Smoking

• 1. Introduction

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  Smoking can be dated as early as 5000 BCE, and across the centuries it has worn almost every mask a human practice can wear. Holy and sinful. Sophisticated and vulgar. A panacea and a deadly health hazard. Today more than one billion people light up worldwide, the majority of them in developing countries, drawing the dried leaves of the tobacco plant into their lungs as a cigarette, a pipe, a cigar, or a bong. How did a plant once burned to reach the gods become the leading preventable cause of death on the planet? Why did sultans, emperors, popes and a patriarch all try to stamp it out, and fail so completely that London held some 7,000 tobacco sellers by the early 17th century? And what exactly happens inside the body in the less than one second it takes for the first inhalation to reach the brain? This is the story of a practice that the late 20th century came to view in a decidedly negative light, and of everything it touched on the way there.

• 2. The Pull On The Lungs

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  The lungs hold several million tiny bulbs called alveoli, which together cover an area of over 70 square meters, roughly the size of a tennis court. That vast surface is why smoking works as a drug-delivery method. Vaporized gas diffuses straight into the pulmonary vein, then into the heart, then to the brain, affecting the user in less than a second of the first inhalation. The active substances mimic naturally occurring chemicals like endorphins and dopamine, which are tied to sensations of pleasure. The result is what people call a high, ranging from the mild stimulus of nicotine to the intense euphoria caused by heroin, cocaine and methamphetamines. In tobacco, the key player is the alkaloid nicotine, which stimulates the nicotinic acetylcholine receptors in the brain. Other drugs follow the same route through smoke: tetrahydrocannabinol from cannabis, morphine from opium, cocaine from crack, and methamphetamine. The method is somewhat inefficient, since not all of the smoke will be inhaled. And not every drug can take this path. Some forms require purer free base versions of a substance and considerable skill to administer properly. Cigarette smokers almost always inhale, yet most pipe and cigar smokers do not, a small distinction that turns out to carry weight in the diseases that follow.

• 3. The Body Pays

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  Diseases related to tobacco smoking kill roughly half of long-term smokers, compared to the average mortality of non-smokers. The World Health Organization estimated that smoking killed over seven million smokers worldwide in 2023, plus 1.6 million non-smokers who died from passive smoke. Male and female smokers lose an average of 13.2 and 14.5 years of life. The risk of dying from lung cancer before age 85 reaches 22.1% for a male smoker and 11.9% for a female current smoker, against 1.1% and 0.8% for lifelong nonsmokers. Even a single cigarette a day carries weight, producing a risk of coronary heart disease halfway between a heavy smoker and a non-smoker. Tobacco smoke is a complex mixture of over 5,000 identified chemicals, of which 98 are known to have specific toxicological properties. The most dangerous are those that damage DNA, since that damage appears to be the primary underlying cause of cancer. Researchers including Cunningham combined the microgram weight of each compound in one cigarette's smoke with its genotoxic effect per microgram, and named seven leading carcinogens, among them acrolein, formaldehyde, acrylonitrile, 1,3-butadiene, acetaldehyde, ethylene oxide and isoprene. The mode of smoking shapes the danger. Pipe smokers carried 2.2 times the risk of non-smokers in a study of lung, upper aerodigestive tract and bladder cancers, cigar smokers 3.0 times, and cigarette smokers 5.3 times. The damage is not only internal. Around 8% of long-term smokers develop the set of facial changes doctors call smoker's face.

• 4. The Calm That Isn't

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  Most tobacco smokers begin during adolescence or early adulthood, drawn by elements of risk-taking and rebellion. Because teenagers are influenced more by their peers than by adults, the efforts of parents, schools and health professionals to keep them from trying cigarettes are not always successful. Smokers often report that cigarettes relieve feelings of stress, yet the stress levels of adult smokers run slightly higher than those of nonsmokers. Adolescents describe rising stress as they settle into regular smoking, and quitting reduces it. Far from steadying the mood, nicotine dependency seems to exacerbate stress. Smokers describe normal moods while smoking and worsening moods between cigarettes. The apparent relaxant effect is only the reversal of the tension and irritability that build up during nicotine depletion. Dependent smokers need nicotine simply to feel normal. In the mid-20th century psychologists such as Hans Eysenck sketched a personality profile of the typical smoker of that period, linking smoking with extraversion and describing smokers as sociable, impulsive, risk-taking and excitement-seeking. In terms of the Big Five personality traits, later research found smoking correlated with lower agreeableness and conscientiousness and higher extraversion and neuroticism.

