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| [[Image:Papierosa 1 ubt 0069.jpeg|thumb|200px|An industrially manufactured [[cigarette]] burning in an ashtray; today the most common form of smoking.]] | | [[Image:Papierosa 1 ubt 0069.jpeg|thumb|200px|An industrially manufactured [[cigarette]] burning in an ashtray; today the most common form of smoking.]] |
| {{Smoking}} | | {{Smoking}} |
| {{CMG}}; {{AE}} {{CZ}} | | {{CMG}}; {{AE}} {{USAMA}}, {{SMP}}, {{AKI}}<br> |
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| ==Overview==
| | {{SK}} Smoking, tobacco smoking, cigarette smoking |
| Smoking is a recreational activity in which a substance, most commonly [[tobacco]], is burnt and the smoke tasted or inhaled. This is primarily done as a form of [[recreational drug use]], as [[combustion]] releases the active substances in drugs such as [[nicotine]] and makes them available for absorption through the [[lung]]s. It can also be done as a part of religious rituals, to induce trances and spiritual enlightenment. The most common method of smoking today is through [[cigarette]]s, either industrially manufactured or rolled with loose tobacco and a rolling paper. Other forms, though less common, are pipes, [[cigar]]s, bongs, and [[hookah]]s. | |
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| Smoking is one of the most common forms of recreational drug use. [[Tobacco smoking]] is today by far the most popular form of smoking and is practiced by over one billion people in the majority of all human societies. Less common drugs for smoking include [[cannabis smoking|cannabis]] and [[opium]]. Most drugs that are smoked are considered to be addictive. Some of the substances are classified as hard [[narcotic]]s, like [[heroin]] and [[crack cocaine]], but the use of these is usually limited to socially marginalized groups.
| | ==[[Smoking overview|Overview]]== |
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| The history of smoking can be dated to as early as 5000 BC, and has been recorded in many different cultures across the world. [[Tobacco]] has been cultivated and smoked in the Americas for at least 5000 years, originating in the Peruvian and Ecuadorian Andes.<ref>Gately</ref> The smoking of [[cannabis]] in India has been practiced for over 4000 years.<ref name="Nahas3">Nahas, p. 3</ref> Early smoking evolved in association with religious ceremonies; as offerings to deities, in cleansing rituals or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americas, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Subsaharan Africa, it merged with existing practices of smoking (mostly of cannabis). In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown.
| | ==[[Smoking historical perspective|Historical Perspective]]== |
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| The cultural perception surrounding smoking has varied over time and from one place to another; holy and sinful, sophisticated and vulgar, a [[panacea]] and deadly health hazard. Only recently, and primarily in industrialized Western countries, has smoking come to be viewed in a decidedly negative light. The well-proven health hazards of smoking have caused many countries to institute high taxes on tobacco products and anti-smoking campaigns are launched every year in an attempt to curb smoking. Several countries, states and cities have also imposed [[smoking ban]]s in most public places.
| | ==[[Smoking classification|Classification]]== |
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| ==Historical Perspective== | | ==[[Smoking pathophysiology|Pathophysiology]]== |
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| Smoking has been practiced in one form or another since ancient times. Tobacco and various hallucinogenic drugs were smoked all over the Americas as early as 5000 BC in shamanistic rituals.<ref>Wilbert</ref> Many ancient civilizations, such as the Babylonians, Indians and Chinese, burnt incense as a part of religious rituals, as did the Israelites and the later Catholic and Orthodox Christian churches. In Ancient Greece, smoke was used as healing practice and the Oracle of Delphi made prophecies while intoxicated by inhaling natural gases from a natural bore hole. The Greek historian Herodotos also wrote that the Scythians used [[cannabis]] for ritual purposes and, to some degree, pleasure. He describes how Scythians burned hemp seed:
| | ==[[Smoking causes|Causes]]== |
| {{cquote|At once it begins to smoke, giving off a vapour unsurpassed by any vapour-bath one could find in Greece. The Scythians enjoy it so much that they howl with pleasure.<ref>Gilman, Sander L. and Zhou Xun. ''Smoke''; ''Introduction'' p. 12</ref>}}
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| [[Image:Aztec feast 1.jpg|thumb|150px|left|Aztec women are handed flowers and smoking tubes before eating at a banquet, Florentine Codex, 16th century.]]
