Shopping on line can be easy, simple and save you lots of money. It can also take a lot of your time, frustrate you, and result in unwanted purchases. Now the same can be said for regular high street shopping, but with the vast opportunity presented by the Internet it will pay you to spend a few minutes reading this and understanding how to better optimize your Tobacco Smoking shopping experience:

1. Compare - without doubt the biggest advantage that the Tobacco Smoking offers shoppers today is the ability to compare thousands of Tobacco Smoking at a time. This is a great thing, but not necessarily all the time! Too much can be daunting at times so take advantage of the great comparison sites and where possible let them do the hard work for you.

2. Research - if it has been said it will be on the internet. Ignorance is no longer a justifiable reason for buying the wrong thing. Take the time to research in detail everything that you could possible want to know about

3. Testimonials - don't know anybody that has bought a Tobacco Smoking? Wrong! If the Tobacco Smoking is good the internet will let you know. Use the Internet as a friend and get testimonials before you buy.

4. Questions - Got a question about Tobacco Smoking then search the Forums, FAQ's, Blogs etc. Don't be afraid to ask .....

5. Reputation - Never heard of the company selling Tobacco Smoking? Don't worry, no reason why you should know every company in the world, but you know someone that does! Use the internet to find out what people are saying about Tobacco Smoking and build up a picture of their reputation for sales, returns, customer service, delivery etc.

6. Returns - still worried that even after all of the above your Tobacco Smoking wont be what you want? Check out the returns policy. There is so much competition now that someone, somewhere is bound to offer the terms that you are comfortable with.

7. Feedback - happy with your Tobacco Smoking then let people know, after all you are depending on others people input in your buying decision, so why not give a little back.

8. Security - check for the yellow padlock on the Tobacco Smoking site before you buy, and the s after http:/ /i.e. https:// = a secure site

9. Contact - got a question about Tobacco Smoking, or want to leave a comment then check out the sites contact page. Reputable companies have them and respond.

10. Payment - ready to pay for your Tobacco Smoking, then use your credit card or PayPal! Be aware of companies that don't accept them, there may be genuine reasons but given the huge amount of choice you have when buying online there is no reason at all not to buy via credit card or PayPal.

is the most common method of smoking tobacco. Tobacco smoking is the act of burning the dried or cured leaves of the tobacco plant and smoking for pleasure, for ritualistic or social purposes, self-medication, or simply to satisfy physical dependence. Tobacco use by Indigenous peoples of the Americas throughout North and South America dates back to 2000BC and there are depictions of ancient Mayans smoking a crude cigar. The practice was brought back to Europe by the crew of Christopher Columbus. Tobacco Smoking took hold in Spain and was introduced to the rest of the world, via trade.

Tobacco smoke contains nicotine, an addiction stimulant and Euphoriant. The effect of nicotine in first time or irregular users is an increase in alertness and memory, and mild euphoria. In chronic users, nicotine simply relieves the symptoms of nicotine withdrawal: confusion, restlessness, anxiety, insomnia, and dysphoria. Withdrawal symptoms in chronic users begin to appear approximately 30 minutes after every dose. Nicotine also disturbs metabolism and suppresses appetite. This is because nicotine, like many stimulants, increases blood sugar.

It has been determined that all forms of tobacco use are addictive.

Medical research has determined that chronic tobacco smoking can lead to many health problems, particularly lung cancer, emphysema, and cardiovascular disease. List of health effects by CDC List of health effects by Australia's myDr Methods of smoking Cigarette Cigarette smoking is the most common form of tobacco consumption. It leads all other methods by more than a factor of 10-- but nearly 99% of all tobacco advertising is to promote cigarettes, indicating that the industry finds this format most profitable . A cigarette is a product manufactured from cured and cut tobacco leaves, which are rolled and/or stuffed into a paper-wrapped cylinder. Because of the curing process, the smoke is mild enough to inhale in overdose quantities, unlike cigar or pipe tobacco. The largest state of tobacco production in the United States is North Carolina. Cigarettes also contain a number of additives, particularly to enhance taste. The cigarette is lit, usually with a match or lighter at one end and allowed to burn for the purpose of inhalation of its smoke from the other (usually cigarette filter) end, which is inserted in the mouth. "Roll ups" are also very popular, particularly in European countries; these are prepared from loose tobacco, cigarette papers and filters all bought separately. Cigarettes are smoked by some with a cigarette holder. (See also Beedi).

