the act of inhaling and exhaling the fumes of burning plant material. A variety of plant materials are smoked, including marijuana and hashish, but the act is most commonly associated with tobacco as smoked in a cigarette, cigar, or pipe. Tobacco contains nicotine, an alkaloid that is addictive and can have both stimulating and tranquilizing psychoactive effects. The smoking of tobacco, long practiced by American Indians, was introduced to Europe by Christopher Columbus and other explorers. Smoking soon spread to other areas and today is widely practiced around the world despite medical, social, and religious arguments against it.

By the dawn of the 21st century, in stark contrast, tobacco had become recognized as being highly addictive and one of the world's most devastating causes of death and disease. Moreover, because of the rapid increase in smoking in developing nations in the late 20th century, the number of smoking-related deaths per year is projected to rise rapidly in the 21st century. For example, the World Health Organization (WHO) estimated that in the late 1990s there were approximately 4 million tobacco-caused deaths per year worldwide. This estimate was increased to approximately 5 million in 2003 and could reach 10 million per year by the 2020s. By the mid-21st century, a staggering 500 million of today's cigarette smokers will have died prematurely because of their smoking. Although tobacco use is declining in many countries of western Europe and North America and in Australia, it continues to increase rapidly in many countries in Asia, Africa, and South America.

Major health effects of tobacco product by typeThe primary cause of the escalation in the number of deaths and incidents of disease from tobacco is the large increase in cigarette smoking during the 20th century. During that time cigarette smoking grew to account for approximately 80 percent of the world's tobacco market. Nonetheless, as is shown in the table (Major health effects of tobacco product by type), all tobacco products are toxic and addictive. In some regions of the world, the use of smokeless tobacco products is a major health concern.

Health effects of primary smoke constituentsThe primary constituents of tobacco smoke are nicotine, tar (the particulate residue from combustion), and gases such as carbon dioxide and carbon monoxide. The effects of nicotine, tar, and carbon monoxide on health are summarized in the table (Health effects of primary smoke constituents). Although nicotine can be poisonous at very high dosages, its toxic effect as a component of tobacco smoke is generally considered modest compared with that of many other toxins in the smoke. The main health effect of nicotine is its addictiveness. Carbon monoxide has profound, immediate health effects. It passes easily from the lungs (lung) into the bloodstream, where it binds to hemoglobin, the molecule in red blood cells (erythrocyte) that is responsible for the transfer of oxygen in the body. Carbon monoxide displaces oxygen on the hemoglobin molecule and is removed only slowly. Therefore, smokers frequently accumulate high levels of carbon monoxide, which starves the body of oxygen and puts an enormous strain on the entire cardiovascular system (human cardiovascular system).

The harmful effects of smoking are not limited to the smoker. The toxic components of tobacco smoke are found not only in the smoke that the smoker inhales but also in environmental tobacco smoke, or secondhand smoke—that is, the smoke exhaled by the smoker (mainstream smoke) and the smoke that rises directly from the smoldering tobacco (sidestream smoke). Nonsmokers who are routinely exposed to environmental tobacco smoke are at increased risk for some of the same diseases that afflict smokers, including lung cancer and cardiovascular disease. Clean-air laws that prohibit cigarette smoking are becoming widespread. In the 1980s and 1990s, such laws typically required that nonsmoking areas be established in restaurants and workplaces. However, the finding that toxins in environmental smoke could easily diffuse across large spaces led to much stronger bans. Since 2000 many cities, states, and regions worldwide, including New York City in 2003, Scotland in 2006, Nairobi in 2007, and Chicago in 2008, have implemented complete smoking bans in restaurants, taverns, and enclosed workplaces. In addition, entire countries have implemented smoking bans in workplaces or restaurants or, in some cases, in all public areas, including Ireland, Norway, and New Zealand in 2004 and France and India in 2008. In 2005 Bhutan became the first country to ban both smoking in public places and the sale of tobacco products.