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| Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure or as a social tool.<ref>Robicsek (1978), p. 30</ref> The Maya employed it in classical times (at least from the 10th century) and the Aztecs included it in their mythology. The Aztec goddess Cihuacoahuatl had a body consisting of tobacco and the priests that performed human sacrifices wore tobacco gourds as symbols of divinity. Even today certain Tzeltal Maya sacrifice 13 calabashes of tobacco at New Year.<ref>Robicsek, Francis ''Smoke''; ''Ritual Smoking in Central America'' p. 33</ref> The smoking of tobacco and various other hallucinogenic drugs was used to achieve trances and to come into contact with the spirit world. Reports from the first European explorers and conquistadors to reach the Americas tell of rituals where native priests smoked themselves into such high degrees of intoxication that it is unlikely that the rituals were limited to just tobacco. No concrete evidence of exactly what was smoked exists, but the most probable theory is that the tobacco used was much stronger, consumed in extreme amounts or that it was mixed with any number of other, unknown, psychoactive drugs. In North America the most common form of smoking was in pipes, which today are best known as the peace pipes offered both to other tribes and later European settlers as a gesture of goodwill and diplomacy. In the Caribbean, Mexico and Central and South America, early forms of cigarettes, smoking reeds or cigars were the most common smoking tools. Only in modern times has the use of pipes become fairly widespread. Smoking is depicted in engravings and on various types of pottery as early as the 9th century, but it is not known whether it was limited to just the upper class and priests.<ref>Robicsek, Francis ''Smoke''; ''Ritual Smoking in Central America'' p. 35</ref>
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| By the time Europeans arrived in the Americas in the late 15th century there was widespread use of tobacco smoking as a recreational activity. At the banquets of Aztec nobles, the meal would commence by passing out fragrant flowers and smoking tubes for the dinner guests. At the end of the feast, which would last all night, the remaining flowers, smoking tubes and food would be given as a kind of alms to old and poor people who had been invited to witness the social occasion, or it would be rewarded to the servants.<ref>Coe, pp. 74-81</ref>
| | ==[[Smoking differential diagnosis|Differentiating Any Disease from other Diseases]]== |
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| <div align="left">
| | ==[[Smoking epidemiology and demographics|Epidemiology and Demographics]]== |
| <gallery heights="175" widths="175">
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| Image:Mayan priest smoking.jpg|A carving from the temple at Palenque, Mexico, depicting a Mayan priest using a smoking tube.
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| Image:Die truckene Trunkenheit.jpg|An engraving from Jakob Balde's ''Die truckene Trunkenheit'' ("The Dry Drunkenness") from 1658.
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| </gallery>
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| </div>
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| ===The tobacco revolution=== | | ==[[Smoking risk factors|Risk Factors]]== |
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| After the European exploration and subsequent colonization of the Americas in the 16th century, the smoking, cultivation and trading of [[tobacco]] quickly spread to all corners of the globe. By the mid-17th century every major civilization had been introduced to tobacco smoking and in many cases had already assimilated it into the native culture, despite the attempts of many rulers to stamp the practice out with harsh penalties or fines. Tobacco, both product and plant, followed the major trade routes to major ports and markets, and then on into the hinterlands. The English language term 'smoking' was coined in the late 17th century; until then it was referred to as 'drinking smoke'.<ref name="L&M">Lloyd & Mitchinson</ref>
| | ==[[Smoking screening|Screening]]== |
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| Soon after its introduction to the Old World, tobacco came under frequent criticism from state and religious leaders. Murad IV, sultan of the Ottoman Empire 1623-40 was among the first to attempt a smoking ban by claiming it was a threat to public moral and health. The Chinese emperor Chongzhen issued an edict banning smoking two years before his death and the overthrow of the Ming dynasty. Later, the Manchu of the Qing dynasty, who were originally a tribe of nomadic horse warriors, would proclaim smoking "a more heinous crime than that even of neglecting archery". In Edo period Japan, some of the earliest tobacco plantations were scorned by the shogunate as being a threat to the military economy by letting valuable farmland go to waste for the use of a recreational drug instead of being used to plant food crops.<ref>Screech, Timon ''Smoke''; ''Tobacco in Edo Period Japan'' pp. 92-99</ref> Religious leaders have often been prominent among those who considered smoking immoral or outright blasphemous. In 1634 the Patriarch of Moscow forbade the sale of tobacco and sentenced men and women who flaunted the ban to have their nostrils slit and their backs whipped until skin came off their backs. The Western church leader Urban VII likewise condemned smoking in a papal bull of 1642. Despite many concerted efforts, restrictions and bans were almost universally ignored. When James I of England, a staunch anti-smoker and the author of a ''A Counterblaste to Tobacco'', tried to curb the new trend by enforcing a whopping 4000% tax increase on tobacco in 1604, it proved a failure, as London had some 7,000 tobacco sellers by the early 17th century. Later, scrupulous rulers would realise the futility of smoking bans and instead turned tobacco trade and cultivation into lucrative government monopolies.<ref>Gilman, Sander L. and Zhou Xun. ''Smoke''; ''Introduction'' p. 15-16</ref>
| | ==[[Smoking natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===Europe=== | | ==Diagnosis== |
| [[Image:Gentlemen Smoking and Playing Backgammon in an Interior.jpg|thumb|220px|left|''Gentlemen Smoking and Playing Backgammon in an Interior'' by Dirck Hals, 1627.]] | | [[Smoking history and symptoms|History and Symptoms]] | [[Smoking physical examination|Physical Examination]] | [[Smoking laboratory findings|Laboratory Findings]] | [[Smoking chest x ray|Chest X Ray]] | [[Smoking CT|CT]] | [[Smoking MRI|MRI]] | [[Smoking echocardiography or ultrasound|Ultrasound]] | [[Smoking other imaging findings|Other Imaging Findings]] | [[Smoking other diagnostic studies|Other Diagnostic Studies]] |