Cigar A cigar is a cylinder of tobacco rolled in tobacco leaves for smoking and generally puffed, not inhaled. They come in many shapes and sizes, the most common being the "Corona", "Cigarillo", "Blunt" and "Robusto". The tobacco used is grown throughout the Caribbean in places such as the Dominican Republic, Nicaragua, Honduras, Jamaica, and Cuba. A popular light colored "shade" wrappers is from Connecticut whereas darker Maduro wrappers come from the Caribbean. Cigars manufactured in Cuba have historically been considered to be without peer..

Pipe A pipe for smoking typically consists of a small chamber (bowl) for combustion of the substance to be smoked and a thin stem (shank) that ends in a mouthpiece (also called a bit). Pipes are made from a variety of materials (some obscure): briar, corncob, meerschaum, clay, wood, glass, gourd, bamboo, and various other materials, such as metal. Tobacco used for smoking pipes is often chemically treated and altered to change smell and taste (both functions are affected negatively in humans by smoking) not available in other tobacco products sold commercially. Many of these are mixtures using staple ingredients of variously cured Burley and Virginia tobaccos which are mixed with tobaccos from different areas, such as Oriental or Balkan locations. Latakia (tobacco) (a fire-cured tobacco of Cypriot or Syrian origin), Perique (only grown in St. James Parish, Louisiana) or combinations of Virginia and Burley tobaccos of African, Indian, or South American origins. Traditionally, many U.S. tobaccos are made of American Burley with artificial sweeteners and flavorings added to create an artificial "aromatic" smell, whereas "English" blends are based on natural Virginia tobaccos enhanced with Oriental and other natural tobaccos. There is a growing tendency towards "natural" tobaccos which derive their aromas from blending with spice tobaccos alone and historically-based curing processes.

Pipes can range from the very simple machine-made briar pipe to handmade and artful implements created by pipe-makers which can be very expensive collector's items. The popularity of pipe smoking in Western countries has declined in recent years under the onslaught of cigarette advertising. However, it has also enjoyed a resurgence of late among younger and middle aged smokers who find its contemplative nature and age-transcendent status as "hobby not habit" to be both thoroughly enjoyable and stress-relieving. As many pipe-smokers say, "We don't inhale."

Hookah A hookah (or sheesha) is a type of traditional Middle Eastern and South Asian water pipe, a pipe which operates by water-filtration and indirect heat. Hookahs are most popular in the Middle East, but form a niche market in many other places. In many situations, hookahs are loaded with hashish or opium. In the Far East opium and cannabis are also among the traditional drugs used.

Typically, tobacco is smoked from a hookah by placing richly flavored tobaccos in the smoking bowl, covering it with foil, and placing a coal on top of the foil. This keeps the tobacco from burning, and allows it to bake. The resulting vapors are further cooled by the hookah water, resulting in a moist, warm smoke. The Al-Waha, Al Fakher, and Nakhla tobacco companies compete for market share in the Middle East by producing increasingly luxurious flavored tobaccos for use in the hookah. Currently available flavors include the traditional apple, grape, double apple, orange, strawberry, cherry, mango, vanilla, and melon flavors; as well as the modern cola, coconut, cappuccino, and banana milk flavors.