It is not surprising that smokers suffer from many respiratory diseases other than lung cancer. One such disease is chronic obstructive pulmonary disease, or COPD, which is one of the major causes of debilitation and eventual death in cigarette smokers. More than 80 percent of those diagnosed with COPD are smokers, and most of these people die prematurely, with a greater number of women dying from COPD than men. COPD is a general term that refers to respiratory diseases in which airflow is obstructed. Women's airways appear to be more sensitive to the effect of cigarette smoke. Women with COPD often experience greater breathlessness and a disproportionately greater thickening of airway walls relative to men with COPD. Most commonly, COPD refers to chronic bronchitis (chronic cough and phlegm production) and emphysema (permanent enlargement of air spaces accompanied by deterioration of lung walls), although specific diagnostic criteria sometimes differ. Active smoking and exposure to environmental tobacco smoke are also responsible for increases in other respiratory ailments, such as pneumonia, the common cold, and influenza. Smokers who contract these ailments take longer than nonsmokers to recover from them. Children are especially susceptible to the effects of environmental tobacco smoke. When raised in a household in which they are regularly exposed to environmental tobacco smoke, children are more likely to suffer from asthma and chronic cough, and they may suffer from reduced lung growth and function.

For centuries, a major factor in setting public policy regarding tobacco products was the economic importance of the tobacco industry. Therefore, despite occasional efforts to prohibit the production of tobacco products, the main impetus of tobacco regulation throughout the world was to ensure the continued viability of the tobacco trade and to collect taxes on its products. The specific regulatory framework varied from country to country, but the result was essentially the same everywhere: tobacco was exempt from the ordinary controls to which other products were subject. In the United States, for example, tobacco products, which fell under the jurisdiction of the Bureau of Alcohol, Tobacco and Firearms, were exempt from the most basic safety and health standards required of other consumer products.

● Reducing access to tobacco products by prohibiting sales to minors, raising prices, and making them more difficult to purchase.

● Promoting educational campaigns that provide detailed health information and ensuring that tobacco products include appropriate health warnings and information on how to get help in quitting.

● Restricting smoking in public areas and the workplace in order to protect nonsmokers. This action also has the effect of making it difficult to smoke and increases the pressure on smokers to quit.

● Regulating product manufacture to minimize the health risks to which tobacco users are exposed.

A cigarette is the perfect type of a perfect pleasure. It is exquisite and it leaves one unsatisfied. What more can one want?

Although the origin of tobacco use in Native American culture (American Indian) is uncertain, tobacco clearly played a far more ceremonial and structured role than it would come to play in Europe and the modern world. Along with several other hallucinogens and narcotics, a strong, dark, high-nicotine and, consequently, mind-altering tobacco was crucial to the performance of shamanistic rituals (shamanism) and social ceremonies. Usually smoked but also chewed, drunk, taken as snuff, and even given as an enema, tobacco was seen by Native Americans (American Indian) as a means for providing communication with the supernatural world through the medium of the shaman, for either medicinal or spiritual purposes. Among other medical applications, tobacco was used as a cure for toothache by the Iroquois, as a cure for earache by the Indians of central Mexico, as a painkiller by the Cherokee, and as an antiseptic in Guatemala. Beyond such practical functions, tobacco was also often exchanged as a gift, helping to forge social connections and establish community hierarchies. In many groups tobacco was given as an offering to the gods, and in some groups, in particular among the Maya, tobacco was itself deified as a divine plant. Tobacco was also linked to the fertility both of the land and of women, and it was used in initiation ceremonies for boys entering manhood. Most famously, tobacco was used in the calumet ritual, when agreements and obligations would be made binding with the passing of the ritual pipe (the calumet, or Sacred Pipe). Tobacco was thus central to Native American culture, be it with the cigar in the South or the pipe in the North, and its properties were known from Canada to Argentina and from the Atlantic to the Pacific. So important was it that some native groups, such as the Blackfoot and the Crow, cultivated no other crop.

