Bronze-level articleTobacco smoking

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Tobacco smoking, most often associated with "coffin nails," or cigarettes of the tobacco plant (Nicotiana tabacum), is a foul, disgusting habit that stains your fingers and teeth, costs a fortune, "harms nearly every organ of the body" and causes:[1]

  • cancer of the lung (most cases), and some cancers of the bladder, blood (acute myeloid leukemia), cervix, colon and rectum, esophagus, kidney and ureter, larynx, liver, oropharynx, pancreas, and stomach
  • cardiovascular disease, including stroke
  • asthma
  • chronic obstructive pulmonary disease [COPD]
  • reproductive risks (preterm birth, stillbirth, low birth weight, sudden infant death syndrome, ectopic pregnancy, orofacial clefts, reduced sperm quality)
  • lower bone density
  • tooth and gum disease
  • cataracts and age-related macular degeneration
  • type 2 diabetes mellitus
  • inflammation
  • rheumatoid arthritis

Unfortunately, the smokers that visit this page will not care about that stuff.

As drugs go, tobacco has a ridiculously low buzz/harm ratio — in other words, very little buzz, and extremely harmful. And nicotine is actually at least as addictive as heroin or cocaine.[2][3] And delivered like crack.

Contents

[edit] Medicinal use

Buy some 100% all-natural medicinal cigarette cures today! Available at your local naturopath's health food store. (Or at least they would be, if it weren't for those pesky regulations…)[4]
The cure "They" don't want you to know about.

The Native Americans used tobacco as traditional remedy for centuries; they considered it a panacea, using it for teeth whitening, pain relief, diarrhea, neck gland diseases, ulcerated abscesses, burns, wounds, fistulas, sores, polyps, colds, catarrh, headaches, and many other things.[5] The Europeans, when they came, immediately took a liking to it, calling it "God's remedy", and the "holy herb", and started using it for virtually everything. Nicolas Monardes, a physician from Seville, claimed tobacco could cure 36 diseases, including cancer, toothache, and worms.[6] Here are some of his thoughts on tobacco:[7]

I having ministered it to many people as well men as women, in great number, and being grieved of ten, and of twenty years they have healed old rotten sores in legs, and other parts of the body, with only this remedy to the great admiration of all men.
I saw a man that had certain old sores in his nose, whereby he did cast out from him much matter, and daily did rot and canker, and I caused him to take at his nose the juice of this Tobacco, and so he did, and at the second time, he did cast out from him, more then twenty little worms, and afterward a few more, until that he remained clean of them, and using it so certain days, he did heal of the sores, that he had in the inner part of his nose: and if he had tarried any longer, I think that there had remained nothing of his nose, but all had been eaten away, as it does happen to many, which we do see without them. And being writing of this, a daughter of a gentle man of this City, had many years a certain manner of dry scabs, or well near scurvy in her head, I had cured her, and done unto her many benefits, universal, and particular: and also Masters of Surgery had done their diligence, and all did not profit.

Aren't anecdotes fun?

The name nicotiana derives from the name of the French ambassador to Portugal Jean Nicot, who considered tobacco to be a very good remedy and used it to treat cancer (among other things).[6] He also used it for wounds:[5]

When a cook in Nicot's household nearly cut off his thumb with a chopping knife, the steward ran for the tobacco plant and bound the thumb back on; after five or six dressings of the same sort, the wound healed.

Critics of tobacco started becoming active from the 17th century onward (though medicinal tobacco use never really ceased); a notable opponent of tobacco was King James VI of Scotland (of Bible fame), who wrote A Counterblaste to Tobacco in 1604. According to that work, tobacco was also used for smallpox:

For Tobacco being a common herbe, which (though under divers names) growes almost every where, was first found out by some of the barbarous Indians, to be a Preservative, or Antidot against the Pockes, a filthy disease, whereunto these barbarous people are (as all men know) very much subject, what through the uncleanly and adust constitution of their bodies, and what through the intemperate heate of their Climat: so that as from them was first brought into Christendome, that most detestable disease, so from them likewise was brought this use of Tobacco, as a stinking and unsavorie Antidot, for so corrupted and execrable a Maladie, the stinking Suffumigation whereof they yet use against that disease, making so one canker or venime to eate out another.[8]

Wouldn't it have been wonderful if humanity had used the tried-and-true remedies of tobacco and birthwort[9] instead of inventing that harmful smallpox vaccine?