• 5. Smoke For The Gods

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  The history of smoking dates back as early as 5000 BCE for shamanistic rituals. Ancient civilizations such as the Babylonian and Chinese burnt incense as part of religious rites, as did the Israelites and later the Catholic and Orthodox Christian churches. In India, fumigation, called dhupa, and fire offerings, called homa, are prescribed in the Ayurveda for medical purposes and have been practiced for at least 3,000 years, while smoking itself, dhumrapana, literally drinking smoke, goes back at least 2,000 years. Archaeological findings show pipes for smoking opium in Cyprus and Crete as far back as the Bronze Age. Cannabis smoking was common in the Middle East before tobacco arrived, often centered around the water pipe called a hookah, and it became woven into Muslim society through weddings, funerals, architecture, clothing, literature and poetry. Cannabis reached Sub-Saharan Africa through Ethiopia and the east African coast by Indian or Arab traders in the 13th century or earlier, traveling the same routes as coffee and smoked in calabash water pipes with terracotta bowls, apparently an Ethiopian invention. When the first European explorers and conquistadors reached the Americas, they told of rituals where native priests smoked themselves into such intoxication that the practice was unlikely to have been limited to tobacco alone.

• 6. Golden Weed

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  In 1612, six years after the settlement of Jamestown, John Rolfe was credited as the first settler to successfully grow tobacco as a cash crop. Demand grew quickly for the plant they called golden weed, which revived the Virginia Company after its failed hunts for American gold. Tobacco was grown in succession and depleted the land, pushing settlers west and expanding production. Indentured servants formed the early labor force until Bacon's Rebellion turned the focus to slavery. A Frenchman named Jean Nicot, whose name gives us the word nicotine, introduced tobacco to France in 1560, and from France it spread to England. The first report documents an English sailor in Bristol in 1556, seen emitting smoke from his nostrils. Criticism followed almost immediately. Murad IV, sultan of the Ottoman Empire from 1623 to 1640, was among the first to attempt a smoking ban, calling it a threat to public morality and health. The Chongzhen Emperor of China banned smoking two years before his death and the fall of the Ming dynasty, and the later Qing rulers called it a more heinous crime than even neglecting archery. In 1634 the Patriarch of Moscow and all Rus forbade tobacco sales and ordered violators to have their nostrils slit and their backs whipped. Pope Urban VII condemned smoking in a papal bull of 1590. James VI and I, author of A Counterblaste to Tobacco, tried a 4000% tax increase in 1604, and failed. Rulers eventually grasped the futility of bans and turned tobacco into lucrative government monopolies. The English term smoking was coined in the late 18th century. Before then, the practice was called drinking smoke.

• 7. Opium And Crack

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  In the 19th century, smoking opium became widespread in China, where the drug had previously only been ingested, and then only as a medicinal anaesthetic. Outlawed in the early 18th century for the societal harm it caused, opium flowed back in when foreign merchants smuggled it through Canton, driven by a massive trade imbalance. The Chinese official Lin Zexu tried to eliminate the trade, and his efforts led to the First Opium War. Defeat in the First and Second Opium Wars forced China to legalize opium imports. The habit traveled with Chinese immigrants into opium dens in Chinatowns across South and Southeast Asia, Europe and the Americas. In the latter half of the 19th century it became popular among European artists, turning Paris neighborhoods like Montparnasse and Montmartre into virtual opium capitals, a trend that largely faded after the outbreak of World War I. Opium use in China itself declined during the Cultural Revolution of the 1960s and 1970s. A different smokable drug surged much later. In the early 1980s, organized international cocaine trafficking grew, and overproduction with tighter enforcement pushed dealers to convert the powder into crack, a solid, smokable form sold in smaller quantities to more people. That trend abated in the 1990s as police action and a strong economy led many to give up or never start.

