Smoking, 

inhalation and exhalation of the fumes of burning tobacco. Leaves of the

tobacco plant are smoked in various ways. After a drying and curing process, they may

be rolled into cigars or shredded for insertion into smoking pipes. Cigarettes, the most

popular method of smoking, consist of finely shredded tobacco rolled in lightweight

paper. About 46 million people in the United States smoke an estimated 420 billion

cigarettes each year.

Until the 1940s smoking was considered harmless, but laboratory and clinical research

has since confirmed that tobacco smoke presents a hazard to health. Smoke from the

average cigarette contains around 4,000 chemicals, some of which are highly toxic and

at least 43 of which cause cancer. Nicotine, a major constituent of tobacco smoke, is

both poisonous and highly addictive. According to the American Cancer Society,

smoking is the most preventable cause of death in America today.

European explorers who arrived in the Western Hemisphere in the 1500s observed

Native Americans smoking tobacco plant leaves in pipes. The colonists who followed

them grew tobacco plants as a cash crop for export, and smoking became part of

European culture by the 1600s. Most tobacco was consumed in pipes and cigars or as

snuff (finely pulverized tobacco inhaled into the nostrils). This pattern changed by the

early 20th century, by which time smokers consumed more than 1,000 cigarettes per

capita each year in the United States and some European countries. The general

attitude of society was that smoking relieved tension and produced no ill effects. During

World War II (1939-1945) American physicians endorsed sending soldiers tobacco, and

cigarettes were included in the field ration kits of U.S. armed forces personnel until

1975.
Some scientists noticed, however, that lung cancer, which was rare before the 20th

century, had increased dramatically since about 1930. The American Cancer Society

and other organizations initiated studies comparing deaths among smokers and

nonsmokers over a period of several years. All such studies found increased mortality

among smokers, both from cancer and other causes. In addition, experimental studies

in animals showed that many of the chemicals contained in cigarette smoke are

carcinogenic.

In 1962 the U.S. government appointed a panel of ten scientists to study the available

evidence concerning the health effects of smoking. Their conclusions were included in

the 1964 surgeon general’s report, which stated that “cigarette smoking is a health

hazard of sufficient importance in the United States to warrant appropriate remedial

action.” Smoking in adults, measured as an average number of cigarettes smoked per

year, began to decline steadily after the 1964 report and has fallen more than 40

percent since 1965.

About 442,000 people in the United States die each year from illnesses caused by

cigarette smoking. Smoking accounts for nearly 90 percent of lung cancer deaths.

Additionally, smokers are at increased risk for cancer of the larynx, oral cavity,

esophagus, bladder, kidney, and pancreas. While some negative health effects of

smoking manifest slowly over time, others can be measured almost immediately. Sticky

brown tar leaves yellow stains on fingers and teeth. Some of the inhaled tar is absorbed

by lung cells, causing them to die. Tar also damages the cilia in the upper airways that

protect against infection. Nicotine causes arteries to constrict, lowering skin temperature

and reducing blood flow to the hands and feet. Carbon monoxide deprives the body of
oxygen, binding to red blood cells in place of the oxygen molecule and forcing the heart

to pump more blood through the body.

One-third of smoking-related deaths are caused by coronary heart disease or chronic

airway obstruction. For example, the nicotine in tobacco combines with carbon

monoxide in tobacco smoke to damage the lining of blood vessels and make blood

platelets stickier. Platelets form part of the damaging plaque buildup in artery walls (see

Arteriosclerosis). These effects in combination contribute to the development of heart

disease. Smoking also increases the risk of stroke by 50 percent—40 percent among

men and 60 percent among women. Other research has shown that mothers who

smoke give birth more frequently to premature or underweight babies, probably

because of a decrease in blood flow to the placenta. Babies born to mothers who

smoke during pregnancy are also at increased risk for sudden infant death syndrome.

