Essay on Tobacco
Tobacco And Tobacco
of Americans younger than 18 years will likely die from a tobacco-related illness if tobacco use persists at the current rate among youth in the United States (1). Tobacco use is the largest preventable cause of mortality and disease in the United States (2). Approximately 480, 000 Americans die from tobacco-related diseases, while greater than 16 million Americans suffer from at least one illness caused by tobacco, each year (2). Tobacco products are made entirely or partly from the nicotine-rich
Tobacco Of Tobacco And Tobacco
smoker (King, 2015). Tobacco addiction is an issue the United States is struggling with, partially due to the fact that 90% of adult smokers began before or by the age of 18 (Ahmad, 2015). Researchers believe that since younger people become easily addicted to tobacco and older people have an easier time quitting tobacco product use, raising the minimum age for tobacco sales could prevent this addiction from spreading (Ahmad, 2015). Public opinion about tobacco use, the Tobacco 21 bill, California’s
Tobacco Use Tobacco
Tobacco Use How many Americans use tobacco products? Well there is A LOT and it causes a lot of deaths per year also. Tobacco products cause 6 million deaths per year or more. Tobacco is dangerous for your body. It can cause serious health issues, Smoking has a long term effect to it. It could cause asthma, reduced lung growth, reduced lung functions and that's pretty serious if you ask me. The tobacco industry is influencing kids with their products for kids like the little play cigarettes that
Tobacco And Its Impact On Tobacco
death in the world, Tobacco has put itself at the top of social problems. Looking though out history, tobacco was widely accepted in American society as well as all around the world. There were three major changes in society that aided in the transformation of tobacco from a social norm into a major social issue. The major changes of technology enhancement of cigarette production, society’s views on tobacco intake, and the improvements of scientific knowledge on health issues tobacco causes have all
The consumption of tobacco and cigarette products have consistently shown harmful and life changing consequences, but the course of history represents how difficult it can be for people to change this popular and ingrained lifestyle habit. The use of these products can be dated back to the 16th century in which tobacco was on the rise. Their popularity was first seen in Europe directly in the England, but they quickly moved to the New World. Part of this advancement was due to the profitability of
Smoking is the act of breathing in the smoke produced by burning tobacco either in cigarettes, cigars or pipes. Smoking was introduced to the European culture by explorers such as Christopher Columbus, the practice soon spread across the globe. Smoking (2017) describes the use of tobacco products in the early 20th century as medicinal. Health practitioners believed smoking would aid in elevating the disposition, concentration and productivity of their patients. However, by the early 21st century
Tobacco use is one of the leading causes of death throughout the United States and many other countries. For American Indian/Alaskan Native people, recreation cigarette smoking is the number one leading cause of death among these communities. For generations, tobacco has had a strong spiritual and sacred meaning to the Native American people even before the plant became recreationally used. Tobacco is believed to make individuals and families strong and free and live a long-healthy life. Traditional
Tobacco And Tobacco Use
Inhaling Death Tobacco was responsible for over 100 million deaths worldwide in the 20th Century (Cancerresearchuk.org). Tobacco and nicotine use is a growing problem in our world. There are 13 deadly cancers that develop from tobacco use. As stated in cancer.gov, the cancers that develop from tobacco use include the following: lung, larynx, mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon/rectum, and the cervix. Over the years, the amount of people who develop lung cancer
Tobacco became very popular in Europe when brought by Christopher Columbus. “On October 15, 1492, Christopher Columbus was offered dried tobacco leaves as a gift from the American Indians that he encountered. Soon after, sailors brought tobacco back to Europe, and the plant was being grown all over Europe” (University of Dayton). It was popular throughout the ages till scientific studies found out that tobacco products are very harmful to the human body. The chemicals in the tobacco products harm
entitled, Effect of sports sponsorship by tobacco companies on children’s experimentation with tobacco, utilized a questionnaire that asked adolescents aged 13-16 about their knowledge of tobacco’s addictive and destructive nature, their level of temptation to buy or experiment with tobacco, and their awareness of tobacco as a sponsor of sporting events. The majority of those questioned were cognizant of the significant negative implications that tobacco could have on one’s health, including causing
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Writing help, paraphrasing tool, tobacco - free essay samples and topic ideas.
Tobacco, a plant whose leaves are used to produce various products like cigarettes and cigars, has significant health, economic, and social implications. Essays might explore the history of tobacco use, the health risks associated with tobacco consumption, and the economic costs and benefits of the tobacco industry. Discussions could also extend to the ethics of tobacco marketing, legislation regulating tobacco sales and advertising, and the global efforts to reduce tobacco use to improve public health. A substantial compilation of free essay instances related to Tobacco you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.
Smoking Tobacco Among Teens
Smoking is widespread among the US teenagers, with risk factors including health issues, peer influence, and risky sexual behavior; advocates should, therefore, focus on means to curb peer influence and risky behavior. Several solutions can be offered to help curb large amounts of peer pressure and risky sexual behavior. They include; vaping, community youth groups and free distribution of condoms among others. Although many factors affect teenagers, tobacco smoking, peer pressure, and risky sexual behavior are the most common ones. […]
How Obama’s Tobacco Tax would Drive down Smoking Rates
How Obama's Tobacco Tax Would Drive Down Smoking Rates Obama's proposal to single out tobacco users, and raise a tax on the products they use, is actually a plan to get money for the government. In The Washington Post, the proposal seems like an excellent idea because you are blinded by the so-called "benefits," but there are far more flaws in the former president's plan than what initially comes to the eye. Doubling the tax on tobacco will not innocently […]
Comparison of Smoking Cigarettes and Vaping
The uprise of vaping in comparison to smoking cigarettes is an open-ended debate. It's a tough argument because there isn't enough information to prove whether vaping is a better alternative to smoking or not. Experts are working their hardest to discover an answer on the effects of vaping versus smoking. Many people use vaping as an attempt to stop smoking cigarettes, but the design and attraction to vapes is a possible cause to more people using them. The differences between […]
An Issue of Tobacco Taxes
Tobacco tax increases could drive youth smoking into near-nonexistence if done correctly. Sin taxes are a series of taxes aimed at products deemed not beneficial or otherwise destructive ("Sin Taxes" par. 1). Taxes aimed at tobacco products, sometimes referred to as tobacco taxes, create numerous benefits for the country. Money generated by tobacco taxes is produced at the local, state, and federal levels (par. 2). Tobacco taxes create incentives to quit usage because of health benefits deriving from it (Campaign […]
Tobacco Products the Harm to Humans and Nature
Recently, scientists have discovered many usages of tobacco in medical field. We could not deny the advantages that tobacco products bring to us. However, the consumption of tobacco products clearly caused some extreme troubles. Products from tobacco (such as: cigarette, tobacco chewing gum, cigar, beedi, kretek…) are widely consumed. The active and passive smokers, after many years, have been diagnosed with many kinds of cancers, for example: lung, breast, esophagus, mouth, and colon cancer. The smokers also suffer from a […]
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Child Labor in the 21st Century
It is the 21st century and in the comforts of America the thought of child labor is far from the minds of the average individual. What has failed to be realized is that still in many rural areas of America we still have children working in the agriculture industry for food so that we may eat and have clothes to wear. Or that children in poverty stricken countries are mining metals such as cobalt or precious diamonds so that we […]
Impact of Smoking in a Tobacco Growing Developing Country
Abstract The chapter outlines the impact of smoking aspects for a developing country whose economy is dependent on tobacco growing. On the environmental front, other than the pollution of the air by tobacco smoke; large tracts of forests are destroyed, and heavy losses are incurred due to perennial veld fires that would destroy properties, flora and fauna, and in some instances human lives, when smoldering cigarette stubs are recklessly thrown away after smoking. Public health bill is shooting up in […]
Complications of Tobacco Smoking
Surgery and anesthesia are associated with exacerbating the body's stress response, which can lead to several postoperative complications and an increased hospital stay. As a future anesthesia provider, I know that it is imperative for patients to abstain from tobacco use prior to anesthesia or any surgical procedure. Preoperative screening of patients offers an opportunity to educate patients on the intraoperative risks associated with smoking, as well as providing resources and interventions that can aid with compliance and abstinence. Although […]
Effects of Smoking on Teens
Come on everyone is doing it, is a phrase that sadly is to often said. Teens these days are so pressured with the idea of "cool" that they are willing to do just about anything to obtain this status, including mutilate their body. According to the CDC, "5.6 million of today's Americans younger than 18 will die early from a smoking-related illness. That's about 1 of every 13 Americans aged 17 years or younger alive today." That is a staggering […]
Behavioral Interventions for Tobacco Hookah Use Using Theoretical Models
Background: There are many theoretical frameworks in behavioral science that act as baselines for possible intervention programs that are successful in assessing most social determinants leading to unhealthy behaviors. These unhealthy behaviors often lead to life threatening diseases that are caused from behavioral leading activity. The use of tobacco in hookah (waterpipe) smoking is an important selection targeted for planned intervention programs. Though there are several theories that can be used to help plan, create and evaluate subsequent intervention programs […]
A Topic Of Smoking Bans
Smoking Bans This topic has been constantly debated and argued about by many people for the past seven years. People don't understand the positive effects that this can bring to the world, this is an important change that must be made. These are just some effects that can make a significant impact on the world today. Banning smoking in public places is essential because of the positive effects it has such as: healthier living, less pollution, and more business' […]
Smoking and the Rhetorical Analysis of a TUPP Ad
The overall composition of an anti-smoking advertisement is designed to make addicted smokers feel ashamed of themselves. Most especially in this advertisement from the organization based in California Tobacco Use Prevention Program (TUPP). This analysis focuses on the aspects of these advertisement's components that might persuade the target audience, which in this case would be young women in their seemingly early twenties and are adjusting into the party scene. The advertising manipulates the audience to think a certain way about […]
Cigarette Smoking and its Impact on People
ANTI SMOKING AD Cigarette smoking is the focal cause of avoidable illness and annihilation in the United States, accounting for 480,000 deaths every year, or around 1 in 5 deaths. In the United States there are almost 20% of adults that smoke cigarettes, men were heavier cigarette smokers than women. Anti-smoking ads periodically show up everywhere in this population generally showing the disastrous effects of tobacco use through photographic pictures or other alarming appearance. The anti-smoking ad I've embraced is […]
Advertisements as Anti-Smoking Tool
Anti-Smoking Did you know that in the United States that almost 20 percent of adults smokes cigarettes? Smoking cigarettes are one of the most preventable leading cause of death. The anti-smoking advertisement by The Real Cost Commercial "Stay in Control" often pops up on across our televisions and our social media, frequently broadcasting the deadly effects of tobacco use through shocking images, and vivid videos. The advertisement I picked is a dull colored picture, portraying a high school girl signing […]
My Attitude to Smoking
Smoking cigarettes is probably one of the most toxic things you can put in your body. It used to be popular back in the day, because people just wanted to do it for the thrill and because it was a common thing to do so most people tagged along and did it too. People also choose to smoke cigarettes to try to reduce stress and, but it really isn't worth getting cancer and diseases from it. Furthermore, I already […]
The Negative Effects of Smoking in the US
Tobacco is one of the leading causes in the U.S. Individuals can sniff, chew or smoke it. Cigarette smoking kills more than 500,000 people in the United States. According to the CDC, 9 out of 10 teenagers will try smoking before they reach 19. Most teenagers become addicted to it after their first cigarette. Why do teens smoke? What are the negative effects of smoking in the US? Tobacco contains many harmful chemicals. It contains nicotine which makes individuals even […]
Smoking in Public and its Affect
Smoking in public is a big problem because it affects people that are near the smoker. People don't seem to understand that secondhand smoking is a severe problem that needs to be reduced. Secondhand smoking has been proven to be one of the reasons people get sick. People who smoke have to be cautious and realize that not everyone might like the smell, or they might have some sickness like asthma. They might not be able to stop smoking, but […]
Antismoking Policies in Schools
Antismoking Policies in Schools Tobacco use is one of the leading preventable causes of mortality in the United States. Even though it is spread out across the whole population, the young adults between the ages of 19-29 years old are the highest, with a 30-day prevalence of 17% (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health 1). For the high school students, the prevalence rate is 9%. The prevention of smoking is […]
Smoking as One of the Main Problems in America
Smoking is causing multiple problems in america today. You can buy cigarettes anywhere th gas station , your local grocery story. Cigaret buds are found on roads in your grass . many people are starting to smoke at a young age because they believe it's cool ,but they don't know the out comes.Smoking causes cancer, destroys the environment, and waste valuable money. People who smoke dont understand how harmful it is. smoking can cause 15 different types of cancers . […]
Passive Smoking and Children’s Health
Passive Smoking And Children's Health The impacts of passive smoking will not disappear unless everyone in the world does not smoke. Many people hold the view that the adverse impacts on active smokers are more than passive smokers and therefore people often give enough tolerance to active smoking. However, there is no safe passive smoke exposure. Passive smoking causes more than 600,000 deaths every year, one third of which are children. Children's health is under threat from passive smoking. Why […]
Forthcoming Referendum on no Smoking
Forthcoming Referendum on no Smoking Considering the impacts that a referendum can have on the progress of the state, it is safe to assume that the forthcoming referendum is likely to have many good intentions and impacts on the health of the residents of the state. For instance, in Kentucky non-smokers have continued to suffer from the effects of passive smoking. For this reason, the incoming referendum will create awareness among the members of the public regarding the health risks […]
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Persuasive Essay Guide
Persuasive Essay About Smoking
Persuasive Essay About Smoking - Making a Powerful Argument with Examples
Published on: Feb 22, 2023
Last updated on: Nov 29, 2023
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Are you wondering how to write your next persuasive essay about smoking?
Smoking has been one of the most controversial topics in our society for years. It is associated with many health risks and can be seen as a danger to both individuals and communities.
Writing an effective persuasive essay about smoking can help sway public opinion. It can also encourage people to make healthier choices and stop smoking.
But where do you begin?
In this blog, we’ll provide some examples to get you started. So read on to get inspired!
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What You Need To Know About Persuasive Essay
A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.
It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.
A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:
Simple persuasive essay about smoking
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Persuasive Essay Examples About Smoking
Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.
A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.
Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:
Persuasive speech on smoking outline
Persuasive essay about smoking should be banned
Persuasive essay about smoking pdf
Persuasive essay about smoking cannot relieve stress
Persuasive essay about smoking in public places
Speech about smoking is dangerous
Persuasive Essay About Smoking Introduction
Persuasive Essay About Stop Smoking
Short Persuasive Essay About Smoking
Stop Smoking Persuasive Speech
Check out some more persuasive essay examples on various other topics.
Argumentative Essay About Smoking Examples
An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.
If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.
Argumentative essay about smoking pdf
Argumentative essay about smoking in public places
Argumentative essay about smoking introduction
Check out the video below to find useful arguments against smoking:
Tips for Writing a Persuasive Essay About Smoking
You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.
Choose a Specific Angle
Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.
Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.
Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!
Research the Facts
Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.
You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.
For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.
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Make an Outline
The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.
Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.
Use Persuasive Language
When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.
Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.
Introduce Opposing Arguments
Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.
By doing this, your essay will come off as more balanced and objective, making it more convincing.
Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.
A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.
By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.
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- Published: 24 March 2022
Tobacco and nicotine use
- Bernard Le Foll 1 , 2 ,
- Megan E. Piper 3 , 4 ,
- Christie D. Fowler 5 ,
- Serena Tonstad 6 ,
- Laura Bierut 7 ,
- Lin Lu ORCID: orcid.org/0000-0003-0742-9072 8 , 9 ,
- Prabhat Jha 10 &
- Wayne D. Hall 11 , 12
Nature Reviews Disease Primers volume 8 , Article number: 19 ( 2022 ) Cite this article
- Disease genetics
- Experimental models of disease
- Preventive medicine
Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide. More than a billion people smoke, and without major increases in cessation, at least half will die prematurely from tobacco-related complications. In addition, people who smoke have a significant reduction in their quality of life. Neurobiological findings have identified the mechanisms by which nicotine in tobacco affects the brain reward system and causes addiction. These brain changes contribute to the maintenance of nicotine or tobacco use despite knowledge of its negative consequences, a hallmark of addiction. Effective approaches to screen, prevent and treat tobacco use can be widely implemented to limit tobacco’s effect on individuals and society. The effectiveness of psychosocial and pharmacological interventions in helping people quit smoking has been demonstrated. As the majority of people who smoke ultimately relapse, it is important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.
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Tobacco is the second most commonly used psychoactive substance worldwide, with more than one billion smokers globally 1 . Although smoking prevalence has reduced in many high-income countries (HICs), tobacco use is still very prevalent in low-income and middle-income countries (LMICs). The majority of smokers are addicted to nicotine delivered by cigarettes (defined as tobacco dependence in the International Classification of Diseases, Tenth Revision (ICD-10) or tobacco use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)). As a result of the neuro-adaptations and psychological mechanisms caused by repeated exposure to nicotine delivered rapidly by cigarettes, cessation can also lead to a well-characterized withdrawal syndrome, typically manifesting as irritability, anxiety, low mood, difficulty concentrating, increased appetite, insomnia and restlessness, that contributes to the difficulty in quitting tobacco use 2 , 3 , 4 .
Historically, tobacco was used in some cultures as part of traditional ceremonies, but its use was infrequent and not widely disseminated in the population. However, since the early twentieth century, the use of commercial cigarettes has increased dramatically 5 because of automated manufacturing practices that enable large-scale production of inexpensive products that are heavily promoted by media and advertising. Tobacco use became highly prevalent in the past century and was followed by substantial increases in the prevalence of tobacco-induced diseases decades later 5 . It took decades to establish the relationship between tobacco use and associated health effects 6 , 7 and to discover the addictive role of nicotine in maintaining tobacco smoking 8 , 9 , and also to educate people about these effects. It should be noted that the tobacco industry disputed this evidence to allow continuing tobacco sales 10 . The expansion of public health campaigns to reduce smoking has gradually decreased the use of tobacco in HICs, with marked increases in adult cessation, but less progress has been achieved in LMICs 1 .
Nicotine is the addictive compound in tobacco and is responsible for continued use of tobacco despite harms and a desire to quit, but nicotine is not directly responsible for the harmful effects of using tobacco products (Box 1 ). Other components in tobacco may modulate the addictive potential of tobacco (for example, flavours and non-nicotine compounds) 11 . The major harms related to tobacco use, which are well covered elsewhere 5 , are linked to a multitude of compounds present in tobacco smoke (such as carcinogens, toxicants, particulate matter and carbon monoxide). In adults, adverse health outcomes of tobacco use include cancer in virtually all peripheral organs exposed to tobacco smoke and chronic diseases such as eye disease, periodontal disease, cardiovascular diseases, chronic obstructive pulmonary disease, stroke, diabetes mellitus, rheumatoid arthritis and disorders affecting immune function 5 . Moreover, smoking during pregnancy can increase the risk of adverse reproductive effects, such as ectopic pregnancy, low birthweight and preterm birth 5 . Exposure to secondhand cigarette smoke in children has been linked to sudden infant death syndrome, impaired lung function and respiratory illnesses, in addition to cognitive and behavioural impairments 5 . The long-term developmental effects of nicotine are probably due to structural and functional changes in the brain during this early developmental period 12 , 13 .
Nicotine administered alone in various nicotine replacement formulations (such as patches, gum and lozenges) is safe and effective as an evidence-based smoking cessation aid. Novel forms of nicotine delivery systems have also emerged (called electronic nicotine delivery systems (ENDS) or e-cigarettes), which can potentially reduce the harmful effects of tobacco smoking for those who switch completely from combustible to e-cigarettes 14 , 15 .
This Primer focuses on the determinants of nicotine and tobacco use, and reviews the neurobiology of nicotine effects on the brain reward circuitry and the functioning of brain networks in ways that contribute to the difficulty in stopping smoking. This Primer also discusses how to prevent tobacco use, screen for smoking, and offer people who smoke tobacco psychosocial and pharmacological interventions to assist in quitting. Moreover, this Primer presents emerging pharmacological and novel brain interventions that could improve rates of successful smoking cessation, in addition to public health approaches that could be beneficial.
Box 1 Tobacco products
Conventional tobacco products include combustible products that produce inhaled smoke (most commonly cigarettes, bidis (small domestically manufactured cigarettes used in South Asia) or cigars) and those that deliver nicotine without using combustion (chewing or dipping tobacco and snuff). Newer alternative products that do not involve combustion include nicotine-containing e-cigarettes and heat-not-burn tobacco devices. Although non-combustion and alternative products may constitute a lesser risk than burned ones 14 , 15 , 194 , no form of tobacco is entirely risk-free.
Prevalence and burden of disease.
The Global Burden of Disease Project (GBDP) estimated that around 1.14 billion people smoked in 2019, worldwide, increasing from just under a billion in 1990 (ref. 1 ). Of note, the prevalence of smoking decreased significantly between 1990 and 2019, but increases in the adult population meant that the total number of global smokers increased. One smoking-associated death occurs for approximately every 0.8–1.1 million cigarettes smoked 16 , suggesting that the estimated worldwide consumption of about 7.4 trillion cigarettes in 2019 has led to around 7 million deaths 1 .