As late as 1931, the herbalist book A Modern Herbal promoted the use of tobacco (emphasis added):

The alkaloid nicotine is a virulent poison producing great disturbance in the digestive and circulatory organs. It innervates the heart, causing palpitation and cardiac irregularities and vascular contraction, and is considered one of the causes of arterial degeneration.

[...]

Tobacco was once used as a relaxant, but is no longer employed except occasionally in chronic asthma. Its active principle is readily absorbed by the skin, and serious, even fatal, poisoning, from a too free application of it to the surface of the skin has resulted.

The smoke acts on the brain, causing nausea, vomiting and drowsiness.

Medicinally it is used as a sedative, diuretic, expectorant, discutient, and sialagogue, and internally only as an emetic, when all other emetics fail. The smoke injected into the rectum or the leaf rolled into a suppository has been beneficial in strangulated hernia, also for obstinate constipation, due to spasm of the bowels, also for retention of urine, spasmodic urethral stricture, hysterical convulsions, worms, and in spasms caused by lead, for croup, and inflammation of the peritoneum, to produce evacuation of the bowels, moderating reaction and dispelling tympanitis, and also in tetanus. To inject the smoke it should be blown into milk and injected, for croup and spasms of the rima glottides it is made into a plaster with Scotch snuff and lard and applied to throat and breast, and has proved very effectual. A cataplasm of the leaves may be used as an ointment for cutaneous diseases. The leaves in combination with the leaves of belladonna or stramonium make an excellent application for obstinate ulcers, painful tremors and spasmodic affections. A wet Tobacco leaf applied to piles is a certain cure. The inspissated juice cures facial neuralgia if rubbed along the tracks of the affected nerve. The quantity of the injection must never exceed a scruple to begin with; half a drachm has been known to produce amaurosis and other eye affections, deafness, etc.

[...]

Externally nicotine is an antiseptic. It is eliminated partly by the lungs, but chiefly in the urine, the secretion of which it increases. Formerly Tobacco in the form of an enema of the leaves was used to relax muscular spasms, to facilitate the reduction of dislocations.[10]

The admission that "nicotine is a virulent poison" is based not on traditional knowledge, but on scientific research conducted in 1828, meaning that if science had left tobacco alone, the book would have probably been much more positive.[5] Note also that no mention is made of the carcinogenity of the plant.[11]

The reason that naturopaths and herbalists today don't recommend tobacco probably has more to do with social taboos rather than any real thought on their part. From a traditional and anecdotal point of view (Native Americans used tobacco for hundreds (if not thousands) of years as a panacea and didn't notice any harmful effects,[5]), there is no reason not to prescribe tobacco. It is true that, from a scientific point of view, medicinal tobacco use is indefensible, but then so are homeopathy and Reiki, key parts of naturopathic healthcare. Naturopaths have absolutely no problem denying the evidence when it suits them, and this anti-science attitude is completely compatible with the prescribing of medicinal tobacco. (Even today, some insist on using cansema, bleach, and bloodletting for medicinal purposes. Tobacco denialism wouldn't be a very radical addition to CAM "thought".)

Governments around the world have tried to warn the public of the dangers of tobacco by initiating anti-smoking campaigns, mandating warnings and graphic images of tobacco-induced diseases on cigarette packs, and banning pro-tobacco ads, to the point that the harms of tobacco are common knowledge; there is virtually no one who does not know tobacco is harmful. In other words, the governments of the world forcibly imposed the scientific consensus that a traditional herbal remedy is ineffective and harmful on the general public, and curtailed its sale by means of stringent regulation. (This is very similar to the sort of scenario that health freedom advocates try to prevent, and it also reminds one of Big Pharma conspiracy theories.) Naturopathy is based pretty much on believing whatever "feels" good, regardless of the evidence, so the position of most naturopaths that tobacco is harmful is probably due to social attitudes caused by governmental regulation (people who seriously claim that tobacco is harmless or even beneficial are met with suspicion or hostility.) Not that it's a bad thing naturopaths reject tobacco, but it's a sheer accident that has nothing to do with their cherry-picking approach being correct. In all likelihood, if it had not been for evidence-based medicine and government regulation, herbalists would still be prescribing medicinal tobacco today.

[edit] Who wins and who loses?

Inherently sexy and rock'n'roll!