Cigar and pipe smoke contains the same toxic and carcinogenic compounds found in

cigarette smoke. A report by the National Cancer Institute concluded that the mortality

rates from cancer of the mouth, throat, larynx, pharynx, and esophagus are

approximately equal in users of cigarettes, cigars, and pipes. Rates of coronary heart

disease, lung cancer, emphysema, and chronic bronchitis are elevated for cigar and

pipe smokers and are correlated to the amount of smoking and the degree of inhalation.

Studies have found that cigarettes are addictive because an unknown component of

tobacco smoke appears to destroy an important brain enzyme known as monoamine

oxidase B (MAO B). The enzyme is vital for breaking down excess amounts of

dopamine, a neurotransmitter that triggers pleasure-seeking behavior. Smokers have

encourage the smoker to seek the pleasure of more tobacco smoke.

Even nonsmokers are at risk from smoking. Recent research has focused on the effects

of environmental tobacco smoke (ETS)—that is, the effect of tobacco smoke on

nonsmokers who must share the same environment with a smoker. The United States

Environmental Protection Agency (EPA) estimates that exposure to ETS, which

contains all the toxic agents inhaled by a smoker, causes 3,000 lung cancer deaths and

an estimated 35,000 deaths from heart disease per year among nonsmokers.

Secondhand smoke can aggravate asthma, pneumonia, and bronchitis, and impair

blood circulation.

The smoking habit and addiction to nicotine usually begin at an early age. In the United

States, more than 90 percent of adults who smoke started by age 21, and nearly half of

them were regular smokers by the age of 18. Despite increasing warnings about the

health hazards of smoking and widespread bans on smoking in public places, smoking

remains common among teenagers and young adults. In 2001 surveys of students in

grades 9 through 12 found that more than 38 percent of male students and nearly 30

percent of female students smoke. Although black teenagers have the lowest smoking

rates of any racial group, cigarette smoking among black teens increased 80 percent in

the late 1990s. Advertisements aimed at a young audience are largely blamed for this

new generation of smokers.

decreases with each year of abstinence. According to the World Health Organization

(WHO), smokers who quit smoking before the age of 50 reduce their risk of life-

threatening disease by half after just one year, compared with those who continue

smoking.

Other benefits of quitting smoking include more disposable income, admission to social

activities and institutions that ban smoking, and often, lower health insurance premiums.

Nonetheless, to quit smoking is difficult, most likely because smokers crave the effect of

the nicotine in the smoke. The U.S. surgeon general declared nicotine an addictive drug

comparable to other addictive substances, including cocaine, heroin, and alcohol, in its

ability to induce dependence. Overall, tobacco smoking causes about 20 times the

number of deaths in the United States than all other addictive drugs combined.

Smoking cessation methods are plentiful, and many books and products are available to

help an individual stop smoking. Many smokers turn to group help because of the

support and understanding provided by other former smokers or people trying to quit.

Most successful group-help techniques involve a challenge and reward system that also

bolsters the self-discipline of the former smoker.

A number of nicotine replacement products are available to help a person quit smoking.

Nicotine patches are small, nicotine-containing adhesive disks that must be applied to

the skin. The nicotine is slowly absorbed through the skin and enters the bloodstream.

Over time, a smoker uses nicotine patches containing smaller and smaller doses of

nicotine until eventually the craving for nicotine ends. Nicotine gum works in a similar
manner, providing small doses of nicotine when chewed. A nicotine nasal spray is a

physician-prescribed spray that relieves cravings for a cigarette by delivering nicotine to

the nasal membranes. Also available by prescription, the nicotine inhaler looks like a

cigarette; when puffed, the inhaler releases nicotine into the mouth.

An approach combining three different smoking cessation therapies has found

remarkable success. This approach combines an antidepressant drug called bupropin,

marketed under the brand name Zyban, with a nicotine replacement product and

counseling. While less than 25 percent of smokers who use nicotine replacement

products alone remain smoke-free for more than a year, 40 to 60 percent of smokers

using this combination approach achieved this milestone.