| A Frenchman named Jean Nicot (from whose name the word nicotine is derived) introduced tobacco to France in 1560. From France tobacco spread to England. The first report of a smoking Englishman is of a sailor in Bristol in 1556, seen "emitting smoke from his nostrils".<ref name="L&M"/> Like tea, coffee and opium, tobacco was just one of many intoxicants that was originally used as a form of medicine.<ref>Pollard, Tanya ''Smoke''; ''The Pleasures and Perils of Smoking in Early Modern England'' p. 38</ref> Early modern European medical science was still to a great extent based on humorism, the idea that everything had a specific humoral nature that varied between hot and cold, dry and moist. Tobacco was often seen as something that was beneficially in its heating and drying properties and was assigned an endless list of beneficial properties. The concept of ingesting substances in the form of smoke was also entirely new and was met with both astonishment and great skepticism by Europeans. The debate raged among priests, scientists and laymen whether tobacco was a bane or boon and both sides had powerful supporters. The English king James I of England|James I was one of the first outspoken skeptics and wrote ''A Counterblaste to Tobacco'', an unforgiving literary assault on what he believed was a menace to society. Though rife with, at times, irrelevant and partial arguments, it did address some of the health issues and pointed out the peculiar fact that tobacco was frequently assigned conflicting, and at times almost miraculous, properties:
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| {{cquote|It makes a man sober that was drunke. It refreshes a weary man, and yet makes a man hungry. Being taken when they goe to bed, it makes one sleepe soundly, and yet being taken when a man is sleepie and drowsie, it will, as they say, awake his braine, and quicken his understanding. As for curing of the Pockes, it serves for that use but among the pockie Indian slaves. Here in England it is refined, and will not deigne to cure heere any other then cleanly and gentlemanly diseases.}}
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| ===The Middle East=== | | ==Treatment== |
| [[Image:Persian girl smoking.jpg|thumb|150px|left|A Persian girl smoking by Muhammad Qasim. Isfahan, 17th century.]] | | [[Heat stroke medical therapy|Medical Therapy]] | [[Heat stroke surgery|Surgery]] | [[Heat stroke primary prevention|Primary Prevention]] | [[Heat stroke secondary prevention|Secondary Prevention]] | [[Heat stroke cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Heat stroke future or investigational therapies|Future or Investigational Therapies]] |
| [[Cannabis smoking]] was common in the Middle East before the arrival of tobacco, and was early on a common social activity that centered around the type of water pipe called a [[hookah]]. The pipes would often have several tubes from which more than one person could smoke at a time, or the nozzle would be passed around in the many smoking houses that functioned as social hubs in major centers of Muslim culture like Constantinople, Baghdad and Cairo. Smoking, especially after the introduction of tobacco, was an essential component of Muslim society and culture and became integrated with important traditions like weddings, funerals and was expressed in architecture, clothing, literature and poetry.<ref>Gilman, Sander L. and Zhou Xun. ''Smoke''; ''Introduction'' p. 20-21</ref> | |
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| There is reference to tobacco in Persian poem dating from before 1536, but because of the lack of any corroborating sources, the authenticity of the source has been questioned. The next reliable eyewitness account of tobacco smoking is by a Spanish envoy in 1617, but by this time the practice was already deeply engrained in Persian society. The water pipe called ''qalyan'' (or [[hookah]]) most likely originated in India, but it was in Safavid dynasty Persia that it became a refined smoking tool. The pipes of the rich were made of finely crafted glass and precious metals while common people used coconuts with bamboo tubing, and these were used to smoke cannabis before the arrival of tobacco. The two substances in combination proved very popular and were also smoked in normal "dry" pipes, but the water pipe remained the most common smoking tool until the introduction of the cigarette in the 20th century. Foreign visitors to the region often remarked that smoking was immensely popular among Persians; on Ramadan, the Muslim period of fasting when no food was to be eaten while the sun was up, among the first thing many Persians did after sunset was to light their pipes. Both sexes smoked, but for women it was a private affair enjoyed in the seclusion of private homes. In the 19th century Iran was one of the world's largest tobacco exporters and the habit had by then become something considered a national Iranian trait.<ref>''Smoke'', ''Tobacco in Iran'' pp. 58-67</ref>
| | ==Case Studies== |
| | [[Smoking case study one|Case #1]] |
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| ===East Asia===
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| [[Image:Komon gawa.jpg|thumb|100px|left|A man smoking a kiseru on the cover of ''Komon gawa'' ("Elegant chats on fashion"), a novel by Santō Kyōden published in 1790.]]
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| After the European discovery of the Americas, tobacco was spread to Asia, first by Spanish and Portuguese sailors and later by the Dutch and English. Spain and Portugal were active in Central and South America, where cigarettes and cigars were the smoking tools of choice, and their sailors smoked mostly cigars. The English and Dutch had contact with the pipe smoking natives of North America, and took over their habits. While the southern Europeans began smoking earlier, it was the long-stemmed pipes of the northerners that became popular in East and Southeast Asia. Tobacco smoking arrived through expatriates in the Phillipines and was introduced as early as the 1570s.<ref>Suzuki, Barnabas Tatsuya ''Smoke''; ''Tobacco Culture in Japan'' pp. 76-83</ref>
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| By the early 1600s the kiseru, a long-stemmed Japanese pipe inspired by Dutch clay pipes, was common enough to be mentioned in Buddhist text books for children. The practice of tobacco smoking evolved as a part of the Japanese tea ceremony by employing many of the traditional object used to burn incense for tobacco smoking. The ''kō-bon'' (the incense tray) became the ''tabako-bon'', the incense burner evolved into a pot for tobacco embers and the incense pot became an ash tray.