In most populations, smoking prevalence is much higher among groups with lower levels of education or income 17 and among those with mental health disorders and other co-addictions 18 , 19 . Smoking is also more frequent among men than women (Figs 1 – 3 ). Sexual and/or gender minority individuals have disproportionately high rates of smoking and other addictions 17 , 20 . In addition, the prevalence of smoking varies substantially between regions and ethnicities; smoking rates are high in some regions of Asia, such as China and India, but are lower in North America and Australia. Of note, the prevalence of mental health disorders and other co-addictions is higher in individuals who smoke compared with non-smokers 18 , 19 , 21 . For example, the odds of smoking in people with any substance use disorder is more than five times higher than the odds in people without a substance use disorder 19 . Similarly, the odds of smoking in people with any psychiatric disorder is more than three times higher than the odds of smoking in those without a psychiatric diagnosis 22 . In a study in the USA, compared with a population of smokers with no psychiatric diagnosis, subjects with anxiety, depression and phobia showed an approximately twofold higher prevalence of smoking, and subjects with agoraphobia, mania or hypomania, psychosis and antisocial personality or conduct disorders showed at least a threefold higher prevalence of smoking 22 . Comorbid disorders are also associated with higher rates of smoking 22 , 23 .
a | Number of current male smokers aged 15 years or older per country expressed in millions. b | Former male smokers aged 45–59 years per country expressed in millions. c | Former male smokers aged 45–59 years per country expressed as the percentage of smokers who stopped. The data shown are for male smokers for the period 2015–2019 from countries with direct smoking surveys. The prevalence of smoking among males is less variable than among females. Data from ref. 1 .
a | Number of current female smokers aged 15 years or older per country expressed in millions. b | Former female smokers aged 45–59 years per country expressed in millions. c | Former female smokers aged 45–59 years per country expressed as the percentage of smokers who stopped. The data shown are for female smokers for the period 2015–2019 from countries with direct smoking surveys. The prevalence of smoking among females is much lower in East and South Asia than in Latin America or Eastern Europe. Data from ref. 1 .
a | Number of current male and female smokers aged 15 years or older per country expressed in millions. b | Former male and female smokers aged 45–59 years per country expressed in millions. c | Former male and female smokers aged 45–59 years per country expressed as the percentage of smokers who stopped. The data shown are for the period 2015–2019 from countries with direct smoking surveys. Cessation rates are higher in high-income countries, but also notably high in Brazil. Cessation is far less common in South and East Asia and Russia and other Eastern European countries, and also low in South Africa. Data from ref. 1 .
Age at onset
Most smokers start smoking during adolescence, with almost 90% of smokers beginning between 15 and 25 years of age 24 . The prevalence of tobacco smoking among youths substantially declined in multiple HICs between 1990 and 2019 (ref. 25 ). More recently, the widespread uptake of ENDS in some regions such as Canada and the USA has raised concerns about the long-term effects of prolonged nicotine use among adolescents, including the possible notion that ENDS will increase the use of combustible smoking products 25 , 26 (although some studies have not found much aggregate effect at the population level) 27 .
Smoking that commences in early adolescence or young adulthood and persists throughout life has a more severe effect on health than smoking that starts later in life and/or that is not persistent 16 , 28 , 29 . Over 640 million adults under 30 years of age smoke in 22 jurisdictions alone (including 27 countries in the European Union where central efforts to reduce tobacco dependence might be possible) 30 . In those younger than 30 years of age, at least 320 million smoking-related deaths will occur unless they quit smoking 31 . The actual number of smoking-related deaths might be greater than one in two, and perhaps as high as two in three, long-term smokers 5 , 16 , 29 , 32 , 33 . At least half of these deaths are likely to occur in middle age (30–69 years) 16 , 29 , leading to a loss of two or more decades of life. People who smoke can expect to lose an average of at least a decade of life versus otherwise similar non-smokers 16 , 28 , 29 .
Direct epidemiological studies in several countries paired with model-based estimates have estimated that smoking tobacco accounted for 7.7 million deaths globally in 2020, of which 80% were in men and 87% were current smokers 1 . In HICs, the major causes of tobacco deaths are lung cancer, emphysema, heart attack, stroke, cancer of the upper aerodigestive areas and bladder cancer 28 , 29 . In some lower income countries, tuberculosis is an additional important cause of tobacco-related death 29 , 34 , which could be related to, for example, increased prevalence of infection, more severe tuberculosis/mortality and higher prevalence of treatment-resistant tuberculosis in smokers than in non-smokers in low-income countries 35 , 36 .
Despite substantial reductions in the prevalence of smoking, there were 34 million smokers in the USA, 7 million in the UK and 5 million in Canada in 2017 (ref. 16 ), and cigarette smoking remains the largest cause of premature death before 70 years of age in much of Europe and North America 1 , 16 , 28 , 29 . Smoking-associated diseases accounted for around 41 million deaths in the USA, UK and Canada from 1960 to 2020 (ref. 16 ). Moreover, as smoking-associated diseases are more prevalent among groups with lower levels of education and income, smoking accounts for at least half of the difference in overall mortality between these social groups 37 . Any reduction in smoking prevalence reduces the absolute mortality gap between these groups 38 .
Smoking cessation has become common in HICs with good tobacco control interventions. For example, in France, the number of ex-smokers is four times the number of current smokers among those aged 50 years or more 30 . By contrast, smoking cessation in LMICs remains uncommon before smokers develop tobacco-related diseases 39 . Smoking cessation greatly reduces the risks of smoking-related diseases. Indeed, smokers who quit smoking before 40 years of age avoid nearly all the increased mortality risks 31 , 33 . Moreover, individuals who quit smoking by 50 years of age reduce the risk of death from lung cancer by about two-thirds 40 . More modest hazards persist for deaths from lung cancer and emphysema 16 , 28 ; however, the risks among former smokers are an order of magnitude lower than among those who continue to smoke 33 .
Nicotine is the main psychoactive agent in tobacco and e-cigarettes. Nicotine acts as an agonist at nicotinic acetylcholine receptors (nAChRs), which are localized throughout the brain and peripheral nervous system 41 . nAChRs are pentameric ion channels that consist of varying combinations of α 2 –α 7 and β 2 –β 4 subunits, and for which acetylcholine (ACh) is the endogenous ligand 42 , 43 , 44 . When activated by nicotine binding, nAChR undergoes a conformational change that opens the internal pore, allowing an influx of sodium and calcium ions 45 . At postsynaptic membranes, nAChR activation can lead to action potential firing and downstream modulation of gene expression through calcium-mediated second messenger systems 46 . nAChRs are also localized to presynaptic membranes, where they modulate neurotransmitter release 47 . nAChRs become desensitized after activation, during which ligand binding will not open the channel 45 .
nAChRs with varying combinations of α-subunits and β-subunits have differences in nicotine binding affinity, efficacy and desensitization rate, and have differential expression depending on the brain region and cell type 48 , 49 , 50 . For instance, at nicotine concentrations found in human smokers, β 2 -containing nAChRs desensitize relatively quickly after activation, whereas α 7 -containing nAChRs have a slower desensitization profile 48 . Chronic nicotine exposure in experimental animal models or in humans induces an increase in cortical expression of α 4 β 2 -containing nAChRs 51 , 52 , 53 , 54 , 55 , but also increases the expression of β 3 and β 4 nAChR subunits in the medial habenula (MHb)–interpeduncular nucleus (IPN) pathway 56 , 57 . It is clear that both the brain localization and the type of nAChR are critical elements in mediating the various effects of nicotine, but other factors such as rate of nicotine delivery may also modulate addictive effects of nicotine 58 .
Neurocircuitry of nicotine addiction
Nicotine has both rewarding effects (such as a ‘buzz’ or ‘high’) and aversive effects (such as nausea and dizziness), with the net outcome dependent on dose and others factors such as interindividual sensitivity and presence of tolerance 59 . Thus, the addictive properties of nicotine involve integration of contrasting signals from multiple brain regions that process reward and aversion (Fig. 4 ).
During initial use, nicotine exerts both reinforcing and aversive effects, which together determine the likelihood of continued use. As the individual transitions to more frequent patterns of chronic use, nicotine induces pharmacodynamic changes in brain circuits, which is thought to lead to a reduction in sensitivity to the aversive properties of the drug. Nicotine is also a powerful reinforcer that leads to the conditioning of secondary cues associated with the drug-taking experience (such as cigarette pack, sensory properties of cigarette smoke and feel of the cigarette in the hand or mouth), which serves to enhance the incentive salience of these environmental factors and drive further drug intake. When the individual enters into states of abstinence (such as daily during sleep at night or during quit attempts), withdrawal symptomology is experienced, which may include irritability, restlessness, learning or memory deficits, difficulty concentrating, anxiety and hunger. These negative affective and cognitive symptoms lead to an intensification of the individual’s preoccupation to obtain and use the tobacco/nicotine product, and subsequently such intense craving can lead to relapse.
The rewarding actions of nicotine have largely been attributed to the mesolimbic pathway, which consists of dopaminergic neurons in the ventral tegmental area (VTA) that project to the nucleus accumbens and prefrontal cortex 60 , 61 , 62 (Fig. 5 ). VTA integrating circuits and projection regions express several nAChR subtypes on dopaminergic, GABAergic, and glutamatergic neurons 63 , 64 . Ultimately, administration of nicotine increases dopamine levels through increased dopaminergic neuron firing in striatal and extrastriatal areas (such as the ventral pallidum) 65 (Fig. 6 ). This effect is involved in reward and is believed to be primarily mediated by the action of nicotine on α 4 -containing and β 2 -containing nAChRs in the VTA 66 , 67 .
Multiple lines of research have demonstrated that nicotine reinforcement is mainly controlled by two brain pathways, which relay predominantly reward-related or aversion-related signals. The rewarding properties of nicotine that promote drug intake involve the mesolimbic dopamine projection from the ventral tegmental area (VTA) to the nucleus accumbens (NAc). By contrast, the aversive properties of nicotine that limit drug intake and mitigate withdrawal symptoms involve the fasciculus retroflexus projection from the medial habenula (MHb) to the interpeduncular nucleus (IPN). Additional brain regions have also been implicated in various aspects of nicotine dependence, such as the prefrontal cortex (PFC), ventral pallidum (VP), nucleus tractus solitarius (NTS) and insula (not shown here for clarity). All of these brain regions are directly or indirectly interconnected as integrative circuits to drive drug-seeking and drug-taking behaviours.
Smokers received brain PET scans with [ 11 C]PHNO, a dopamine D 2/3 PET tracer that has high sensitivity in detecting fluctuations of dopamine. PET scans were performed during abstinence or after smoking a cigarette. Reduced binding potential (BP ND ) was observed after smoking, indicating increased dopamine levels in the ventral striatum and in the area that corresponds to the ventral pallidum. The images show clusters with statistically significant decreases of [ 11 C]PHNO BP ND after smoking a cigarette versus abstinence condition. Those clusters have been superimposed on structural T1 MRI images of the brain. Reprinted from ref. 65 , Springer Nature Limited.
The aversive properties of nicotine are mediated by neurons in the MHb, which project to the IPN. Studies in rodents using genetic knockdown and knockout strategies demonstrated that the α 5 -containing, α 3 -containing and β 4 -containing nAChRs in the MHb–IPN pathway mediate the aversive properties of nicotine that limit drug intake, especially when animals are given the opportunity to consume higher nicotine doses 68 , 69 , 70 , 71 , 72 . In addition to nAChRs, other signalling factors acting on the MHb terminals in the IPN also regulate the actions of nicotine. For instance, under conditions of chronic nicotine exposure or with optogenetic activation of IPN neurons, a subtype of IPN neurons co-expressing Chrna5 (encoding the α 5 nAChR subunit) and Amigo1 (encoding adhesion molecule with immunoglobulin-like domain 1) release nitric oxide from the cell body that retrogradely inhibits MHb axon terminals 70 . In addition, nicotine activates α 5 -containing nAChR-expressing neurons that project from the nucleus tractus solitarius to the IPN, leading to release of glucagon-like peptide-1 that binds to GLP receptors on habenular axon terminals, which subsequently increases IPN neuron activation and decreases nicotine self-administration 73 . Taken together, these findings suggest a dynamic signalling process at MHb axonal terminals in the IPN, which regulates the addictive properties of nicotine and determines the amount of nicotine that is self-administered.
Nicotine withdrawal in animal models can be assessed by examining somatic signs (such as shaking, scratching, head nods and chewing) and affective signs (such as increased anxiety-related behaviours and conditioned place aversion). Interestingly, few nicotine withdrawal somatic signs are found in mice with genetic knockout of the α 2 , α 5 or β 4 nAChR subunits 74 , 75 . By contrast, β 2 nAChR-knockout mice have fewer anxiety-related behaviours during nicotine withdrawal, with no differences in somatic symptoms compared with wild-type mice 74 , 76 .
In addition to the VTA (mediating reward) and the MHb–IPN pathway (mediating aversion), other brain areas are involved in nicotine addiction (Fig. 5 ). In animals, the insular cortex controls nicotine taking and nicotine seeking 77 . Moreover, humans with lesions of the insular cortex can quit smoking easily without relapse 78 . This finding led to the development of a novel therapeutic intervention modulating insula function (see Management, below) 79 , 80 . Various brain areas (shell of nucleus accumbens, basolateral amygdala and prelimbic cortex) expressing cannabinoid CB 1 receptors are also critical in controlling rewarding effects and relapse 81 , 82 . The α 1 -adrenergic receptor expressed in the cortex also control these effects, probably through glutamatergic afferents to the nucleus accumbens 83 .
Individual differences in nicotine addiction risk
Vulnerability to nicotine dependence varies between individuals, and the reasons for these differences are multidimensional. Many social factors (such as education level and income) play a role 84 . Broad psychological and social factors also modulate this risk. For example, peer smoking status, knowledge on effect of tobacco, expectation on social acceptance, exposure to passive smoking modulate the risk of initiating tobacco use 85 , 86 .
Genetic factors have a role in smoking initiation, the development of nicotine addiction and the likelihood of smoking cessation. Indeed, heritability has been estimated to contribute to approximatively half of the variability in nicotine dependence 87 , 88 , 89 , 90 . Important advances in our understanding of such genetic contributions have evolved with large-scale genome-wide association studies of smokers and non-smokers. One of the most striking findings has been that allelic variation in the CHRNA5 – CHRNA3 – CHRNB4 gene cluster, which encodes α 5 , α 3 and β 4 nAChR subunits, correlates with an increased vulnerability for nicotine addiction, indicated by a higher likelihood of becoming dependent on nicotine and smoking a greater number of cigarettes per day 91 , 92 , 93 , 94 , 95 . The most significant effect has been found for a single-nucleotide polymorphism in CHRNA5 (rs16969968), which results in an amino acid change and reduced function of α 5 -containing nAChRs 92 .
Allelic variation in CYP2A6 (encoding the CYP2A6 enzyme, which metabolizes nicotine) has also been associated with differential vulnerability to nicotine dependence 96 , 97 , 98 . CYP2A6 is highly polymorphic, resulting in variable enzymatic activity 96 , 99 , 100 . Individuals with allelic variation that results in slow nicotine metabolism consume less nicotine per day, experience less-severe withdrawal symptoms and are more successful at quitting smoking than individuals with normal or fast metabolism 101 , 102 , 103 , 104 . Moreover, individuals with slow nicotine metabolism have lower dopaminergic receptor expression in the dopamine D2 regions of the associative striatum and sensorimotor striatum in PET studies 105 and take fewer puffs of nicotine-containing cigarettes (compared with de-nicotinized cigarettes) in a forced choice task 106 . Slower nicotine metabolism is thought to increase the duration of action of nicotine, allowing nicotine levels to accumulate over time, therefore enabling lower levels of intake to sustain activation of nAChRs 107 .
Large-scale genetic studies have identified hundreds of other genetic loci that influence smoking initiation, age of smoking initiation, cigarettes smoked per day and successful smoking cessation 108 . The strongest genetic contributions to smoking through the nicotinic receptors and nicotine metabolism are among the strongest genetic contributors to lung cancer 109 . Other genetic variations (such as those related to cannabinoid, dopamine receptors or other neurotransmitters) may affect certain phenotypes related to smoking (such as nicotine preference and cue-reactivity) 110 , 111 , 112 , 113 , 114 , 115 .
Diagnosis, screening and prevention
Screening for cigarette smoking.
Screening for cigarette smoking should happen at every doctor’s visit 116 . In this regard, a simple and direct question about a person’s tobacco use can provide an opportunity to offer information about its potential risks and treatments to assist in quitting. All smokers should be offered assistance in quitting because even low levels of smoking present a significant health risk 33 , 117 , 118 . Smoking status can be assessed by self-categorization or self-reported assessment of smoking behaviour (Table 1 ). In people who smoke, smoking frequency can be assessed 119 and a combined quantity frequency measure such as pack-year history (that is, average number of cigarettes smoked per day multiplied by the number of years, divided by 20), can be used to estimate cumulative risk of adverse health outcomes. The Association for the Treatment of Tobacco Use and Dependence recommends that all electronic health records should document smoking status using the self-report categories listed in Table 1 .
Owing to the advent of e-cigarettes and heat-not-burn products, and the popularity of little cigars in the US that mimic combustible cigarettes, people who use tobacco may use multiple products concurrently 120 , 121 . Thus, screening for other nicotine and tobacco product use is important in clinical practice. The self-categorization approach can also be used to describe the use of these other products.
Traditionally tobacco use has been classified according to whether the smoker meets criteria for nicotine dependence in one of the two main diagnostic classifications: the DSM 122 (tobacco use disorder) and the ICD (tobacco dependence) 123 . The diagnosis of tobacco use disorder according to DSM-5 criteria requires the presence of at least 2 of 11 symptoms that have produced marked clinical impairment or distress within a 12-month period (Box 2 ). Of note, these symptoms are similar for all substance use disorder diagnoses and may not all be relevant to tobacco use disorder (such as failure to complete life roles). In the ICD-10, codes allow the identification of specific tobacco products used (cigarettes, chewing tobacco and other tobacco products).
Dependence can also be assessed as a continuous construct associated with higher levels of use, greater withdrawal and reduced likelihood of quitting. The level of dependence can be assessed with the Fagerström Test for Nicotine Dependence, a short questionnaire comprising six questions 124 (Box 2 ). A score of ≥4 indicates moderate to high dependence. As very limited time may be available in clinical consultations, the Heaviness of Smoking Index (HSI) was developed, which comprises two questions on the number of cigarettes smoked per day and how soon after waking the first cigarette is smoked 125 . The HSI can guide dosing for nicotine replacement therapy (NRT).
Other measures of cigarette dependence have been developed but are not used in the clinical setting, such as the Cigarette Dependence Scale 126 , Hooked on Nicotine Checklist 127 , Nicotine Dependence Syndrome Scale 128 , the Wisconsin Inventory of Smoking Dependence Motives (Brief) 129 and the Penn State Cigarette Dependence Index 130 . However, in practice, these are not often used, as the most important aspect is to screen for smoking and encourage all smokers to quit smoking regardless of their dependence status.
Box 2 DSM-5 criteria for tobacco use disorder and items of the Fagerström Test for nicotine dependence
DSM-5 (ref. 122 )
Taxonomic and diagnostic tool for tobacco use disorder published by the American Psychiatric Association.
A problematic pattern of tobacco use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period.
Tobacco often used in larger amounts or over a longer period of time than intended
A persistent desire or unsuccessful efforts to reduce or control tobacco use
A great deal of time spent in activities necessary to obtain or use tobacco
Craving, or a strong desire or urge to use tobacco
Recurrent tobacco use resulting in a failure to fulfil major role obligations at work, school or home
Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco (for example, arguments with others about tobacco use)
Important social, occupational or recreational activities given up or reduced because of tobacco use
Recurrent tobacco use in hazardous situations (such as smoking in bed)
Tobacco use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco use
Tolerance, defined by either of the following.
A need for markedly increased amounts of tobacco to achieve the desired effect
A markedly diminished effect with continued use of the same amount of tobacco
Withdrawal, manifesting as either of the following.
Withdrawal syndrome for tobacco
Tobacco (or a closely related substance, such as nicotine) taken to relieve or avoid withdrawal symptoms
Fagerström Test for Nicotine Dependence 124
A standard instrument for assessing the intensity of physical addiction to nicotine.
How soon after you wake up do you smoke your first cigarette?
Within 5 min (scores 3 points)
5 to 30 min (scores 2 points)
31 to 60 min (scores 1 point)
After 60 min (scores 0 points)
Do you find it difficult not to smoke in places where you should not, such as in church or school, in a movie, at the library, on a bus, in court or in a hospital?
Yes (scores 1 point)
No (scores 0 points)
Which cigarette would you most hate to give up; which cigarette do you treasure the most?
The first one in the morning (scores 1 point)
Any other one (scores 0 points)
How many cigarettes do you smoke each day?
10 or fewer (scores 0 points)
11 to 20 (scores 1 point)
21 to 30 (scores 2 points)
31 or more (scores 3 points)
Do you smoke more during the first few hours after waking up than during the rest of the day?
Do you still smoke if you are so sick that you are in bed most of the day or if you have a cold or the flu and have trouble breathing?
A score of 7–10 points is classified as highly dependent; 4–6 points is classified as moderately dependent; <4 points is classified as minimally dependent.
DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Young people who do not start smoking cigarettes between 15 and 25 years of age have a very low risk of ever smoking 24 , 131 , 132 . This age group provides a critical opportunity to prevent cigarette smoking using effective, evidence-based strategies to prevent smoking initiation and reduce escalation from experimentation to regular use 131 , 132 , 133 , 134 , 135 .
Effective prevention of cigarette uptake requires a comprehensive package of cost-effective policies 134 , 136 , 137 to synergistically reduce the population prevalence of cigarette smoking 131 , 135 . These policies include high rates of tobacco taxation 30 , 134 , 137 , 138 , widespread and rigorously enforced smoke-free policies 139 , bans on tobacco advertising and promotions 140 , use of plain packaging and graphic warnings about the health risks of smoking 135 , 141 , mass media and peer-based education programmes to discourage smoking, and enforcement of laws against the sale of cigarettes to young people below the minimum legal purchase age 131 , 135 . These policies make cigarettes less available and affordable to young people. Moreover, these policies make it more difficult for young people to purchase cigarettes and make smoking a much less socially acceptable practice. Of note, these policies are typically mostly enacted in HICs, which may be related to the declining prevalence of smoking in these countries, compared with the prevalence in LMICs.
Three evidence-based classes of pharmacotherapy are available for smoking cessation: NRT (using nicotine-based patches, gum, lozenges, mini-lozenges, nasal sprays and inhalers), varenicline (a nAChR partial agonist), and bupropion (a noradrenaline/dopamine reuptake inhibitor that also inhibits nAChR function and is also used as an antidepressant). These FDA-approved and EMA-approved pharmacotherapies are cost-effective smoking cessation treatments that double or triple successful abstinence rates compared with no treatment or placebo controls 116 , 142 .
Combinations of pharmacotherapies are also effective for smoking cessation 116 , 142 . For example, combining NRTs (such as the steady-state nicotine patch and as-needed NRT such as gum or mini-lozenge) is more effective than a single form of NRT 116 , 142 , 143 . Combining NRT and varenicline is the most effective smoking cessation pharmacotherapy 116 , 142 , 143 . Combining FDA-approved pharmacotherapy with behavioural counselling further increases the likelihood of successful cessation 142 . Second-line pharmacotherapies (for example, nortriptyline) have some potential for smoking cessation, but their use is limited due to their tolerability profile.
All smokers should receive pharmacotherapy to help them quit smoking, except those in whom pharmacotherapy has insufficient evidence of effectiveness (among adolescents, smokeless tobacco users, pregnant women or light smokers) or those in whom pharmacotherapy is medically contraindicated 144 . Table 2 provides specific information regarding dosing and duration for each FDA-approved pharmacotherapy. Extended use of pharmacotherapy beyond the standard 12-week regimen after cessation is effective and should be considered 116 . Moreover, preloading pharmacotherapy (that is, initiating cessation medication in advance of a quit attempt), especially with the nicotine patch, is a promising treatment, although further studies are required to confirm efficacy.
Cytisine has been used for smoking cessation in Eastern Europe for a long time and is available in some countries (such as Canada) without prescription 145 . Cytisine is a partial agonist of nAChRs and its structure was the precursor for the development of varenicline 145 . Cytisine is at least as effective as some approved pharmacotherapies for smoking cessation, such as NRT 146 , 147 , 148 , and the role of cytisine in smoking cessation is likely to expand in the future, notably owing to its much lower cost than traditional pharmacotherapies. E-cigarettes also have the potential to be useful as smoking cessation devices 149 , 150 . The 2020 US Surgeon General’s Report concluded that there was insufficient evidence to promote cytisine or e-cigarettes as effective smoking cessation treatments, but in the UK its use is recommended for smoking cessation (see ref. 15 for regularly updated review).
Counselling and behavioural treatments
Psychosocial counselling significantly increases the likelihood of successful cessation, especially when combined with pharmacotherapy. Even a counselling session lasting only 3 minutes can help smokers quit 116 , although the 2008 US Public Health Service guidelines and the Preventive Services Task Force 151 each concluded that more intensive counselling (≥20 min per session) is more effective than less intensive counselling (<20 min per session). Higher smoking cessation rates are obtained by using behavioural change techniques that target associative and self-regulatory processes 152 . In addition, behavioural change techniques that will favour commitment, social reward and identity associated with changed behaviour seems associated with higher success rates 152 . Evidence-based counselling focuses on providing social support during treatment, building skills to cope with withdrawal and cessation, and problem-solving in challenging situations 116 , 153 . Effective counselling can be delivered by diverse providers (such as physicians, nurses, pharmacists, social workers, psychologists and certified tobacco treatment specialists) 116 .
Counselling can be delivered in a variety of modalities. In-person individual and group counselling are effective, as is telephone counselling (quit lines) 142 . Internet and text-based intervention seem to be effective in smoking cessation, especially when they are interactive and tailored to a smoker’s specific circumstances 142 . Over the past several years, the number of smoking cessation smartphone apps has increased, but there the evidence that the use of these apps significantly increases smoking cessation rates is not sufficient.
Contingency management (providing financial incentives for abstinence or engagement in treatment) has shown promising results 154 , 155 but its effects are not sustained once the contingencies are removed 155 , 156 . Other treatments such as hypnosis, acupuncture and laser treatment have not been shown to improve smoking cessation rates compared with placebo treatments 116 . Moreover, no solid evidence supports the use of conventional transcranial magnetic stimulation (TMS) for long-term smoking cessation 157 , 158 .
Although a variety of empirically supported smoking cessation interventions are available, more than two-thirds of adult smokers who made quit attempts in the USA during the past year did not use an evidence-based treatment and the rate is likely to be lower in many other countries 142 . This speaks to the need to increase awareness of, and access to, effective cessation aids among all smokers.
The insula (part of the frontal cortex) is a critical brain structure involved in cigarette craving and relapse 78 , 79 . The activity of the insula can be modulated using an innovative approach called deep insula/prefrontal cortex TMS (deep TMS), which is effective in helping people quit smoking 80 , 159 . This approach has now been approved by the FDA as an effective smoking cessation intervention 80 . However, although this intervention was developed and is effective for smoking cessation, the number of people with access to it is limited owing to the limited number of sites equipped and with trained personnel, and the cost of this intervention.
Quality of life
Generic instruments (such as the Short-Form (SF-36) Health Survey) can be used to evaluate quality of life (QOL) in smokers. People who smoke rate their QOL lower than people who do not smoke both before and after they become smokers 160 , 161 . QOL improves when smokers quit 162 . Mental health may also improve on quitting smoking 163 . Moreover, QOL is much poorer in smokers with tobacco-related diseases, such as chronic respiratory diseases and cancers, than in individuals without tobacco-related diseases 161 , 164 . The dimensions of QOL that show the largest decrements in people who smoke are those related to physical health, day-to-day activities and mental health such as depression 160 . Smoking also increases the risk of diabetes mellitus 165 , 166 , which is a major determinant of poor QOL for a wide range of conditions.
The high toll of premature death from cigarette smoking can obscure the fact that many of the diseases that cause these deaths also produce substantial disability in the years before death 1 . Indeed, death in smokers is typically preceded by several years of living with the serious disability and impairment of everyday activities caused by chronic respiratory disease, heart disease and cancer 2 . Smokers’ QOL in these years may also be adversely affected by the adverse effects of the medical treatments that they receive for these smoking-related diseases (such as major surgery and radiotherapy).
Expanding cessation worldwide
The major global challenge is to consider individual and population-based strategies that could increase the substantially low rates of adult cessation in most LMICs and indeed strategies to ensure that even in HICs, cessation continues to increase. In general, the most effective tools recommended by WHO to expand cessation are the same tools that can prevent smoking initiation, notably higher tobacco taxes, bans on advertising and promotion, prominent warning labels or plain packaging, bans on public smoking, and mass media and educational efforts 29 , 167 . The effective use of these policies, particularly taxation, lags behind in most LMICs compared with most HICs, with important exceptions such as Brazil 167 . Access to effective pharmacotherapies and counselling as well as support for co-existing mental health conditions would also be required to accelerate cessation in LMICs. This is particularly important as smokers living in LMICs often have no access to the full range of effective treatment options.
Regulating access to e-cigarettes
How e-cigarettes should be used is debated within the tobacco control field. In some countries (for example, the UK), the use of e-cigarettes as a cigarette smoking cessation aid and as a harm reduction strategy is supported, based on the idea that e-cigarette use will lead to much less exposure to toxic compounds than tobacco use, therefore reducing global harm. In other countries (for example, the USA), there is more concern with preventing the increased use of e-cigarettes by youths that may subsequently lead to smoking 25 , 26 . Regulating e-cigarettes in nuanced ways that enable smokers to access those products whilst preventing their uptake among youths is critical.
Regulating nicotine content in tobacco products
Reducing the nicotine content of cigarettes could potentially produce less addictive products that would allow a gradual reduction in the population prevalence of smoking. Some clinical studies have found no compensatory increase in smoking whilst providing access to low nicotine tobacco 168 . Future regulation may be implemented to gradually decrease the nicotine content of combustible tobacco and other nicotine products 169 , 170 , 171 .
Tobacco end games
Some individuals have proposed getting rid of commercial tobacco products this century or using the major economic disruption arising from the COVID-19 pandemic to accelerate the demise of the tobacco industry 172 , 173 . Some tobacco producers have even proposed this strategy as an internal goal, with the idea of switching to nicotine delivery systems that are less harmful ( Philip Morris International ). Some countries are moving towards such an objective; for example, in New Zealand, the goal that fewer than 5% of New Zealanders will be smokers in 2025 has been set (ref. 174 ). The tobacco end-game approach would overall be the best approach to reduce the burden of tobacco use on society, but it would require coordination of multiple countries and strong public and private consensus on the strategy to avoid a major expansion of the existing illicit market in tobacco products in some countries.
The COVID-19 pandemic has shown that large-scale investment in research can lead to rapid development of successful therapeutic interventions. By contrast, smoking cessation has been underfunded compared with the contribution that it makes to the global burden of disease. In addition, there is limited coordination between research teams and most studies are small-scale and often underpowered 79 . It is time to fund an ambitious, coordinated programme of research to test the most promising therapies based on an increased understanding of the neurobiological basis of smoking and nicotine addiction (Table 3 ). Many of those ideas have not yet been tested properly and this could be carried out by a coordinated programme of research at the international level.
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B.Le F. is supported by a clinician-scientist award from the Department of Family and Community Medicine at the University of Toronto and the Addiction Psychiatry Chair from the University of Toronto. The funding bodies had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The authors thank H. Fu (University of Toronto) for assistance with Figs 1–3.
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Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
Bernard Le Foll
Departments of Family and Community Medicine, Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
Department of Medicine, University of Wisconsin, Madison, WI, USA
Megan E. Piper
University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA
Department of Neurobiology and Behaviour, University of California Irvine, Irvine, CA, USA
Christie D. Fowler
Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
National Institute on Drug Dependence, Peking University Health Science Center, Beijing, China
Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
Wayne D. Hall
Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
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Introduction (B.Le F.); Epidemiology (P.J. and W.D.H.); Mechanisms/pathophysiology (C.D.F., L.B., L.L. and B.Le F.); Diagnosis, screening and prevention (P.J., M.E.P., S.T. and B.Le F.); Management (M.E.P., S.T., W.D.H., L.L. and B.Le F.); Quality of life (P.J. and W.D.H.); Outlook (all); Conclusions (all). All authors contributed substantially to the review and editing of the manuscript.
Correspondence to Bernard Le Foll .
B.Le F. has obtained funding from Pfizer (GRAND Awards, including salary support) for investigator-initiated projects. B.Le F. has received some in-kind donations of cannabis product from Aurora and medication donation from Pfizer and Bioprojet and was provided a coil for TMS study from Brainsway. B.Le F. has obtained industry funding from Canopy (through research grants handled by CAMH or the University of Toronto), Bioprojet, ACS, Indivior and Alkermes. B.Le F. has received in-kind donations of nabiximols from GW Pharma for past studies funded by CIHR and NIH. B.Le F. has been an advisor to Shinoghi. S.T. has received honoraria from Pfizer the manufacturer of varenicline for lectures and advice. All other authors declare no competing interests.
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Le Foll, B., Piper, M.E., Fowler, C.D. et al. Tobacco and nicotine use. Nat Rev Dis Primers 8 , 19 (2022). https://doi.org/10.1038/s41572-022-00346-w
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DOI : https://doi.org/10.1038/s41572-022-00346-w
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Office on Smoking and Health (US). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2006.
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.
1 introduction, summary, and conclusions.
The topic of passive or involuntary smoking was first addressed in the 1972 U.S. Surgeon General’s report ( The Health Consequences of Smoking , U.S. Department of Health, Education, and Welfare [USDHEW] 1972 ), only eight years after the first Surgeon General’s report on the health consequences of active smoking ( USDHEW 1964 ). Surgeon General Dr. Jesse Steinfeld had raised concerns about this topic, leading to its inclusion in that report. According to the 1972 report, nonsmokers inhale the mixture of sidestream smoke given off by a smoldering cigarette and mainstream smoke exhaled by a smoker, a mixture now referred to as “secondhand smoke” or “environmental tobacco smoke.” Cited experimental studies showed that smoking in enclosed spaces could lead to high levels of cigarette smoke components in the air. For carbon monoxide ( CO ) specifically, levels in enclosed spaces could exceed levels then permitted in outdoor air. The studies supported a conclusion that “an atmosphere contaminated with tobacco smoke can contribute to the discomfort of many individuals” ( USDHEW 1972 , p. 7). The possibility that CO emitted from cigarettes could harm persons with chronic heart or lung disease was also mentioned.
Secondhand tobacco smoke was then addressed in greater depth in Chapter 4 (Involuntary Smoking) of the 1975 Surgeon General’s report, The Health Consequences of Smoking ( USDHEW 1975 ). The chapter noted that involuntary smoking takes place when nonsmokers inhale both sidestream and exhaled mainstream smoke and that this “smoking” is “involuntary” when “the exposure occurs as an unavoidable consequence of breathing in a smoke-filled environment” (p. 87). The report covered exposures and potential health consequences of involuntary smoking, and the researchers concluded that smoking on buses and airplanes was annoying to nonsmokers and that involuntary smoking had potentially adverse consequences for persons with heart and lung diseases. Two studies on nicotine concentrations in nonsmokers raised concerns about nicotine as a contributing factor to atherosclerotic cardiovascular disease in nonsmokers.
The 1979 Surgeon General’s report, Smoking and Health: A Report of the Surgeon General ( USDHEW 1979 ), also contained a chapter entitled “Involuntary Smoking.” The chapter stressed that “attention to involuntary smoking is of recent vintage, and only limited information regarding the health effects of such exposure upon the nonsmoker is available” (p. 11–35). The chapter concluded with recommendations for research including epidemiologic and clinical studies. The 1982 Surgeon General’s report specifically addressed smoking and cancer ( U.S. Department of Health and Human Services [USDHHS] 1982 ). By 1982, there were three published epidemiologic studies on involuntary smoking and lung cancer, and the 1982 Surgeon General’s report included a brief chapter on this topic. That chapter commented on the methodologic difficulties inherent in such studies, including exposure assessment, the lengthy interval during which exposures are likely to be relevant, and accounting for exposures to other carcinogens. Nonetheless, the report concluded that “Although the currently available evidence is not sufficient to conclude that passive or involuntary smoking causes lung cancer in nonsmokers, the evidence does raise concern about a possible serious public health problem” (p. 251).
Involuntary smoking was also reviewed in the 1984 report, which focused on chronic obstructive pulmonary disease and smoking ( USDHHS 1984 ). Chapter 7 (Passive Smoking) of that report included a comprehensive review of the mounting information on smoking by parents and the effects on respiratory health of their children, data on irritation of the eye, and the more limited evidence on pulmonary effects of involuntary smoking on adults. The chapter began with a compilation of measurements of tobacco smoke components in various indoor environments. The extent of the data had increased substantially since 1972. By 1984, the data included measurements of more specific indicators such as acrolein and nicotine, and less specific indicators such as particulate matter ( PM ), nitrogen oxides, and CO . The report reviewed new evidence on exposures of nonsmokers using bio-markers, with substantial information on levels of cotinine, a major nicotine metabolite. The report anticipated future conclusions with regard to respiratory effects of parental smoking on child respiratory health ( Table 1.1 ).
Conclusions from previous Surgeon General’s reports on the health effects of secondhand smoke exposure
Involuntary smoking was the topic for the entire 1986 Surgeon General’s report, The Health Consequences of Involuntary Smoking ( USDHHS 1986 ). In its 359 pages, the report covered the full breadth of the topic, addressing toxicology and dosimetry of tobacco smoke; the relevant evidence on active smoking; patterns of exposure of nonsmokers to tobacco smoke; the epidemiologic evidence on involuntary smoking and disease risks for infants, children, and adults; and policies to control involuntary exposure to tobacco smoke. That report concluded that involuntary smoking caused lung cancer in lifetime nonsmoking adults and was associated with adverse effects on respiratory health in children. The report also stated that simply separating smokers and nonsmokers within the same airspace reduced but did not eliminate exposure to secondhand smoke. All of these findings are relevant to public health and public policy ( Table 1.1 ). The lung cancer conclusion was based on extensive information already available on the carcinogenicity of active smoking, the qualitative similarities between secondhand and mainstream smoke, the uptake of tobacco smoke components by nonsmokers, and the epidemiologic data on involuntary smoking. The three major conclusions of the report ( Table 1.2 ), led Dr. C. Everett Koop, Surgeon General at the time, to comment in his preface that “the right of smokers to smoke ends where their behavior affects the health and well-being of others; furthermore, it is the smokers’ responsibility to ensure that they do not expose nonsmokers to the potential [ sic ] harmful effects of tobacco smoke” ( USDHHS 1986 , p. xii).
Major conclusions of the 1986 Surgeon General’s report, The Health Consequences of Involuntary Smoking
Two other reports published in 1986 also reached the conclusion that involuntary smoking increased the risk for lung cancer. The International Agency for Research on Cancer ( IARC ) of the World Health Organization concluded that “passive smoking gives rise to some risk of cancer” ( IARC 1986 , p. 314). In its monograph on tobacco smoking, the agency supported this conclusion on the basis of the characteristics of sidestream and mainstream smoke, the absorption of tobacco smoke materials during an involuntary exposure, and the nature of dose-response relationships for carcinogenesis. In the same year, the National Research Council ( NRC ) also concluded that involuntary smoking increases the incidence of lung cancer in nonsmokers ( NRC 1986 ). In reaching this conclusion, the NRC report cited the biologic plausibility of the association between exposure to secondhand smoke and lung cancer and the supporting epidemiologic evidence. On the basis of a pooled analysis of the epidemiologic data adjusted for bias, the report concluded that the best estimate for the excess risk of lung cancer in nonsmokers married to smokers was 25 percent, compared with nonsmokers married to nonsmokers. With regard to the effects of involuntary smoking on children, the NRC report commented on the literature linking secondhand smoke exposures from parental smoking to increased risks for respiratory symptoms and infections and to a slightly diminished rate of lung growth.
Since 1986, the conclusions with regard to both the carcinogenicity of secondhand smoke and the adverse effects of parental smoking on the health of children have been echoed and expanded ( Table 1.3 ). In 1992, the U.S. Environmental Protection Agency ( EPA ) published its risk assessment of secondhand smoke as a carcinogen ( USEPA 1992 ). The agency’s evaluation drew on toxicologic information on secondhand smoke and the extensive literature on active smoking. A comprehensive meta-analysis of the 31 epidemiologic studies of secondhand smoke and lung cancer published up to that time was central to the decision to classify secondhand smoke as a group A carcinogen—namely, a known human carcinogen. Estimates of approximately 3,000 U.S. lung cancer deaths per year in non-smokers were attributed to secondhand smoke. The report also covered other respiratory health effects in children and adults and concluded that involuntary smoking is causally associated with several adverse respiratory effects in children. There was also a quantitative risk assessment for the impact of involuntary smoking on childhood asthma and lower respiratory tract infections in young children.
Selected major reports, other than those of the U.S. Surgeon General, addressing adverse effects from exposure to tobacco smoke
In the decade since the 1992 EPA report, scientific panels continued to evaluate the mounting evidence linking involuntary smoking to adverse health effects ( Table 1.3 ). The most recent was the 2005 report of the California EPA ( Cal/EPA 2005 ). Over time, research has repeatedly affirmed the conclusions of the 1986 Surgeon General’s reports and studies have further identified causal associations of involuntary smoking with diseases and other health disorders. The epidemiologic evidence on involuntary smoking has markedly expanded since 1986, as have the data on exposure to tobacco smoke in the many environments where people spend time. An understanding of the mechanisms by which involuntary smoking causes disease has also deepened.
As part of the environmental health hazard assessment, Cal/EPA identified specific health effects causally associated with exposure to secondhand smoke. The agency estimated the annual excess deaths in the United States that are attributable to secondhand smoke exposure for specific disorders: sudden infant death syndrome ( SIDS ), cardiac-related illnesses (ischemic heart disease), and lung cancer ( Cal/EPA 2005 ). For the excess incidence of other health outcomes, either new estimates were provided or estimates from the 1997 health hazard assessment were used without any revisions ( Cal/EPA 1997 ). Overall, Cal/EPA estimated that about 50,000 excess deaths result annually from exposure to secondhand smoke ( Cal/EPA 2005 ). Estimated annual excess deaths for the total U.S. population are about 3,400 (a range of 3,423 to 8,866) from lung cancer, 46,000 (a range of 22,700 to 69,600) from cardiac-related illnesses, and 430 from SIDS. The agency also estimated that between 24,300 and 71,900 low birth weight or pre-term deliveries, about 202,300 episodes of childhood asthma (new cases and exacerbations), between 150,000 and 300,000 cases of lower respiratory illness in children, and about 789,700 cases of middle ear infections in children occur each year in the United States as a result of exposure to secondhand smoke.