In the United States, the first direct action to curb smoking after the U.S. surgeon

general’s 1964 report on smoking was the mandate of a warning on cigarette packages

by the Federal Trade Commission. This warning took effect in 1964 and was

strengthened in 1969 to read: “Warning: The Surgeon General Has Determined That

Cigarette Smoking Is Dangerous to Your Health.” A stronger sequence of four

alternative warnings was developed in 1984. In 1971 all cigarette advertising was

banned from radio and television, and cities and states passed laws requiring

nonsmoking sections in public places and workplaces.

This trend has continued and smoking is now banned at the federal and state levels in

most government buildings and in many private businesses. As of February 1990

federal law banned smoking on all domestic United States airline flights under six hours
in duration. By 1998 more than 90 percent of nonstop flights between the United States

and all foreign countries were also smoke free.

In 2002 President George W. Bush signed into law the Safe and Drug-Free Schools and

Communities Act. The law bans smoking within any indoor facility used for childhood

education. By 2003 a number of states (including New York, Connecticut, Maine, and

California) and cities (including Boston, Massachusetts and Austin, Texas) passed laws

banning smoking in all bars, restaurants, and clubs. Several European countries also

began to ban smoking in public places—especially in restaurants, bars, and cafes. They

include Ireland, Italy, Netherlands, and Norway. A ban in the United Kingdom is

scheduled to take effect in 2007; a ban in France, in 2008.

The tobacco industry has been increasingly criticized for its role in encouraging

smoking, particularly in young people. Various lawsuits have been brought against

tobacco companies to reclaim damages due to disease or death associated with

smoking. The first major successful suit occurred in March 1996 when the Liggett

Group, a consortium of companies, agreed to pay damages to five states. An onslaught

of litigation against the tobacco industry followed. In part to avoid potentially ruinous

lawsuits filed by states, in 1998 the tobacco industry and attorneys general from 46 U.S.

states agreed to a $206-billion settlement. The settlement, to be paid over 25 years, will

be used to compensate states for the costs of treating smoking-related illness, to

finance nationwide antismoking programs, and to underwrite health care for uninsured

children.
The tobacco industry must also contend with a barrage of lawsuits filed by individual

smokers and their families seeking damages for smoking-related health problems and

deaths. Across the United States, such lawsuits have had mixed results. In several

cases, juries have cleared the tobacco companies of all responsibility. While several

other cases have resulted in large awards for the plaintiffs, few hold up under the

appeals process.

Tobacco industry representatives long denied that nicotine is addictive and that there is

a link between smoking and poor health. In recent years, however, cigarette makers

have faced increased pressure from smoking-related lawsuits and federal regulators to

accept prevailing scientific opinions about the health risks of smoking. In late 1999

Philip Morris, now known as Altria, the nation’s largest cigarette maker, publicly

acknowledged that smoking is addictive and causes serious health problems. This latest

admission was considered a way to make it more difficult for those who have recently

started smoking to claim they were unaware of the dangers if they choose to sue

cigarette companies. In 2003 an Illinois judge ordered Philip Morris to pay $10.1 billion

in damages for using misleading advertising campaigns suggesting that cigarette

brands marketed as “low tar” or “light” are safer than regular brands. Numerous

scientific studies prove that the use of low-tar cigarettes does not reduce the risk of

developing smoking-related disease, and the judge found that Philip Morris intentionally

disregarded consumer rights by spreading disinformation.

Smoking is “hateful to the nose, harmful to the brain, and dangerous to the lungs.” This

was the view of England’s king James I in 1604. For long afterward, smoking was

considered harmless. Today, more and more people agree with King James.
TOBACCO AND NICOTINE

Smoking means breathing the smoke of burning tobacco leaves. Tobacco is a plant.

Tobacco is processed for smoking in different ways. People smoke tobacco in pipes,

cigars, and cigarettes.

Tobacco smoke contains about 4,000 chemicals. One of them is nicotine. In large

amounts, nicotine is a poison. In small amounts in the human body, nicotine stimulates

the nerves. It makes the heart beat faster.