Smoking not only fills the coffers of the death industry but also those of the government through high tobacco taxation.[12] At the same time it is also profitable to the pension providers[13] because they don't have to pay out so much to those who die before their time, and also the health insurance companies who can charge higher premiums for smokers. It is estimated that some 15,000 children in the UK end up with asthma as result of their parents' tobacco addiction.[14]

It is also immensely irritating to non-smokers who may be in the vicinity.[15]

[edit] What's in it for the smoker?

The nicotine provides both stimulant and relaxant effects in one go. (That other site has the full list.) The really addictive element is inhaled through the lungs and straight into the brain — even weeks or months after your body has finished withdrawal from the drug, your brain remembers and craves the hit.

In addition to nicotine, tobacco smoke also contains monoamine oxidase (MAO) inhibitors (which act as anti-depressants), which may make the nicotine even more addictive.[16]

Unsurprisingly, users see smoking as a relaxing and deliciously addictive pastime. Most nicotine addicts claim to be aware of the health risks posed by smoking, but aren't really worried until they approach 50, or until they get cancer[17] — whichever comes first. Other favored arguments by proponents are personal freedom (of the tobacco industry to make money) or the "Ah, but X is worse" fallacy.

Logic doesn't work here. Either they're addicted and know the dangers, they're addicted and in denial or they're in the business and want to keep the money rolling in.

While it has been alleged that cigarette smoking makes one look sexy and glamorous, in truth only people who are already sexy and glamorous look this way when smoking.[18] No robust findings have been published on smoking's effect on how fabulously sexy one is, though it does cause premature aging if you find that sexy.[19] (If you're smoking during sex, get a decent water-based lubricant.)

Tobacco is one of the very rare occurrences of a situation (perhaps the only thing similar is the advertising for marmite) in which the producers of a product are paying[20] for advertisements attempting to get people to stop using the product.[21]

For those who absolutely must fill their lungs with gook, pot smoking is much more fun, but, according to some, more dangerous.[22] Marijuana is, however, not causative of lung cancer as tobacco smoking is known to be.[23][24][25] (The lack of marijuana chain smokers who inhale 2 packs a day may have something to do with this.) The possession of marijuana is also illegal in many countries, with punishments ranging from a small fine to execution. So, at least you get the thrill of being a genuine rebel.

[edit] Advantages of smoking

A cigarette, with an attached cancer-causing "filter".

If you smoke, you need no longer pay any attention to the putative health hazards of:

  • Air pollution (that you don't create)
  • Radon leaking up into your house
  • Pesticides in your food
  • Volcanic dust

Think of it like consolidating a pile of small debts into one big debt. But dumber.

[edit] Disadvantages of smoking

If you really need to be told that smoking is bad for you and extremely stupid, you should probably be on a wiki that cares more about the hard of thinking.

[edit] Dirty tricks played by cigarette manufacturers

[edit] Menthol

Menthol (basically mint crystals) was originally added to cigarettes to make the smoke less harsh. However, it was soon discovered that it could also increase the sensation from smoking, to make it a more "fun" (read: addictive) experience. There's now a movement afoot to ban menthol in cigarettes.[26]

[edit] Asbestos filters

In the 1960s, it was not generally known that asbestos contributed to lung cancer. It was not known to the public, it may not have been known to the tobacco industry, but from the 1930s to 1960s the asbestos industry had been covering up all evidence in their research that there was a connection between asbestos and cancer[wp]. So, Kent cigarettes came out with a new, "safer" filter that would supposedly block more of the harmful chemicals in cigarette smoke and wouldn't catch fire (1952-1954). Unbeknownst to most of the public, the secret of this new filter was that it was made of asbestos.[27]

Asbestos filters, mercifully, have been discontinued.

Oh and, the regular, secretly-defective, non-asbestos filter that was used for 40 years was also harmful but the tobacco industry didn't think you would care.[27]

[edit] Other filters

The first cigarette filters were used in 1860.[28] As the hazards of cigarette smoking started to become apparent, the tobacco industry, from the mid-1950s to the mid-1960s, worked on the so-called "filter problem", that is how could the cigarette filter be designed to remove some or most of the dangerous substances from mainstream tobacco smoke. Toward the end of this period the industry concluded that the same substances that were harmful in mainstream smoke were those that gave smokers "satisfaction". Rather than publicly announcing this important conclusion, the industry instead recast the "filter problem" from one of eliminating hazard to one of perpetuation of the false "notion that cigarette filters are effective in reducing these hazards."[29][30]

[edit] "Low tar" cigarettes

"Tar", in double-quotes, is a catch-all term for everything in cigarette smoke that isn't carbon dioxide, carbon monoxide, or nicotine.

