The Tobacco Epidemic

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Progress in Respiratory Research
Vol. 42

Series Editor

Felix J.F. Herth Heidelberg

The Tobacco Epidemic
2nd, revised and extended edition

Volume Editors

Robert Loddenkemper Berlin

Michael Kreuter Heidelberg

85 figures, 31 in color, 29 tables, 2015

Basel · Freiburg · Paris · London · New York · Chennai · New Delhi ·

Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney
Prof. Dr. Robert Loddenkemper Ass. Prof. Dr. Michael Kreuter
Hertastrasse 3 Department of Pneumology and Respiratory Critical Care Medicine
D-14169 Berlin Thoraxklinik, University of Heidelberg
Germany Amalienstrasse 5
D-69126 Heidelberg
Germany

Library of Congress Cataloging-in-Publication Data

The tobacco epidemic / volume editors, Robert Loddenkemper, Michael Kreuter.

-- 2nd, revised and extended edition.
p. ; cm. -- (Progress in respiratory research, ISSN 1422-2140 ; vol.
42)
Includes bibliographical references and indexes.
ISBN 978-3-318-02656-6 (hard cover : alk. paper) -- ISBN 978-3-318-02657-3
(electronic version)
I. Loddenkemper, Robert, editor. II. Kreuter, Michael, editor. III.
Series: Progress in respiratory research ; v. 42. 1422-2140
[DNLM: 1. Smoking. 2. Smoking Cessation--methods. 3. Tobacco Products.
4. Tobacco Smoke Pollution. 5. Tobacco Use Disorder. W1 PR681DM / QV 137]
RC567
616.86’5--dc23
2015000956

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1st edition published in 1997 and edited by C.T. Bolliger and K.O. Fagerström as The Tobacco Epidemic (Progress in Respiratory Research, Vol. 28)
2nd edition © Copyright 2015 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland)
www.karger.com
Printed in Germany on acid-free and non-aging paper (ISO 9706) by Kraft Druck GmbH, Ettlingen
ISSN 1422–2140
e-ISSN 1662–3932
ISBN 978–3–318–02656–6
e-ISBN 978–3–318–02657–3
Contents

Foreword VII
Preface VIII

Chapter 1 History of Tobacco Production and Use 1

Hanafin, J.; Clancy, L. (Dublin)
Chapter 2 Global Tobacco Epidemic 19
Mackay, J. (Hong Kong); Schluger, N. (New York, N.Y.)
Chapter 3 The Tobacco Epidemic and the Commercial Sector: Tobacco Industry Strategies to Increase
Profits and Prevent Regulation 27
Weishaar, H. (Glasgow)
Chapter 4 Chemistry and Primary Toxicity of Tobacco and Tobacco Smoke 37
Wiebel, F.J. (Neuherberg)
Chapter 5 Nicotine Dependence 47
Zaveri, N.T. (Mountain View, Calif.); Rollema, H. (Mystic, Conn.); Swan, G.E. (Stanford, Calif.)
Chapter 6 The Psychology of the Smoker 58
Gilbert, D.G. (Carbondale, Ill.); Pergadia, M.L. (Boca Raton, Fla./St. Louis, Mo.)
Chapter 7 Respiratory Disorders Related to Smoking Tobacco 72
Murray, J.F. (San Francisco, Calif.); Buist, A.S. (Portland, Oreg.)
Chapter 8 Cardiovascular and Other (Except Respiratory) Disorders Related to Smoking Tobacco 85
Barnoya, J. (St. Louis, Mo./Guatemala City); Monzon, J.C. (Guatemala City)
Chapter 9 Health Effects of Passive Smoking in Children 97
Bush, A. (London)
Chapter 10 Health Effects of Passive Smoking in Adults 110
Clancy, L. (Dublin); Kabir, Z. (Dublin/Cork)
Chapter 11 Economics of Tobacco Use and Control 121
Townsend, J. (London)
Chapter 12 Legislation and Smoking Prevention 136
Latif, E.; Warner, V. (Edinburgh)
Chapter 13 The WHO Framework Convention on Tobacco Control 149
Pötschke-Langer, M. (Heidelberg); Schotte, K.; Szilagyi, T. (Geneva)
Chapter 14 Youth and Tobacco 158
Bauer, C.; Kreuter, M. (Heidelberg)

