazilian real|R$]]1 in 2024]]
Some countries also impose legal requirements on the packaging of tobacco products. For example, in the countries of the European Union, Turkey, Australia<ref name="auswarn">[https://web.archive.org/web/20080422050428/http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-drugs-tobacco-warnings.htm Tobacco – Health warnings] Australian Government Department of Health and Ageing. Retrieved 29 August 2008</ref> and South Africa, cigarette packs must be prominently labeled with the health risks associated with smoking.<ref>[http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTPHAAG/0,contentMDK:20799704~menuPK:1314842~pagePK:64229817~piPK:64229743~theSitePK:672263,00.html Public Health at a Glance – Tobacco Pack Information]</ref> Canada, Australia, Thailand, Iceland and Brazil have also imposed labels upon cigarette packs warning smokers of the effects, and they include graphic images of the potential health effects of smoking. Cards are also inserted into cigarette packs in Canada. There are sixteen of them, and only one comes in a pack. They explain different methods of quitting smoking. Also, in the United Kingdom, there have been many graphic [[National Health Service|NHS]] advertisements, one showing a cigarette filled with fatty deposits as if the cigarette is symbolizing the artery of a smoker.
Some countries have also banned advertisements at the point of sale. The United Kingdom and Ireland have limited the advertisement of tobacco at retailers.<ref>{{Cite web|url=http://www2.gov.scot/Topics/Health/Services/Smoking/TopicsHealthServicesSmoking|title=Tobacco Display Ban Guidance|last=Scottish Government|first=St Andrew's House|date=21 January 2013|website=www2.gov.scot|language=en|access-date=27 November 2019|archive-date=27 November 2019|archive-url=https://web.archive.org/web/20191127230008/https://www2.gov.scot/Topics/Health/Services/Smoking/TopicsHealthServicesSmoking|url-status=dead}}</ref><ref>{{Cite web|url=https://www.health-ni.gov.uk/publications/guidance-display-and-pricing-tobacco-products-northern-ireland|title=Guidance on the display and pricing of tobacco products in Northern Ireland {{!}} Department of Health|date=25 August 2015|website=Health|language=en|access-date=27 November 2019|archive-date=27 November 2019|archive-url=https://web.archive.org/web/20191127230001/https://www.health-ni.gov.uk/publications/guidance-display-and-pricing-tobacco-products-northern-ireland|url-status=live}}</ref> This includes storing of cigarettes behind a covered shelf not visible to the public. They do, however, allow some limited advertising at retailers. Norway has a complete ban on point-of-sale advertising.<ref>{{Cite web|url=http://data.euro.who.int/tobacco/Repository/NO/Norway_Act%20No.%2014%20Relating%20to%20Prevention%20of%20the%20Harmful%20Effects%20of%20Tobacco%20(the%20Tobacco%20Control%20Act)_1973(consolidated%20as%20of%201996).pdf |archive-url=https://web.archive.org/web/20170318211259/http://data.euro.who.int/tobacco/Repository/NO/Norway_Act%20No.%2014%20Relating%20to%20Prevention%20of%20the%20Harmful%20Effects%20of%20Tobacco%20(the%20Tobacco%20Control%20Act)_1973(consolidated%20as%20of%201996).pdf |url-status=dead|archive-date=18 March 2017|title=Act No. 14 of March 9th, 1973 Relating to Prevention of the Harmful Effects of Tobacco (The Tobacco Control Act)|last=Norwegian Government|date=1996|access-date=27 November 2019}}</ref> This includes smoking products and accessories. Implementing these policies can be challenging; all of these countries experienced resistance and challenges from the tobacco industry.<ref>{{Cite web|url=https://www.who.int/fctc/implementation/news/news_nor/en/|title=WHO {{!