Low "tar" cigarettes were all the rage in the 1970s. They didn't use new tobacco formulations, or filter tips that were more selective to screening out "tar" compounds, or anything of the sort. Instead, they relied on the way the Federal Trade Commission tested each brand for its "tar" content: The testers plugged the filter end of a cigarette into a suction machine, ignited the other end, collected all the gases that came out, and measured the amount of "tar" in the collected sample. By adding tiny perforations to the filter in front of the point where it plugged into the suction nozzle, a significant fraction of the gases produced would escape into the air and not be collected by the machine.

Smokers, of course, could simply cover up the filter perforations with their fingers, thus getting far more "tar" in their lungs than the FTC method would suggest. They had an incentive to do so, too: Every bit of escaping "tar" smoke also took some of the precious nicotine with it.

[edit] Added ammonia

Ever on the lookout for new ways to keep their customers hooked, cigarette companies eventually stumbled upon the notion of adding ammonia to the tobacco. This resulted in the nicotine being absorbed more quickly into the smokers' lungs, thereby increasing the "hit" that they experienced and deepening their addiction.

[edit] Who should smoke?

Nobody. You might hear some people claim that smoking can help alleviate symptoms from maladie du jour, but just remember: bleach would be a perfectly good antibacterial if it didn't also kill the patient. There is nothing that smoking could treat that would offset the harm done by smoking… that said, smoking has some known effects that some people might consider for self-medication.

People with mental disorders and schizophrenics in particular have heavy rates of smoking.[31] It has been widely thought that tobacco use is a form of self-medication, but there is some evidence that usage is actually causative of psychosis.[32] Or because mental hospitals are incredibly boring places. However, the high rate of smoking in schizophrenics and other mentally ill patients has resulted in 30% more heart disease and 30% more respiratory disorders than the general population. A doctor would be ill-advised to recommend smoking as any advisable course of action for any patient with a mental disorder.

Nicotine has been found to provide limited help with cognition (memory, attention and thought organization) impairment in patients suffering from schizophrenia,[33] but since nicotine is still less than ideal even without the carcinogenic burning vegetable matter (e.g. it correlates with Alzheimer's[34]), scientists are at work on drugs similar to nicotine to provide the benefits without the dangers. Smoking is however still not in any way recommendable to schizophrenics for helping with these cognition impairments because the positive effects are short-lived as resistance sets in very quickly, while the highly-addictive nature of nicotine results in a quick dependence upon the drug even though positive benefits have already been exhausted.

In short, even if you're schizophrenic, you might only find temporary relief of cognition impairment, but once the positive effects have fully faded away, you're now addicted to a deadly poison that is killing you. So, don't smoke.

It is well known that smoking causes an increase in blood pressure,[35] which is just one of the many reasons why doctors recommend people quit smoking, as raising blood pressure is typically a bad idea for almost everyone. However, some conditions result in symptoms of chronic low blood pressure (hypotension), and while this is typically regarded as a fortunate situation, in some cases low blood pressure can become so drastic that it starts becoming symptomatic, i.e. dizziness and fainting. But since doctors typically only deal with acute hypotension due to shock or blood loss, most treatments for symptomatic hypotension focus on treatments that are really only available in hospitals on an emergency basis. Thus, people struggling with chronic low blood pressure and inadequate healthcare might be tempted to self-medicate their condition with smoking, and unlike the case with schizophrenics, this relatively beneficial raising of the blood pressure does not quickly disappear, and would actually work as a long-term solution… You know, if it weren't for the lung and heart problems, cancer, and other generally lethal consequences of smoking.