V
Chapter 15 Impact of Media, Movies and TV on Tobacco Use in the Youth 171
Sargent, J.D. (Lebanon, N.H.); Hanewinkel, R. (Kiel)
Chapter 16 Social Determinants of Cigarette Smoking 181
Upson, D. (Albuquerque, N. Mex.)
Chapter 17 Smoking and Mental Health Problems 199
Caillé, S. (Bordeaux); Baker, A.L.; Todd, J. (Newcastle, N.S.W./Callaghan, N.S.W.);
Turner, A. (Newcastle, N.S.W./Callaghan, N.S.W./Geelong, Vic./Parkville, Vic.);
Dayas, C.V. (Newcastle, N.S.W./Callaghan, N.S.W.)
Chapter 18 Patterns and Predictors of Smoking Cessation 210
Ditre, J.W.; Zale, E.L. (Syracuse, N.Y.); Brandon, T.H. (Tampa, Fla.)
Chapter 19 Examining the Role of the Health Care Professional in Controlling the Tobacco Epidemic:
Individual, Organizational and Institutional Responsibilities 219
Leone, F.T.; Evers-Casey, S. (Philadelphia, Pa.)
Chapter 20 Pharmacotherapy: Nicotine Replacement Therapy and Other Drugs in Smoking Cessation
(Including Vaccination) 229
Tønnesen, P. (Glostrup)
Chapter 21 Smokeless Tobacco – Health Hazards or Less Harm? 243
Bolinder, G.; Gilljam, H. (Stockholm)
Chapter 22 Waterpipe Tobacco Smoking: A Less Harmful Alternative? 252
Jawad, M. (London)
Chapter 23 Electronic Cigarettes: The Issues behind the Moral Quandary 258
Vardavas, C.I. (Boston, Mass./Crete); Agaku, I.T. (Boston, Mass.)

Author Index 268

Subject Index 269

VI Contents
Foreword

Tobacco entered America long before the Europeans ar- ered, starting with its history and ending with an emerging
rived. A Spanish crew member of the Santa Maria, the flag- problem: electronic cigarettes.
ship of Christopher Columbus’s first expedition, is credited The editors were able to motivate the ‘who is who’ in the
with being the first European smoker. In Japan, tobacco was field, and, true to the heart of the series, the book concen-
introduced by Portuguese sailors in the middle of the 16th trated on an ongoing problem in the world, and all authors
century. In Australia, smoking started when it was intro- included the latest relevant references.
duced to northern-dwelling communities by visiting
Indonesian fishermen in the early 18th century. My congratulations to the editors and the authors for this
The world was conquered by tobacco and the disaster great volume.
started.
The 42nd volume of Progress in Respiratory Research Enjoy reading
presents an updated edition of this topic. In this revised and
extended version, all actual aspects of the epidemic are cov- Felix J.F. Herth, Heidelberg
ered. In 23 chapters, the complete tobacco story is consid-