This new 2006 Surgeon General’s report returns to the topic of involuntary smoking. The health effects of involuntary smoking have not received comprehensive coverage in this series of reports since 1986. Reports since then have touched on selected aspects of the topic: the 1994 report on tobacco use among young people ( USDHHS 1994 ), the 1998 report on tobacco use among U.S. racial and ethnic minorities ( USDHHS 1998 ), and the 2001 report on women and smoking ( USDHHS 2001 ). As involuntary smoking remains widespread in the United States and elsewhere, the preparation of this report was motivated by the persistence of involuntary smoking as a public health problem and the need to evaluate the substantial new evidence reported since 1986. This report substantially expands the list of topics that were included in the 1986 report. Additional topics include SIDS , developmental effects, and other reproductive effects; heart disease in adults; and cancer sites beyond the lung. For some associations of involuntary smoking with adverse health effects, only a few studies were reviewed in 1986 (e. g ., ear disease in children); now, the relevant literature is substantial. Consequently, this report uses meta-analysis to quantitatively summarize evidence as appropriate. Following the approach used in the 2004 report ( The Health Consequences of Smoking , USDHHS 2004 ), this 2006 report also systematically evaluates the evidence for causality, judging the extent of the evidence available and then making an inference as to the nature of the association.
Organization of the Report
This twenty-ninth report of the Surgeon General examines the topics of toxicology of secondhand smoke, assessment and prevalence of exposure to secondhand smoke, reproductive and developmental health effects, respiratory effects of exposure to secondhand smoke in children and adults, cancer among adults, cardiovascular diseases, and the control of secondhand smoke exposure.
This introductory chapter (Chapter 1) includes a discussion of the concept of causation and introduces concepts of causality that are used throughout this report; this chapter also summarizes the major conclusions of the report. Chapter 2 (Toxicology of Secondhand Smoke) sets out a foundation for interpreting the observational evidence that is the focus of most of the following chapters. The discussion details the mechanisms that enable tobacco smoke components to injure the respiratory tract and cause nonmalignant and malignant diseases and other adverse effects. Chapter 3 (Assessment of Exposure to Secondhand Smoke) provides a perspective on key factors that determine exposures of people to secondhand smoke in indoor environments, including building designs and operations, atmospheric markers of secondhand smoke, exposure models, and biomarkers of exposure to secondhand smoke. Chapter 4 (Prevalence of Exposure to Secondhand Smoke) summarizes findings that focus on nicotine measurements in the air and cotinine measurements in biologic materials. The chapter includes exposures in the home, workplace, public places, and special populations. Chapter 5 (Reproductive and Developmental Effects from Exposure to Secondhand Smoke) reviews the health effects on reproduction, on infants, and on child development. Chapter 6 (Respiratory Effects in Children from Exposure to Secondhand Smoke) examines the effects of parental smoking on the respiratory health of children. Chapter 7 (Cancer Among Adults from Exposure to Secondhand Smoke) summarizes the evidence on cancer of the lung, breast, nasal sinuses, and the cervix. Chapter 8 (Cardiovascular Diseases from Exposure to Secondhand Smoke) discusses coronary heart disease ( CHD ), stroke, and subclinical vascular disease. Chapter 9 (Respiratory Effects in Adults from Exposure to Secondhand Smoke) examines odor and irritation, respiratory symptoms, lung function, and respiratory diseases such as asthma and chronic obstructive pulmonary disease. Chapter 10 (Control of Secondhand Smoke Exposure) considers measures used to control exposure to secondhand smoke in public places, including legislation, education, and approaches based on building designs and operations. The report concludes with “A Vision for the Future.” Major conclusions of the report were distilled from the chapter conclusions and appear later in this chapter.
Preparation of the Report
This report of the Surgeon General was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention ( CDC ), and U.S. DHHS. Initial chapters were written by 22 experts who were selected because of their knowledge of a particular topic. The contributions of the initial experts were consolidated into 10 major chapters that were then reviewed by more than 40 peer reviewers. The entire manuscript was then sent to more than 30 scientists and experts who reviewed it for its scientific integrity. After each review cycle, the drafts were revised by the scientific editors on the basis of the experts’ comments. Subsequently, the report was reviewed by various institutes and agencies within U.S. DHHS. Publication lags, even short ones, prevent an up-to-the-minute inclusion of all recently published articles and data. Therefore, by the time the public reads this report, there may be additional published studies or data. To provide published information as current as possible, this report includes an Appendix of more recent studies that represent major additions to the literature.
This report is also accompanied by a companion database of key evidence that is accessible through the Internet ( http://www.cdc.gov/tobacco ). The database includes a uniform description of the studies and results on the health effects of exposure to secondhand smoke that were presented in a format compatible with abstraction into standardized tables. Readers of the report may access these data for additional analyses, tables, or figures.
- Definitions and Terminology
The inhalation of tobacco smoke by nonsmokers has been variably referred to as “passive smoking” or “involuntary smoking.” Smokers, of course, also inhale secondhand smoke. Cigarette smoke contains both particles and gases generated by the combustion at high temperatures of tobacco, paper, and additives. The smoke inhaled by nonsmokers that contaminates indoor spaces and outdoor environments has often been referred to as “secondhand smoke” or “environmental tobacco smoke.” This inhaled smoke is the mixture of sidestream smoke released by the smoldering cigarette and the mainstream smoke that is exhaled by a smoker. Sidestream smoke, generated at lower temperatures and under somewhat different combustion conditions than mainstream smoke, tends to have higher concentrations of many of the toxins found in cigarette smoke ( USDHHS 1986 ). However, it is rapidly diluted as it travels away from the burning cigarette.
Secondhand smoke is an inherently dynamic mixture that changes in characteristics and concentration with the time since it was formed and the distance it has traveled. The smoke particles change in size and composition as gaseous components are volatilized and moisture content changes; gaseous elements of secondhand smoke may be adsorbed onto materials, and particle concentrations drop with both dilution in the air or environment and impaction on surfaces, including the lungs or on the body. Because of its dynamic nature, a specific quantitative definition of secondhand smoke cannot be offered.
This report uses the term secondhand smoke in preference to environmental tobacco smoke, even though the latter may have been used more frequently in previous reports. The descriptor “secondhand” captures the involuntary nature of the exposure, while “environmental” does not. This report also refers to the inhalation of secondhand smoke as involuntary smoking, acknowledging that most nonsmokers do not want to inhale tobacco smoke. The exposure of the fetus to tobacco smoke, whether from active smoking by the mother or from her exposure to secondhand smoke, also constitutes involuntary smoking.
- Evidence Evaluation
Following the model of the 1964 report, the Surgeon General’s reports on smoking have included comprehensive compilations of the evidence on the health effects of smoking. The evidence is analyzed to identify causal associations between smoking and disease according to enunciated principles, sometimes referred to as the “Surgeon General’s criteria” or the “Hill” criteria (after Sir Austin Bradford Hill) for causality ( USDHEW 1964 ; USDHHS 2004 ). Application of these criteria involves covering all relevant observational and experimental evidence. The criteria, offered in a brief chapter of the 1964 report entitled “Criteria for Judgment,” included (1) the consistency of the association, (2) the strength of the association, (3) the specificity of the association, (4) the temporal relationship of the association, and (5) the coherence of the association. Although these criteria have been criticized (e. g ., Rothman and Greenland 1998 ), they have proved useful as a framework for interpreting evidence on smoking and other postulated causes of disease, and for judging whether causality can be inferred.
In the 2004 report of the Surgeon General, The Health Consequences of Smoking , the framework for interpreting evidence on smoking and health was revisited in depth for the first time since the 1964 report ( USDHHS 2004 ). The 2004 report provided a four-level hierarchy for interpreting evidence ( Table 1.4 ). The categories acknowledge that evidence can be “suggestive” but not adequate to infer a causal relationship, and also allows for evidence that is “suggestive of no causal relationship.” Since the 2004 report, the individual chapter conclusions have consistently used this four-level hierarchy ( Table 1.4 ), but evidence syntheses and other summary statements may use either the term “increased risk” or “cause” to describe instances in which there is sufficient evidence to conclude that active or involuntary smoking causes a disease or condition. This four-level framework also sharply and completely separates conclusions regarding causality from the implications of such conclusions.
Four-level hierarchy for classifying the strength of causal inferences based on available evidence
That same framework was used in this report on involuntary smoking and health. The criteria dating back to the 1964 Surgeon General’s report remain useful as guidelines for evaluating evidence ( USDHEW 1964 ), but they were not intended to be applied strictly or as a “checklist” that needed to be met before the designation of “causal” could be applied to an association. In fact, for involuntary smoking and health, several of the criteria will not be met for some associations. Specificity, referring to a unique exposure-disease relationship (e. g ., the association between thalidomide use during pregnancy and unusual birth defects), can be set aside as not relevant, as all of the health effects considered in this report have causes other than involuntary smoking. Associations are considered more likely to be causal as the strength of an association increases because competing explanations become less plausible alternatives. However, based on knowledge of dosimetry and mechanisms of injury and disease causation, the risk is anticipated to be only slightly or modestly increased for some associations of involuntary smoking with disease, such as lung cancer, particularly when the very strong relative risks found for active smokers are compared with those for lifetime nonsmokers. The finding of only a small elevation in risk, as in the example of spousal smoking and lung cancer risk in lifetime nonsmokers, does not weigh against a causal association; however, alternative explanations for a risk of a small magnitude need full exploration and cannot be so easily set aside as alternative explanations for a stronger association. Consistency, coherence, and the temporal relationship of involuntary smoking with disease are central to the interpretations in this report. To address coherence, the report draws not only on the evidence for involuntary smoking, but on the even more extensive literature on active smoking and disease.
Although the evidence reviewed in this report comes largely from investigations of secondhand smoke specifically, the larger body of evidence on active smoking is also relevant to many of the associations that were evaluated. The 1986 report found secondhand smoke to be qualitatively similar to mainstream smoke inhaled by the smoker and concluded that secondhand smoke would be expected to have “a toxic and carcinogenic potential that would not be expected to be qualitatively different from that of MS [mainstream smoke]” ( USDHHS 1986 , p. 23). The 2004 report of the Surgeon General revisited the health consequences of active smoking ( USDHHS 2004 ), and the conclusions substantially expanded the list of diseases and conditions caused by smoking. Chapters in the present report consider the evidence on active smoking that is relevant to biologic plausibility for causal associations between involuntary smoking and disease. The reviews included in this report cover evidence identified through search strategies set out in each chapter. Of necessity, the evidence on mechanisms was selectively reviewed. However, an attempt was made to cover all health studies through specified target dates. Because of the substantial amount of time involved in preparing this report, lists of new key references published after these cut-off dates are included in an Appendix . Literature reviews were extended when new evidence was sufficient to possibly change the level of a causal conclusion.
- Major Conclusions
This report returns to involuntary smoking, the topic of the 1986 Surgeon General’s report. Since then, there have been many advances in the research on secondhand smoke, and substantial evidence has been reported over the ensuing 20 years. This report uses the revised language for causal conclusions that was implemented in the 2004 Surgeon General’s report ( USDHHS 2004 ). Each chapter provides a comprehensive review of the evidence, a quantitative synthesis of the evidence if appropriate, and a rigorous assessment of sources of bias that may affect interpretations of the findings. The reviews in this report reaffirm and strengthen the findings of the 1986 report. With regard to the involuntary exposure of nonsmokers to tobacco smoke, the scientific evidence now supports the following major conclusions:
- Secondhand smoke causes premature death and disease in children and in adults who do not smoke.
- Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome ( SIDS ), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
- Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
- The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
- Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
- Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.
- Chapter Conclusions
Chapter 2 Toxicology of Secondhand Smoke
Evidence of carcinogenic effects from secondhand smoke exposure.
- 1. More than 50 carcinogens have been identified in sidestream and secondhand smoke.
- 2. The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and its condensates and tumors in laboratory animals.
- 3. The evidence is sufficient to infer that exposure of nonsmokers to secondhand smoke causes a significant increase in urinary levels of metabolites of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone ( NNK ). The presence of these metabolites links exposure to secondhand smoke with an increased risk for lung cancer.
- 4. The mechanisms by which secondhand smoke causes lung cancer are probably similar to those observed in smokers. The overall risk of secondhand smoke exposure, compared with active smoking, is diminished by a substantially lower carcinogenic dose.
Mechanisms of Respiratory Tract Injury and Disease Caused by Secondhand Smoke Exposure
- 5. The evidence indicates multiple mechanisms by which secondhand smoke exposure causes injury to the respiratory tract.
- 6. The evidence indicates mechanisms by which secondhand smoke exposure could increase the risk for sudden infant death syndrome.
Mechanisms of Secondhand Smoke Exposure and Heart Disease
- 7. The evidence is sufficient to infer that exposure to secondhand smoke has a prothrombotic effect.
- 8. The evidence is sufficient to infer that exposure to secondhand smoke causes endothelial cell dysfunctions.
- 9. The evidence is sufficient to infer that exposure to secondhand smoke causes atherosclerosis in animal models.
Chapter 3. Assessment of Exposure to Secondhand Smoke
Building designs and operations.
- 1. Current heating, ventilating, and air conditioning systems alone cannot control exposure to secondhand smoke.
- 2. The operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke throughout a building.
- 3. Atmospheric concentration of nicotine is a sensitive and specific indicator for secondhand smoke.
- 4. Smoking increases indoor particle concentrations.
- 5. Models can be used to estimate concentrations of secondhand smoke.
Biomarkers of Exposure to Secondhand Smoke
- 6. Biomarkers suitable for assessing recent exposures to secondhand smoke are available.
- 7. At this time, cotinine, the primary proximate metabolite of nicotine, remains the biomarker of choice for assessing secondhand smoke exposure.
- 8. Individual biomarkers of exposure to secondhand smoke represent only one component of a complex mixture, and measurements of one marker may not wholly reflect an exposure to other components of concern as a result of involuntary smoking.
Chapter 4. Prevalence of Exposure to Secondhand Smoke
- The evidence is sufficient to infer that large numbers of nonsmokers are still exposed to secondhand smoke.
- Exposure of nonsmokers to secondhand smoke has declined in the United States since the 1986 Surgeon General’s report, The Health Consequences of Involuntary Smoking .
- The evidence indicates that the extent of secondhand smoke exposure varies across the country.
- Homes and workplaces are the predominant locations for exposure to secondhand smoke.
- Exposure to secondhand smoke tends to be greater for persons with lower incomes.
- Exposure to secondhand smoke continues in restaurants, bars, casinos, gaming halls, and vehicles.
Chapter 5. Reproductive and Developmental Effects from Exposure to Secondhand Smoke
- 1. The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke and female fertility or fecundability. No data were found on paternal exposure to secondhand smoke and male fertility or fecundability.
Pregnancy (Spontaneous Abortion and Perinatal Death)
- 2. The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke during pregnancy and spontaneous abortion.
- 3. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and neonatal mortality.
Sudden Infant Death Syndrome
- 4. The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome.
- 5. The evidence is suggestive but not sufficient to infer a causal relationship between maternal exposure to secondhand smoke during pregnancy and preterm delivery.
Low Birth Weight
- 6. The evidence is sufficient to infer a causal relationship between maternal exposure to secondhand smoke during pregnancy and a small reduction in birth weight.
- 7. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and congenital malformations.
- 8. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and cognitive functioning among children.
- 9. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and behavioral problems among children.
- 10. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and children’s height/growth.
- 11. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood cancer.
- 12. The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke during pregnancy and childhood cancer.
- 13. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke during infancy and childhood cancer.
- 14. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood leukemias.
- 15. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood lymphomas.
- 16. The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood brain tumors.
- 17. The evidence is inadequate to infer the presence or absence of a causal relationship between prenatal and postnatal exposure to secondhand smoke and other childhood cancer types.
Chapter 6. Respiratory Effects in Children from Exposure to Secondhand Smoke
Lower respiratory illnesses in infancy and early childhood.
- 1. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and lower respiratory illnesses in infants and children.
- 2. The increased risk for lower respiratory illnesses is greatest from smoking by the mother.
Middle Ear Disease and Adenotonsillectomy
- 3. The evidence is sufficient to infer a causal relationship between parental smoking and middle ear disease in children, including acute and recurrent otitis media and chronic middle ear effusion.
- 4. The evidence is suggestive but not sufficient to infer a causal relationship between parental smoking and the natural history of middle ear effusion.
- 5. The evidence is inadequate to infer the presence or absence of a causal relationship between parental smoking and an increase in the risk of adenoidectomy or tonsillectomy among children.
Respiratory Symptoms and Prevalent Asthma in School-Age Children
- 6. The evidence is sufficient to infer a causal relationship between parental smoking and cough, phlegm, wheeze, and breathlessness among children of school age.
- 7. The evidence is sufficient to infer a causal relationship between parental smoking and ever having asthma among children of school age.
Childhood Asthma Onset
- 8. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and the onset of wheeze illnesses in early childhood.
- 9. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and the onset of childhood asthma.
- 10. The evidence is inadequate to infer the presence or absence of a causal relationship between parental smoking and the risk of immunoglobulin E-mediated allergy in their children.
Lung Growth and Pulmonary Function
- 11. The evidence is sufficient to infer a causal relationship between maternal smoking during pregnancy and persistent adverse effects on lung function across childhood.
- 12. The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke after birth and a lower level of lung function during childhood.
Chapter 7. Cancer Among Adults from Exposure to Secondhand Smoke
- 1. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure and lung cancer among lifetime nonsmokers. This conclusion extends to all secondhand smoke exposure, regardless of location.
- 2. The pooled evidence indicates a 20 to 30 percent increase in the risk of lung cancer from secondhand smoke exposure associated with living with a smoker.
- 3. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke and breast cancer.
Nasal Sinus Cavity and Nasopharyngeal Carcinoma
- 4. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and a risk of nasal sinus cancer among nonsmokers.
- 5. The evidence is inadequate to infer the presence or absence of a causal relationship between secondhand smoke exposure and a risk of nasopharyngeal carcinoma among nonsmokers.
- 6. The evidence is inadequate to infer the presence or absence of a causal relationship between secondhand smoke exposure and the risk of cervical cancer among lifetime nonsmokers.
Chapter 8. Cardiovascular Diseases from Exposure to Secondhand Smoke
- The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and increased risks of coronary heart disease morbidity and mortality among both men and women.
- Pooled relative risks from meta-analyses indicate a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke.
- The evidence is suggestive but not sufficient to infer a causal relationship between exposure to secondhand smoke and an increased risk of stroke.
- Studies of secondhand smoke and subclinical vascular disease, particularly carotid arterial wall thickening, are suggestive but not sufficient to infer a causal relationship between exposure to secondhand smoke and atherosclerosis.
Chapter 9. Respiratory Effects in Adults from Exposure to Secondhand Smoke
Odor and irritation.
- 1. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure and odor annoyance.
- 2. The evidence is sufficient to infer a causal relationship between secondhand smoke exposure and nasal irritation.
- 3. The evidence is suggestive but not sufficient to conclude that persons with nasal allergies or a history of respiratory illnesses are more susceptible to developing nasal irritation from secondhand smoke exposure.
- 4. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms including cough, wheeze, chest tightness, and difficulty breathing among persons with asthma.
- 5. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms including cough, wheeze, chest tightness, and difficulty breathing among healthy persons.
- 6. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and chronic respiratory symptoms.
- 7. The evidence is suggestive but not sufficient to infer a causal relationship between short-term secondhand smoke exposure and an acute decline in lung function in persons with asthma.
- 8. The evidence is inadequate to infer the presence or absence of a causal relationship between short-term secondhand smoke exposure and an acute decline in lung function in healthy persons.
- 9. The evidence is suggestive but not sufficient to infer a causal relationship between chronic secondhand smoke exposure and a small decrement in lung function in the general population.
- 10. The evidence is inadequate to infer the presence or absence of a causal relationship between chronic secondhand smoke exposure and an accelerated decline in lung function.
- 11. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and adult-onset asthma.
- 12. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and a worsening of asthma control.
Chronic Obstructive Pulmonary Disease
- 13. The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and risk for chronic obstructive pulmonary disease.
- 14. The evidence is inadequate to infer the presence or absence of a causal relationship between secondhand smoke exposure and morbidity in persons with chronic obstructive pulmonary disease.
Chapter 10. Control of Secondhand Smoke Exposure
- Workplace smoking restrictions are effective in reducing secondhand smoke exposure.
- Workplace smoking restrictions lead to less smoking among covered workers.
- Establishing smoke-free workplaces is the only effective way to ensure that secondhand smoke exposure does not occur in the workplace.
- The majority of workers in the United States are now covered by smoke-free policies.