[edit] Second-hand smoke

See the main article on this topic: Second-hand smoke

[edit] Second-hand smoke deniers

[edit] Vaporizers

Electronic cigarettes (a.k.a. e-cigarettes, or vaporisers) dispense a still-dodgy nicotine hit without the immense amounts of intensely carcinogenic burning vegetable matter. They are much more convenient, as the user does not have to worry about smoke detectors/smoking bans, a lasting smell, having an ashtray on hand indoors etc. and is not restricted to single cigarette lengths, easily turning a light smoker into a chain smoker heavy nicotine addict. E-cigarettes are largely unregulated. As of December 2014, children can legally buy them in in 10 US states and the District of Columbia.[37]

E-cigarettes were introduced in the US in 2007 and marketed as a way for smokers to quit, they actually do not increase the rate of smoking cessation.[38][39]

Teen use of e-cigarettes has become especially high recently, even surpassing the use of regular cigarettes starting in 2014.[37] Though e-cigarettes are often marketed as being harmless — or at least not harmful — nicotine in itself is particularly addictive to young people (as tobacco companies have long known) and can be harmful in itself, causing impaired attention, depression, anxiety and increased impulsive behavior.[37][40] Vaporized nicotine alone, as well as nicotine-free e-liquid, can harm lung tissue in vitro.[37][41] E-liquids, with or without nicotine, both caused toxicity, oxidative stress and inflammation to mouse lung tissues when tested in vivo.[37][42] Chronic inflammation is a known cause of cancer.[43] As far as acute toxicity in humans, there were 1351 poisonings from e-liquids in 2013, including one suicide by injection of nicotine.[44]

The contents of e-liquids used in vaping are rarely fully disclosed, and the amounts of nicotine or other chemicals included is often not accurate. Claims of safety may be based on FDA approval of food additives, but the safety of food additives was never intended to imply inhalation safety. Some of the chemicals found in e-liquids even exceeded workplace safety levels.[37][45] Pyrazines, long added to cigarettes, have also been added to e-cigarettes, making them less harsh (and likely more addictive).[37][46]

[edit] Quitting

Stopping smoking is very difficult for most people. Nicotine is ridiculously addictive. The removal of nicotine's antipsychotic effects means that many quitters find themselves becoming crazy people for a time.

Nicotine patches or gum work for some people, but don't provide the hit.

Alternatively one can read a certain book, which has the effect of brainwashing the reader into believing quitting smoking is easy and the best thing you will do in your life by repeating an analogy about smoking being like wearing tight shoes all day to experience the relief of taking them off (a lot). This (along with hypnosis and other self-help programs and support groups) might rely on the placebo effect, but unfortunately, when it comes to any addiction without a convenient agonist (and nicotine doesn't have one), the placebo effect is in medical terms the only effect you can count on.

All that aside, the horrifying fact is that the pathways physical dependency emerges from are highly flexible, but not elastic. They adapt to a certain dosage schedule and respond (as any ex-smoker can tell you, do they ever!) when that schedule isn't met. The result for most narcotics (and certainly for nicotine) is a ratchet effect. The only way to go from the constant agony of withdrawal to the occasional agony of post-addiction is to stop introducing the addictive stimulus. Or, in even simpler terms, if you're addicted to nicotine to the point that you need a biologically significant amount in your system at all times, whenever you stop taking nicotine, you will undergo severe withdrawals. Once you're habituated, the severity and length of habit make only a minor difference in how nasty it is to break that habit.

What's worse, significantly undercutting the habitual dosage schedule is also highly unpleasant — and can only reduce the body's anticipated dosage schedule glacially. You are going to experience what many people rate as the worst experience of their lives, and levels of discomfort, unease, mental instability, and craving you literally have no way to imagine, for no less than a week. And that's being optimistic. (If you don't smoke or are only doing so "occasionally", best to avoid that, huh?) Any smoking cessation plan in which one actually quits smoking eventually ends in 1-2 weeks of withdrawal, months to years of situational cravings, and a lifetime with that much less respiratory damage, carcinogenic risk, and hand-over-fist expense to worry about.

There's medically just no way better than cold turkey. Unlike alcohol, heroin, and certain benzodiazepines, abrupt cessation is never going to kill you. (Don't go cold turkey from those after long-term addiction, please.) Nicotine delivery methods other than cigarettes as a quitting system will only kick the can down the road. They are, on the other hand, a good way for the people selling them to make money off of your anxiety, and their commercials look almost as scientific as the ones for shampoo. It's your call, isn't it?

[edit] Support

The best advice for supporting a quitter is to take it seriously. Help them avoid nicotine, even though everything in their body is incessantly begging for it. If they've given over the pack or carton they have on hand just in case, put a few degrees of separation between it and you. At the very least, never make it easier for them to lapse.