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| During the Edo period weapons were frequently used as objects with which one could flaunt ones wealth and social status. Since only samurais were allowed to carry weapons, an elaborate kiseru slung from the waist would serve a similar purpose. After the Meiji restoration and the abolishment of the caste system, many craftsmen who previously had worked on decorating swords moved on to designing kiserus and buckles for tobacco pouches. Though mass-production of cigarettes began in the late 19th century, it was not until after World War II that the kiseru went of out style and became an object of tradition and relative obscurity.<ref>Screech, Timon ''Smoke''; ''Tobacco in Edo Period Japan'' pp. 92-99</ref>
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| ===South Asia===
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| [[Image:Djarum-blacks-kretek.jpg|thumb|150px|left|Djarum Blacks, a popular brand of Indonesian clove-flavoured cigarettes called ''kretek''.]]
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| Cannabis smoking in India has been known at least since 2000 BC and is first mentioned in the ''Atharvaveda'' which dates back a few hundred years BC. Fumigation (''dhupa'') and fire offerings (''homa'') are prescribed in the Ayurveda for medical purposes and have been practiced for at least 3,000 years while smoking, ''dhumapana'' (literally "drinking smoke"), has been practiced for at least 2,000 years. Fumigation and fire offerings have been performed with various substances, including clarified butter (ghee), fish offal, dried snake skins and various pastes molded around incense sticks and lit to spread the smoke over wide areas. The practice of inhaling smoke has been employed as a remedy for many different ailments and has not been limited to just [[cannabis smoking|cannabis]], but also various plants and medicinal concoctions, and is also recommended to be performed daily to promote general health. Before modern times, smoking was done with pipes with stems of various lengths or chillums. Today ''dhumapana'' has been replaced almost entirely with cigarette smoking, but both ''dhupa'' and ''homa'' are still practiced. [[Beedi]], a type of handrolled herbal cigarette consisting of cloves, ground betel nut, and tobacco, usually with rather low proportion of tobacco, are a modern descendant of the historical ''dhumapana''.<ref>Manohar, P. Ram, ''Smoke''; ''Smoking and Ayurvedic Medicine in India'' pp. 68-75</ref>
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| In Indonesia, a specific type of cigarette which includes cloves called ''[[kretek]]'' was invented in the early 1880s as a way of delivering the therapeutic properties of clove oil, or [[eugenol]], to the lungs. It quickly become a popular cough remedy and in the early 20th century ''kretek'' began to be marketed as a pre-rolled cigarette (rather than being mixed and rolled by consumers). In the 1960s and 70s, ''kretek'' took on the form of a national symbol, with tax breaks compared to "white" cigarettes<ref>Website of US Embassy in Jakarta, [http://www.usembassyjakarta.org/econ/kretek.html JUNE 3, 1999: WHERE THERE'S SMOKE, THERE'S KRETEK: THE CIGARETTE INDUSTRY IN INDONESIA], accessed July 20, 2007</ref> and the production began to shift from traditional hand-rolling to machine-rolling. The industrial method passed the hand-rolled type in numbers in the mid-1980s and today ''kretek'' dominates up to 90% of the Indonesian cigarette market. The production is one of the largest sources of income for the Indonesian government and the production, which is spread out on some 500 independent manufacturers, employs some 180,000 people directly and over 10 million indirectly.<ref>Hanusz, Mark ''Smoke''; ''A Century of Kretek'' pp. 140-143</ref>
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| ===Sub-Saharan Africa===
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| [[Image:Nama Woman Smoking Kalahari Desert Namibia Luca Galuzzi 2004.JPG|thumb|left|240px|A Nana woman smoking in the Kalahari Desert in Namibia.]]