- The extent to which workplaces are covered by smoke-free policies varies among worker groups, across states, and by sociodemographic factors. Workplaces related to the entertainment and hospitality industries have notably high potential for secondhand smoke exposure.
- Evidence from peer-reviewed studies shows that smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry.
- Evidence suggests that exposure to secondhand smoke varies by ethnicity and gender.
- In the United States, the home is now becoming the predominant location for exposure of children and adults to secondhand smoke.
- Total bans on indoor smoking in hospitals, restaurants, bars, and offices substantially reduce secondhand smoke exposure, up to several orders of magnitude with incomplete compliance, and with full compliance, exposures are eliminated.
- Exposures of nonsmokers to secondhand smoke cannot be controlled by air cleaning or mechanical air exchange.
- Methodologic Issues
Much of the evidence on the health effects of involuntary smoking comes from observational epidemiologic studies that were carried out to test hypotheses related to secondhand smoke and risk for diseases and other adverse health effects. The challenges faced in carrying out these studies reflect those of observational research generally: assessment of the relevant exposures and outcomes with sufficient validity and precision, selection of an appropriate study design, identification of an appropriate and sufficiently large study population, and collection of information on other relevant factors that may confound or modify the association being studied. The challenge of accurately classifying secondhand smoke exposures confronts all studies of such exposures, and consequently the literature on approaches to and limitations of exposure classification is substantial. Sources of bias that can affect the findings of epidemiologic studies have been widely discussed ( Rothman and Greenland 1998 ), both in general and in relation to studies of involuntary smoking. Concerns about bias apply to any study of an environmental agent and disease risk: misclassification of exposures or outcomes, confounding effect modification, and proper selection of study participants. In addition, the generalizability of findings from one population to another (external validity) further determines the value of evidence from a study. Another methodologic concern affecting secondhand smoke literature comes from the use of meta-analysis to combine the findings of epidemiologic studies; general concerns related to the use of meta-analysis for observational data and more specific concerns related to involuntary smoking have also been raised. This chapter considers these methodologic issues in anticipation of more specific treatment in the following chapters.
Classification of Secondhand Smoke Exposure
For secondhand smoke, as for any environmental factor that may be a cause of disease, the exposure assessment might encompass the time and place of the exposure, cumulative exposures, exposure during a particular time, or a recent exposure ( Jaakkola and Jaakkola 1997 ; Jaakkola and Samet 1999 ). For example, exposures to secondhand smoke across the full life span may be of interest for lung cancer, while only more recent exposures may be relevant to the exacerbation of asthma. For CHD , both temporally remote and current exposures may affect risk. Assessments of exposures are further complicated by the multiplicity of environments where exposures take place and the difficulty of characterizing the exposure in some locations, such as public places or workplaces. Additionally, exposures probably vary qualitatively and quantitatively over time and across locations because of temporal changes and geographic differences in smoking patterns.
Nonetheless, researchers have used a variety of approaches for exposure assessments in epidemiologic studies of adverse health effects from involuntary smoking. Several core concepts that are fundamental to these approaches are illustrated in Figure 1.1 ( Samet and Jaakkola 1999 ). Cigarette smoking is, of course, the source of most secondhand smoke in the United States, followed by pipes, cigars, and other products. Epidemiologic studies generally focus on assessing the exposure, which is the contact with secondhand smoke. The concentrations of secondhand smoke components in a space depend on the number of smokers and the rate at which they are smoking, the volume into which the smoke is distributed, the rate at which the air in the space exchanges with uncontaminated air, and the rate at which the secondhand smoke is removed from the air. Concentration, exposure, and dose differ in their definitions, although the terms are sometimes used without sharp distinctions. However, surrogate indicators that generally describe a source of exposure may also be used to assess the exposure, such as marriage to a smoker or the number of cigarettes smoked in the home. Biomarkers can provide an indication of an exposure or possibly the dose, but for secondhand smoke they are used for recent exposure only.
The determinants of exposure, dose, and biologically effective dose that underlie the development of health effects from smoking. Source: Samet and Jaakkola (more...)
People are exposed to secondhand smoke in a number of different places, often referred to as “microenvironments” ( NRC 1991 ). A microenvironment is a definable location that has a constant concentration of the contaminant of interest, such as secondhand smoke, during the time that a person is there. Some key microenvironments for secondhand smoke include the home, the workplace, public places, and transportation environments ( Klepeis 1999 ). Based on the microenvironmental model, total exposure can be estimated as the weighted average of the concentrations of secondhand smoke or indicator compounds, such as nicotine, in the microenvironments where time is spent; the weights are the time spent in each microenvironment. Klepeis (1999) illustrates the application of the microenvironmental model with national data from the National Human Activity Pattern Survey conducted by the EPA . His calculations yield an overall estimate of exposure to airborne particles from smoking and of the contributions to this exposure from various microenvironments.
Much of the epidemiologic evidence addresses the consequences of an exposure in a particular microenvironment, such as the home (spousal smoking and lung cancer risk or maternal smoking and risk for asthma exacerbation), or the workplace (exacerbation of asthma by the presence of smokers). Some studies have attempted to cover multiple microenvironments and to characterize exposures over time. For example, in the multicenter study of secondhand smoke exposure and lung cancer carried out in the United States, Fontham and colleagues (1994) assessed exposures during childhood, in workplaces, and at home during adulthood. Questionnaires that assess exposures have been the primary tool used in epidemiologic studies of secondhand smoke and disease. Measurement of biomarkers has been added in some studies, either as an additional and complementary exposure assessment approach or for validating questionnaire responses. Some studies have also measured components of secondhand smoke in the air.
Questionnaires generally address sources of exposure in microenvironments and can be tailored to address the time period of interest. Questionnaires represent the only approach that can be used to assess exposures retrospectively over a life span, because available biomarkers only reflect exposures over recent days or, at most, weeks. Questionnaires on secondhand smoke exposure have been assessed for their reliability and validity, generally based on comparisons with either biomarker or air monitoring data as the “gold” standard ( Jaakkola and Jaakkola 1997 ). Two studies evaluated the reliability of questionnaires on lifetime exposures ( Pron et al. 1988 ; Coultas et al. 1989 ). Both showed a high degree of repeatability for questions concerning whether a spouse had smoked, but a lower reliability for responses concerning the quantitative aspects of an exposure. Emerson and colleagues (1995) evaluated the repeatability of information from parents of children with asthma. They found a high reliability for parent-reported tobacco use and for the number of cigarettes to which the child was exposed in the home during the past week.
To assess validity, questionnaire reports of current or recent exposures have been compared with levels of cotinine and other biomarkers. These studies tend to show a moderate correlation between levels of cotinine and questionnaire indicators of exposures ( Kawachi and Colditz 1996 ; Cal/EPA 1997 ; Jaakkola and Jaakkola 1997 ). However, cotinine levels reflect not only exposure but metabolism and excretion ( Benowitz 1999 ). Consequently, exposure is only one determinant of variation in cotinine levels among persons; there also are individual variations in metabolism and excretion rates. In spite of these sources of variability, mean levels of cotinine vary as anticipated across categories of self-reported exposures ( Cal/EPA 1997 ; Jaakkola and Jaakkola 1997 ), and self-reported exposures are moderately associated with measured levels of markers ( Cal/EPA 1997 ; Jaakkola and Jaakkola 1997 ).
Biomarkers are also used for assessing exposures to secondhand smoke. A number of biomarkers are available, but they vary in their specificity and in the dynamics of the temporal relationship between the exposure and the marker level ( Cal/EPA 1997 ; Benowitz 1999 ). These markers include specific tobacco smoke components (nicotine) or metabolites (cotinine and tobacco-specific nitrosamines), nonspecific biomarkers (thiocyanate and CO ), adducts with tobacco smoke components or metabolites (4-amino-biphenyl hemoglobin adducts, benzo[ a ]pyrene DNA adducts, and polycyclic aromatic hydrocarbon albumin adducts), and nonspecific assays (urinary mutagenicity). Cotinine has been the most widely used biomarker, primarily because of its specificity, half-life, and ease of measurement in body fluids (e. g ., urine, blood, and saliva). Biomarkers are discussed in detail in Chapter 3 (Assessment of Exposure to Secondhand Smoke).
Some epidemiologic studies have also incorporated air monitoring, either direct personal sampling or the indirect approach based on the microenvironmental model. Nicotine, present in the gas phase of secondhand smoke, can be monitored passively with a special filter or actively using a pump and a sorbent. Hammond and Leaderer (1987) first described a diffusion monitor for the passive sampling of nicotine in 1987; this device has now been widely used to assess concentrations in different environments and to study health effects. Airborne particles have also been measured using active monitoring devices.
Each of these approaches for assessing exposures has strengths and limitations, and preference for one over another will depend on the research question and its context ( Jaakkola and Jaakkola 1997 ; Jaakkola and Samet 1999 ). Questionnaires can be used to characterize sources of exposures, such as smoking by parents. With air concentrations of markers and time-activity information, estimates of secondhand smoke exposures can be made with the microenvironmental model. Biomarkers provide exposure measures that reflect the patterns of exposure and the kinetics of the marker; the cotinine level in body fluids, for example, reflects an exposure during several days. Air monitoring may be useful for validating measurements of exposure. Exposure assessment strategies are matched to the research question and often employ a mixture of approaches determined by feasibility and cost constraints.
Misclassification of Secondhand Smoke Exposure
Misclassification may occur when classifying exposures, outcomes, confounding factors, or modifying factors. Misclassification may be differential on either exposure or outcome, or it may be random ( Armstrong et al. 1992 ). Differential or nonrandom misclassification may either increase or decrease estimates of effect, while random misclassification tends to reduce the apparent effect and weaken the relationship of exposure with disease risk. In studies of secondhand smoke and disease risk, exposure misclassification has been a major consideration in the interpretation of the evidence, although misclassification of health outcome measures has not been a substantial issue in this research. The consequences for epidemiologic studies of misclassification in general are well established ( Rothman and Greenland 1998 ).
An extensive body of literature on the classification of exposures to secondhand smoke is reviewed in this and other chapters, as well as in some publications on the consequences of misclassification ( Wu 1999 ). Two general patterns of exposure misclassification are of concern to secondhand smoke: (1) random misclassification that is not differential by the presence or absence of the health outcome and (2) systematic misclassification that is differential by the health outcome. In studying the health effects of secondhand smoke in adults, there is a further concern as to the classification of the active smoking status (never, current, or former smoking); in studies of children, the accuracy of secondhand smoke exposure classification is the primary methodologic issue around exposure assessment, but unreported active smoking by adolescents is also a concern.
With regard to random misclassification of secondhand smoke exposures, there is an inherent degree of unavoidable measurement error in the exposure measures used in epidemiologic studies. Questionnaires generally assess contact with sources of an exposure (e. g ., smoking in the home or work-place) and cannot capture all exposures nor the intensity of exposures; biomarkers provide an exposure index for a particular time window and have intrinsic variability. Some building-related factors that determine an exposure cannot be assessed accurately by a questionnaire, such as the rate of air exchange and the size of the microenvironment where time is spent, nor can concentrations be assessed accurately by subjective reports of the perceived level of tobacco smoke. In general, random misclassification of exposures tends to reduce the likelihood that studies of secondhand smoke exposure will find an effect. This type of misclassification lessens the contrast between exposure groups, because some truly exposed persons are placed in the unexposed group and some truly unexposed persons are placed in the exposed group. Differential misclassification, also a concern, may increase or decrease associations, depending on the pattern of misreporting.
One particular form of misclassification has been raised with regard to secondhand smoke exposure and lung cancer: the classification of some current or former smokers as lifetime nonsmokers ( USEPA 1992 ; Lee and Forey 1995 ; Hackshaw et al. 1997 ; Wu 1999 ). The resulting bias would tend to increase the apparent association of secondhand smoke with lung cancer, if the misclassified active smokers are also more likely to be classified as involuntary smokers. Most studies of lung cancer and secondhand smoke have used spousal smoking as a main exposure variable. As smoking tends to aggregate between spouses (smokers are more likely to marry smokers), misclassification of active smoking would tend to be differential on the basis of spousal smoking (the exposure under investigation). Because active smoking is strongly associated with increased disease risk, greater misclassification of an actively smoking spouse as a non-smoker among spouses of smokers compared with spouses of nonsmokers would lead to risk estimates for spousal smoking that are biased upward by the effect of active smoking. This type of misclassification is also relevant to studies of spousal exposure and CHD risk or other diseases also caused by active smoking, although the potential for bias is less because the association of active smoking with CHD is not as strong as with lung cancer.
There have been a number of publications on this form of misclassification. Wu (1999) provides a review, and Lee and colleagues (2001) offer an assessment of potential consequences. A number of models have been developed to assess the extent of bias resulting from the misclassification of active smokers as lifetime nonsmokers ( USEPA 1992 ; Hackshaw et al. 1997 ). These models incorporate estimates of the rate of misclassification, the degree of aggregation of smokers by marriage, the prevalence of smoking in the population, and the risk of lung cancer in misclassified smokers ( Wu 1999 ). Although debate about this issue continues, analyses show that estimates of upward bias from misclassifying active smokers as lifetime nonsmokers cannot fully explain the observed increase in risk for lung cancer among lifetime non-smokers married to smokers ( Hackshaw et al. 1997 ; Wu 1999 ).
There is one additional issue related to exposure misclassification. During the time the epidemiologic studies of secondhand smoke have been carried out, exposure has been widespread and almost unavoidable. Therefore, the risk estimates may be biased downward because there are no truly unexposed persons. The 1986 Surgeon General’s report recognized this methodologic issue and noted the need for further data on population exposures to secondhand smoke ( USDHHS 1986 ). This bias was also recognized in the 1986 report of the NRC , and an adjustment for this misclassification was made to the lung cancer estimate ( NRC 1986 ). Similarly, the 1992 report of the EPA commented on background exposure and made an adjustment ( USEPA 1992 ). Some later studies have attempted to address this issue; for example, in a case-control study of active and involuntary smoking and breast cancer in Switzerland, Morabia and colleagues (2000) used a questionnaire to assess exposure and identified a small group of lifetime nonsmokers who also reported no exposure to secondhand smoke. With this subgroup of controls as the reference population, the risks of secondhand smoke exposure were substantially greater for active smoking than when the full control population was used.
This Surgeon General’s report further addresses specific issues of exposure misclassification when they are relevant to the health outcome under consideration.
Use of Meta-Analysis
Meta-analysis refers to the process of evaluating and combining a body of research literature that addresses a common question. Meta-analysis is composed of qualitative and quantitative components. The qualitative component involves the systematic identification of all relevant investigations, a systematic assessment of their characteristics and quality, and the decision to include or exclude studies based on predetermined criteria. Consideration can be directed toward sources of bias that might affect the findings. The quantitative component involves the calculation and display of study results on common scales and, if appropriate, the statistical combination of these results across studies and an exploration of the reasons for any heterogeneity of findings. Viewing the findings of all studies as a single plot provides insights into the consistency of results and the precision of the studies considered. Most meta-analyses are based on published summary results, although they are most powerful when applied to data at the level of individual participants. Meta-analysis is most widely used to synthesize evidence from randomized clinical trials, sometimes yielding findings that were not evident from the results of individual studies. Meta-analysis also has been used extensively to examine bodies of observational evidence.
Beginning with the 1986 NRC report, meta-analysis has been used to summarize the evidence on involuntary smoking and health. Meta-analysis was central to the 1992 EPA risk assessment of secondhand smoke, and a series of meta-analyses supported the conclusions of the 1998 report of the Scientific Committee on Tobacco and Health in the United Kingdom. The central role of meta-analysis in interpreting and applying the evidence related to involuntary smoking and disease has led to focused criticisms of the use of meta-analysis in this context. Several papers that acknowledged support from the tobacco industry have addressed the epidemiologic findings for lung cancer, including the selection and quality of the studies, the methods for meta-analysis, and dose-response associations ( Fleiss and Gross 1991 ; Tweedie and Mengersen 1995 ; Lee 1998 , 1999 ). In a lawsuit brought by the tobacco industry against the EPA, the 1998 decision handed down by Judge William L . Osteen, Sr., in the North Carolina Federal District Court criticized the approach EPA had used to select studies for its meta-analysis and criticized the use of 90 percent rather than 95 percent confidence intervals for the summary estimates ( Flue-Cured Tobacco Cooperative Stabilization Corp. v. United States Environmental Protection Agency , 857 F. Supp. 1137 [M.D.N.C. 1993]). In December 2002, the 4th U.S. Circuit Court of Appeals threw out the lawsuit on the basis that tobacco companies cannot sue the EPA over its secondhand smoke report because the report was not a final agency action and therefore not subject to court review ( Flue-Cured Tobacco Cooperative Stabilization Corp. v. The United States Environmental Protection Agency , No. 98–2407 [4th Cir., December 11, 2002], cited in 17.7 TPLR 2.472 ).
Recognizing that there is still an active discussion around the use of meta-analysis to pool data from observational studies (versus clinical trials), the authors of this Surgeon General’s report used this methodology to summarize the available data when deemed appropriate and useful, even while recognizing that the uncertainty around the meta-analytic estimates may exceed the uncertainty indicated by conventional statistical indices, because of biases either within the observational studies or produced by the manner of their selection. However, a decision to not combine estimates might have produced conclusions that are far more uncertain than the data warrant because the review would have focused on individual study results without considering their overall pattern, and without allowing for a full accounting of different sample sizes and effect estimates.
The possibility of publication bias has been raised as a potential limitation to the interpretation of evidence on involuntary smoking and disease in general, and on lung cancer and secondhand smoke exposure specifically. A 1988 paper by Vandenbroucke used a descriptive approach, called a “funnel plot,” to assess the possibility that publication bias affected the 13 studies considered in a review by Wald and colleagues (1986) . This type of plot characterizes the relationship between the magnitude of estimates and their precision. Vandenbroucke suggested the possibility of publication bias only in reference to the studies of men. Bero and colleagues (1994) concluded that there had not been a publication bias against studies with statistically significant findings, nor against the publication of studies with nonsignificant or mixed findings in the research literature. The researchers were able to identify only five unpublished “negative” studies, of which two were dissertations that tend to be delayed in publication. A subsequent study by Misakian and Bero (1998) did find a delay in the publication of studies with nonsignificant results in comparison with studies having significant results; whether this pattern has varied over the several decades of research on secondhand smoke was not addressed. More recently, Copas and Shi (2000) assessed the 37 studies considered in the meta-analysis by Hackshaw and colleagues (1997) for publication bias. Copas and Shi (2000) found a significant correlation between the estimated risk of exposure and sample size, such that smaller studies tended to have higher values. This pattern suggests the possibility of publication bias. However, using a funnel plot of the same studies, Lubin (1999) found little evidence for publication bias.
On this issue of publication bias, it is critical to distinguish between indirect statistical arguments and arguments based on actual identification of previously unidentified research. The strongest case against substantive publication bias has been made by researchers who mounted intensive efforts to find the possibly missing studies; these efforts have yielded little nothing that would alter published conclusions ( Bero et al. 1994 ; Glantz 2000 ). Presumably because this exposure is a great public health concern, the findings of studies that do not have statistically significant outcomes continue to be published ( Kawachi and Colditz 1996 ).
The quantitative results of the meta-analyses, however, were not determinate in making causal inferences in this Surgeon General’s report. In particular, the level of statistical significance of estimates from the meta-analyses was not a predominant factor in making a causal conclusion. For that purpose, this report relied on the approach and criteria set out in the 1964 and 2004 reports of the Surgeon General, which involved judgments based on an array of quantitative and qualitative considerations that included the degree of heterogeneity in the designs of the studies that were examined. Sometimes this heterogeneity limits the inference from meta-analysis by weakening the rationale for pooling the study results. However, the availability of consistent evidence from heterogenous designs can strengthen the meta-analytic findings by making it unlikely that a common bias could persist across different study designs and populations.
Confounding, which refers in this context to the mixing of the effect of another factor with that of secondhand smoke, has been proposed as an explanation for associations of secondhand smoke with adverse health consequences. Confounding occurs when the factor of interest (secondhand smoke) is associated in the data under consideration with another factor (the confounder) that, by itself, increases the risk for the disease ( Rothman and Greenland 1998 ). Correlates of secondhand smoke exposures are not confounding factors unless an exposure to them increases the risk of disease. A factor proposed as a potential confounder is not necessarily an actual confounder unless it fulfills the two elements of the definition. Although lengthy lists of potential confounding factors have been offered as alternatives to direct associations of secondhand smoke exposures with the risk for disease, the factors on these lists generally have not been shown to be confounding in the particular data of interest.
The term confounding also conveys an implicit conceptualization as to the causal pathways that link secondhand smoke and the confounding factor to disease risk. Confounding implies that the confounding factor has an effect on risk that is independent of secondhand smoke exposure. Some factors considered as potential confounders may, however, be in the same causal pathway as a secondhand smoke exposure. Although socioeconomic status ( SES ) is often cited as a potential confounding factor, it may not have an independent effect but can affect disease risk through its association with secondhand smoke exposure ( Figure 1.2 ). This figure shows general alternative relationships among SES, secondhand smoke exposure, and risk for an adverse effect. SES may have a direct effect, or it may indirectly exert its effect through an association with secondhand smoke exposure, or it may confound the relationship between secondhand smoke exposure and disease risk. To control for SES as a potential confounding factor without considering underlying relationships may lead to incorrect risk estimates. For example, controlling for SES would not be appropriate if it is a determinant of secondhand smoke exposure but has no direct effect.