}} Norway: Prohibition on the visible display of tobacco products at the points of sale|website=WHO|access-date=27 November 2019|archive-date=13 February 2020|archive-url=https://web.archive.org/web/20200213134415/https://www.who.int/fctc/implementation/news/news_nor/en/|url-status=live}}</ref><ref>{{Cite web|url=http://www.independent.co.uk/news/uk/home-news/imperial-tobacco-take-fight-against-cigarette-display-ban-to-supreme-court-8306650.html |archive-url=https://ghostarchive.org/archive/20220621/http://www.independent.co.uk/news/uk/home-news/imperial-tobacco-take-fight-against-cigarette-display-ban-to-supreme-court-8306650.html |archive-date=21 June 2022 |url-access=subscription |url-status=live|title=Imperial Tobacco take fight against cigarette display ban to Supreme|date=12 November 2012|website=The Independent|language=en|access-date=27 November 2019}}</ref><ref>{{Cite news|url=https://www.theguardian.com/society/2012/dec/12/scotland-ban-cigarette-display-shop-court|title=Scotland to ban cigarette displays in shops after court challenge fails|last=Carrell|first=Severin|date=12 December 2012|work=The Guardian|access-date=27 November 2019|language=en-GB|issn=0261-3077|archive-date=27 November 2019|archive-url=https://web.archive.org/web/20191127225951/https://www.theguardian.com/society/2012/dec/12/scotland-ban-cigarette-display-shop-court|url-status=live}}</ref> The World Health Organization recommends the complete ban of all types of advertisement or product placement, including at vending machines, at airports and on internet shops selling tobacco.<ref>{{Cite web|url=http://www.euro.who.int/__data/assets/pdf_file/0005/339233/who-evidence-brief-pos-ban-eng.pdf|title=Evidence brief: Tobacco point-of-sale display bans|last=World Health Organization|date=2017|website=WHO|url-status=dead|archive-url=https://web.archive.org/web/20191127225952/http://www.euro.who.int/__data/assets/pdf_file/0005/339233/who-evidence-brief-pos-ban-eng.pdf|archive-date=27 November 2019|access-date=27 November 2019}}</ref> The evidence is as yet unclear as to the effect of such bans.
Many countries have a [[smoking age]]. In many countries, including the United States, most European Union member states, New Zealand, Canada, South Africa, Israel, India,<ref name=":0" /> Brazil, Chile, Costa Rica and Australia, it is illegal to sell tobacco products to minors and in the Netherlands, Austria, Belgium, Denmark and South Africa it is illegal to sell tobacco products to people under the age of 18. On 1 September 2007 the minimum age to buy tobacco products in Germany rose from 16 to 18, as well as in the United Kingdom where on 1 October 2007 it rose from 16 to 18.<ref>{{cite web|url=http://www.tobacco18.co.uk/index.html|title=Tobacco Sales Law|access-date=29 February 2016|archive-date=23 November 2010|archive-url=https://web.archive.org/web/20101123174957/http://www.tobacco18.co.uk/index.html|url-status=dead}}</ref> Underlying such laws is the belief that people should make an informed decision regarding the risks of tobacco use. These laws have lax enforcement in some nations and states. In China, Turkey, and many other countries, a child has little problem buying tobacco products because they are often told to go to the store to buy tobacco for their parents.
Several countries such as Ireland, Latvia, Estonia, the Netherlands, Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore, Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United Kingdom, Slovenia, Türkiye and Malta have legislated against smoking in public places, often including bars and restaurants. Restaurateurs have been permitted in some jurisdictions to build designated smoking areas (or to prohibit smoking). In the United States, many states prohibit smoking in restaurants, and some also prohibit smoking in bars. In provinces of Canada, smoking is illegal in indoor workplaces and public places, including bars and restaurants. As of 31 March 2008, Canada has introduced a smoke-free law in all public places, as well as within 10 meters of an entrance to any public place. In Australia, smoke-free laws vary from state to state. In New Zealand and Brazil, smoking is restricted in enclosed public places, including bars, restaurants, and pubs. Hong Kong restricted smoking on 1 January 2007 in the workplace, public spaces such as restaurants, karaoke rooms, buildings, and public parks (bars that do not admit minors were exempt until 2009). In Romania, smoking is illegal in trains, metro stations, public institutions (except where designated, usually outside), and public transport. In Germany, in addition to smoking bans in public buildings and transport, an anti-smoking ordinance for bars and restaurants was implemented in late 2007. A study by the University of Hamburg (Ahlfeldt and Maennig 2010) demonstrates that the smoking ban had, if any, only short-run effects on bar and restaurant revenues. In the medium and long run, no negative effect was measurable. The results suggest either that consumption in bars and restaurants is not affected by smoking bans in the long run or that negative revenue effects from smokers are compensated by increasing revenues from non-smokers.