VII
Preface

Tobacco use causes one of the world’s deadliest epidemics bacco industry is now likely to be “rolled back” on other
ever. It killed 100 million people in the 20th century and, if fronts, too. Actions are now also mounting in Europe. Ciga-
trends do not change, will be responsible for the deaths of rette smoking will most likely not be exempt from regula-
1 billion people in this century. Most of those projected tions as in the past. However, smoking may still grow in the
deaths will occur in low- and middle-income countries, developing world and make up for the sales lost in the USA
where the tobacco industry has shifted its efforts to recruit and other developed countries’.
new smokers (Framework Convention Alliance, Moscow, However, in the past 18 years, some essential progress
October 13–18, 2014). has been made in the fight against the deadly epidemic, the
In 1997, our friend Chris Bolliger – who sadly died in most important being certainly the WHO Framework Con-
2012 – wrote in his preface to the 1st volume of the book se- vention on Tobacco Control, approved in 2006, which
ries Progress in Respiratory Research under his editorship: changed the landscape of public health being one of the
‘For this first volume ‘‘The Tobacco Epidemic’’ to appear un- most widely adopted treaties in the history of the United Na-
der my editorship I have chosen the area of smoking, which tions, with 179 Parties to the Convention covering over 85%
is more than just ‘‘timely’’ considering the current legal de- of the world’s population. This was followed in 2008 by the
velopments on everything concerning smoking in the USA. introduction of six WHO MPOWER measures, a policy
It further represents a topic which should appeal to a large package intended to assist implementation of effective inter-
readership across many medical specialities, but also to non- ventions to reduce tobacco use worldwide at the country
medical people interested in tobacco’. level. The first Tobacco Atlas was released in 2002 and the
We, the editors of this 2nd edition of ‘The Tobacco Epi- editors of the 4th edition in 2012 stated rightly that the last
demic’, have to acknowledge the progress meanwhile 10 years had likely been the most productive period in the
achieved in many areas against this deadly tobacco epidem- history of tobacco control, but that far too much remains to
ic; however, as outlined in several chapters, recent data show be done. The regular US Surgeon General’s Reports – last
that the global problem has even been aggravated since year under the heading The Health Consequences of Smok-
1997. ing – 50 Years of Progress – helped essentially to raise the
In their foreword to the book the two editors Chris Bol- awareness about the dangers related to tobacco and its in-
liger and Karl Olov Fagerström stated: ‘In the summer of dustry. In several countries, strict regulations with smoking
1997, American tobacco companies were pushed against the bans were introduced, ‘smoke free’ – the first complete ban
wall and agreed to: (a) pay well over USD 300 billion to on workplace smoking – in Ireland in 2004. Seventeen
smokers and health care givers; (b) restrict their marketing, European Union (EU) countries have introduced compre-
and (c) make sure that smoking in adolescence declines’. hensive laws since then and more than 60 countries world-
The contributions in this 2015 edition reveal that this has wide and 28 US states have comprehensive smoke-free laws.
not been implemented; on the contrary, the predictions of In the EU, the first Tobacco Product Directive of 2001 was
the former editors have unfortunately come true: ‘The to- comprehensively revised in 2014, thus strengthening the

VIII
Robert Loddenkemper Michael Kreuter

rules on how tobacco products are manufactured, produced less and waterpipe tobacco smoking, the final chapter analy-
and presented in the EU and introducing specific rules for ses the potential harms and benefits of e-cigarettes and oth-
certain tobacco-related products. er electronic nicotine-delivering devices, a topic which has
The scientific knowledge on the health hazards of recently achieved high public attention and which – on one
tobacco – almost all organs of the body are now found to be side – may help smokers to quit but entails – on the other
affected – and on nicotine addiction has enlarged consider- side – the danger of renormalization of smoking, in particu-
ably since the 1st edition. This 2nd edition with its 23 chap- lar appealing to the youth.
ters written by outstanding experts covers all clinical, public We are convinced that the request of Chris Bolliger that
health and political aspects on tobacco smoking. The book ‘Individual contributions should be a mix of highly scien-
is illustrated with 85 figures and 29 tables and contains a tific but also easy-to-read writing…’ has been fulfilled in this
broad range of the most recent literature. The reader can extended and completely revised 2nd edition. We are grate-
learn about the long history of tobacco production and use, ful to all authors representing so many countries and organ-
about the economical aspects of tobacco use and control as isations for their dedicated contributions. We hope that this
well as the health consequences of voluntary and involun- book will be helpful not only to medical doctors, medical
tary smoking, both in adults and in children. Special chap- trainees and nurses from various fields who witness the bur-
ters depict the impact of media, movies and TV on tobacco den of smoking-related diseases in their daily practice (e.g.
use in the youth, the most relevant target of the cigarette public health, respiratory medicine, thoracic surgery, cardi-
industry. The patterns and predictors of smoking cessation ology, internal medicine, paediatric medicine, psychiatry,
in the general population as well as in different social sub- psychology, occupational medicine and obstetrics) but also
groups are described. The reader will further be updated on to interested journalists and politicians/legislators.
the development and features of nicotine dependence, how As an outlook to a potential 3rd edition, we express the
it can be treated with nicotine replacement medications and hope that the fight against the tobacco epidemic will move
other drugs, the role of general practitioners, nurses and on successfully to stop the epidemic and that this 2nd edi-
pharmacists in aiding smokers to quit, what effects smoke- tion will contribute to the success and assist those engaged
free environments, advertising bans and price increases in this fight.
have on smoking prevalence, and, of course, what smoking Robert Loddenkemper, Berlin
prevalence looks like worldwide. Besides chapters on smoke- Michael Kreuter, Heidelberg