Model for socioeconomic status (SES) and secondhand smoke (SHS) exposure. Arrows indicate directionality of association.
Nonetheless, because the health effects of involuntary smoking have other causes, the possibility of confounding needs careful exploration when assessing associations of secondhand smoke exposure with adverse health effects. In addition, survey data from the last several decades show that secondhand smoke exposure is associated with correlates of lifestyle that may influence the risk for some health effects, thus increasing concerns for the possibility of confounding ( Kawachi and Colditz 1996 ). Survey data from the United States ( Matanoski et al. 1995 ) and the United Kingdom ( Thornton et al. 1994 ) show that adults with secondhand smoke exposures generally tend to have less healthful lifestyles. However, the extent to which these patterns of association can be generalized, either to other countries or to the past, is uncertain.
The potential bias from confounding varies with the association of the confounder to secondhand smoke exposures in a particular study and to the strength of the confounder as a risk factor. The importance of confounding to the interpretation of evidence depends further on the magnitude of the effect of secondhand smoke on disease. As the strength of an association lessens, confounding as an alternative explanation for an association becomes an increasing concern. In prior reviews, confounding has been addressed either quantitatively ( Hackshaw et al. 1997 ) or qualitatively ( Cal/EPA 1997 ; Thun et al. 1999 ). In the chapters in this report that focus on specific diseases, confounding is specifically addressed in the context of potential confounding factors for the particular diseases.
- Tobacco Industry Activities
The evidence on secondhand smoke and disease risk, given the public health and public policy implications, has been reviewed extensively in the published peer-reviewed literature and in evaluations by a number of expert panels. In addition, the evidence has been criticized repeatedly by the tobacco industry and its consultants in venues that have included the peer-reviewed literature, public meetings and hearings, and scientific symposia that included symposia sponsored by the industry. Open criticism in the peer-reviewed literature can strengthen the credibility of scientific evidence by challenging researchers to consider the arguments proposed by critics and to rebut them.
Industry documents indicate that the tobacco industry has engaged in widespread activities, however, that have gone beyond the bounds of accepted scientific practice ( Glantz 1996 ; Ong and Glantz 2000 , 2001 ; Rampton and Stauber 2000 ; Yach and Bialous 2001 ; Hong and Bero 2002 ; Diethelm et al. 2004 ). Through a variety of organized tactics, the industry has attempted to undermine the credibility of the scientific evidence on secondhand smoke. The industry has funded or carried out research that has been judged to be biased, supported scientists to generate letters to editors that criticized research publications, attempted to undermine the findings of key studies, assisted in establishing a scientific society with a journal, and attempted to sustain controversy even as the scientific community reached consensus ( Garne et al. 2005 ). These tactics are not a topic of this report, but to the extent that the scientific literature has been distorted, they are addressed as the evidence is reviewed. This report does not specifically identify tobacco industry sponsorship of publications unless that information is relevant to the interpretation of the findings and conclusions.
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Tobacco Smoking and Its Dangers Essay
Tobacco use, including smoking, has become a universally recognized issue that endangers the health of the population of our entire planet through both active and second-hand smoking. Pro-tobacco arguments are next to non-existent, while its harm is well-documented and proven through past and contemporary studies (Jha et al., 2013). Despite this fact, smoking remains a widespread habit that involves about one billion smokers all over the world, even though lower-income countries are disproportionally affected (World Health Organization [WHO], 2016). In this essay, I will review the dangers of tobacco use and consider some of the remaining pro-tobacco arguments to demonstrate that no reason can explain or support the choice to smoke, which endangers the smoker and other people.
The Dangers of Smoking
Almost every organ and system in the human body is negatively affected by tobacco, which is why smoking is reported to cause up to six million deaths on an annual basis (WHO, 2016, para. 2). The figure is expected to grow and increase by two million within the next fifteen years (Centers for Disease Control and Prevention [CDC], 2016a). Smoking can cause cancer in at least sixteen organs (including the respiratory and digestive systems), autoimmune diseases (including diabetes), numerous heart and blood problems (including stroke and hypertension); in addition, it damages lungs, vision, and bones, and leads to reproductive issues (including stillbirth) (U.S. Department of Health & Human Services, 2016).
Moreover, nicotine is addictive, and its withdrawal symptoms include anxiety, which tends to cumulate and contribute to stress (Parrott & Murphy, 2012). Other symptoms may involve mood swings and increased hunger, as well as thinking difficulties (Centers for Disease Control and Prevention [CDC], 2016b). Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders (Cavazos-Rehg et al., 2014).
In the end, smoking reduces the human lifespan, as a result of which smokers are twice as likely as non-smokers to die between the ages of 25 and 79 (Jha et al., 2013, p. 341). Fortunately, smoking cessation tends to add up to ten years of life for former smokers, if they were to give up smoking before they turned 40 (Jha et al., 2013, p. 349). Similarly, the risk of developing mental issues also tends to be reversed to an extent, but it is not clear if it becomes completely eliminated or not (Cavazos-Rehg et al., 2014). The CDC (2016b) also reports that smoking cessation results in an improved respiratory condition and lower risks of developing cancer, cardiovascular diseases, and infertility.
At the same time, Cavazos-Rehg et al. (2014) state that there is not sufficient evidence to indicate that smoking cessation may cause mental issues, which implies that ceasing to smoke is likely to be a very good decision. Unfortunately, it is not always easy; many people make several attempts at quitting, experiencing difficulties because of abstinence symptoms, and in the process may gain weight and may require the help of professional doctors and counselors (CDC, 2016b). It is also noteworthy that only twenty-four countries in the world have comprehensive services aimed specifically at smoking cessation assistance (WHO, 2016, para. 18).
To sum up, tobacco is a drug that is harmful to people’s health, but it is also the basis of a gigantic industry that is subject to taxes, which implies that governments are typically interested in its development (CDC, 2016a). As a result, their spending in the field of prevention and cessation activities may not live up to expectations, despite the fact that governments have multiple means of reducing tobacco consumption, in particular, banning ads, adding taxes, and eliminating illicit trade (WHO, 2016). In the meantime, people who smoke search for arguments in order to rationalize their choice, which contributes to the deterioration of their own health and that of their communities.
Possible Pro-Tobacco Arguments
It is not that dangerous.
It is admittedly difficult to find a reputable source that would promote smoking, which is understandable. However, certain pro-tobacco arguments can be suggested for the sake of attempting to understand the reasons for the phenomenon. For example, given the obvious lack of positive judgments, it may be hinted that the problem is overrated and the horrors of tobacco use are exaggerated. In this case, it is implied that scientific studies that highlight the dangers of smoking are not trustworthy to some extent. In fact, it cannot be denied that untrustworthy studies exist, but the scientific community does its best to eliminate them.
For example, the article by Moylan, Jacka, Pasco, and Berk (2012) contains a critique of 47 studies, which allows the authors to conclude that some research studies do not introduce sufficient controls. Despite this, the authors maintain that there is satisfactory evidence that indicates a correlation between certain mental disorders and smoking. They also admit that the evidence is less homogenous for some disorders, and suggest carrying out a further examination. As a result, it appears possible to consider the effects of tobacco use that are described by reputable organizations and peer-reviewed articles to be correct, which implies that all the horrible outcomes are indeed a possibility.
Tobacco Has Positive Effects
Given the information about tobacco’s negative effects, any number of positive ones that it may have appears insignificant. However, these may still be regarded as a pro-tobacco argument. One example is a calming, “feeling-good” effect that smokers tend to report. Parrott and Murphy (2012) explore this phenomenon, along with other mood-related effects of tobacco use, and explain that the feeling of calmness is the result of abstinence symptoms abatement.
In other words, smokers do not experience calmness when they get a cigarette; instead, they just stop experiencing abstinence-related anxiety. Moreover, apart from causing anxiety as an abstinence symptom, smoking tends to heighten the risks of various mental disorders, including anxiety disorder (Moylan et al., 2012), and alcohol use disorder (Cavazos-Rehg et al., 2014). It may be suggested that the belief in the positive effects of smoking is likely to result from the lack of education on the matter (WHO, 2016).
It Is My Free Choice
The freedom of choice is important to defend, and some may argue that they like the taste of the smoke or enjoy some of its effects (like the above-mentioned calming one), and they have the right to make a choice with regard to what they are going to do with their lives. Unfortunately, there is a factor that makes their choice more socially significant: Second-hand smoke intake also can affect people’s health in a negative way.
WHO (2016) estimates that about 600,000 non-smoking people, who never chose to smoke but were forced to inhale some second-hand smoke, die every year because of smoking-related issues (para. 2). In 2004, twenty-eight percent of second-hand smoke victims were children (WHO, 2016, para. 14). In other words, a smoker needs to be cautious and attempt to ensure that no deaths are caused by his or her free choice.
Moreover, even the freedom of the choice to smoke is sometimes questionable. In particular, the media has been accused of creating alluring images of smoking, which impairs the ability of people to make their own decisions (Malaspina, 2014). Similarly, the phenomenon of social smoking is explained by the wish to fit in within a community, to which teenage persons are especially prone (Nichter, 2015). As a result, the free choice argument may be regarded as typically invalid, which makes tobacco smoking even less reasonable or defensible.
It is extremely simple to argue against tobacco use: The activity has virtually no pluses, and any advantage that can be discovered by a diligent researcher would probably seem insignificant when contrasted to all the problems that smoking tends to cause. Despite this, people proceed to smoke as a result of the lack of education on the matter (WHO, 2016), harmful media images (Malaspina, 2014), and probably a number of other factors.
It is noteworthy, though, that since 2002, the number of people who have managed to quit smoking exceeds that of active smokers (CDC, 2016b, para. 22). Given the pressure of WHO (2016) in urging governments to do more to improve the situation, we may hope that tobacco use will be greatly reduced in the future, and people will stop engaging in this kind of self-harm.
Cavazos-Rehg, P. A., Breslau, N., Hatsukami, D., Krauss, M. J., Spitznagel, E. L., Grucza, R. A.,… & Bierut, L. J. (2014). Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders. Psychological Medicine , 44 (12), 2523-2535.
The article investigates the correlation between smoking cessation and certain mental disorders with the help of data from a national longitudinal study that was carried out in the United States between 2001 and 2006 by the National Institute on Alcohol Abuse and Alcoholism. The article concludes that there is a drop in anxiety disorder as well as the use of alcohol that is related to giving up smoking. The authors highlight the fact that the conclusion is not final and suggest that additional investigation is required. However, in their view, the idea that smoking cessation is related to an increased risk of anxiety disorders remains unproven and even contradicted by the results of their research.
For this essay, the article contributes information about the relationships between smoking and mood issues, which contradicts the myth about nicotine calming people. Also, it demonstrates the positive effects of giving up smoking, which is an argument against continued smoking.
Centers for Disease Control and Prevention. (2016a). Smoking & tobacco use .
The website offers fast facts on tobacco use, including those for the world and the United States, and illustrates them with the help of statistics. The facts demonstrate that smoking has a negative impact on human health (limiting the lifespan and causing diseases) and results in significant costs for countries (primarily as healthcare expenditures). Also, the website mentions that tobacco prevention expenditures and efforts are often limited. The website finishes with statistics that illustrate the scope of the problem, that is, the number of smokers in the United States.
For this essay, the website contributes useful information and statistics on smoking and its consequences, including data on costs. Also, it mentions the profitability of the tobacco industry, and the issue of preventive measures, arguments that are capable of explaining the phenomenon of the continued existence of the problem of smoking.
Centers for Disease Control and Prevention. (2016b). Quitting smoking .
The website contains information on the difficulties in quitting, provides relevant statistics, and suggests informative and supportive resources for those who wish to quit. It also highlights the dangers of smoking, the benefits of quitting, and the specifics of nicotine dependence.
For this essay, the website contributes some information on the dangers of smoking with a particular emphasis on the dependence and its consequences. The statistics can be used for illustrative purposes, in particular, with respect to quitting difficulties. However, the website also demonstrates that quitting is possible and beneficial, which is an argument against continued smoking that can be employed in the essay.
Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N.,… & Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States . New England Journal of Medicine , 368 (4), 341-350.
The article is devoted to conducting a new research on life expectancy in smokers in order to take into account new factors of the changing environment. Also, the authors consider the life expectancy of the people who have quitted smoking. The study has an impressive sample size: It uses 202,248 histories of smoking cessation. The authors conclude that smokers’ lives are shorter while ceasing to smoke can help to “gain” several years, especially if it is done before the age of 40.
The article offers evidence on lifespan reduction as a result of smoking, and some data on smoking cessation benefits that can be used in the essay as arguments and illustrations. Also, the sample size of the article implies its credibility, making it a more attractive source.
Malaspina, A. (2014). False images, deadly promises . Broomall, Pa.: Mason Crest.
The book contains much information on smoking risks, but it focuses on the role of the media in popularizing this habit. Also, it considers other reasons for taking up smoking, including peer pressure, and mentions the problem of the profitability of the tobacco industry, which hinders the process of smoking eradication.
The book offers a comprehensive overview of the costs of tobacco, which makes it a very useful source. For the essay, the book contributes the study of media tobacco images, which is an interesting perspective. It can be used to demonstrate the question of free choice and the effect of the media on that choice.
Moylan, S., Jacka, F., Pasco, J., & Berk, M. (2012). Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies . BMC Medicine , 10 (1), 123.
The article reviews studies that are devoted to the correlation between anxiety and other mental disorders and smoking. The authors criticize some of the studies, demonstrating that there is limited evidence in some of them, but still conclude that the correlation between smoking and the risk of developing some disorders (in particular, generalized anxiety disorder) is sufficiently proven.
For the essay, the article provides direct information on tobacco use and its consequences and also demonstrates that unscrupulous studies are not unlikely to be produced, but this fact does not prove the lack of dangers in smoking. The existence of unscrupulous studies can be used as a pro-tobacco argument. Given the fact that it is difficult to find reputable sources that contain an alternative (approving) perspective on tobacco, it is a very important contribution to an argumentative essay.
Nichter, M. (2015). Lighting up . New York, NY: NYU Press.
The book contains a significant amount of information on tobacco-related issues, and it specifically focuses on the phenomenon of social smoking in college students. In particular, it discusses the issue of peer pressure as well as wrong perceptions, which are, in part, caused by the media. For example, it examines the harmful stereotype of smoking having a calming effect, which tends to attract youngsters who are experiencing a crisis.
The book is quite comprehensive and contains much useful information on smoking myths. For the essay, the book offers an explanation of one of the reasons for taking up smoking and demonstrates its harmfulness. It can be used to prove a pro-tobacco argument to be false and destructive.
Parrott, A. & Murphy, R. (2012). Explaining the stress-inducing effects of nicotine to cigarette smokers. Human Psychopharmacology: Clinical and Experimental , 27 (2), 150-155 .
The authors explain the mechanism of the abstinence symptoms in smokers, relate it to resulting anxiety disorders, and demonstrate that the perceived calming effect of smoking consists of addiction consequences. In other words, the authors demonstrate that tobacco is only capable of removing the abstinence-related anxiety caused by smoking tobacco, which makes the effect pointless. The authors also review prior studies and show that non-smokers or quitters are less likely to report irritability, stress, depression, and anxiety than smokers.
For the essay, the article explains one of the few pro-tobacco arguments (that smoking has a calming effect) and proves that it is false and harmful. As a result, the article is an important contribution that provides some information on the opposite point of view, according to which there are benefits to smoking, and proves it wrong.
U.S. Department of Health & Human Services. (2016). Effects of smoking on your health .
The website contains detailed information on health-related smoking effects. It demonstrates that there is hardly a part of a smoker’s body that remains unaffected. Also, the website describes particular issues that are caused by smoking, with respect to every specific part of a human body.
The website is the most comprehensive yet concise source in this bibliography with respect to smoking-related health issues. It presents information in the form of lists and pictures, which helps it to provide more details while taking up less space and readers’ time. For the essay, the website offers information on the health problems that are caused by smoking and describes them in greater detail than the rest of the sources.
World Health Organization. (2016). Tobacco fact sheet .
The website offers limited statistics and information on the dangers of smoking and the process of quitting. Among other things, it describes the dangers of “second-hand” smoke with relevant statistics and an emphasis on the consequences for young children. Also, its states the WHO’s position on the matter, as well as the organization’s recommendations for government-level anti-tobacco activities.
For the essay, the website provides useful tobacco-related information that includes global statistics; the “second-hand” smoke information is also a very important argument that should be used in the paper. Moreover, the website creates a sense of urgency by demonstrating that the issue of tobacco smoking requires the attention of governments and healthcare organizations all over the world.
Cavazos-Rehg, P. A., Breslau, N., Hatsukami, D., Krauss, M. J., Spitznagel, E. L., Grucza, R. A.,… & Bierut, L. J. (2014). Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders . Psychological Medicine , 44 (12), 2523-2535.
Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N.,… & Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine , 368 (4), 341-350.
Parrott, A. & Murphy, R. (2012). Explaining the stress-inducing effects of nicotine to cigarette smokers. Human Psychopharmacology: Clinical and Experimental , 27 (2), 150-155.
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190 Smoking Essay Topics
🏆 best essay topics on smoking, 👍 good smoking research topics & essay examples, 🌶️ hot smoking ideas to write about, 🎓 most interesting smoking research titles, 💡 simple smoking essay ideas, 📌 easy smoking essay topics, ❓ research questions about smoking.
- Should Smoking Be Illegal? The ban on smoking is a very hard step to be undertaken especially when the number of worldwide users is in billions. Attempts by some nations to do this have often been met with failures.
- Effects of Public Smoking and Arguments for the Prohibition of Public Smoking The essentiality of the essentiality of this paper is to explore the effects of public smoking and provide arguments that will lead to the prohibition of public smoking.
- Is Smoking Cigarettes Just for Fun or a Death Sentence? Smoking cigarettes is one of the most popular bad habits in the world. Those who are addicted to it keep saying that there is nothing wrong about smoking.
- Cigarette Smoking Role in Public Health Cigarette smoking produces little marginal social benefits. This paper provides an insight into the debate surrounding cigarette smoking and public health.
- “Thank You for Smoking” by Jason Reitman The movie, ‘Thank You for Not Smoking’ has a theme that mainly revolves within the tobacco industry. The movie Thank You for Smoking is a campaigner for use of tobacco products.
- Are Anti-smoking Adverts Effective? The loss of individuals due to tobacco use affects the economy of many societies. Many children in the developed world lose their guardians yearly due to smoking.
- Banning Public Smoking The essentiality of the essentiality of this paper is to explore the effects of public smoking and provide arguments that will lead to the prohibition of public smoking.
- Anti-Smoking Poster Visual Analysis in Advertising This discussion presents a visual analysis of an anti-smoking poster that explores usage of words, images, colors, settings, and layout to deliver message to the audience.
- Smoking Cessation and Depression It was estimated that nicotine affects the human’s reward system. As a result, smoking cessation might lead to depression and other mental disorder.
- Relationship between Asthma and Smoking The relationship between asthma and smoking explains why many adults who develop asthma past their 50th birthdays often have a history of smoking tobacco.
- The Central Connecticut State University Smoking Banning CCSU should bans smoking from campus because according to cancer.gov, it is proven that secondhand smoke contains at least 250 dangerous chemical and could cause a lot of diseases.
- Smoking Hazards and Cessation Benefits in the US In the article on smoking-related hazards, the reference to the measurements made by national healthcare representatives to define the benefits of smoking-cessation.
- E-Cigarettes Smoking: Threat or Solution? Nowadays, the new challenge looms on the horizon – the introduction of electronic cigarettes. There are many views on vaping, smoking e-cigarettes, both positive and negative.
- Asthma Incidence and Smoking among African Immigrants in California This paper explores the association between asthma incidence and smoking among African immigrants in California.
- Asthma and Smoking Among Adult African Immigrants This study explores the association between asthma and smoking status among adult African immigrants in California using a quantitative correlational approach.
- “Impact of Institutional Smoking Bans on Reducing Harms and Secondhand Smoke Exposure”: Article Review This paper focuses on a systematic review of the article Impact of institutional smoking bans on reducing harms and secondhand smoke exposure.
- Children With Asthma: Risks Created by Smoking Parents The available literature indicates that secondhand smoking from parents hurts children with asthma and other respiratory diseases, causing complications.
- Smoking Cessation and Depression Problem The aim of the study is to scrutinize the issues inherent in the process of smoking cessation and align them with the occurrence of depression in an extensive sample of individuals.
- Tobacco and E-Cigarettes Smoking: Negative Effects Cigarette smoking is well known to have diverse health effects on humans, include chronic obstructive pulmonary disease, stroke, bronchitis and heart attack.
- Asthma Incidence and Smoking among Immigrants in California This paper analyzes relationship between smoking behaviors and asthma cases in states or regions that have multiple immigrant population groups, such as New York and California.
- Nursing Interventions for Smoking Cessation The article “Nursing Interventions for Smoking Cessation” aims to investigate the effectiveness of nursing-initiated interventions. The authors are the nursing professionals.
- Smoking Bans in the Nationwide Indoor This paper highlights opinions on indoor smoking bans by the US government and the results show that smoking bans are generally approved by the public.