Popular myth suggests that hookah smoking is considered to be safer than other forms of smoking. However, water is not effective for removing all relevant toxins, e.g. the carcinogenic aromatic hydrocarbons are not water-soluble. Several serious negative health effects are linked to hookah smoking and studies indicate that it is likely to be more harmful to health than cigarettes, due in part to the volume of smoke inhaled. One study found hookah smoke to be both clastogenic and genotoxic for human beings, Genetic risk assessment in hookah smokers. while another study showed that the carbon monoxide hazard is as high with hookah smoking as with cigarette smoking. Carbon monoxide fractions in cigarette and hookah (hubble bubble) smoke. In addition to the cancer risk, there is some risk of infectious disease resulting from pipe sharing, and other risks associated with the common addition of other psychoactive drugs to the tobacco. Water-Pipe (Narghile) Smoking: An Emerging Health Risk Behavior

Health effects As the use of tobacco became popular in Europe, some people became concerned about its possible ill effects on the health of its users. One of the first was James I of England. In 1604, he wrote A Counterblaste to Tobacco in which he asked his subjects A Counterblaste to Tobacco, by King James I of England

You have not reason then to be ashamed, and to forbeare this filthie noveltie, so basely grounded, so foolishly received and so grossly mistaken in the right use thereof? In your abuse thereof sinning against God, harming your selves both in persons and goods, and raking also thereby the marks and notes of vanitie upon you: by the custome thereof making your selves to be wondered at by all forraine civil Nations, and by all strangers that come among you, to be scorned and contemned. A custom loathsome to the eye, hateful to the Nose, harmful to the brain, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse.

In 1761, English doctor John Hill published "Cautions against the Immoderate Use of Snuff" in which he warned snuff users that they were vulnerable to cancers of the nose. http://books.nap.edu/openbook.php?record_id=10029&page=593 Tobacco Timeline: The Eighteenth Century -- Snuff Holds Sway In 1795, American Samuel Thomas von Soemmering reported on cancers of the lip in pipe smokers. The late-19th century invention of automated cigarette making machinery in the American South made possible mass production of cigarettes at low cost; the profits endowed Duke University, and cigarettes became elegant and fashionable among society men as the Victorian era gave way to the Edwardian. In 1912, American Dr. Isaac Adler was the first to strongly suggest that lung cancer is related to smoking. Isaac Adler. Primary Malignant Growth of the Lung and Bronchi. New York, Longmans, Green and Company, 1912, pp. 3-12. Reprinted in 1980 by A Cancer Journal for Clinicians In 1929, Fritz Lickint of Dresden, Germany, published a formal statistical evidence of a lung cancer–tobacco link, based on a study showing that lung cancer sufferers were likely to be smokers. http://ije.oxfordjournals.org/cgi/content/full/30/1/31 Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less). Many American and other servicemen began smoking during World War I and World War II when cigarettes were included in military rations and distributed by charitable organizations.

In 1950, Dr. Richard Doll published research in a 1950 issue of the British Medical Journal showing a close link between smoking and lung cancer. Four years later, in 1954 the British Doctors Study, a study of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related. The British Doctors Study lasted till 2001, with result published every ten years and final results published in 2004. Reader's Digest was a major crusader and for decades published many anti-smoking articles. In 1964, Luther L. Terry, M.D., Surgeon General of the United States, released the report of the Surgeon General's Advisory Committee on Smoking and Health. It was based on over 7000 scientific articles that linked tobacco use with cancer and other diseases. This report led to laws requiring warning labels on tobacco products and to restrictions on tobacco advertisements. As these began to come into force, tobacco marketing became more subtle, with sweets shaped like cigarettes put on the market, and a number of adverts designed to appeal to children, particularly those featuring Joe Camel resulting in increased awareness and uptake of smoking among childrenWhile D, Kelly S, Huang W, Charlton A. Cigarette advertising and onset of smoking in children: questionnaire survey. BMJ. 1996 Aug 17;313(7054):398-9. PMID 8761227. However, restrictions did have an effect on adult quit rates, with its use declining to the point that by 2004, nearly half of all Americans who had ever smoked had quit. Cigarette Smoking Among Adults — United States, 2004 MMWR Weekly, November 11, 2005. In the 1950s, manufacturers began adding filter tips to cigarettes to remove some of the tar and nicotine as they were smoked. "Safer", "less potent" cigarette brands were also introduced. Light cigarettes became so popular that, as of 2004, half of American smokers preferred them over regular cigarettes. Light but just as deadly, by Peter Lavelle. The Pulse, October 21, 2004. in spite the fact that the idea of a "safer" cigarette is a myth. Cigarettes that offer, "low tar and nicotine" cause the smoker to smoke more or to inhale more deeply to get the same level of nicotine. According to The Federal Government’s National Cancer Institute (NCI), light cigarettes provide no benefit to smoker's health. The Truth About "Light" Cigarettes: Questions and Answers, from the National Cancer Institute factsheet 'Safer' cigarette myth goes up in smoke, by Andy Coghlan. New Scientist, 2004