Nicotine is highly addictive. This means that smokers become dependent on its effect

as a stimulant. When this effect wears off, the body strongly desires more. That is why

people who smoke find it hard to stop.

HISTORY

Native Americans smoked tobacco as long as 2,000 years ago. Explorer Christopher

Columbus saw them smoking in 1492. His crew brought tobacco to Europe. European

sailors spread it around the world. Some people believed then that smoking could cure

diseases. By 1600, people smoked mainly for enjoyment.

Cigarettes were invented in Europe. They did not become popular until the 1800s. They

were expensive because people had to make them by hand. Then a cigarette-rolling

machine was invented.

In the 1940s, doctors began to notice connections between smoking and lung cancer

and other diseases. They began to study the chemicals in cigarette smoke. Many of

these chemicals were found to cause cancer. A group of scientists prepared a report for
the United States government in 1964. The report declared cigarette smoking to be a

serious health danger.

Since then, smoking in the United States has greatly declined. Health warnings appear

on cigarette packages. Smoking is banned on most airline flights. It is banned from

many offices and public places.

SMOKING AND HEALTH

Cancer experts say that cigarettes kill hundreds of thousands of Americans every year.

Lung cancer kills more Americans than any other kind of cancer. Smokers are 20 times

more likely than nonsmokers to develop lung cancer.

Smokers also are at greater risk for other forms of cancer and other lung diseases.

Mothers who smoke can injure the health of their babies.

Quitting smoking greatly lowers the chances of dying from diseases caused by smoking.

“Is it catching?” People sometimes ask this question when they hear that someone is

sick. They are talking about a kind of human disease. The kinds of diseases that are

contagious (catching) are caused by microscopic germs. Diseases caused by germs are

called infectious diseases. Other human diseases can be caused by many things.

Pneumonia, strep throat, and food poisoning are some of the diseases caused by

germs called bacteria. Bacteria are living things made of just one cell.

Germs called viruses cause colds, chicken pox, flu, mumps, measles, polio, and AIDS.

Viruses are even tinier than bacteria.

protozoan. Protozoans are made of one cell and are like tiny animals. Mad cow disease

may be caused by a strange bit of protein called a prion.

Many germs spread in coughs and sneezes. Sick people get these germs on their

hands. You can pick up these germs by touching a doorknob or something else that a

sick person touched. Washing your hands regularly can help keep you safe from many

diseases caused by germs.

Long ago, many people in Europe and North America died from diseases called cholera

and typhoid. The germs that cause these diseases live in dirty water. Good sewers and

clean water stopped the spread of these diseases in many countries. These diseases

are still a problem in poor countries.

Contact with poisons can cause disease. Smoking tobacco can cause lung cancer and

other lung diseases. Drinking lots of alcohol can damage the brain and liver. Lead in

drinking water or paint can cause mental problems in children.

Smoking 'light' cigarettes (those low in nicotine and other substances) apparently does

not reduce the risk of cigarette-related heart attacks, researchers reported this year.

Further confirming the notion that it's better to quit than switch, another study found that

light cigarettes, in fact, have as much nicotine as regular cigarettes.

The first study, conducted by researchers from Boston and Harvard universities,

compared the smoking habits of 502 men between the ages of 30 and 54 who were

hospitalized after suffering first heart attacks with the habits of 835 men hospitalized for

other reasons. It was found that the men who smoked faced almost three times the risk
of heart attacks as those who did not smoke. Researchers also found that the level of

risk did not change with the amount of nicotine and carbon monoxide in the cigarettes

smoked. The effect of these two substances was studied because nicotine is known to

increase blood pressure and carbon monoxide to reduce the amount of oxygen that

reaches the heart.