<ref>Ahlfeldt, G., Maennig, W. (2010), Impact of non-smoking ordinances on hospitality revenues: The case of Germany, in Journal of Economics and Statistics, 230(5), 506–521; preliminary version in: Hamburg Contemporary Discussion Papers N° 26, http://www.uni-hamburg.de/economicpolicy/hced.html {{Webarchive|url=https://web.archive.org/web/20160523194904/https://www2.uni-hamburg.de/economicpolicy//hced.html |date=23 May 2016 }}.</ref>
===Ignition safety===
An indirect public health problem posed by cigarettes is that of accidental fires, usually linked with consumption of [[alcohol (drug)|alcohol]]. Enhanced combustion using nitrates was traditionally used, but cigarette manufacturers have been silent on this subject, claiming at first that a safe cigarette was technically impossible, then that it could only be achieved by modifying the paper. Roll-your-own cigarettes contain no additives and are fire-safe. Numerous [[fire safe cigarette]] designs have been proposed, some by tobacco companies themselves, which would extinguish a cigarette left unattended for more than a minute or two, thereby reducing the risk of fire. Among American tobacco companies, some have resisted this idea, while others have embraced it. [[RJ Reynolds]] was a leader in making prototypes of these cigarettes in 1983<ref>{{cite web|url=http://www.nfpa.org/newsReleaseDetails.asp?categoryid=488&itemId=36577&cookie%5Ftest=1|title=NFPA applauds Reynolds American Inc|access-date=29 February 2016|url-status=dead|archive-url=https://web.archive.org/web/20130301031633/http://www.nfpa.org/newsReleaseDetails.asp?categoryid=488&itemId=36577&cookie%5Ftest=1|archive-date=1 March 2013}}</ref> and will make all of their U.S. market cigarettes fire-safe by 2010.<ref>{{cite web|url=http://www.nfpa.org/assets/files//FSC/ReynoldsLetter.pdf|title=NFPA|access-date=29 February 2016|url-status=dead|archive-url=https://web.archive.org/web/20071120013338/http://www.nfpa.org/assets/files//FSC/ReynoldsLetter.pdf|archive-date=20 November 2007}}</ref> [[Philip Morris USA|Phillip Morris]] is not in active support of it.<ref name="letter_fire_safe_cigarettes">{{cite web|url=http://firesafecigarettes.org/itemDetail.asp?categoryID=91&itemID=1370&URL=Letter%20to%20tobacco%20companies|title=Coalition for Fire-Safe Cigarettes|access-date=29 February 2016|archive-date=16 August 2011|archive-url=https://web.archive.org/web/20110816102947/http://firesafecigarettes.org/itemDetail.asp?categoryID=91&itemID=1370&URL=Letter%20to%20tobacco%20companies|url-status=live}}</ref> [[Lorillard]] (purchased by [[RJ Reynolds]]), the US' 3rd-largest tobacco company, seems to be ambivalent.<ref name="letter_fire_safe_cigarettes"/>
===Health warnings===
Individual cigarettes in Canada now carry warnings such as "poison in every puff" and "cigarettes cause impotence" in what the government says is an effort to make it "virtually impossible to avoid health warnings altogether".<ref>{{Cite news |last=Lindeman |first=Tracey |date=2023-08-01 |title='Poison in every puff': Canada puts health warnings on individual cigarettes |language=en-GB |work=The Guardian |url=https://www.theguardian.com/world/2023/aug/01/canada-cigarette-health-warnings-tobacco-industry |access-date=2023-08-08 |issn=0261-3077}}</ref>
==Gateway drug theory==
{{Main|Tobacco and other drugs|Gateway drug theory}}