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| Cannabis smoking was introduced to Sub-Saharan Africa through Ethiopia and the east African coast by either Indian or Arab traders in the 13th century or earlier and spread on the same trade routes as those that carried coffee, which originated in the highlands of Ethiopia.<ref>Phillips, pp. 303-319</ref> It was smoked in calabash water pipes with terra cotta smoking bowls, apparently an Ethiopian invention which was later conveyed to eastern, southern and central Africa. Tobacco was introduced around 1600 by French merchants in what today is modern-day Gambia and Senegal. At the same time caravans from Morocco brought tobacco to the areas around Timbuktu and the Portuguese brought the commodity (and the plant) to southern Africa, establishing the popularity of tobacco throughout all of Africa by the 1650s. Both imported tobacco and tobacco pipes became prized and valuable trading goods and were both quickly absorbed into African cultural traditions, rituals and politics. A rich artistic tradition of decorated pipes of wood, ceramics and, eventually, metal developed and spawned an endless variety of themes and motifs of all shapes and sizes. Tobacco and cannabis were used, much like elsewhere in the world, to confirm social relations, but also created entirely new ones. In what is today Congo, a society called Bena Diemba ("People of Cannabis") was organized in the late 19th century in Lubuko ("The Land of Friendship"). The Bena Diemba were collectivist pacifists that rejected alcohol and herbal medicines in favor of cannabis and practiced ritual nudity, shaved their heads and bodies to break with their former social identities. They built large communal dwellings which built around a central plaza where cannabis would be smoked by the entire community through enormous water pipes made from gourds.<ref>Roberts, Allen F. ''Smoke''; ''Smoking in Sub-Saharan Africa'' pp. 53-54</ref>
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| Certain other herbs have been and still are smoked by certain African communities. Tabwa shamans smoke ''lubowe'' (''Amaranthus dubius''), a plant that is said to aid in the shamans in seeing invisible spirit sorcerer, even though there are no reports of the substance being hallucinogenic. Some groups, such as the Fang of Gabon consume ''eboga'' (''Tabernanthe iboga''), a mind-altering drug in religious rituals. In modern Africa, smoking is in most areas considered to be modern and an expression of modernity, and many of the strong adverse opinions that prevail in the West receive much less attention.<ref>Roberts, Allen F. ''Smoke''; ''Smoking in Sub-Saharan Africa'' pp. 46-57</ref>
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| ===Opium smoking===
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| {{main|Opium}}
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| [[Image:French opium den.jpg|thumb|150px|An illustration of an opium den on the cover of ''Le Petit Journal'', July 5, 1903.]]
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| In the 19th century the practice of smoking [[opium]] became common. Previously it had only been eaten, and then primarily for its medical properties. A massive increase in opium smoking in China was more or less directly instigated by the British trade deficit with Qing dynasty China. As a way to amend this problem, the British began exporting large amounts of opium grown in the Indian colonies. The social problems and the large net loss of currency led to several Chinese attempts to stop the imports which eventually culminated in the Opium Wars. Opium smoking later spread with Chinese immigrants and spawned many infamous opium dens in China towns around South and Southeast Asia and Europe. In the later half of the 19th century, opium smoking became popular in the artistic community in Europe, especially Paris in artists' neighborhoods such as and Montparnasse and Montmartre being virtual "opium capitals". While opium dens that catered primarily to emigrant Chinese continued to exist in China Towns around the world, the trend among the European artists largely abated after the outbreak of World War I.<ref>Ten Berge, Jos ''Smoke''; ''The ''Belle Epoque'' of Opium'' p. 114</ref>
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| ===The social stigma===
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| Ever since smoking was introduced outside of the Americas, there had been many vehement protests against it. Arguments had ranged from socio-economic ones, with tobacco being considered a usurper of good farm land, to purely moralistic ones, where many religiously devout individuals saw tobacco as merely another form of immoral intoxication. Many arguments were presented to the effect that smoking was harmful, and even if the critics were in the end right about many of their claims, the complaints were usually not based on scientific arguments, and if they were, these often relied on humorism and other pre-modern scientific methods. It was not until the early 20th century that serious medical studies began to be conducted and one of the true breakthroughs came in 1948, when the British physiologist [[Richard Doll]] published the first major studies that proved that smoking could cause serious health damage.<ref>Gilman, Sander L. and Zhou Xun. ''Smoke''; ''Introduction'' p. 25</ref>
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| ==Pathophysiology==
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| [[Image:Blood nicotine graph.jpg|thumb|200px|right|A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake.]]
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| Inhaling the vaporized gas form of substances into the lungs is a quick and very effective way of delivering drugs into the bloodstream and affects the user within seconds of the first inhalation. The lungs consist of several million tiny bulbs called [[alveoli]] that altogether have an area of over 70 m²(about the area of a tennis court). This can be used to administer useful medical as well as recreational drugs that as aerosols, consisting of tiny droplets of a medication, or as gas produced by burning plant material with a psychoactive substance or pure forms of the substance itself. Not all drugs can be smoked, for example the sulphate derivative that is most commonly inhaled through the nose, though purer free base forms of substances can, but often require considerable skill in administering the drug properly. The method is also somewhat inefficient since not all of the smoke will be inhaled.<ref>Iverson, Leslie; ''Smoke'', ''Why do We Smoke?: The Physiology of Smoking'' p. 318</ref> The inhaled substances trigger chemical reactions in nerve endings in the brain due to being similar to naturally occurring substances such as [[endorphin]]s and [[dopamine]]s, which are associated with sensations of pleasure. The result is what is usually referred to as a "high" that ranges between the mild stimulus caused by [[nicotine]] to the intense euphoria caused by [[heroin]], [[cocaine]] and [[methamphetamine]]s.<ref>Iverson, Leslie; ''Smoke'', ''Why do We Smoke?: The Physiology of Smoking'' pp. 320-321</ref>
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| Inhaling smoke into the lungs, no matter the substance, has adverse effects on one's health. The incomplete combustion produced by burning plant material, like tobacco or cannabis, produces [[carbon monoxide]], which impairs the ability of blood to carry oxygen when inhaled into the lungs. There are several other toxic compounds in tobacco that constitute serious health hazards to long-term smokers from a whole range of causes; [[lung cancer]], [[myocardial infarction|heart attack]]s, [[stroke]]s, [[impotence]], low birth weight of infants born by smoking mothers.