If you're a smoker, keep it out of the environment. Don't smoke around them, try not to have cigarettes on you when dealing with them if possible, and don't talk about smoking. If their quitting bothers you for some reason, suck it up and deal with it like an adult; if you blow smoke in their face or offer them one on the side like a giant Goddamn baby, you're basically angling to sentence them to more time in withdrawal, which is a lot like Hell (only it's a real thing and there's no way to cheat your way out of it by being a nice person or pitching woo to a bearded man). Don't be Dennis Leary.

If you're not a smoker or a vicious prick, by all means make yourself useful, but don't get in their way. They're likely to snap at you, like everything else in the world, because their brains have temporarily replaced the 'response' part of stimulus/response with 'impotent rage'. Let them have it after they're out of the woods, by all means, but don't bother trying to beat it out of them — their reptile brain would swan dive into a family of bears for another smoke before being hugged to a paste and devoured, and you're no bear.

If you're a bear, why are you here? This is a wiki. There is nothing for bears here.

[edit] What about quitting smoking, without quitting nicotine?

Since nicotine is so ferociously addictive, it may not be possible for every smoker to quit. Some may see the alternative of getting their nicotine fix in a non-carcinogenic package as preferable to both the incessant cravings of quitting and the death sentence of continuing to smoke cigarettes.

If you're planning to go this route — whether through nicotine gum, inhalers, e-cigarettes, air-cured smokeless tobacco[47], or some other nicotine delivery system — be aware of two things:

  1. Other means of getting nicotine are not guaranteed to eliminate your craving for cigarettes. Cigarettes deliver the nicotine to your lungs in a very specific way, which contributes to its addictive quality and which other means might lack. Cigarette smoke also contains MAO Inhibitors, which contribute to the addictive nature of smoking and which other nicotine delivery systems lack.
  2. Nicotine itself has some health risks, separate and distinct from tobacco smoke. It's linked with Alzheimer's disease (though correlation does not imply causation), it causes a temporary constriction of the blood vessels and increase in blood pressure, and may very well be the component of cigarette smoke that contributes to atherosclerosis.

Quitting all nicotine products entirely carries the greatest potential health benefit. You'll just have to weigh that benefit against its cost.

[edit] Ye Olde Cigarette Shoppe

These claims are completely different from the ones used to sell supplements. Not the same at all. Really.

Many of these ancient "medicinal" cigarettes used cubeb[wp] instead of tobacco. While cubeb (Piper cubeba) is not known for containing nicotine, setting it on fire and inhaling the smoke will surely impart just as nasty a cocktail of carcinogens to your lungs as smoking a tobacco cigarette will.

More vintage cigarette ads that can't be added to RationalWiki for copyright reasons can be found here (medical claims abound).

[edit] See also

Icon fun.svg For those of you in the mood, RationalWiki has a fun article about Tobacco.