Preface IX
Chapter 1
Loddenkemper R, Kreuter M (eds): The Tobacco Epidemic, ed 2, rev. and ext.
Prog Respir Res. Basel, Karger, 2015, vol 42, pp 1–18 (DOI: 10.1159/000369289)

History of Tobacco Production and Use

Joan Hanafin · Luke Clancy
TobaccoFree Research Institute Ireland, Dublin, Ireland

Abstract The chapter is divided into three sections. Firstly, a brief

Tobacco has been in use for over 10,000 years and worldwide for over history of tobacco cultivation, production, preparation and
500 years, but its use was limited by the intensity of time and labour use throughout the ages is presented; secondly, a historical
involved in producing, preparing and using it. From the late 1800s,
developments in mechanisation, transport and technology led to
account of beliefs and knowledge about the health effects of
greater ease of production and use. Marketing, advertising and pro- tobacco are described, and, thirdly, the history of tobacco
motion by tobacco companies led to tobacco use on such a scale as control and regulation and of the responses of the tobacco
to be called an epidemic. Tobacco regulation has existed since at least industry are summarised. The chapter concludes with a
1500. Growing scientific evidence based on tobacco-related mortal- brief account, within the foregoing historic context, of cur-
ity and morbidity, notably since the early 20th century, and public
rent global trends and issues in tobacco use and control.
health interventions in place since the mid-20th century, led to a de-
crease in tobacco use amongst better-off, industrialised, western
populations. There has been a concomitant increase in tobacco use
among middle- and lower-income countries. As tobacco is a main risk Tobacco Cultivation, Production, Preparation and Use
factor for chronic diseases, including cancer, lung diseases and car-
diovascular diseases, the late 20th and early 21st century have been This section gives an account of tobacco from its earliest cul-
characterised by public health campaigns to regulate tobacco. Many
countries have enacted legislation in conformity with the WHO
tivation and use in agricultural societies for religious, cre-
Framework Convention on Tobacco Control, but the number of ative and social purposes through the globalization of to-
smokers continues to rise, and tobacco-related disease and death bacco cultivation and use following the creation of new
continue to increase. © 2015 S. Karger AG, Basel trade routes in the 1500s, to its greatly increased use follow-
ing industrialisation, peaking in developed countries in the
mid-20th century, and the pattern of socially unequal use in
This chapter provides an overview of the history of tobacco: the early decades of the 21st century, characterised by dif-
its early agricultural and ceremonial origins; the globaliza- ferentiated patterns of use by age, gender, material resourc-
tion of tobacco cultivation and use; changes in tobacco pro- es and geography.
duction and use that occurred with industrialisation and
mass production; the development of an empirical, epide- Early Tobacco Cultivation
miological, scientific evidence base regarding the health ef- The oldest record of tobacco, dating to the Pleistocene Era
fects of tobacco use; historic and current initiatives in regu- 2.5 million years ago, is a small cluster of fossilised tobacco
lating and controlling tobacco, and the evolving strategies of leaves reported to have been found in 2010 by palaeontolo-
the tobacco industry in combatting tobacco control and in- gists in northeastern Peru [1]. There is no indication of ha-
creasing the number of users of its products, leading to the bitual use of tobacco by humans in the Ancient World on
current global state of play regarding tobacco production, any continent except the tropical Americas, and it is thought
use and control. that the tobacco plant began growing there about 6000 BCE
[1]. By 1 CE, tobacco was ‘nearly everywhere’ in the Amer-
icas and ways of using tobacco included various smoking
methods, chewing and probably hallucinogenic enemas [1].
The tobacco plant refers to any of various members of
the genus Nicotiana in the nightshade (Solanaceae) family,
which includes also the potato, tomato, garden pepper and
many garden ornamental flowers. The plant genus Nicoti-
ana was named in 1756 by the Swedish botanist Carolus
Linnaeus; he described two species: Nicotiana rustica
(fig. 1) and Nicotiana tabacum (fig. 2). Within the Nicoti-
ana genus, there are about seventy species. N. tabacum
does not occur naturally but is a product of human cultiva-
tion, a hybrid of Nicotiana sylvestris and Nicotiana tomen-
tosiformis [2]. Native Americans used several species, the
most popular of which was N. tabacum, thought to have
been first cultivated in the highlands of Peru and Ecuador
[3]. Tobacco can grow in any warm, moist environment,
which means it can be farmed on all continents except
Antarctica.
Fig. 1. N. rustica.
From its origins in tropical America, tobacco spread northwards
during prehistoric times [4]. N. rustica (developed later in Russia as
machorka) was the variety cultivated in North America and has
higher nicotine content than the other tobacco plants [2]. Tobacco
plants are cultivated for their leaves, which are dried and processed,
mainly for smoking in cigarettes, cigars and pipes; it is also cut to
form chewing tobacco or ground to make snuff or dipping tobacco,
as well as other less common preparations [2]. Amerindians, in cul-
tivating tobacco, developed the major ways of consuming the herb
that are in use today [5]. All tobacco products deliver nicotine, a
highly addictive ingredient to the central nervous system, with a
confirmed risk of dependence [6, 7] (see also chapter 5).