- Smoking and Heart Disease Rates in African-Americans High prevalence of smoking in African-Americans leads to the increased incidence of heart disease in this population.
- The Link Between Asthma and Immigrant Smoking The purpose of this study is to determine the association between asthma and smoking status among adult African immigrants in California.
- Teratogenic Effects of Alcohol and Smoking The teratogen is an umbrella term for substances that can have adverse effects on an embryo. In the situation, a girl continues drinking alcohol and smoking cigarettes despite being pregnant.
- Primary and Seconary Smokers’ Health Implications Primary smokers are people who smoke directly while secondary smokers are people who inhale smoke released by other smokers.
- Health Problem in Delaware and Smokers’ Families The paper reviews the NHIS data collection system, explores health problems in Delaware, and studies an article that assumes that married smokers are less likely to quit smoke.
- Weyco Inc.’s Smoking Ban in Deontological Ethics This paper investigates the case study of the smoking ban used in Weyco Inc. from a deontological (non-consequentialist) perspective.
- Smoking Cessation and Stages of the Change The paper studies a case of a client addressed for help to solve his smoking cessation. It identifies the questions to ask the client during each stage of change.
- Tobacco Smoking Problem in Miami-Dade County The paper presents the analysis of the tobacco smoking problem in Miami Dade County and analyses the opportunities of the community for resolving this complicated issue.
- The Relationship Between Asthma and Smoking This study explores the relationship between asthma and smoking among adult African Immigrants in California that are a relatively understudied group.
- Indoor Smoking Ban: Study Methodology The issue of whether or not the United States should pass a nationwide ban on indoor smoking is one that has managed to elicit a lot of debate.
- Weight Watchers: the Analysis of Smoking The lack of alternatives to the rewards of smoking as a method of controlling weight has created an inelastic demand for the product, which is unlikely to change with the decision to impose high taxes.
- Anti-Smoking Persuasion: Rhetorical Situation Analysis This paper narrates a rhetorical moment in which I had an argument with my brother on his smoking behavior while he was in high school.
- Lowering Drinking and Smoking Age in the U.S. Some scholars indicate that lowering the minimum legal drinking age from 21 to 17 years will help to limit the number of negative consequences faced by young adults.
- Smoking in Cities: Prohibition Bill The proposed bill presupposes the complete prohibition of smoking in cities except for the places that are specially created for it and equipped with corresponding devices.
- Introduction of New Legislation Regarding Smoking in Miami-Dade County Florida Health Department identifies three major risk factors of heart disease: high cholesterol, high blood pressure, and smoking.
- Acupuncture for Smoking Cessation: Research Process People want to know if acupuncture may be regarded as an effective method for smokers to quit this harmful habit considering that numerous past attempts were taken in vain.
- Smoking Cessation and Patient Teaching Plan The key purpose of this patient teaching plan is to collaborate with him regarding the improvement of his lifestyle, smoking cessation, awareness related to smoking damages.
- Smoking Management and Patient Teaching Plan Most smokers need outside prompts to jumpstart their quitting process. This can involve reminding the participant the benefits of quitting.
- The Changing Public Image of Smoking in the United States Scholars have discovered that 15 of every 100 country residents use tobacco products on a regular basis, which poses the problem as a nationwide issue.
- Secondhand Smoking: Environmental Health Promotion Smoking remains a significant environmental problem that affects many people. Secondhand smoking can also be a dangerous issue because of the pernicious impact of tobacco.
- Quit Smoking: Therapies and Medications This paper describes how nicotine replacement therapy (NRT), non-nicotine medications, and behavior therapy are valid ways to quit smoking.
- Smoking Cessation Plan with mHealth Application The goal of this paper is to develop a smoking cessation plan for a patient at risk of depression, using a mHealth application based on Acceptance and Commitment Therapy.
- Smoking in Movies: Tobacco Industry Tactics The American tobacco industry has a long history of collaboration with the film industry to promote smoking and advertise some tobacco brands.
- Smoking Bans in Workplaces and Public Spaces The paper researches evidence that secondhand smoke causes the same problems as direct smoking, including lung cancer, cardiovascular disease, and lung ailments.
- The Problem of Smoking Ban The goal of the essay is to provide arguments to defend nonsmokers on the dispute regarding smoking-related restrictions.
- Anti-Smoking Persuasive Campaigns and Factors Determining Outcomes Tobacco has become one of the major health issues, affecting most of the American population and other world citizens.
- Cigarette Smokers and Their Types A smoker is any person who consumes burned tobacco or its vapors, either through tasting or through inhaling. This paper will look at various types of cigarette smokers.
- Smoking and Public Policy in the United States In the USA, a number of public transportation agencies have decided to ban smoking in their transportation facilities, like trains and busses.
- Smoking Should Be Banned in Public Places Smoking should be banned in public places because it has negative effects on those people who do not smoke and violates their rights to clean air and health safety.
- Cigarette Smoking Cessation Methods This essay is about smoking as a bad habit that people should quit and strict laws should be applied against it.
- Smoking Ban in Bars and Restaurants The smoking ban in bars and restaurants law took effect in New York in the year 2003. The law stated that there was no one who was supposed to smoke in a café, restaurant or bar.
- Ban on Smoking in the Workplace The third state after Delaware and California to issue anti-smoking legislature banning the use of tobacco products in public places with effect from April 2008.
- Smoking: Addiction Treatment Methods The therapists advise those who are daily tobacco users to quit, despite their willingness. However, the intervention for smokers without any desire to stop is a complicated one.
- Young Mothers-Smokers: The Transtheoretical Model The transtheoretical model by Prochaska and DiClemente involves five consistent stages that are as follows: pre-contemplation, contemplation, action, maintenance, and relapse.
- Effects of Smoking on Your Health This paper discusses smoking. Smoking causes severe damage to lungs, increased risk of respiratory infections, etc. Disease caused by smoking.
- Why Should Smoking Be Banned in Public? Cardiovascular diseases, lung cancer, and chronic obstructive pulmonary disease are associated with prolonged exposure to tobacco smoke.
- Health Risks: Smoking and Usage of Substances The purpose of this article is to consider the health risks to which people who smoke and use psychoactive substances are exposed.
- Reducing Cigarette Smoking American Youth The number of smokers among juvenility in America is alarming. Instead of going down, this amount just leveled up.
- Tobacco Smoking Among Adolescents: Signature Assignment The purpose of this paper is to describe the reasons for the prevalence of tobacco use among adolescents of low and middle-income households.
- Motivation Methods to Quit Smoking According to the recommendations for treating tobacco use, the interventions for such patients should be aimed at motivating them to finally quit smoking.
- Impact of Smoking on a Pregnant Woman Smoking has various effects not only on a pregnant woman: it affects both the unborn child and the woman who is expectant.
- Smoking in Public Places: Should It Be Banned? Restriction on smoking in public places may contribute to achieving several important benefits. It will solve certain environmental issues, protecting animals and birds.
- Smoking Cessation: Causes and Statistics This article focuses on smoking, examining the causes, statistics, and approved medications used to quit smoking.
- Should Cigarette Smoking Be Banned? The question of whether cigarette smoking should be banned as it causes diseases, increases the healthcare system’s burden, and pollutes the environment, is pondered in this paper.
- Antismoking Ads and Youth Smoking Prevalence The article “Evidence of a dose-response relationship between “truth” antismoking ads and youth smoking prevalence” elaborates on the influence of antismoking advertisements.
- Motivational Interviewing as a Smoking Cessation Method Motivational Interviewing intervention is one of the primary cessation methods that is used among patients that reluctant to abstain from tobacco use.
- Smoking and Cognitive Dissonance Theory This paper seeks to study smoking from the perspective of the Cognitive Dissonance Theory (CDT) and dissect the issue of dissonance-reducing beliefs in smoking people.
- The Problem of Smoking in Young Adults This paper will propose cigarette cessation as a health promotion plan to address smoking in young adults.
- ‘Social Smoking Among Young Adults’ by Song & Ling In the article, Social smoking among young adults: Investigation of Intentions and Attempts to Quit, Song and Ling discuss social smoking among young adults.
- Community-Based Interventions to Promote Non-Smoking The research article’s design is experimental. An experimental design to come up with the cause-effect association among a collection of variables of scientific approaches
- A Health Problem – Smoking Analysis Smoking has been a health problem worldwide due to its adverse health effects. The paper gives several alternatives that have been advanced to assist addicts in quitting smoking.
- Problems of Smoking in Public Places The below discussion will discuss the arguments for and against banning smoking in public places which will lead to a comparison of the same.
- Tobacco Smoking Trend in Australia The following essay investigates the trends of tobacco smoking in Australia and what environmental and health effects it might bear.
- Team Collaboration for Smoking Cessation The Centers for Diseases Control and Prevention (2018) show that smoking harms almost every single organ in the human body, causes various diseases and conditions.
- Smoking in Public Places: Negative Effects Public smoking should be banned in all public places to ensure workers perform their duties without interference. Also tobacco contains harmful substances that intoxicate people.
- Health-Care Cost of Smoking: Economic Impacts Smoking simply refers to a practice in which a known substance, usually cannabis or tobacco, is burnt and the smoke it produces is inhaled directly.
- Design and Health Promotion Program for Someone to Quit Smoking The paper will present a smoking intervention program that combines medical and psychological solutions that address all the aspects of smoking addiction.
- The US Veterans: The Problem of Tobacco Smoking Although the rate of tobacco use among American veterans has been declining, those returning from Afghanistan and Iraq are smoking at an alarming rate.
- The Pharmacists’ Action on Smoking Program The purpose of the research is to analyze and evaluate the results of the Pharmacists’ Action on the Smoking program.
- The Dangers of Smoking and Its Prevent The article argues the ill effects brought by smoking since it proves to be the biggest threat to current and future world health.
- Smoking and Health Promotion in the UK In the following paper, issues of health promotion and smoking, in particular, will be evaluated and analysed on the basis of facts from the United Kingdom.
- Adverse Effects of Smoking Marijuana on Probation The smoking marijuana is associated with many possible negative health effects. Despite the initial euphoric state, panic attacks, confusion and anxiety are common.
- Lung and Bronchus Cancer in Smoking Americans Among the causes of lung and bronchus cancer, smoking is the first to be distinguished, which is the reason for the vast majority of incidence cases.
- Smoking Cessation and Increase in Quality of Life This paper seeks to establish whether smoking cessation improves the quality of life in African American women beyond 50 years who are smokers with COPD.
- Correlating Smoking to Comorbidities The smoking problem engulfing the world about comorbidities is worrying a lot. Millions of old African Americans suffer through this scourge, whose prevalence increases daily.
- The Ban on Smoking: Main Reasons One reason why smoking should be banned is because it has got several health effects. It harms almost every organ of the body.
- Smoking Patients. Practice Recommendations There are several ways to handle smoking patients. Brief interventions to screen all clients for all forms of tobacco use and initiate treatment as appropriate are suggested.
- Drinking and Smoking During Pregnancy Smoking and drinking alcohol is a wrong decision for a pregnant woman who wants to heighten the chances of light delivery and good health for her child.
- Tobacco Smoking Cessation The Addiction Institute of Mount Sinai’s interventions alleviates the economic and social burdens caused by tobacco use.
- Health Effects of Smoking. Rhinosinusitis Symptoms Smoking has negative impacts on the health of individuals. Many people have developed various complications, whereby some have lost their lives.
- Passive Smoking and Pancreatic Cancer in Women The association between ETS and pancreatic cancer is weak. The pancreatic cancer risk associated is confounded by environmental tobacco smoke exposures.
- Why Should Smoking Be Illegal? Cigarettes have been the most harmful invention in human history. Because of this, it is a huge financial and political drain.
- Smoking Dependence Treatment & Statistics The study used a two-group design that involved two samples of 40 participants who had ended treatment for smoking dependence. There were two treatment options.
- Discussion: Smoking and Health Risks The WHO and numerous other influential organizations are persistent in their attempts to draw attention to the problem and encourage efficient ways to prevent people from smoking.
- Smoking: An Idea for a Statistical Experiment The hypothesis is that people who smoke cigarettes daily tend to earn more than others: this is a personal observation that requires careful experimental testing.
- Discussion: Treating Smoking Dependence A controlled study was performed to determine the efficacy of Mindfulness Therapy (MT) in treating smoking dependence among 40 adults.
- Should Cigarette Smoking Be Banned? The paper highlights the harmful effects of smoking. The chemicals trigger various adverse health conditions, many of which can cause death.
- Impact of UK Smoking Ban on Pub Closures Smoking bans in bars came with serious risks and a dire prognosis; pub owners expected harm in the short term, yet such a ban benefited British society.
- Adult Smoking in Hatch, New Mexico Adult smoking is one of the health risk factors with the highest prevalence in Dona Ana County in New Mexico where Hatch is located.
- Aspects of the Harm of Smoking The paper states that it is a mistake to believe that if you smoke one cigarette for two or three, then the harm to the body will be less.
- Analysis of the Movie “Thank You for Smoking”: The Propaganda The movie presents the deceitful nature of Tobacco Academy Studies that use the skills of their lobbyist Nick Naylor to confuse the public that cigarette smoking is good for their.
- Smoking-Related Harmful Health Effects Smoking tobacco continues to be a leading cause of early disability and mortality worldwide. The use of combusted tobacco has health risks that are now beyond dispute.
- Harmful Effects of Smoking: Why to Quit Smoking? This paper highlights the harmful effects of smoking on the human body and associated health risks and emphasizes the need for smoking cessation.
- Current and Long-Term Effects of Smoking
- Nationwide Indoor Smoking Ban
- Does Smoking Affect Body Weight and Obesity in China
- Psychological and Social Influences on Smoking Behaviour
- Nicotine Dependence and Smoking Cessation
- Women Smoking During Pregnancy Effects on the Children They Carry
- How Will More Obesity and Less Smoking Affect Life Expectancy
- Human Body and the Impact of Smoking
- Nursing Management Plan For Smoking Cessation of a Patient
- Sigmund Freud’s Psychosexual Smoking
- How Nurses Can Prevent the Onset of Smoking
- Each Year More Americans Die Due to Complications of Smoking
- Link Between Smoking and the Occurrence of Cardiovascular
- Working Time and Cigarette Smoking: Evidence From Australia and the United Kingdom
- Smoke Signals: The Intergenerational Transmission of Smoking Behavior
- Lifetime Smoking and Asthma: A Mendelian Randomization Study
- How Smoking Affects Your Life and People Around You
- Motivation and the Brain: Quitting Smoking
- Pregnant Women and the Cessation of Smoking
- Cigarette Smoking and Its Health Risks
- What Effects Can Cigarette Smoking Have On the Respiratory System
- Analyzing Two Opposing Perspectives on Smoking
- Youth Smoking Uptake Progress: Price and Public Policy Effects
- New York Smoking Ban and Its Constitutionality
- Diseases Associated With Cigarette Smoking
- How Smoking Affects Adults Health & Well-Being
- Anti Smoking Campaign for Smoking
- Should the Government Ban Smoking
- Links Between Smoking and Panic Attacks
- How Smoking Affect Relationships in Work or Home
- Quit Smoking and Intervention for Adolescent Smokers
- Intervention for Smoking Cessation of Smoking
- Gender Dynamics and Smoking Prevalence in Japan
- Midwives, Pregnant Women, and Quitting Smoking
- How Nicotine Affects Your Quit Smoking Victory
- How Smoking Can Negatively Affect Your Life
- Lung Cancer Women Smoking Effects
- Public Places and the Hazards of Smoking
- Cigarette Smoking: The Negative Effects on the Human Body
- How Smoking Tobacco Affect Your Life and Surrounding
- Lung Tissue and Cigarette Smoking Effects
- Persuasive Against Smoking for Teens
- How Smoking Has Changed Through the Years
- Anti Smoking Advertisement Just Makes a Smoker
- How Smoking Affects the Teenage Brain
- Cigarette Smoking and Its Negative Effects on Children and Adults
- How Smoking Bans Are Bad for Business
- How Smoking Increases the Risk of Lung Cancer
- Does Smoking Cause Lung Cancer
- How Smoking Cigarettes Destroys Your Health
- Maternal Smoking During Pregnancy and Early Child Outcomes
- Does Falling Smoking Lead To Rising Obesity
- Hypnosis Quit Smoking Techniques
- Obesity, Cigarette Prices, Youth Access Laws, and Adolescent Smoking Initiation
- How Smoking Affects the Health Care Costs
- Research Project About Likelihood of Smoking for Children of Smokers
- Knowledge, Attitudes, and Practices on Smoking Habits Among School Children
- Drug Smoking and Drug Trafficking in the World
- Cigarette Smoking Slowly Kills the Country
- Anti-smoking Advertisements: Why They Don’t Work
- What Effects Can Cigarette Smoking Have on the Respiratory System?
- Does Smoking Cigarettes Relieve Stress?
- What Are the Reasons for the Teenagers in Smoking?
- Does Smoking Have Benefits?
- What Kills More Cigarettes Smoking or Obesity?
- Does Elevated Job Stress Affect Smoking Levels?
- When Quitting Smoking Leads to Nicotine Gum Addiction?
- Why Stop Smoking Commercials Are Still on for Cinema Halls?
- What Are the Effects of Smoking on the Respiratory System?
- Why Quitting Smoking during Pregnancy?
- Can Economic-Psychological Parameters Predict Successful Smoking Cessation?
- What Happens When You Quit Smoking?
- What Effects Did the 2006/2007 Smoking Ban Have on the UK?
- Can Public Policy Deter Smoking Escalation among Young Adults?
- What Are the Leading Factors That Affect the Girls and Boys to Start Smoking?
- Does Smoking Affect Body Weight and Obesity in China?
- What Are the Inventions to Promote Smoking Cessations?
- What Makes Smoking and Computers Similar?
- Why Smoking Should Not Be Banned?
- Does Cigarette Smuggling Prop Up Smoking Rates?
- What Are the Advantages and Disadvantages of Banning Smoking in Public Places?
- What Are the Most Prevalent Dangers of Smoking and Drinking?
- Does Smoking Harm Your Earnings So Much?
- Can Counselling Assist with Smoking Cessation?
- What Are the Effects and Causes of Smoking in the Human Body?
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StudyCorgi. (2023, November 9). 190 Smoking Essay Topics. Retrieved from https://studycorgi.com/ideas/smoking-essay-topics/
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These essay examples and topics on Smoking were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.
The essay topic collection was published on September 9, 2021 . Last updated on November 9, 2023 .
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Tobacco industry history of tobacco ancient times.
Tobacco Industry History of Tobacco Ancient Times Fifteenth Century Sixteenth Century Seventeenth Century Eighteenth Century Nineteenth Century Twentieth Century Modern Times Corporate Stakeholders Ethics & Social Values Ecology & Natural esources Saint Leo Core Values Throughout its long and storied history, tobacco has served the various appetites of religious shamans, aristocratic noblemen, common sailors, money changers and modern-day captains of industry. The aeromatic plant grew naturally in the moderate climates of the Americas and was transported to every corner of the world by seagoing merchants. Tobacco evolved from a miracle cure-all to a current medical pariah. From the days of King Philip III of Spain to present days, the tobacco industry has been controlled by a small number of governments and private companies. It wasn't until the nineteenth century that scientists began to understand the destructive nature of nicotine, about the same time that the automated cigarette rolling machine was invented, dramatically expanding the market. Modern evidence supports the conclusion that tobacco is a….
Altria, (2011), Standard & Poor Stock Report, Charles Schwab, retrieved April 14, 2011 from https://www.schwab.wallst.com
Andre, Clair & Velasquez, Manuel, (2011), "The Morality of Marketing the Marlboro Man," Markkula Center for Applied Ethics, Santa Clara University, retrieved April 14, 2011 from http://www.scu.edu/ethics/publications/iie/v1n4/marlboro/htm
Borio, Gene, (2011), Tobacco.org, "The Tobacco Timeline," retrieved April 14, 2011 from http://www.tobacco.org/resources/history/Tobacco_History
Boston University Medical Center, (2011), "History of Tobacco," retrieved April 14, 2011 from http://academic.udayton.edu/health/syllabi/tobacco/ history.htm#begin
Tobacco and Its Influence on the American
Tobacco and Its Influence on the American Economy Tobacco trade has been an integral part of the American economy for centuries. From its early use by the Native American Indians to its adoption by the European settlers in the New World in the early 17th century, tobacco has played a significant role in early and modern America in both an economic and political sense. "y the advent of the Civil War, the Indian custom had been transformed into a significant American industry. " (The Story behind the Homestead and Museum) The powerful modern American economy can be traced back to the early European settlers and their search for economic security and gain. The initial New World economy gradually developed into a successful farming economy and eventually into the complex industrial economy of today. (The U.S. Economy: A rief History) In this process tobacco played an impart part in the founding of the….
Nichols, Capper. Tobacco and the rise of writing in colonial Maryland., The Mississippi Quarterly, December 22, 1996.