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| ==Smoking substances==
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| The most popular type of substance that is smoked is [[tobacco smoking|tobacco]]. There are many different tobacco cultivars which are made into a wide variety of mixtures and brands. Tobacco is often sold flavored, often with various fruit aromas, something which is especially popular for use with water pipes, such as [[hookah]]s. The second most common substance that is smoked is [[cannabis smoking|cannabis]], made from the flowers or leaves of ''[[Cannabis sativa]]''. The substance is considered illegal in most countries in the world and in those countries that tolerate public consumption, it is usually only pseudo-legal. Despite this, a considerable percentage of the adult population in many countries have tried it with smaller minorities doing it on a regular basis. Since cannabis is illegal or only tolerated in most jurisdictions, there is no industrial mass-production of cigarettes, meaning that the most common form of smoking is with hand-rolled cigarettes (often called [[joint]]s) or with pipes. Water pipes are also fairly common, and when used for cannabis are called bongs.
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| A few other recreational drugs are smoked by smaller minorities. Most of these substances are [[controlled substance|controlled]], and some are considerably more intoxicating than either tobacco or cannabis. These include [[crack cocaine]], [[heroin]], [[methamphetamine]] and [[Phencyclidine|PCP]]. A small number of [[psychedelic]] drugs are also smoked, including [[dimethyltryptamine|DMT]], [[5-Meo-DMT]], and [[Salvia divinorum]].
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| ==Smoking Tools==
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| [[Image:Fangspipe ubt.jpeg|thumb|200px|right|An elaborately decorated pipe.]]
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| Even the most primitive form of smoking requires tools of some sort to perform. This has resulted in a staggering variety of smoking tools from all over the world. Whether tobacco, herbs, or some other form of receptacle is required along with a source of fire to light the mixture. The most common today is by far the [[cigarette]], consisting of a tightly rolled tube of paper, which is usually manufactured industrially or rolled from loose tobacco, rolling papers and usually includes a filter. Other popular smoking tools are various pipes and [[cigar]]s. A less common but increasingly popular form is through [[vaporizer]]s, which operate using hot air convection by heating and delivering the substance without combustion; thereby decreasing health risks to lungs.
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| Other than the actual smoking equipment, many other items are associated with smoking: cigarette cases, cigar boxes, lighters, matchboxes, cigarette holders, cigar holders, ashtrays, pipe cleaners, tobacco cutters, match stands, pipe tampers, cigarette companions and so on. Many of these have become valuable collector items and particularly ornate and antique items can fetch high prices at the finest auction houses.
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| ==Social effects==
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| Smoking, primarily of tobacco, is an activity that is practiced by some 1.1 billion people, and up to 1/3 of the adult population.<ref>Gilman, Sander L. and Zhou Xun. ''Smoke''; ''Introduction'' p. 26</ref> The image of the smoker can vary considerably, but is very often associated, especially in fiction, with individuality and aloofness. Even so, smoking of both tobacco and cannabis can be a social activity which serves as a reinforcement of social structures and is part of the cultural rituals of many and diverse social and ethnic groups. Many smokers begin smoking in social settings and the offering and sharing of a cigarette is often an important rite of initiation or simply a good excuse to start a conversation with strangers in many settings; in bars, night clubs, at work or on the street. Lighting a cigarette is often seen as an effective way of avoiding the appearance of idleness or mere loitering. For adolescents, it can function as a first step out of childhood or as an act of rebellion against the adult world. Other than recreational drug use, it can be used to construct identity and a development of self-image by associating it with personal experiences connected with smoking. The rise of the modern anti-smoking movement in the late 19th century did more than create awareness of the hazards of smoking; it provoked reactions of smokers against what was, and often still is, perceived as an assault on personal freedom and has created an identity among smokers as rebels, apart from non-smokers:
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| {{cquote|There is a new Marlboro land, not of lonesome cowboys, but of social-spirited urbanites, united against the perceived strictures of public health.<ref>Hilton, Matthew ''Smoke''; ''Smoking and Sociability'' p. 133</ref>}}
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| The importance of tobacco to soldiers was early on recognized as something that could not be ignored by commanders. By the 17th century allowances of tobacco were a standard part of the naval rations of many nations and by World War I cigarette manufacturers and governments collaborated in securing tobacco and cigarette allowances to soldiers in the field. Until the mid-20th century, the majority of the adult population in many Western nations were smokers and the claims of anti-smoking activists were met with much skepticism, if not outright contempt. Today the movement has considerably more weight and evidence of its claims, but a considerable proportion of the population remains steadfast smokers.<ref>Hilton, Matthew ''Smoke''; ''Smoking and Sociability'' pp. 126-133</ref>
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| ===Public health and crime===
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| {{main|Health effects of tobacco smoking}}
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| [[Image:Cancer smoking lung cancer correlation from NIH.svg|thumb|200px|right|Chart showing the relation between lung-cancer and smoking.]]