Unlike every other crop cultivated by indigenous peo-

ples during prehistoric times, tobacco was not cultivated
for nutritional purposes. According to many accounts, to-
bacco played a critical role in religious and healing prac-
tices. Due to its high nicotine content, as well as the manner Fig. 2. Field of flowering N. tabacum.
in which it was used, early tobacco use could produce hal-
lucinogenic experiences [4]. Tobacco became a sacred plant
and 10,000 years ago, Mayan priests lit sacred fires for cer- emony … and the lesser Indians, who rolled tobacco leaves
emonial religious purposes, blowing repeatedly on the em- together to form a crude cigar’ [1]. The first pictorial record
bers to kindle them into life, inhaling the smoke and thus (fig. 3) of tobacco being smoked was found on Guatemalan
experiencing the effects of the ingredients of the plant [2, p. pottery dating from around 600–1000 CE, on which a Maya
1]. The tobacco plant also attained a ceremonial religious is depicted smoking a roll of tobacco leaves tied with a
status in the context of bringing a sacrificial offering to the string and a more than 1,300-year-old Mayan vessel deco-
gods [2] although other mixtures of sacred herbs were also rated with hieroglyphics and containing tobacco was dis-
common. Between 470 and 630 CE as the Mayas migrated covered by Dmitri Zagorevski, director of the Proteomics
and the Toltecs created the Aztec Empire, two ‘castes of Core in the Center for Biotechnology and Interdisciplinary
smokers emerged … Those … who mingled tobacco with Studies at Rensselaer, and Jennifer Loughmiller-Newman,
the resin of other leaves and smoked pipes with great cer- a doctoral candidate at the University at Albany in 2012.