The reason for the lack of difference may lie in part in the findings of the second study,

conducted by Dr. Neal L. Benowitz of San Francisco General Hospital and Medical

Center and colleagues. They found that despite the claims of cigarette manufacturers

and contrary to the results of previous tests made by the Federal Trade Commission,

the tobacco in low-yield cigarettes did not contain less nicotine than does that in most

regular-strength cigarettes. The investigators reached this conclusion after extracting

and measuring the nicotine content in different cigarettes. To determine how much

nicotine was consumed by smokers of low-yield cigarettes, the blood concentration of a

nicotine by-product was measured after 272 subjects smoked various brands. The

researchers suggested that their methods provided more accurate information than did

the smoking machines used in the FTC tests.

Smoking has also been named as the factor that bridges the 'longevity gap' between

men and women. A study conducted by Drs. Dean R. Gerstein of the U.S. National

Research Council and Gus H. Miller of Pennsylvania's Indiana University suggested that

the 'overwhelming' reason why American women are statistically likely to live longer

than men is that they have tended to smoke less. But because women are now

beginning to smoke almost as much as men, the 7½-year difference in their lifespans

may gradually vanish.

they removed two factors in their analysis—smoking and death from violent causes—

they found that longevity for men and women was about equal. The analysis suggests

that the difference in longevity is not, as other studies have suggested, the result of

either innate differences or the greater on-the-job stress to which men are presumably

subject. Stress, however, may play a role; those who are forced to cope with more

stress may seek to alleviate its effects by smoking. Young women are currently taking

up smoking at higher rates than are young men; the study concludes that when the

adverse health effects catch up with them, the women will probably develop cancer and

other cigarette-related diseases at rates as great as those of men.

Smoking,women who smoke run a higher risk of suffering a stroke than nonsmokers or

former smokers, according to researchers at Harvard Medical School and Boston's

Brigham and Women's Hospital, who reported their findings in April. The researchers

studied over 100,000 women between the ages of 30 and 55 for eight years. Compared

to women who never smoked, those who did had significantly higher rates of stroke,

both fatal and nonfatal, which increased with the number of cigarettes smoked daily.

The researchers found that women who quit smoking quickly reduced their risk of stroke

(and heart attack) back to the level of risk of nonsmokers. Previously, researchers had

determined that cigarette smoking was associated with an increased risk of stroke in

men, but studies investigating the link in women had generally failed to find a

statistically significant association, largely because of the small numbers of women

studied.
In his annual report on smoking and health, issued in May, U.S. Surgeon General Koop

said that nicotine in cigarettes met the criteria for addictive drugs. The report said that

nicotine stimulates the heart and constricts small blood vessels, alters moods, promotes

repetitive patterns of use, and causes withdrawal symptoms. Although Koop did not ask

for a ban on tobacco, he suggested that the warning labels on cigarettes mention the

potential for addiction. He also criticized authorities who fail to enforce laws prohibiting

the sale of cigarettes to minors; he recommended that cigarette vendors be required to

obtain a license.

In a landmark verdict, a six-member federal jury in Newark, N.J., ordered the Liggett

Group Inc., maker of Chesterfield and L&M brand cigarettes, to pay Antonio Cipollone of

New Jersey $400,000 in damages for its contribution to the death of his wife, Rose. Mrs.

Cipollone smoked for over 40 years, continuing to smoke after 1966, when federal law

required manufacturers to place warning labels on cigarettes; after she developed a

tumor that forced surgeons to remove part of her right lung in 1981; and even after her

entire lung was removed in 1982. She did not quit smoking until about a year before

cancer killed her in 1984, at age 58. Though tobacco companies have faced more than

300 lawsuits since 1954, the Cipollone case was the first in which a manufacturer was

ordered to pay damages. The $32 billion tobacco industry still claimed victory, partly

because the jury failed to find the Liggett Group, Philip Morris Inc., or Lorillard Inc. (all

charged in the suit) guilty of charges of fraud and conspiracy to hide the hazards of

smoking from the public. Because the jury apparently remained unconvinced about

Cipollone's efforts to quit, it decided that she was 80 percent responsible for her own

illness and that Liggett was only 20 percent responsible. Liggett filed an appeal in
September; lawyers for Antonio Cipollone also appealed, arguing that the damages

should be greater.