The relationship between tobacco and other drug use has been well-established, however, the nature of this association remains unclear. The two main theories are the [[Gateway drug theory|phenotypic causation]] (gateway) model and the correlated liabilities model. The causation model argues that smoking is a primary influence on future drug use,<ref>{{cite journal | last1 = C. Merrill | first1 = J. | last2 = Kleber | first2 = H. D. | last3 = Shwartz | first3 = M. | last4 = Liu | first4 = H. | last5 = Lewis | first5 = S. R. | title = Cigarettes, alcohol, marijuana, other risk behaviors, and American youth | journal = Drug and Alcohol Dependence | volume = 56 | issue = 3 | pages = 205–212 | year = 1999 | pmid = 10529022 | doi = 10.1016/S0376-8716(99)00034-4 }}</ref> while the correlated liabilities model argues that smoking and other drug use are predicated on genetic or environmental factors.<ref>{{cite journal | last1 = Swan | first1 = G. C. | last2 = Carmelli | first2 = D. | last3 = Rosenman | first3 = R. H. | last4 = Fabsitz | first4 = R. R. | last5 = Christian | first5 = J. C. | title = Smoking and alcohol consumption in adult male twins: genetic heritability and shared environmental influences | journal = Journal of Substance Abuse | volume = 2 | issue = 1 | pages = 39–50 | year = 1990 | pmid = 2136102 | doi = 10.1016/S0899-3289(05)80044-6 | url = https://www.medlineplus.gov/alcohol.html | format = Free full text | issn = 0899-3289 | access-date = 7 April 2016 | archive-date = 4 July 2016 | archive-url = https://web.archive.org/web/20160704221747/https://www.nlm.nih.gov/medlineplus/alcohol.html | url-status = live }}</ref> One study published by the NIH found that tobacco use may be linked to cocaine addiction and marijuana use. The study stated that 90% of adults who used cocaine had smoked cigarettes before (this was for people ages 18–34). This study could support the gateway drug theory.<ref>{{Cite web|url=https://www.nih.gov/news-events/nih-research-matters/why-nicotine-gateway-drug|title=Why Nicotine is a Gateway Drug|date=22 May 2015|website=National Institutes of Health (NIH)|language=EN|access-date=20 April 2020|archive-date=11 April 2020|archive-url=https://web.archive.org/web/20200411153307/https://www.nih.gov/news-events/nih-research-matters/why-nicotine-gateway-drug|url-status=dead}}</ref>
==Cessation==
{{Main|Smoking cessation}}
Quitting smoking often involves advice from physicians or social workers,<ref name=":0" /> [[cold turkey]], [[nicotine replacement therapy]], contingent vouchers,<ref>{{Cite journal|last1=Rohsenow|first1=Damaris J.|last2=Martin|first2=Rosemarie A.|last3=Tidey|first3=Jennifer W.|last4=Colby|first4=Suzanne M.|last5=Monti|first5=Peter M.|title=Treating Smokers in Substance Treatment With Contingent Vouchers, Nicotine Replacement and Brief Advice Adapted for Sobriety Settings|journal=Journal of Substance Abuse Treatment|doi=10.1016/j.jsat.2016.08.012|pmid=27658756|pmc=5154824|volume=72|pages=72–79|year=2017}}</ref> [[antidepressant]]s, vaping,<ref>{{Cite web |date=2022-09-20 |title=Vaping to quit smoking - NHS |url=https://www.nhs.uk/better-health/quit-smoking/vaping-to-quit-smoking/ |access-date=2023-06-13 |website=nhs.uk |language=en |archive-date=21 June 2023 |archive-url=https://web.archive.org/web/20230621034541/https://www.nhs.uk/better-health/quit-smoking/vaping-to-quit-smoking/ |url-status=live }}</ref> [[hypnosis]], self-help (mindfulness meditation),<ref>{{Cite journal|last1=Tang|first1=Yi-Yuan|last2=Tang|first2=Rongxiang|last3=Posner|first3=Michael I.|title=Mindfulness meditation improves emotion regulation and reduces drug abuse|journal=Drug and Alcohol Dependence|volume=163|pages=S13–S18|doi=10.1016/j.drugalcdep.2015.11.041|pmid=27306725|year=2016|doi-access=free}}</ref> and support groups.
In the United States, about 70% of smokers would like to quit smoking, and 50% report having attempted to do so in the past year.<ref>{{cite journal |title= Quitting smoking among adults—United States, 2001–2010 |journal= MMWR. Morbidity and Mortality Weekly Report |volume= 60 |issue= 44 |pages= 1513–9 |date= November 2011 |pmid= 22071589 |author1= Centers for Disease Control Prevention (CDC) }}</ref> Without support, 1% of smokers will successfully quit smoking each year. Physician advice to quit smoking increases the rate to 3% per year.<ref name=Brunetta2022>{{cite book|vauthors=Brunetta PG, Kroon L |chapter=Smoking Cessation |title=Murray & Nadel's Textbook of Respiratory Medicine |edition=7 |date=2022 |publisher=Elsevier |pages=900–909 |veditors= Broaddus C, Ernst JD, King, TE ''et al''}}</ref> Adding first‐line smoking cessation medications (and some behavioral help), increased quit rates to around 20% of smokers in a year.