2 Hanafin · Clancy

Loddenkemper R, Kreuter M (eds): The Tobacco Epidemic, ed 2, rev. and ext.

Prog Respir Res. Basel, Karger, 2015, vol 42, pp 1–18 (DOI: 10.1159/000369289)
 In his wide-ranging early history of tobacco, Comptom
Mackenzie [10, p. 71] wrote that there was ‘not a tittle of
evidence’ that Columbus brought back any of those dry to-
bacco leaves; that the two members of Columbus’s crew who
saw the first cigars being smoked near Havana ‘vanished
forthwith from recorded history’, and that it is ‘impossible
to find any evidence to justify the de Torres/de Jerez claims’.
Rather, Mackenzie [10, p. 73] claimed that a French Francis-
can – Frère André Thévet – was the first person to bring to-
bacco seeds to Europe and that he was growing it in his gar-
den in Angoulême several years before Nicot was given the
credit for sending seeds to France from Lisbon. In short,
while Columbus may have brought a few tobacco leaves and
Fig. 3. Guatemalian pottery dating from around 600–1000 CE [53].
seeds with him back to Europe at the end of the 15th cen-
tury, it is likely that most Europeans did not get their first
taste of tobacco until around the mid- to late 1550s when
The Language of Smoking adventurers and diplomats began to popularise its use.
The language of smoking has its origins mainly in this place When tobacco was first introduced into Europe from the
and time. In 1870, Brewer [8, p. 5] wrote that the word to- Americas, it was regarded as a medicinal plant, included in
bacco was ‘probably derived from Tabac, an instrument used the descriptions of plants and their properties known as
by the Americans in smoking the herb’; others say it derived Herbals, and was widely used for medicinal purposes. When
from the islands of Tobago or Tabasco; others again from Nicot presented the tobacco plant N. rustica (fig. 1) to the
‘the circumstances that the herb is wrapped up for use in a queen mother Catherine de Medici for the royal herb garden
dry leaf which forms a sheath or envelope, and this kind of around 1560, it was as a wonderful medicinal herb from the
sheath is always called Tabacos by the Carribeans’ [8, p. 6]. New World [5]. A highly influential treatise on the medici-
The Mayan term for smoking is sikar, from which the word nal uses of tobacco written in 1571 by a Spanish physician
cigar and subsequently the word cigarette (derived from the was so successful that it was translated into English, Latin,
French cigarette meaning small cigar) most likely derives. French and Italian [11].

The Globalization of Tobacco Africa

Europe Tobacco was introduced to Africa in the 17th century by the
From these origins in the Americas, tobacco grew to be- Ottoman conquests in the north and the slave trade, and
come, in the 16th and 17th centuries, a global commodity. cultivation spread rapidly throughout the continent [12].
There is general agreement that tobacco was unknown to The first major tobacco manufacturing group was set up in
Europeans prior to the 15th century and that it was intro- the late 1880s in South Africa, and over time all of the major
duced to Europe from the Americas as a result of the in- tobacco trading companies came to be represented there. By
crease in naval exploration. Many sources note Columbus’s 1993, there were 33 African countries growing tobacco with
‘voyage of discovery’ as the moment of introduction and only 2 exporting more than they imported as a combination
various individuals are said to have been responsible for the of urbanization, westernization and increased disposable in-
introduction of different uses of tobacco to different come together with increased promotion and marketing by
European countries. For example, Christopher Columbus is the tobacco industry led to increases in smoking [12].
said to have recorded, in 1492, having been offered certain
dried leaves; the Spanish explorers Luis de Torres and Ro- Asia
drigo de Jerez are credited with first observing smoking; Jer- In the late 16th century, tobacco ‘swept into China on the
ez was said to have become a smoker and brought the habit same crest of global mobility that carried it to Africa and
to Spain; the French ambassador to Portugal, Jean Nicot (af- other parts of Eurasia’ [13, p. 5] although when tobacco first
ter whom nicotine was named) sent the tobacco plant to entered China is undocumented. It was introduced by
France in 1560; Sir Francis Drake is said to have brought Spanish and Portuguese traders along the maritime coast, by
pipe smoking to England in 1572, and so on [9]. Korean merchants over land and along Central Asian cara-

History of Tobacco Production and Use 3

Loddenkemper R, Kreuter M (eds): The Tobacco Epidemic, ed 2, rev. and ext.