It is likely that sailors returning from the Americas to various ports in Europe in the late 15th and early 16th centuries took with them the practice of smoking. Northern Europeans adopted the practice of pipe smoking, which was prevalent along the north Atlantic seaboard, and Spaniards brought the practice of cigar smoking, which was prevalent in the regions around the Caribbean. Many Europeans believed tobacco was a panacea, a new herb that could be incorporated into Western medical traditions and celebrated as an almost universal curative. In the late 16th century, the Spanish doctor Nicolas Monardes claimed that tobacco alleviated hunger, acted as a relaxant and a painkiller, and was even a cure for cancer. However, this view was opposed by others, including King James I of England. James's Counterblaste to Tobacco, published in 1604, described smoking as “a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless.” Elsewhere, Popes Urban VIII and Innocent IX issued papal bulls excommunicating those who snuffed in church, the Ottoman sultan Murad IV made smoking a capital offense, and Russians were subject to having their noses cut off if caught smoking. Nevertheless, the acceptance of tobacco into Old World culture was assisted by the patronage it received from various aristocrats and rulers. For example, tobacco was introduced into the court of Catherine de Médicis in 1560 by Jean Nicot (from whom nicotine and tobacco's botanical name, Nicotiana tabacum, get their name) and into the court of Elizabeth I by Sir Walter Raleigh (Raleigh, Sir Walter), who himself had been introduced to smoking by Sir Francis Drake (Drake, Sir Francis).

After tobacco's introduction into Europe, the smoking and cultivation of it rapidly spread to other parts of the world. By the beginning of the 17th century, tobacco was being grown in India, China, Japan, Southeast Asia, the Middle East, and West Africa. With the availability of inexpensive clay pipes, tobacco became an item of mass consumption in England as early as 1670. Pipe manufacture spread throughout Europe. By the end of the 18th century, Dutch towns such as Gouda could support 350 pipe manufacturers, thanks to the smoking culture of coffeehouses and alehouses. snuff also proliferated, often rivaling smoking as the dominant form of tobacco consumption and producing such fascinating novelties as the perhaps apocryphal but frequently cited special pockets in the clothes of Frederick the Great (Frederick II) of Prussia, which were enlarged to cope with his considerable consumption. In southern Europe the great state-owned tobacco factories of Cádiz and Sevilla ensured the continued popularity of the cigar, though it was not until the Peninsular War (1808–14) that military officers began to popularize it in Britain. When pipes (pipe) were introduced into Asia, they were quickly adapted and made from materials as diverse as wood, bamboo, jade, ivory, metal, and porcelain. Arab communities took up the hookah, or water pipe, and smoking became a shared activity typically enjoyed with conversation and coffee. The hookah spread throughout Persia (present-day Iran) and into India, eventually reaching China, Southeast Asia, and many parts of Africa by the end of the 17th century. By the mid-19th century, smoking had become an established ritual throughout the world. It was celebrated in prose, in verse, in art, and on the stage, and its use came to be seen as a central component of manhood. Literary sources captured the paraphernalia of the smoking ritual—pipes, cleaners, holders, spills, spittoons, ashtrays, pouches, storage jars, and lighters, as well as smoking jackets, armchairs, hats, and slippers—all of which, ideally, had to be collected in “that chamber of liberty, that sanctuary of the persecuted, that temple of refuge… the smoking room” ( Ouida, Under Two Flags, 1867).

Cigarettes were originally sold as an expensive handmade luxury item for the urban elites of Europe. However, cigarette manufacture was revolutionized by the introduction of a rolling machine called the Bonsack machine, which was patented by American James Bonsack in the United States in 1880. The machine was soon put into use by the American industrialist James Buchanan Duke (Duke, James Buchanan), who founded the American Tobacco Company (ATC) in 1890. Inexpensive mass-produced cigarettes, promoted by Duke's aggressive marketing methods and advertising, gradually led to a decline in pipe-smoking and tobacco-chewing habits in the United States. In Britain the manufacturer Henry Wills began using the machine in Bristol in 1883, and this enabled him to dominate the cigarette trade within just a few years. Then, in 1901, Duke attempted to enter the British market. The subsequent “tobacco war” resulted in a standoff as the British manufacturers united within the Imperial Tobacco Company. An agreement in 1902 allowed both sides to claim a victory. Duke retreated to the United States, and the British market was left to Imperial, but together they formed the British-American Tobacco Company (British American Tobacco PLC) (BAT) to market and sell their products to the rest of the world, especially India, China, and the British dominions. Although other American companies entered the global market following the breakup of the ATC—the result of a 1911 Supreme Court ruling under the Sherman Antitrust Act (1890)—BAT continued to meet much success. In 1999 the company produced more than 800 billion cigarettes per year, which made it the world's third largest tobacco company (just behind the Philip Morris USA and Philip Morris International companies, together ranking second, and the China National Tobacco Corporation, ranking first).