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| Tobacco-related diseases are (according to some studies) some of the biggest killers in the world today and is cited as being one of the biggest cause of premature death in industrial countries. In the United States some 500,000 deaths per year are attributed to lung cancer and a recent study estimated that as much as 1/3 of China's male population will suffer shortened life-spans due to smoking.<ref>Iverson, Leslie, ''Smoke''; ''Why do We Smoke?: The Physiology of Smoking'' p. 320</ref>
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| The effects of addiction on society vary considerably between different substances that can be smoked and the indirect social problems that they cause, in great part because of the differences in legislation and the enforcement of narcotics legislation around the world. Though nicotine is a highly addictive drug, its effects on cognition are not as intense, noticeable or debilitating as cannabis, cocaine, amphetamines or any of the [[opiate]]s. As tobacco is also not an illegal drug, there is no black market with high risks and high prices for consumers.
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| ==Smoking in culture==
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| Smoking has been accepted into culture, in various art forms, and has developed many distinct, and often conflicting or mutually exclusive, meanings depending on time, place and the practitioners of smoking. Pipe smoking, until recently one of the most common forms of smoking, is today often associated with solemn contemplation, old age and is often considered quaint and archaic. Cigarette smoking, which did not begin to become widespread until the late 19th century, has more associations of modernity and the faster pace of the industrialized world. Cigars have been, and still are, associated with masculinity, power and is an iconic image associated with the stereotypical capitalist. Smoking in public has for a long time been something reserved for men and when done by women has been associated with promiscuity. In Japan during the Edo period, prostitutes and their clients would often approach one another under the guise of offering a smoke and the same was true for 19th century Europe.<ref>Screech, Timon ''Smoke''; ''Tobacco in Edo Period Japan'' pp. 92-99</ref>
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| ===Art===
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| [[Image:Apothecary smoking pipe.jpg|thumb|right|''An Apothecary Smoking in an Interior'' by Adriaen van Ostade, oil on panel, 1646.]]
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| Among the earliest depictions of smoking can be found on Classical Mayan pottery from around the 9th century. The art was primarily religious in nature and depicted deities or rulers smoking early forms of cigarettes.<ref>Robicsek (1978)</ref> Soon after smoking was introduced outside of the Americas it began appearing in painting in Europe and Asia. The painters of the Dutch Golden Age were among the first to paint portraits of people smoking and still-lifes of pipes and tobacco. For southern European painters of the 17th century, a pipe was much too modern to include in the preferred motifs inspired by mythology from Greek and Roman antiquity. At first smoking was considered lowly and was associated with peasants. Many early paintings were of scenes set in taverns or brothels. Later, as the Dutch Republic rose to considerable power and wealth, smoking became more common amongst the affluent and portraits of elegant gentlemen tastefully raising a pipe appeared. Smoking represented pleasure, transience and the briefness of earthly life as it, quite literally, went up in smoke. Smoking was also associated with representations of both the sense of smell and that of taste.
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| In the 18th century smoking became far more sparse in painting as the elegant practice of taking snuff became popular. Smoking a pipe was again relegated to portraits of lowly commoners and country folk and the refined sniffing of shredded tobacco followed by sneezing was rare in art. When smoking appeared it was often in the exotic portraits influenced by Orientalism, projecting an image of European superiority over its colonies and a perception of male dominance of a feminized Occident. The theme of the exotic and alien "Other" escalated in the 19th century, fueled by the rise in popularity of ethnology during the Enlightenment.<ref>Davidson Kalmar, Ivan ''Smoke''; ''The ''Houkah'' in the Harem: On Smoking and Orientalist Art'' pp. 218-229</ref>
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| [[Image:Skull with a Burning Cigarette.jpg|thumb|150px|left|''Skull with a Burning Cigarette '' by Vincent van Gogh, oil on canvas, 1885.]]
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| In the 19th century smoking was common as a symbol of simple pleasures; the pipe smoking "noble savage", solemn contemplation by Classical Roman ruins, scenes of an artists becoming one with nature while slowly toking a pipe. The newly-empowered middle class also found a new dimension of smoking as a harmless pleasure enjoyed in smoking saloons and libraries. Smoking a cigarette or a cigar would also become associated with the bohemian, someone who shunned the conservative middle class values and displayed his contempts for conservatism. But this was a pleasure that was to be confined to a male world; women smokers were associated with prostitution and was not something that proper ladies should be involved in. It was not until the turn of the century that smoking women would appear in paintings and photos, giving a chic and charming impression. Impressionists like Vincent van Gogh, who was a pipe smoker himself, would also begin to associate smoking with gloom and ''fin-du-siècle'' fatalism.
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| While the symbolism of the cigarette, pipe and cigar respectively were consolidated in the late 19th century, it was not until the 20th century that artists began to use it fully; a pipe would stand for thoughtfulness and calm; the cigarette symbolized modernity, strength and youth, but also nervous anxiety; the cigar was a sign of authority, wealth and power. The decades following World War II, during the apex of smoking when the practice had still not come under fire by the growing anti-smoking movement, a cigarette casually tucked between the lips represented the young rebel, epitomized in actors like Marlon Brando and James Dean or mainstays of advertising like the Marlboro Man. It was not until the 1970s when the negative aspects of smoking began to appear; the unhealthy lower-class loser, reeking of cigarette smoke and lack of motivation and drive, especially in art inspired or commissioned by anti-smoking campaigns.<ref>Tempel, Benno ''Smoke''; ''Symbol and Image: Smoking in Art since the Seventeenth Century'' pp. 206-217</ref>
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| ===Film===
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| [[Image:Humphrey Bogart by Karsh (Library and Archives Canada).jpg|200px|thumb|right|Film star and iconic smoker Humphrey Bogart.]]