Prog Respir Res. Basel, Karger, 2015, vol 42, pp 1–18 (DOI: 10.1159/000369289)
van routes. Even earlier, prior to the 1560s, before the Ming within 7 years, it was the colony’s largest export and remained
Dynasty lifted official bans on overseas trade, Chinese mer- until 1793 the most valuable staple export from the English
chants and sailors carried out clandestine commerce with American mainland colonies and the United States. Tobacco
neighbours in Japan and Southeast Asia and, by the second as a cash crop grew over the next 2 centuries, fuelling the de-
half of the 16th century, the habit of tobacco smoking was mand in North America for slave labour. By the middle of the
‘readily appropriated by Chinese, Japanese, and Southeast 1800s, the tobacco plant was being cultivated throughout ‘the
Asian merchants and sailors’ [13, p. 5]. By the late 1630s, whole extent of the United States, Canada, New Brunswick,
tobacco was being commercially grown and traded in China. Mexico, the Western Coast, the Spanish main, Brazil, Cuba,
Snuff and waterpipe tobacco became popular with Chinese St. Domingo, Trinidad, Turkey, Persia, India, China,
elites in the 18th century [13, p. 6]. Unlike in Europe, there Australia, the Philippine Islands, Japan, Egypt, Algeria, the
was little concern regarding tobacco as a ‘foreign’ or ‘bar- Canary Islands, and the Cape of Good Hope’ [14, p. 2].
baric’ product and no concern or restriction of women The latter half of the 19th century was a key period in the
smoking. By contrast, tobacco consumption placed health at increased production and use of tobacco and tobacco prod-
risk by ‘crossing moral boundaries of frugality and absti- ucts. Developments during this period included new meth-
nence into the hedonism of overindulgence’ [13, p. 97]. ods of curing tobacco, credited to tobacco farmers in North
Carolina, which made smoke easier to inhale, and the dis-
Commercial Production of Tobacco covery by ‘a slave named Bill’ that intense heat during curing
Europe would produce a golden leaf [15]. Other late 19th-century
By the early decades of the 16th century, Europeans had be- developments included the invention of the Bonsack ma-
gun cultivating tobacco in the Americas, and, thanks to chine that transformed the labour-intensive cigarette manu-
Spanish and other European sailors who took the tobacco facturing industry, being capable of making 120,000 ciga-
plant with them on voyages of exploration and trade, tobac- rettes in a day; the development and spread of the safety
co was being grown around the world well before 1700 [5]. match (for which mass production was refined by 1900) that
Around 1614, Seville was established as a world centre for obviated the need for a burning flame and allowed tobacco
the production of cigars, and European cigarette use also to be smoked anywhere, and the development of efficient
began here as beggars patched together tobacco from used rail transportation, making it possible to distribute rapidly
cigars and rolled them in paper [9]. Slade [5] described throughout the nation a perishable product and making it
many aspects of the economics of tobacco production dur- easier for factories to utilize raw materials from distant loca-
ing this period. European governments set up lucrative tions in greater quantity [5] (fig. 4).
state-run monopolies to manage tobacco. The wealthy Most of the tobacco smoked prior to the 20th century used
French monopoly helped to finance the American Revolu- air-cured rather than flue-cured tobacco, which when burned
tion. In England, the tobacco trade was organised as a pri- produced a non-inhalable smoke [3]. Flue curing (the pro-
vate enterprise, with the government receiving income from cess by which tobacco plants are heated soon after harvest) as
excise taxes. British farmers were not permitted to grow to- a method of tobacco production made cigarettes unique
bacco because their produce could not be taxed. among all forms of tobacco by producing an inhalable smoke,
thus making it the single most important manufacturing pro-
North America cess responsible for the global lung cancer epidemic [3]. Un-
Historically, tobacco is one of the half-dozen most impor- til the 1960s, the United States not only grew but also manu-
tant crops grown by American farmers [2]. In 1612, the to- factured and exported more tobacco than any other country.
bacco plant N. tabacum (fig. 2) was introduced to Virginia The publication of conclusive epidemiological evidence in
and the crop became the economic base for Britain’s south- the mid-20th century of tobacco-related disease, disability
ern colonies in North America and has remained a major and death led to a decline in official support for producers
cash crop. Early trade agreements took place around this and manufacturers of tobacco as an agricultural commodity.
time and, in 1620, an agreement between the British Crown
and the Virginia Tobacco Company banned commercial to- Tobacco Use throughout the Centuries
bacco growing in England, in return for a duty on Virginia Various forms of tobacco use developed at different times in
tobacco. different countries between the late 1500s and the early
The first successful commercial tobacco crop was culti- 1900s, until cigarette smoking became the norm in most of
vated in Virginia in 1621 by Englishman John Rolfe, and, the developed world by the mid-20th century [16]. Tobacco