Health risks of smoking The health effects of tobacco smoking are related to direct tobacco smoking, as well as passive smoking, inhalation of environmental or secondhand tobacco smoke. A British Doctors Study showed that nonsmokers lived about 10 years longer than smokers. For those born between 1920 and 1929 the Mortality rate between the ages of 35 and 69 for nonsmokers was 15% and for smokers was 45%, three times as great. Claims that personalities of smokers account for these differences are not convincing in light of the fact that the heavy smokers were about 25 times more likely to die of lung cancer or chronic obstructive pulmonary disease than the nonsmokers. Another source claims smoking is responsible for 87% of lung cancer deaths.

The main health risks in tobacco pertain to diseases of the cardiovascular system, in particular myocardial infarction (heart attack), diseases of the respiratory system such as Chronic Obstructive Pulmonary Disease (COPD), asthmaGilliland FD, Islam T, Berhane K, Gauderman WJ, McConnell R, Avol E, Peters JM. Regular smoking and asthma incidence in adolescents. Am J Respir Crit Care Med. 2006 Nov 15;174(10):1094-100. PMID 16973983, emphysema, and cancer, particularly lung cancer and cancers of the larynx and tongue. Prior to World War I, lung cancer was considered to be a rare disease, which most physicians would never see during their careerWitschi 2001, A Short History of Lung Cancer. Toxicol Sci. 2001 Nov;64(1):4-6. PMID 11606795 Adler I. Primary malignant growths of the lungs and bronchi. New York: Longmans, Green, and Company; 1912., cited in Spiro SG, Silvestri GA. One hundred years of lung cancer. Am J Respir Crit Care Med. 2005 Sep 1;172(5):523-9. PMID 15961694. With the postwar rise in popularity of cigarette smoking, however, came a virtual epidemic of lung cancer.

A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker. The health risks of smoking are not uniform across all smokers. Risks vary according to amount of tobacco smoked, with those who smoke more at greater risk. Light smoking is still a health risk.

According to the Surgeon General of The United States, mortality rates for pipe smokers and cigar smokers who smoke less than five cigars per day are roughly the same as for non-smokers. The data regarding smoking to date focuses primarily on cigarette smoking, which even by conservative estimates increases mortality rates by 40%. Men who smoke 10-19 cigarettes a day have a 70% increase in mortality rates, men who smoke 20-39 cigarettes a day have an increase in mortality rate by 90%, for men smoking two packs a day or more, their mortality rates increased 120%.http://profiles.nlm.nih.gov/NN/B/B/K/M/_/nnbbkm.pdf 1967 Surgeon General's Report on Smoking

According to the Canadian Lung Association, tobacco kills between 40,000–45,000 Canadians per year, more than the total number of deaths from AIDS, traffic accidents, suicide, murder, fires and accidental poisoning. Smoking and Teens, Canadian Lung Association, Newspaper articles, Canada, Canadian Cancer Society Allan Rock announces collaborative research initiative on smoking The United States' Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide".

Tobacco smoke has been shown to contain trace amounts of the radioactive isotope Polonium 210, which is around 250 thousand times as toxic as hydrogen cyanide.