[edit] External links

[edit] Footnotes

  1. CDC: Smoking & Tobacco Use
  2. Nicotine and addiction, June 2013 — http://ash.org.uk/files/documents/ASH_114.pdf
  3. Though in 1994 several tobacco company executives flat-out denied that it is addictive, thus winning the 1996 Ig Nobel Prize for Medicine.[1][2]
  4. Of course, since smoking will alleviate the immediate symptoms (coughing), it seems to work initially (hence why it was once recommended as a cough remedy), but as smoking actually worsen the underlying illness (ever heard a smoker's "morning cough" before the first smoke of the day?) it's pretty much like pissing in your pants to keep warm in the winter.
  5. 5.0 5.1 5.2 5.3 Medicinal uses of tobacco in history, Anne Charlton, J R Soc Med. 2004 June; 97(6): 292–296. PMCID: PMC1079499.
  6. 6.0 6.1 A history of the medicinal use of tobacco 1492-1860, Grace G. Stewart, Med Hist. 1967 July; 11(3): 228–268. PMCID: PMC1033728.
  7. Of the Tabaco and of His Greate Vertues
  8. A Counterblaste to Tobacco, Wikisource.
  9. Birthwort, A Modern Herbal.
  10. Tobacco, A Modern Herbal, Maud Grieve.
  11. Raw tobacco leaves actually contain no known carcinogens. During flue-curing (but not air-curing), carcinogenic compounds develop in tobacco leaves, which is why smokeless tobacco (including chewing tobacco) causes oral and pancreatic cancers in humans.[3] Setting tobacco on fire, on the other hand, creates a far worse cocktail of carcinogens; this is the main reason cigarette smoking causes cancer.
  12. Subject to change depends on the health care expenses incurred (if government pays for health care) due to the consequences of smoking.
  13. Unless the pension is defined-benefit and includes post-employment health care coverages for some odd reason.
  14. 15,000 kids with asthma
  15. Especially those with pre-existing attitude or lung problems
  16. Monoamine Oxidase Inhibition Dramatically Increases the Motivation to Self-Administer Nicotine in Rats, The Journal of Neuroscience, August (?) 2005
  17. Or emphysema, heart disease, chronic hacking coughs, etc.
  18. Unless you have a smoking fetish. Then the smoker might as well be hideous.
  19. Is it true that smoking causes wrinkles?
  20. Mostly involuntarily, due to legislation or court rulings.
  21. Yes, they are daring you not to buy cigarettes!
  22. Lung damage from pot
  23. Study finds no cancer-marijuana connection
  24. Cannabis 'safer than alcohol and tobacco'
  25. Cannabis smoke less carcinogenic than tobacco smoke
  26. Not Kool: It’s time to ban menthol cigarettes., New Scientist, 26-Oct-2013
  27. 27.0 27.1 Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers by J. L. Pauly et al. Tobacco Control 2002;11:i51-i61 doi:10.1136/tc.11.suppl_1.i51.
  28. Cigarettes with defective filters marketed for 40 years: what Philip Morris never told smokers
  29. The intractable cigarette 'filter problem'
  30. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents by L. Kozlowski & R. O'Connor Tobacco Control 2002 Mar; 11(Suppl 1): i40–i50.
  31. Most people with schizophrenia smoke tobacco, says research (myDr.com.au, 9 April 2001)
  32. New analysis of smoking and schizophrenia suggests causal link Fri Jul 10, 2015 4:31am IST Reuters.
  33. Smoking away Schizophrenia? (Lisa Conti, Scientific American, 2007-11-28)
  34. Nicotine tied to Alzheimer's risk (Wendy Zukerman, New Scientist, 2010-04-14). This appears to supersede earlier reports that nicotine might help break up the amyloid plaques.
  35. Smoking and high blood pressure
  36. http://web.archive.org/web/20080508022124/http://www.forestonline.org/files/pdf/JJ%20Essay%20web.pdf
  37. 37.0 37.1 37.2 37.3 37.4 37.5 37.6 E-cigarettes proving to be a danger to teens: Vaping is more popular than smoking among young people by Janet Raloff (9:00am, June 30, 2015) Science News.
  38. E-cigarettes don’t help smokers quit, study finds: People who tried electronic devices no more likely to give up smokes a year later by Nathan Seppa (4:00pm, March 24, 2014) Science News.
  39. A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation by Rachel A. Grana et al. JAMA Intern. Med. 2014;174(5):812-813. doi:10.1001/jamainternmed.2014.187.
  40. Short- and Long-Term Consequences of Nicotine Exposure during Adolescence for Prefrontal Cortex Neuronal Network Function by Natalia A. Goriounova & Huibert D. Mansvelder Cold Spring Harbor Perspect Med. 2012 Dec; 2(12): a012120. doi: 10.1101/cshperspect.a012120.
  41. Endothelial disruptive pro-inflammatory effects of nicotine and e-cigarette vapor exposures by Kelly S. Schweitzer et al. American Journal of Physiology — Lung Cellular and Molecular Physiology (Published 15 May 2015) DOI: 10.1152/ajplung.00411.2014.
  42. Vapors Produced by Electronic Cigarettes and E-Juices with Flavorings Induce Toxicity, Oxidative Stress, and Inflammatory Response in Lung Epithelial Cells and in Mouse Lung by Chad A. Lerner et al. (February 6, 2015) PLOS One DOI: 10.1371/journal.pone.0116732.
  43. Chronic Inflammation and Cancer by Emily Shacter & Sigmund A. Weitzman (January 31, 2002) Oncology.
  44. Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes by Matt Richtel (March 23, 2014) New York Times.
  45. Flavour chemicals in electronic cigarette fluids by Peyton A. Tierney et al. (15 April 2015) Tob. Control doi:10.1136/tobaccocontrol-2014-052175.
  46. A study of pyrazines in cigarettes and how additives might be used to enhance tobacco addiction by Hillel R. Alpert, et al. (10 June 2015) Tob. Control doi:10.1136/tobaccocontrol-2014-051943.
  47. Smokeless tobacco is also carcinogenic.[4]
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