<ref name="RosenGalili2018">{{cite journal |last1=Rosen |first1=Laura J. |last2=Galili |first2=Tal |last3=Kott |first3=Jeffrey |last4=Goodman |first4=Mark |last5=Freedman |first5=Laurence S. |date=January 2018 |title=Diminishing benefit of smoking cessation medications during the first year: a meta-analysis of randomized controlled trials |journal=[[Addiction (journal)|Addiction]] |publisher=[[Wiley-Blackwell]] on behalf of the [[Society for the Study of Addiction]] |volume=113 |issue=5 |pages=805–816 |doi=10.1111/add.14134 |issn=0965-2140 |pmc=5947828 |pmid=29377409 |s2cid=4764039}}</ref> For cessation of smoking, public participation in health campaigns are important. In Nepal, cardiologist [[Om Murti Anil]] has launched '''smokers are not selfish''' campaign on the occasion of Valentine's Day. He is using social media to motivate people to sacrifice their smoking habits as a gift to their loved ones .<ref>{{Cite web |title=Family First: Dr. Anil's Love-Infused Anti-Smoking Initiative |url=https://risingnepaldaily.com/news/38420 |access-date=2024-02-05 |website=GorakhaPatra}}</ref>
==
*
* [[Cannabis smoking]]
* [[Cigarette smoking among college students]]
* [[Cigarette smoking for weight loss]]
* [[Electronic cigarette]]
* [[Herbal cigarette]]
* [[List of cigarette smoke carcinogens]]
* [[Snuff (tobacco)]]
* [[Smoker's paradox]]
* [[Tobacco advertising]]
* [[Tobacco control]]
* [[History of public health in the United States]]
==References==
{{Reflist|35em}}
==Bibliography==
{{Refbegin}}
* Frieden, Thomas R. et al. ''The Health Consequences of Smoking: 50 Years of Progress: A Report of the Surgeon General'' (2014) [https://archive.org/details/full-report online]
* {{Cite book|last1=Gilman|first1=Sander L.|last2=Xun|first2=Zhou|date=15 August 2004|title=Smoke: A Global History of Smoking|url=https://books.google.com/books?id=mM5bYb_uVcwC&q=smoke|publisher=Reaktion Books|isbn=978-1-86189-200-3|access-date=22 March 2009}}
* Goodman, Jordan, ed. ''Tobacco in History and Culture. An Encyclopedia'' (2 vol, Gage Cengage, 2005) [https://archive.org/details/tobaccoinhistory0000unse/page/n6/mode/1up online]
* Hirschfelder, Arlene B. ''Encyclopedia of smoking and tobacco'' (1999) [https://archive.org/details/encyclopediaofsm0000hirs online]
* Oreskes, Naomi, and Erik M. Conway. ''Merchants of doubt: How a handful of scientists obscured the truth on issues from tobacco smoke to global warming'' (Bloomsbury Publishing USA, 2011).
* {{Cite book|last=Proctor|first=Robert N.|date=15 November 2000|title=The Nazi War on Cancer|url=https://books.google.com/books?id=02NGyKTwko0C&q=The+Nazi+War+on+Cancer|publisher=Princeton University Press|isbn=978-0-691-07051-3|access-date=22 March 2009}}
* {{Cite book|url=https://www.who.int/entity/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf|title=The Global Burden of Disease 2004 Update|last=World Health Organization|publisher=[[World Health Organization]]|year=2008|isbn=978-92-4-156371-0|ref=CITEREFGBD2008|access-date=1 January 2008|archive-date=14 November 2008|archive-url=https://web.archive.org/web/20081114050614/https://www.who.int/entity/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf|url-status=live}}
* {{Cite book|url=https://www.who.int/entity/tobacco/mpower/mpower_report_full_2008.pdf|archive-url=https://wayback.archive-it.org/all/20090207002649/http://www.who.int/entity/tobacco/mpower/mpower_report_full_2008.pdf|url-status=dead|archive-date=7 February 2009|title=WHO Report on the Global Tobacco Epidemic, 2008: the MPOWER package|last=World Health Organization|publisher=[[World Health Organization]]|year=2008|isbn=978-92-4-159628-2|ref=CITEREFMPOWER2008|access-date=1 January 2008}}
{{Refend}}
==External
{{Sister project links|wikt=Smoking|b=Smoking/Contents|q=Tobacco|s=Tobacco|commonscat=Tobacco smoking|n=Smoking|v=Smoking|d=Q7212330}}
{{Refbegin|}}
* [https://web.archive.org/web/19961121221839/http://tobacco.org/History/history.html Tobacco History Links] – repository from Tobacco.org
* [https://web.archive.org/web/20100328130928/http://www.surgeongeneral.gov/tobacco/ '''Surgeon General''': Tobacco Cessation]
{{Refend}}
{{Cigarettes}}
{{Smoking nav}}
{{Drug use}}
{{Authority control}}
{{DEFAULTSORT:Tobacco Smoking}}
[[Category:5th-millennium BC introductions]]
[[Category:Causes of death]]
[[Category:Tobacco smoking| ]]
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