Smoking - inhalation and exhalation of the fumes of burning tobacco in cigars and cigarettes and pipes. Some persons draw the smoke into their lungs; others do not. Smoking was probably first practiced by the indigenous peoples of the Western Hemisphere. Originally used in religious rituals, and in some instances for medicinal purposes, smoking and the use of tobacco became a widespread practice by the late 1500s. Tobacco was introduced into Europe by the explorers of the New World; however, many rulers prohibited its use and penalized offenders. By the end of the 19th cent. mass production of cigarettes had begun, and the smoking of cigarettes became prevalent as the use of cigars and pipes declined. Despite controversy as to the effects of smoking and bans on smoking by certain religious groups, the use of tobacco continued to increase.

Health Effects

Smoking is considered a health hazard because tobacco smoke contains nicotine, a poisonous alkaloid, and other harmful substances such as carbon monoxide, acrolein, ammonia, prussic acid, and a number of aldehydes and tars; in all tobacco contains some 4,000 chemicals. In 1964 definitive proof that cigarette smoking is a serious health hazard was contained in a report by the Surgeon General's Advisory Committee on Health, appointed by the U.S. Public Health Service. The committee drew evidence from numerous studies conducted over decades. They concluded that a smoker has a significantly greater chance of contracting lung cancer than a nonsmoker, the rate varying according to factors such as the number of cigarettes smoked per day, the number of years the subject smoked, and the time in the person's life when he or she began smoking. Cigarette smoking was also found to be an important cause of cancers of the esophagus, nasopharynx, mouth, larynx, kidney, and bladder as well as a cause of chronic obstructive pulmonary disease, emphysema, and heart disease, stroke, and other cardiovascular diseases. Since then it has been found to be an independent risk factor in male impotence. Smoking also increases risks associated with oral contraceptive use and exposure to occupational hazards, such as asbestos. Pipe and cigar smokers, if they do not inhale, are not as prone to lung cancer as cigarette smokers, but they are as likely to develop cancers of the mouth, larynx, and esophagus. Those who use snuff or chewing tobacco (sometimes called "smokeless tobacco") run a greater risk of developing cancer of the mouth.

Inhalation of tobacco smoke by nonsmokers has been found to increase the risk of heart disease and respiratory problems; this has created a movement for smokeless environments in public spaces, including government buildings, office buildings, and restaurants. Fetal damage can be caused if a mother smokes or is exposed to smoke during pregnancy. Children of smokers have a higher risk of asthma and lung disease.

Regulation of Smoking

Because of mounting evidence of health risks, television advertisements for cigarettes were banned beginning in 1971. In the 1980s, Congress began to require stronger warning labels on all print advertising; soon afterward it banned smoking on domestic air flights. A 1988 report of the Surgeon General of the United States recognized nicotine as an addictive substance, leading the Food and Drug Administration (FDA) to consider treating nicotine as any other addictive drug and implementing stricter regulations. The authority of the FDA to regulate smoking was, however, denied by the Supreme Court. The habit of smoking continues to increase in the young despite the illegality of cigarette sales to those under 18 years of age in all 50 states.

The Framework Convention on Tobacco Control, a treaty adopted by World Health Organization members in 2003, will establish international standards for antismoking measures once it is ratified. The convention creates restrictions on the marketing and sale of tobacco products and require health warnings on packages of cigarettes. Indoor air quality laws, high taxes on tobacco, and meansures against cigarette smuggling are encouraged under the pact.

Legal Battles

In the mid- and late 1990s the tobacco industry in the United States faced grave legal and financial threats. Under heavy attack from states seeking compensation to recover costs for smoking-related health care, from the federal government seeking further regulation, and from individual smokers seeking damages for illness, the major cigarette producers sought ways to protect themselves. After a tentative $368 billion settlement (1997) with state attorneys and plaintiffs' lawyers fell apart, lawsuits were brought against the industry by Florida, Minnesota, Mississippi, and Texas; the suits were settled for $40 billion, to be paid over 25 years. In 1998 the remaining 46 states accepted a $206 billion plan to settle lawsuits they had filed against the industry. Individual lawsuits continued to pose potential significant financial threats.

Bibliography

See publications of the Office on Smoking and Health of the Centers for Disease Control and publications of the American Cancer Society and the American Lung Association; see also E. C. Hammond, I. J. Selikoff, and J. Chung, "Asbestos exposure, cigarette smoking and death rates" from Annals of the New York Academy of Sciences (1979); R. J. Troyer and G. E. Markle, Cigarettes: The Battle over Smoking (1983); P. Taylor, The Smoke Ring (1984); Imperial Cancer Research Fund, World Health Organization, and American Cancer Society, Mortality from Smoking in Developed Countries 1950–2000 (1994); R. Kluger, Ashes to Ashes (1996); S. A. Glantz, J. Slade, L. A. Bero, P. Hanauer, D. E. Barnes, The Cigarette Papers (1996).

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