Infant mortality Tobacco smoke reduces the delivery of oxygen to the fetus through the presence of carbon monoxide, cyanide, and aromatic hydrocarbons. Nicotine and other substances in tobacco smoke cause reduction in placental blood flow, creating further reductions in oxygen delivery as well as reductions in nutrients to the unborn baby. Secondhand smoke exposure during pregnancy produces twice the risk of low birth weight babies. Smoking is the single largest modifiable risk factor in intrauterine growth retardation.

Carcinogenicity Smoke, or any partially burnt organic matter, is carcinogenic (cancer-causing). Lung cancer rates are linked to the number of people who smoke. It is noted that an increase in deaths from lung cancer appeared 20 years after an increase in cigarette consumption. The damage a continuing smoker does to their lungs can take up to 20 years before its physical manifestation in lung cancer. Women began smoking later than men, so the rise in death rate amongst women did not appear until later. The male lung cancer death rate decreased in 1975 — roughly 20 years after the fall in cigarette consumption in men. A fall in consumption in women also began in 1975 but by 1991 had not manifested in a decrease in lung cancer related mortalities amongst women.

, a polynuclear aromatic hydrocarbon, produced by burning tobacco.The primary carcinogens are the pyrolysis products of tobacco leaves. Any partially burnt material, tobacco or not, contains polycyclic aromatic hydrocarbons, particularly benzopyrene. The mechanism of their carcinogenity is well-known: oxidation produces an epoxide, which binds to DNA covalently and distorts it. If the cell cannot repair its DNA damage prior to undergoing mitotic division, the daughter cells carry a greater risk of becoming carcinogenic. DNA damage is one of the causes of cancer, because if the poison damages the programmed cell death system severely enough (usually requiring more than one mutation), damaged cells cannot kill themselves and begin to divide uncontrollably. This results in the formation of tumors that have the potential of becoming cancerous. The DNA oxidative damage is non-specific, so oncogenes and tumor suppressor genes (both genes associated with tumorgenicity) aren't always targeted. This results in an essentially random occurrence of cancer, where the probability increases with increasing exposure. In this respect, the mechanism of carcinogenicity closely resembles that of mustard gas, aflatoxin and other DNA alkylating agents.

Tobacco smoke also contains various carcinogens other than polynuclear aromatic hydrocarbons, such as traces of radioactive elements. Smoking is therefore an important route of exposure to ionizing radiation.

For example, smoke from tobacco grown with phosphate fertilizers contains polonium 210. Polonium 210 is an emitter of alpha particles, which cannot penetrate skin and are harmless outside the body, but destructive when present in the lungs. Some researchers have estimated that polonium 210 carries a cancer risk of 4 per 10000 smokers Alpha Radioactivity (210 Polonium) and Tobacco Smoke, while others have estimated the mortality rate to be 18 per million.

The carcinogenity of tobacco smoke is not explained by nicotine per se, which is not carcinogenic or mutagenic. However, it inhibits apoptosis, therefore accelerating existing cancers. Also, NNK, a nicotine derivative converted from nicotine, can be carcinogenic.

Tobacco disease Chronic obstructive pulmonary disease (COPD) caused by smoking, known as tobacco disease, is a permanent, incurable reduction of pulmonary capacity characterized by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis. Smokers have a 26% risk of developing COPD.

The chronic cough associated with smoking is largely due to paralysis of the cilia which sweep mucus and debris out of the lungs (the mucociliary escalator) and up the trachea to the pharynx, from where they are swallowed. Impairment of this system means that mucus collects in the lung bases, and the "Smoker's cough" is an attempt to clear this. It cannot be treated, but tends to resolve if the smoker can quit.

Effects on the heart Smoking contributes to the risk of developing heart disease. All smoke contains very fine particulates that are able to penetrate the alveolar wall into the blood and exert their effects on the heart in a short time.

Inhalation of tobacco smoke causes several immediate responses within the heart and blood vessels. Within one minute the heart rate begins to rise, increasing by as much as 30 percent during the first 10 minutes of smoking. Carbon monoxide in tobacco smoke exerts its negative effects by reducing the blood’s ability to carry oxygen.