4 Hanafin · Clancy

Loddenkemper R, Kreuter M (eds): The Tobacco Epidemic, ed 2, rev. and ext.

Prog Respir Res. Basel, Karger, 2015, vol 42, pp 1–18 (DOI: 10.1159/000369289)
Fig. 4. The Dukes of Durham, Washington Duke and his son, James Fig. 5. The advertising of tobacco cigarettes with military personnel,
Buchanan ‘Buck’ Duke, were the first to recognize fully and develop often combined with some representation of women back home,
machine-made commercial tobacco cigarettes. They built the great was widely employed during World War II and helped sustain the
American Tobacco Company empire, which dominated about 90% of continued increases in cigarette use by advancing the ‘acceptability’
the tobacco market, until it was broken through antitrust action in of the female smoker. World Wars I and II both helped make cigarette
1907–1911 [18]. smoking, practiced a century ago almost entirely by women, a ‘man-
ly behavior’ [18].

use changed and grew over time until, by the mid-20th cen- and snuff. Pipe smoking spread quickly throughout the
tury, its use was so widespread that it came to be known as English society in the latter half of the 16th century. Snuff
the ‘tobacco epidemic’ [4], so called because of the scale of was widely used in the French court, and, in England, it be-
current and predicted morbidity and mortality caused by its came an aristocratic form of tobacco use. Russia’s Peter the
use. The biggest increases in prevalence coincided with the Great encouraged tobacco use in his court [17]. Pipe smok-
liberal supply of cigarettes to men in both World Wars (pro- ing was popular at the Prussian Court: figure 7 depicts the
moted by advertisements as in fig. 5) and the post-war tar- ‘Tobacco Council’ at the court of the Prussian King Freder-
geting by the tobacco industry of smoking by women as an ick William I (about 1737).
equality and freedom issue (fig. 6) [4]. In the early 1800s, cigars became popular, and until the
Within a hundred years of its introduction into Europe, mid- to late 19th century, tobacco was consumed almost en-
tobacco was being burnt in pipes for pleasure, at first in tirely by pipe smoking and snuff, with other lesser amounts
England, then in Europe and throughout the world [16]. Ini- acquired through cigars, smokeless tobacco plugs and by
tially, tobacco was used mainly for pipe smoking, chewing other means [18].

History of Tobacco Production and Use 5

Loddenkemper R, Kreuter M (eds): The Tobacco Epidemic, ed 2, rev. and ext.

Prog Respir Res. Basel, Karger, 2015, vol 42, pp 1–18 (DOI: 10.1159/000369289)