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| Ever since the era of silent films, smoking has had a major part in film symbolism. In the hard boiled ''film noir'' crime thrillers, cigarette smoke often frames characters and is frequently used to add an aura of mystique or even nihilism. One of the forerunners of this symbolism can be seen in Fritz Lang's Weimar era ''Dr Mabuse, der Spieler'' (''Dr Mabuse, the Gambler''), where men mesmerized by card playing smoke cigarettes while gambling. Women smokers in film were also early on associated with a type of sensuous and seductive sexuality, most notably personified by German film star Marlene Dietrich. Similarly, male actors like Humphrey Bogart have been closely identified with their smoker persona and some of their most famous portraits and roles have involved a thick mist of cigarette smoke.
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| Since World War II, smoking has gradually become less frequent on screen as the obvious health hazards of smoking have become more widely known. With the anti-smoking movement gaining greater respect and influence, conscious attempts not to show smoking on screen are now undertaken in order to avoid encouraging smoking or giving it positive associations, particularly for family films. Smoking on screen is more common today among characters who are portrayed as anti-social or even criminal.<ref>Iserberg, Noah ''Smoke''; ''Cinematic Smoke: From Weimar to Hollywood'' pp. 248-255</ref>
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| ===Literature===
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| [[Image:My Lady Nicotine.jpg|thumb|200px|right|The cover of ''My Lady Nicotine: A Study in Smoke'' (1896) by J.M. Barrie, otherwise best known for his play ''Peter Pan''.]]
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| Just as in other types of fiction, smoking has had an important place in literature and smokers are often portrayed as characters with great individuality, or outright eccentrics, something typically personified in one of the most iconic smoking literary figures of all, Sherlock Holmes. Other than being a frequent part of short stories and novels, smoking has spawned endless eulogies, praising its qualities and affirming the author's identity as a devoted smoker. Especially during the late 19th century and early 20th century, a panoply of books with titles like ''Tobacco: Its History and associations'' (1876), ''Cigarettes in Fact and Fancy'' (1906) and ''Pipe and Pouch: The Smokers Own Book of Poetry'' (1905) were written in the UK and the US. The titles were written by men for other men and contained general tidbits and poetic musings about the love for tobacco and all things related to it, and frequently praised the refined bachelor's life. ''The Fragrant Weed: Some of the Good Things Which Have been Said or Sung about Tobacco'', published in 1907, contained, among many others, the following lines from the poem ''A Bachelor's Views'' by Tom Hall that were typical of the attitude in many of the books:
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| {{cquote|So let us drink</br>To her, – but think</br>Of him who has to keep her;</br>And ''sans'' a wife</br>Let's spend our life</br>In bachelordom, – it's cheaper.<ref>Umberger, Eugene ''Smoke''; ''In Praise of Lady Nicotine: A Bygone Era of Prose, Poetry... and Presentation'' p. 241</ref>}}
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| These works were all published in an era before the cigarette had become the dominant form of tobacco consumption and pipes, cigars and chewing tobacco were still commonplace. Many of the books were published in novel packaging that would attract the learned smoking gentleman. ''Pipe and Pouch'' came in a leather bag resembling a tobacco pouch and ''Cigarettes in Fact and Fancy'' (1901) came bound in leather, packaged in an imitation cardboard cigar box. By the late 1920s, the publication of this type of literature largely abated and was only sporadically revived in the later 20th century.<ref>Umberger, Eugene ''Smoke''; ''In Praise of Lady Nicotine: A Bygone Era of Prose, Poetry... and Presentation'' pp. 236-247</ref>
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| ==Related Chapters==
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| *[[Tobacco smoking]]
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| *[[Health effects of tobacco smoking]]
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| *[[Tobacco]]
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| *[[Addiction]]
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| *[[Cancer]]
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| *[[Smokers Rights]]
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| ==References==
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| {{reflist|2}}
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| ==Sources==
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| * Coe, Sophie D. (1994) ''America's first cuisines'' ISBN 0-292-71159-X
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| *Gately, I. (2003) ''Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization'' ISBN 0-80213-960-4
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| *James I of England, ''[http://www.la.utexas.edu/research/poltheory/james/blaste/ A Counterblaste to Tobacco]''
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| *Lloyd, J & Mitchinson, J: "The Book of General Ignorance". Faber & Faber, 2006
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| *Nahas, G. G. (1999) ''Marihuana and Medicine'' ISBN 0-89603-593-X
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| *Phillips, J. E. ''African Smoking and Pipes'',''The Journal of African History'', Vol. 24, No. 3.
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| *Robicsek, F. (1978) ''The Smoking Gods: Tobacco in Maya Art, History, and Religion'' ISBN 0-80611-511-4
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| *''Smoke: A Global History of Smoking'' (2004) edited by Sander L. Gilman and Zhou Xun ISBN 1-86189-200-4
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| *Wilbert, J. (1993) ''Tobacco and Shamanism in South America'' ISBN 0300057903
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| [[Category:Primary care]]
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