Smoking tends to increase blood cholesterol levels. Furthermore, the ratio of high-density lipoprotein (the “good” cholesterol) to low-density lipoprotein (the “bad” cholesterol) tends to be lower in smokers compared to non-smokers. Smoking also raises the levels of fibrinogen and increases platelet production (both involved in blood clotting) which makes the blood viscous. Carbon monoxide binds to haemoglobin (the oxygen-carrying component in red blood cells), resulting in a much stabler complex than haemoglobin bound with oxygen or carbon dioxide--the result is permanent loss of blood cell functionality. Blood cells are naturally recycled after a certain period of time, allowing for the creation of new, functional erythrocytes. However, if carbon monoxide exposure reaches a certain point before they can be recycled, hypoxia (and later death) occurs. All these factors make smokers more at risk of developing various forms of arteriosclerosis. As the arteriosclerosis progresses, blood flows less easily through rigid and narrowed blood vessels, making the blood more likely to form a thrombosis (clot). Sudden blockage of a blood vessel may lead to an infarction (e.g. stroke). However, it is also worth noting that the effects of smoking on the heart may be more subtle. These conditions may develop gradually given the smoking-healing cycle (the human body heals itself between periods of smoking), and therefore a smoker may develop less significant disorders such as worsening or maintenance of unpleasant dermatological conditions, e.g. eczema, due to reduced blood supply. Smoking also increases blood pressure and weakens blood vessels.

Nicotine Nicotine is a powerful, addictive stimulant and is one of the main factors leading to continued tobacco smoking. Although the percentage of the nicotine inhaled with tobacco smoke is quite small (most of the substance is destroyed by the heat) it is still sufficient to cause physical and/or psychological chemical dependency.

Smokers' attitudes Prior to habituation, tobacco smokers often focus on the reinforcing properties of smoking rather than the associated health risks. The diseases caused by smoking surface relatively later in life. As a result, they do not serve to deter smoking given the immediate gratification offered by smoking.

Some smokers claim that the depressant effect of smoking allows them to calm their nerves, often allowing for increased concentration. This, however, is only partly true. According to the Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, whilst higher doses have stimulant effect." Nicotine However, it is impossible to differentiate a drug effect brought on by nicotine use, and the alleviation of nicotine withdrawal.

Passive smoking , a common complaint from those concerned with passive smoking.Passive or involuntary smoking occurs when the exhaled and ambient smoke (otherwise known as environmental or secondhand smoke) from one person's cigarette is inhaled by other people. Passive smoking involves inhaling carcinogens, as well as other toxic components, that are present in secondhand tobacco smoke.

Secondhand smoke is also known to harm children, infants and reproductive health through acute lower respiratory tract illness, asthma induction and exacerbation, chronic respiratory symptoms, middle ear infection, lower birth weight babies, and Sudden infant death syndrome. Effective Tobacco Control Measures In a study released on February 12, 2007 warning signs for cardiovascular disease are higher in people exposed to secondhand tobacco smoke, adding to the link between "passive smoke" and heart disease. "Our study provides further evidence to suggest low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease," said Dr. Andrea Venn of University of Nottingham in Britain, lead author of the study." Secondhand Smoke Raises Heart Disease Risk". Reuters, February 12, 2007.

Passive smoking has long been known as a risk to the health of people with conditions such as asthma, but as recently as the early 1990s few people believed that it was a killer which had the same effect on non-smokers as it did on smokers. United Kingdom entertainer Roy Castle, who died of cancer in 1994, blamed his illness on spending years playing the trumpet in smoky jazz clubs.

In June 2006, U.S. Surgeon General Richard H. Carmona called the evidence of the effects of passive smoke "indisputable" and said "The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and non-smoking adults.". Surgeon General Warns of Secondhand Smoke Passive smoking is one of the key issues that have led to introduction of smoking bans, particularly in workplaces.