The first half of the 20th century was the golden age of the cigarette. In 1950 around half of the population of industrialized countries smoked, though that figure hides the fact that in countries such as the United Kingdom up to 80 percent of adult men were regular smokers. Smoking was an acceptable form of social behaviour in all areas of life—at work, in the home, in bars, and at the cinema—and advertisers were keen to show the full range of leisure activities made complete only through the addition of a cigarette. Smoking cigarettes was popular across all social classes and increasingly among women, once associations of smoking with deviant sexuality began to fade in the 1920s. This development had less to do with the efforts of advertisers—who, for example, in 1925 introduced the Marlboro brand as a woman's cigarette: “Mild as May”—and more to do with the impact of war and a direct confrontation with societal attitudes by so-called new women. Most important, the cigarette habit was legitimated, celebrated, and glamourized on the Hollywood screen and transported to the rest of the world. Movie (motion picture, history of the) stars such as Edward G. Robinson, James Cagney, Spencer Tracy, Gary Cooper, and especially Humphrey Bogart (Bogart, Humphrey), Lauren Bacall, and Marlene Dietrich raised the image of the cigarette to that of the iconic, ensuring it would never lose its sophisticated and loftily independent connotations.

More recent evidence of the harm done to nonsmokers by environmental tobacco smoke has further helped turn attitudes against smoking. Efforts to curtail the individual's liberty to smoke were at first most pronounced in the United States, as in California's 1995 ban on smoking in most enclosed places of employment, but in 2004 Ireland became the first country to ban smoking in enclosed workplaces, and other countries have since followed suit. Nevertheless, the strong grip of smoking on the world's popular culture suggests that the practice will persist. While smoking is increasingly frowned upon in a health-conscious age and the smoker has come to feel marginalized and harassed, the very suppression of smoking only increases its power as a symbol of individualism and resistance. For instance, a survey of internationally successful Hollywood films (motion picture, history of the) found that motion pictures released in 1995 featured four times as much smoking as those released in 1990, with an increase in the number of positive verbal and visual references made to the habit. These images are being broadcast to the very areas of the world where American-owned tobacco companies are beginning to make inroads selling their products. All this suggests that smoking is likely to remain as entrenched in modern global society as it was in pre-Columbian America. Cigarette use might now be more individualistic and less ceremonial than it was at that time, but this change too is a reflection of the transformation of culture to one that has come to value individualism over tradition. Mark Twain (Twain, Mark)'s famous quip regarding his own smoking habit (estimated to have reached more than 20 cigars per day) might be applied to the complex status of smoking in society today:To cease smoking is the easiest thing I ever did. I ought to know because I've done it a thousand times.

American Lung Association, 7 Steps to a Smoke-Free Life (1998), provides a practical approach to helping a smoker quit that anticipates the difficulties and potential setbacks many smokers will face in achieving this goal. Ronald R. Watson and Mark Witten (eds.), Environmental Tobacco Smoke (2001), discusses in scientific detail the effects of tobacco smoke on nonsmokers and also the broader issues concerning the reduction of exposure to environmental tobacco smoke.Jack Henningfield Christine Ann Rose

Kathleen R. Stratton et al. (eds.), Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction (2001), explores various smoking-related products claimed to reduce the health risks associated with tobacco smoke, focusing on the products' effectiveness and suggesting ways that policy makers and other officials should evaluate them. World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco Control (1999), looks at the economic measures available to policy makers to control smoking and assesses the economic consequences associated with a reduction of tobacco consumption. Robert L. Rabin and Stephen D. Sugarman (eds.), Regulating Tobacco (2001), presents a collection of essays dealing with the large array of public policy issues on smoking, including cultural and political questions concerning its regulation.Jack Henningfield David T. Sweanor

Jordan Goodman, Tobacco in History: Cultures of Dependence (1993), provides the most wide-ranging global history of tobacco from Native American society to the present. Richard Kluger, Ashes to Ashes (1996), provides a comprehensive history of smoking in the 20th-century United States. Matthew Hilton, Smoking in British Popular Culture, 1800–2000 (2000), focuses on smoking in Britain, although its thorough account of the social history of smoking over the past two centuries also applies to other national contexts.Matthew J. Hilton