International Tobacco Issue. Accessed December 8. 2004.
http://184.108.40.206/search?q=cache:1n38v7rgIgMJ:www.international.ucla.edu/mun/syn/WHO_InternationalTobaccoIssue.doc+importance+of+tobacco+role+in+the+early+economy+of+America.& hl=en& start=12
The Fundamental Role of Tobacco in Shaping Virginia Society. Virginia Places. Accessed December 10, 2004 http://www.virginiaplaces.org/classschedule/7tobacco.html
Tobacco Alcohol and Gambling The
Ironically, those opposed to smoking used the very same medium to help kill smoking in public places, restaurants, and even cars when children are present (as is the case in several states now). Smoking and tobacco products are a pariah now - no longer the universal symbol of cool, no matter how much money the companies spend on advertising. The alcohol and gambling industries, on the other hand, have clearly taken a chapter out of the strife facing the tobacco companies and have done some very consistent things over the course of time. First, gambling and alcohol, all of the vices for that matter, have been connected with the adult world. But it is the "sin" of drink that led to prohibition, and the "sin" of gambling that led most states in the nation to outlaw the practice entirely. While tobacco has been considered to be a public nuiscance and an….
Hemphill, T.A. (2002). A prohibition on advertising?. Regulation 25:1, p8(3).
Messner, M.A. & Montez, J. (2005). The male consumer as loser: beer and liquor ads in mega sports media events. Signs 30:3, p1879(31).
Pritcher, L. (2007) Tobacco Advertising. Duke.edu. Online. Internet. Avail. http://scriptorium.lib.duke.edu/eaa/tobacco.html . Info Acc: 11 April, 2007.
Quigley, P.H. (2006). Tobacco's Civil War: images of the sectional conflict on tobacco package labels. Southern Cultures 12:2, p53(5).
Tobacco Cessation Evaluation and Pre-Assessment
I would continue offering information including access to Web sites, books, and multimedia sources. If possible, I will spend extra time with the patient to help them reinforce their decision and offer psychological support. Other ways to address resistance to change include asking the patient's family members and close friends to participate in their treatment plan. If the patient has children, the children can volunteer information about how they feel about their parent smoking. The children can offer anything from "I don't like the way it smells" to "I'm worry about mommy dying." Friends who have stopped smoking can be among the greatest sources of psychological and social support during this critical time in the treatment plan. A friend who can be there not just to provide advice but also as a role model is an invaluable asset. Moreover, friends who have stopped will not tempt the patient by smoking in….
The American Cancer Society (2002). Smoking Cessation Products. ACS
The Canadian Council for Tobacco Control (1999). Guide Your Patients to a Smoke-Free Future.
Columbia University College of Dental Medicine. Tobacco Cessation.
Tobacco Smoke Contains About 4 000
Interference of nicotine with the immune system further aggravates the chances of cardio-vascular disease. ("High Blood Pressure") Carbon monoxide, another constituent of tobacco smoke, latches on to the red blood cells reducing their ability to carry oxygen to the heart muscles and other parts of the body. It also causes thickening of the blood which can lead to a greater likelihood of clotting and increased risk of CHD. Works Cited Cigarette Smoking and Cancer: uestions and Answers." National Cancer Institute: Fact Sheet. 11/4/2004. March 8, 2008. http://www.cancer.gov/cancertopics/factsheet/Tobacco/cancer Hecht, Stephen S. "Tobacco Smoke Carcinogens and Lung Cancer." Journal of the National Cancer Institute, Vol. 91, No. 14, 1194-1210, July 21, 1999. March 8, 2008. http://jnci.oxfordjournals.org/cgi/content/full/91/14/1194 High Blood Pressure: Tips to Stop the Silent Killer." University of Maryland Medical Center (UMMC). June 27, 2007. March 8, 2008. http://www.umm.edu/features/blood_pressure.htm &a: Passive Smoking." BBC News World Edition. October 18, 2004. March 8, 2008. http://news.bbc.co.uk/2/hi/health/medical_notes/3235820.stm Tobacco Use and Pregnancy." Centers….
Q&a: Passive Smoking." BBC News World Edition. October 18, 2004. March 8, 2008. http://news.bbc.co.uk/2/hi/health/medical_notes/3235820.stm
Tobacco Use and Pregnancy." Centers for Disease Control and Prevention: Department of Health and Human Services. 10/2 / 07. March 8, 2008. http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/
Prominent carcinogens present in tobacco smoke that have been shown to cause lung tumors in laboratory animals and humans are polycyclic aromatic hydrocarbons (PAHs) and nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (Hecht, 1999)
Tobacco There Are Numerous Legislative Actions That
Tobacco There are numerous legislative actions that have been addressed at the federal level. Both these laws, and the State of Washington's rules and regulations regarding tobacco and smoking present a complete overview of how this behavior is regulated. The federal laws are numerous but there are some that stand out more than others when legislating tobacco. The Federal Trade Commission Act of 1914 prevented deception in acts of commerce which affected many of the health claims made by this industry. The Federal Cigarette Labeling and Advertising Act of 1965 required package warning lable on cigarette packages. The Public Health Cigarette Smoking Act of 1969 prohibited cigarette advertising on television and radio. The Controlled Substances Act of 1970 excluded tobacco from being a controlled substance. More recent legislation includes Public Law 100-202 passed in 1987 that banned smoking on domestic airline flights . The most recent law is the Family Smoking Prevention….
Centers for Disease Control and Prevention. " Smoking and Tobacco Use." Viewed 28 May 2013. Web.
IMDb. "Water For Elephants." Viewed 28 May 2013. Web.
Washington State Department of Labor and Industries. "Tobacco." Viewed 28 Ma7 2013. Web
Tobacco Cessation Treatment Plan This
For example, the patient will be expressly forbidden from smoking based on behavioral cues or previous patterns such as immediately upon waking, with coffee, after meals, in conjunction with social interactions, or while doing anything enjoyable or recreational such as watching television. The purpose is to ensure that the only time the patient smokes during the first phase of this treatment plan will be for the express purpose of administering the necessary "dose" of nicotine to address actual physical withdrawal symptoms. To help ensure that the only smoking will be for the purpose of addressing symptoms of physical withdrawal in the manner intended, the patient will be required to agree to conditions under which permissible smoking will occur. For example, if she determines that smoking is necessary because of actual symptoms of physical withdrawal, she will smoke a half of one cigarette standing on one leg in her backyard, or while….
Tobacco Industry Where Business Meets
Although it is expected to die in Congress -- and President Bush has promised a veto if it does not -- a bill is currently circulating that would allow the FDA to control cigarette contents ("eynolds American" 2008). If this bill were to pass, and the likelihood of it doing so is much greater with a Democratic congress and president, it could mean the perpetual death of the tobacco industry. Thus, these issues continue to be primary as shareholders determine if and when to buy. III. International Ethics Once a symbol of American life and a major contributor to evolutionary War funds, tobacco quickly found itself unwanted by many vocal United States' citizens once its harmful health effects became known. Since the late 1990s, the issue of international ethics has been of prominence in the discussions regarding the tobacco industry. As outraged Americans began to restrict the tobacco industry's options for….
"A brief history of tobacco." (2000). Retrieved September 28, 2008, from CNN.
Web Site: http://edition.cnn.com/U.S./9705/tobacco/history/
Charlton, Anne. (2004). Medicinal uses of tobacco in history. Journal of the Royal
Society of Medicine. 97(6), p. 292-296. Retrieved September 28, 2008, from the Royal Society of Medicine Press.
Tobacco Smoking in United States of America
Tobacco Smoking in United State of America Tobacco is a plant which belong to the nightshade family, which also include potatoes, tomatoes, eggplant and red pepper. Whoever the concentration of nicotine in these vegetables is lower compared to Tobacco. Tobacco smoking has been shown to be unhealthy as it has proved to be the leading cause of preventable deaths in United States, killing more than four hundred thousand people and costing nearly $100 billion in health care bills every year, research shows that nearly all smokers start before the age of 18. Everyday 1000 become regular smokers while one-third of who die prematurely. Research has also shown that it takes long time of constant smoking to actually become dependent to nicotine. People like the effects of nicotine and get used to them making them to desires it more, smokers think tobacco help them to reduce stress, anxiety and controlling their appetite. Tobacco used….
Tobacco Use Management System Analyzing
For example, one approach to regulation would be to outlaw tobacco use entirely, but this action would have serious consequences that the government may not be able to accept. Thus the government must walk a precarious line within its role in the system, cautious of setting precedents that could be harmful in other areas of governing, yet still acting in the interest of the public. The authors identified five systemic problems that exist within the current tobacco management system: 1) Tobacco is marketed with the goal of making a profit, by for-profit tobacco industry companies, and this is at odds with the goals of the public health sector related to reducing the use of tobacco products. 2) the Tobacco Use Control subsystem is limited in its abilities to create and provide cessation products and prevention services, and lacks a dynamic capacity in addressing these issues 3) This same subsystem is split between harm….
Borland, R., Young, D., Coghill, K., & Ying Zhang, J. (2010). The tobacco use management system: Analyzing tobacco control from a systems perspective. American Journal of Public Health, 100, 1229-1236.
Tobacco Companies Should Not Be
" (Sciencentral, 2006) Sepsis is not the only immune response system disease that cigarette smoking has been credited for protection the individual from developing as it is additionally it is reported by Ulla that those who consume cigarettes are "...less prone to another disease of the immune system, ulcerative colitis. This inflammatory disease attacks the digestive system, but was found to affect a disproportionate number of non-smokers." (Sciencentral, 2006) III. The Functions of Tobacco Litigation The work of Vernick, Rutkow and Teret (2007) state in the work entitled: "Public Health enefits of Recent Litigation Against the Tobacco Industry" states that the litigation against the tobacco industry "...as with lawsuits involving other dangerous products...can serve several important functions." (Vernick, Rutkow and Teret, (2007) Those are stated as follows: (1) Lawsuits can compensate individuals harmed by the product; and (2) Lawsuits can serve a public health purpose by encouraging manufacturers to change their products, sales,….
Vernick, J.S.; Rutkow, Lainie; and Teret, Stephen P. (2007) Public Health Benefits of Recent Litigation Against the Tobacco Industry. JAMA Vol. 298. No.1-4 July 2007. Online available at: http://jama.ama-assn.org/cgi/content/extract/298/1/86
Chambers, Marcia (1985) Ideas & Trends; Tobacco Companies Breathe a Bit Easier. 29 Dec 1985. The New York Times. 8 Dec 2009. online available at: http://www.nytimes.com/1985/12/29/weekinreview/ideas-trends-tobacco-companies-breathe-a-bit-easier.html
Richman, Rich (1996) Escape from Responsibility. May 1996. The Future of Freedom Foundation. Online available at: http://www.fff.org/freedom/0596c.asp
Good Nicotine (2006) Sciencentral Archive. Online available at: http://www.sciencentral.com/articles/view.php3?article_id=218392804&cat=1_1
Tobacco vs Other Drugs Nowadays
Alcohol, even at low doses, significantly impairs the judgment and coordination required to drive a car safely. Low to moderate doses of alcohol can also increase the incidence of a variety of aggressive acts, including domestic violence and child abuse. Hangovers are another possible effect after large amounts of alcohol are consumed; a hangover consists of headache, nausea, thirst, dizziness, and fatigue." On the other hand, "prolonged, heavy use of alcohol can lead to addiction (alcoholism). Sudden cessation of long-term, extensive alcohol intake is likely to produce withdrawal symptoms, including severe anxiety, tremors, hallucinations and convulsions. Long-term effects of consuming large quantities of alcohol, especially when combined with poor nutrition, can lead to permanent damage to vital organs such as the brain and liver. In addition, mothers who drink alcohol during pregnancy may give birth to infants with fetal alcohol syndrome." All in all, I consider that the arguments stated above….
Vladimir KRASICOV, "Vice," at http://www.the-philosopher.co.uk/vice.htm
You can quit smoking/Nicotine Addiction/, at http://www.cdc.gov/tobacco/quit_smoking/you_can_quit/nicotine.htm
US Code Collection, 8/14/99 www4.law.cornell.edu/uscode/15/1331.html" Public Health Cigarette Smoking Act of 1969
World Health Organization, at http://en.wikipedia.org/wiki/World_Health_Organization
Tobacco Hornworm an Analysis of
There are, of course, other methods that have been developed for the reduction of destruction to agricultural crops from pest insects such as the Manduca sexta, including the use of aqueous vermicompost solutions as fertilizers for plant growth (Edwards et al. 2010). The efficacy of such other endeavors arguably questions the need for the creation of food alternatives for the purposes of crop protection, and the current research definitely suggests that greater difficulties would be had in this area than in developing other plant-focused (rather than pest-focused) means of protecting crops and the interests of agribusiness. The increased growth rate of the artificial food source could also lead to problems with growing populations of the pest insect, leading to greater destruction by subsequent generations. Ultimately, however, further research into the creation of alternative food sources is suggested before such methods and endeavors are entirely scrapped. The research clearly shows that artificially….
Edwards, C.; Arancon, N.; Vasko-Bennet, M.; Askar, a. & Keeney, G. (2010). "Effect of aqueous extracts from vermicomposts on attacks by cucumber beetles (Acalymna vittatum) on cucumbers and tobacco hornworm (Manduca sexta) on tomatoes." Pedobiologia 53(2), pp. 141-8.
Kingsolver, J. (2007). "Variation in growth and instar number in field and laboratory Manduca sexta." Proceedings - Royal Society. Biological sciences 274(1612), pp. 977-81.
Nijhout, H.; Smith, W. & Schachar, I. (2007). "The control of growth and differentiation of the wing imaginal disks of Manduca sexta." Developmental biology 302(2), pp. 569-76.
Pauchet, Y.; Wilkinson, P.; Vogel, H. & Nelson, D. (2010). "Pyrosequencing the Manduca sexta larval midgut transcriptome: messages for digestion, detoxification and defence." Insect molecular biology 19(1), pp. 61-75.
Tobacco Products Effects Law and Statistics
Tobacco Products Just put out the facts and let the public make their own decision on the use of Tobacco products. At times revealing information and statistics is all the public needs. Tobacco smoking is one of the most common habits prevalent throughout the world. People continue to smoke tobacco and there is very little concern for the health consequences of tobacco use. Every year smoking takes a huge toll on peoples lives, greater than any other epidemic disease like AIDS. Cardiac arrest and lung cancer are two of the potentially fatal diseases, which are directly attributed to tobacco smoking. Apart from this tobacco is also the leading cause for respiratory problems like asthma, bronchitis, emphysema, infertility, oral diseases and other complications. A discussion on the health effects of smoking, laws pertaining to tobacco trade and some statistical insight would certainly help us get a better picture of the problem. The Effects….
1) FRANK D. GILLILAND, YU-FEN LI, and JOHN M. PETERS, "Effects of Maternal Smoking during Pregnancy and Environmental Tobacco Smoke on Asthma and Wheezing in Children," AJRCCM, Volume 163, Number 2, February 2001, 429-436
2) Josephine Thomas, "Toddler Behavior and Early Smoking Experimentation," NIDA Notes, Volume 16, Number 1, March 2001, Accessed on May 13th 2004, http://www.drugabuse.gov/NIDA_Notes/NNVol16N1/Maternal.html
3)EPA, "Fact Sheet: Respiratory Health Effects of Passive Smoking," Accessed on May 14th 2004, http://www.epa.gov/iaq/pubs/etsfs.html
4) HSC, "Smoking: Effects on Mothers and Babies in West Virginia," Accessed on May 14th 2004, http://www.wvdhhr.org/bph/oehp/hsc/briefs/four/
Tobacco Control Program the California Tobacco Control
Tobacco Control Program The California Tobacco Control Program (CTCP) is one of the oldest state tobacco control programs in the Nation. Established in 1990, CTCP was the first tobacco control program to include a change of social norms in its strategy. Largely a success due to impacts in and out of California, CTCP must continue to work against the tobacco industry's marketing tactics. The California Tobacco Control Program (CTCP) was established in 1990 and was the first tobacco control program to incorporate a change of social norms in its core strategy (California Department of Public Health, n.d.). The program's stated mission is "to improve the health of all Californians by reducing illness and premature death attributable to the use of tobacco products" (California Department of Public Health, 2010, modified 10/31/2012). The program's ambitious long-term goals are to empower statewide and local health agencies to promote health and quality of life by….
Sports - Drugs
Tobacco Industry History of Tobacco Ancient Times Fifteenth Century Sixteenth Century Seventeenth Century Eighteenth Century Nineteenth Century Twentieth Century Modern Times Corporate Stakeholders Ethics & Social Values Ecology & Natural esources Saint Leo Core Values Throughout its long and storied history, tobacco has…
Tobacco and Its Influence on the American Economy Tobacco trade has been an integral part of the American economy for centuries. From its early use by the Native American Indians…
Ironically, those opposed to smoking used the very same medium to help kill smoking in public places, restaurants, and even cars when children are present (as is the case…
I would continue offering information including access to Web sites, books, and multimedia sources. If possible, I will spend extra time with the patient to help them reinforce…
Interference of nicotine with the immune system further aggravates the chances of cardio-vascular disease. ("High Blood Pressure") Carbon monoxide, another constituent of tobacco smoke, latches on to the…
Tobacco There are numerous legislative actions that have been addressed at the federal level. Both these laws, and the State of Washington's rules and regulations regarding tobacco and smoking present…
For example, the patient will be expressly forbidden from smoking based on behavioral cues or previous patterns such as immediately upon waking, with coffee, after meals, in conjunction with…
Although it is expected to die in Congress -- and President Bush has promised a veto if it does not -- a bill is currently circulating that would…
Tobacco Smoking in United State of America Tobacco is a plant which belong to the nightshade family, which also include potatoes, tomatoes, eggplant and red pepper. Whoever the concentration of…
For example, one approach to regulation would be to outlaw tobacco use entirely, but this action would have serious consequences that the government may not be able to…
" (Sciencentral, 2006) Sepsis is not the only immune response system disease that cigarette smoking has been credited for protection the individual from developing as it is additionally it is…
Alcohol, even at low doses, significantly impairs the judgment and coordination required to drive a car safely. Low to moderate doses of alcohol can also increase the incidence…
There are, of course, other methods that have been developed for the reduction of destruction to agricultural crops from pest insects such as the Manduca sexta, including the use…
Tobacco Products Just put out the facts and let the public make their own decision on the use of Tobacco products. At times revealing information and statistics is all…
Tobacco Control Program The California Tobacco Control Program (CTCP) is one of the oldest state tobacco control programs in the Nation. Established in 1990, CTCP was the first tobacco…
Essay on Smoking
500 Words Essay On Smoking
One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.
Ill-Effects of Smoking
Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.
Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.
In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.
It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.
Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.
How to Quit Smoking?
There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.
Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.
Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.
One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.
Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.
Get the huge list of more than 500 Essay Topics and Ideas
Conclusion of the Essay on Smoking
Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.
FAQ of Essay on Smoking
Question 1: What are the effects of smoking?
Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .
Question 2: Why should we avoid smoking?
Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.
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Tobacco Use Essay Examples
Tobacco use: death trap.
There exists a trap in today’s society which has claimed many lives. Lives which are now altered to suit its use and need while also gifting their host their arbitrary title of smoker or tobacco addict. Although many use it to alleviates stress or pain,...
Problems and Control of Tobacco Use
A strategic plan is meant to present a clear picture of where a community wants in the future, what it aspires to accomplish, the methods it will apply to succeed, as well as the measures it will use to monitor progress. This particular strategic plan...
Short Essay About Lungs: How Smoking Affects the Health
Smoking is a very harmful habit that people get in to, it affects your whole body but especially your lungs. It is one of the biggest causes of preventable deaths and on average 1 in 2 smokers will die from a smoking related disease. Smoking...
Vaping: a Threat to Public Health in the Age of Smoking Awareness
A lot of people smoke for it makes them calm when they had a very tiring or sad day. How sure are you? That smoking relieves your stress. That it comforts and helps you to cope up with the pain and problems you have experienced...
Persuasive Statement Against Smoking
Smoking is seems something usual and even natural nowadays. Cigarette manufacturers have moved to a new level and begun to produce products that seem to cause less harm to health or have no negative consequences at all. Nevertheless, this is only a lie imposed on...
Tobacco Use, an Unhealthy Diet, Limited Exercise, and Stress as the Main Causes of Cardiovascular Disease
Tobacco use, an unhealthy diet, limited exercise, and stress contribute to cardiovascular problems. In order to grasp how detrimental these can be, it is important to understand what they affect. The cardiovascular system is one of the twelve systems in the human body. It contains...
Research of the Effects of Tobacco Use on Youth's Health and Lives
Smoking behavior may not be so fixed or stable among energetic adults as is regularly anticipated. In continuous examination data, upwards of one fifth of smokers point by point starting smoking after the age of 18 a liberal addition over chronicled guidelines. To be sure,...
Negative Effects of Tobacco Use
Tobacco smoking remains a significant preventable cause of ill health and premature death worldwide despite a decline in prevalence in recent years. In the history of human civilization, the cigarette is the deadliest thing. About six million people are killed every year by tobacco. Tobacco...
Controls on Tobacco Advertising and Corporate Sponsorship to Reduce Tobacco Use in Canada
Currently in Canada, there are about 4. 6 million Canadians who smoke which makes up about 15% of the population, which is significantly lower than previous years, like 1965 when a record 50% of Canadians smoked. Due to the fact that trend of smoking has...
Role of Cigarette Companies’ Promotion and Advertisement in the Tobacco Use
Tobacco use kills nearly six million people worldwide each year. Sadly, of the more than 6 million tobacco-related deaths which are caused every year across the world, one-sixth happen in our country - India alone. Though the ill-effects of tobacco addiction are well-known, its consumption...
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