• 8. Naming The Killer

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  In 1798, Dr. Benjamin Rush, an early American physician and signer of the Declaration of Independence, argued against the habitual use of tobacco, calling it injurious to health and morals. In Germany, anti-smoking groups published advocacy in the journal Der Tabakgegner, The Tobacco Opponent, in 1912 and 1932. In 1929, Fritz Lickint of Dresden published formal statistical evidence of a lung cancer and tobacco link. During the Great Depression, Adolf Hitler condemned his earlier smoking as a waste of money, and Nazi reproductive policy cast women who smoked as unsuitable wives and mothers. Yet the movement could not hold. American manufacturers reentered the German black market after the Second World War, leaders of the Nazi anti-smoking campaign were assassinated, and the Marshall Plan shipped free tobacco to Germany, 24,000 tons in 1948 and 69,000 tons in 1949. The hard science arrived elsewhere. Richard Doll in 1950 published research in the British Medical Journal showing a close link between smoking and lung cancer. Four years later, the British Doctors Study, following some 40 thousand doctors over 20 years, confirmed it. In 1964 the United States Surgeon General's Report on Smoking and Health demonstrated the relationship between smoking and cancer, and a 1986 report concluded that passive smoking was harmful too. As evidence mounted, tobacco companies claimed contributory negligence. Health authorities sided with them until 1998, when they reversed course. The Tobacco Master Settlement Agreement, between the four largest US tobacco companies and the Attorneys General of 46 states, restricted advertising and required health payments, becoming the largest civil settlement in United States history.

  The earliest depictions of smoking appear on Classical Mayan pottery from around the 9th century, religious in nature and showing deities or rulers smoking early forms of cigarettes. When smoking spread beyond the Americas, the painters of the Dutch Golden Age were among the first to portray people smoking and to render still lifes of pipes and tobacco. At first it was considered lowly, tied to peasants. In the 18th century the elegant practice of taking snuff pushed pipe smoking back into portraits of commoners. By the 20th century artists used smoke fully as symbol: the pipe for thoughtfulness and calm, the cigarette for modernity, strength and youth but also nervous anxiety, the cigar for authority, wealth and power. In film, smoke framed characters from the era of silent films onward, lending hard-boiled film noir its aura of mystique or nihilism. After World War II, smoking gradually became less frequent on screen as the hazards grew known. A 2019 study found that the introduction of television in the United States increased the share of smokers by 5 to 15 percentage points, generating roughly 11 million additional smokers between 1946 and 1970. A 2019 CDC analysis of top-grossing films from 2010 to 2018 found tobacco incidents rose 57%, including a 120% increase in PG-13 movies. That same year Netflix announced it would drop smoking from future original series rated TV-14 or below and films rated PG-13 or below, except for historical or factual accuracy. Music carried smoke too. Jazz grew up in bars and clubs thick with it, and cannabis under names like tea, muggles and reefer entered songs such as Louis Armstrong's Muggles. In Jamaica, the Rastafari treated cannabis as a way to come closer to Jah, an association popularized by reggae icons like Bob Marley and Peter Tosh in the 1960s and 70s.

  In the year 2000-32.7% of the global population smoked, and by 2020 that had fallen to 22.7%. Smoking remains far more common among males, with 36.7% of males over 15 smoking compared to 7.8% of females. Among young people aged 15 to 24, the rate dropped from 20.8% in 2000 to 14.2% in 2020. The fastest decline is in the Americas, while Europe sees slower drops. In the United States, smoking fell from 42% in 1965 to 20.8% in 2006, with a significant majority of quitters being professional, affluent men. A paradox sits inside that decline. The average number of cigarettes consumed per person per day rose from 22 in 1954 to 30 in 1978, suggesting that those who quit had smoked less, while those who stayed moved to more light cigarettes. The economic toll is heavy. Smokers cost the U.S. economy an estimated $97.6 billion a year in lost productivity, with another $96.7 billion on health care, over 1% of gross domestic product. A male pack-a-day smoker can expect roughly $19,000 in added lifetime medical expenses, a female pack-a-day smoker about $25,800. International action eventually matched the scale of the problem. The Framework Convention on Tobacco Control, accepted in the World Health Assembly in 2003 and in force in 2005, was the first international treaty on a global health issue, addressing taxes, advertising, trade and more, and helping bring smoke-free laws to 128 countries. Even the military shifted. Within the UK Armed Forces, 27% of personnel smoked in 2011, declining to 18% by 2020, a reversal of an age when tobacco rations were a standard part of the naval rations of many nations.