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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 simply 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]] onwards but embedded itself in certain strata of a number of 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
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
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==
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===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. There were social events like the [[smoke night]] which promoted the habit.
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{{see also|Polycyclic aromatic hydrocarbons}}
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.
[[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 bold face.<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>]]
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
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 |url=https://aacrjournals.org/cebp/article/18/2/541/166699/Interaction-between-Tobacco-and-Alcohol-Use-and |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>
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> Cunningham et al.<ref name=Cunningham>{{cite journal |vauthors=Cunningham FH, Fiebelkorn S, Johnson M, Meredith C |title=A novel application of the Margin of Exposure approach: segregation of tobacco smoke toxicants |journal=Food Chem. Toxicol. |volume=49 |issue=11 |pages=2921–33 |year=2011 |pmid=21802474 |doi=10.1016/j.fct.2011.07.019 }}</ref> combined the microgram weight of the compound in the smoke of one cigarette with the known [[Genotoxicity|genotoxic]] effect per microgram to identify the most [[Carcinogenesis|carcinogenic]] compounds in cigarette smoke: [[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 }}</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 }}</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 }}</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), [[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 />▼
[[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>
The [[World Health Organization]] estimates that tobacco caused 8 million deaths in 2004<ref>{{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> and 100 million deaths over the course of 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 actually successful in doing so.<ref name="Barendregt, J. J. 1997"/>▼
▲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 [[World Health Organization]] estimates that tobacco caused 8 million deaths in 2004<ref
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 in order 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.
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, falling 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>
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[[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 also has 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>
===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 suggesting that heavy smokers generally do not live long enough to develop the costly and chronic illnesses which 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.
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 apologised for the former study, saying: "The funding and public release of this study which, among other things, detailed purported cost savings to the Czech Republic due to premature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptable disregard of basic human values. For one of our tobacco companies to commission this study was not just a terrible mistake, it was wrong. All of us at Philip Morris, no matter where we work, are extremely sorry for this. No one benefits from the very real, serious and significant diseases caused by smoking."<ref name="Czechonomics"/>
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[[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 addiction to cigarettes within his novels. British Prime Minister [[Harold Wilson]] was well known for smoking a pipe in public as was [[Winston Churchill]] for his cigars. [[Sherlock Holmes]], the fictional detective created by [[Sir Arthur Conan Doyle]], smoked a pipe, cigarettes, and cigars. 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 in order to appear "tough".
The problem of smoking at home is particularly difficult 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 fire storms.{{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>
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{{Taxation}}
Many governments have introduced [[excise tax]]es on cigarettes in order to reduce the consumption of cigarettes. The [[World Health
{{
Tobacco excise tax systems are quite complex in several countries, where different tax rates are applied based on prices, product characteristics such as 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 half of price. Higher income countries levy higher taxes on tobacco products and these taxes account for a greater share of 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{{
Substantial scientific evidence shows that higher cigarette prices result in lower overall cigarette consumption. Most studies indicate that a 10% increase in price will reduce overall cigarette consumption by 3% to 5%. Youth, minorities, and low-income smokers are two to three times more likely to quit or smoke less than other smokers in response to price increases.<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>
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>
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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 which 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 a number of 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 advertisement at point of sale. 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 of 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|last1=Carrell|first1=Severin|date=12 December 2012|work=The Guardian|access-date=27 November 2019|last2=correspondent|first2=Scotland|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
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 a lax enforcement in some nations and states. In China, Turkey, and many other countries usually a child will have little problem buying tobacco products, because they are often told to go to the store to buy tobacco for their parents.
Several countries such as Ireland, Latvia, Estonia, the Netherlands, Finland, Norway, Canada, Australia, Sweden, Portugal, Singapore, Italy, Indonesia, India, Lithuania, Chile, Spain, Iceland, United Kingdom, Slovenia,
===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 to be 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
==Gateway drug theory==
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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 made an attempt 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 |url= https://pubmed.ncbi.nlm.nih.gov/22071589/ |access-date= 2015-05-09 |author1= Centers for Disease Control Prevention (CDC) |archive-date= 3 January 2023 |archive-url= https://web.archive.org/web/20230103171810/https://pubmed.ncbi.nlm.nih.gov/22071589/ |url-status= live }}</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
==See also==
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==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}}
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{{DEFAULTSORT:Tobacco Smoking}}
[[Category:5th-millennium BC introductions]]
[[Category:Causes of death]]
[[Category:Tobacco smoking| ]]
[[Category:Habits]]
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