The composition of environmental tobacco smoke (ETS) is similar to fossil fuel combustion products that contribute to air pollution, and has been shown to be responsible for indoor particulate matter (PM) levels far exceeding official outdoor limits. Particulate matter from tobacco versus diesel car exhaust: an educational perspective

A presentation at the American Thoracic Society's 2007 conference suggested that children of smokers who show no signs of respiratory problems may still be experiencing damaging changes in their airways.

Sudden infant death syndrome According to the U.S. Surgeon General’s Report ( Chapter 5; pages 180–194), secondhand smoke is connected to SIDS. Infants who die from SIDS tend to have higher concentrations of nicotine and cotinine (a biological marker for secondhand smoke exposure) in their lungs than those who die from other causes. Infants exposed to secondhand smoke after birth are also at a greater risk of SIDS.

Somatic and psychological effects of nicotine Tobacco smoke contains nicotine. Nicotine acts as an agonist that binds to nicotinic acetylcholine receptor sites in the brain and body. Some of these neurons influence respiration, heart rate, memory, alertness, and muscle movement, and are therefore affected by nicotine.

Nicotine's effect in the body results in desensitization of acetylcholine receptors in the brain and body— a physiological response to excess stimulation of nicotinic acetylcholine receptors. This desensitization can become problematic when a smoker stops smoking, as lower levels of acetylcholine receptor stimulation can affect respiration, heart rate, memory, alertness, and muscle movement until the receptors are resensitized or restimulated.

Recent evidence has shown that smoking tobacco increases the release of dopamine in the brain, specifically in the mesolimbic pathway, the same neuro-reward circuit activated by drugs of abuse such as heroin and cocaine. This suggests nicotine use has a pleasurable effect that triggers positive reinforcement. Nicotine and the Brain One study found that smokers exhibit better reaction-time and memory performance compared to non-smokers, which is consistent with increased activation of dopamine receptors. The effects of cigarette smoking on overnight performance Neurologically, rodent studies have found that nicotine self-administration causes lowering of reward thresholds--a finding opposite that of most other drugs of abuse (e.g. cocaine and heroin). This increase in reward circuit sensitivity persisted months after the self-administration ended, suggesting that nicotine's alteration of brain reward function is either long lasting or permanent. Furthermore, it has been found that nicotine can activate long term potentiation in vivo and in vitro. These studies suggests nicotine’s "trace memory" may contribute to difficulties in nicotine abstinence.

Somatic and psychological addiction Nicotine, a component of tobacco smoke, is one of the most addictive psychoactive chemicals. When tobacco is smoked, most of the nicotine is Pyrolysis; a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. According to studies by Henningfield and Benowitz, overall nicotine is more addictive than Cannabis (drug), caffeine, ethanol, cocaine, and heroin when considering both somatic and psychological dependence. However, due to the stronger withdrawal effects of ethanol, cocaine and heroin, nicotine may have a lower potential for somatic dependence than these substances. A study by Perrine concludes that nicotine's potential for psychological dependency exceeds all other studied drugs ProCon.org - Addiction Chart - even ethanol, an extremely physically addictive substance with severe Delirium tremens symptoms that can be fatal. About half of Canadians who currently smoke have tried to quit. AADAC |Truth About Tobacco - Addiction McGill University health professor Jennifer O'Loughlin stated that nicotine addiction can occur as soon as five months after the start of smoking. Cigarette addiction faster than expected. The London Free Press (August 2, 2006).

It can be difficult to quit smoking due to the withdrawal symptoms which include insomnia, irritability, anxiety, decreased heart rate, weight gain, and nicotine cravings. The relapse rate for quitters is high: about 60% relapse within three months. In addition, nicotine users typically do not associate the aversive properties to nicotine as these develop long after the positive associations have been made.

A component of both somatic and psychological addiction is the lowering of reward thresholds associated with nicotine use. Studies from The Scripps Research Institute have shown that acute and chronic nicotine use lowers reward thresholds, sensitizing this neurocircuit. Though nicotinic acetylcholine receptors are being desensitized, the body compensates for the compensatory mechanism by up-regulating the number these receptors. The reason for this is not known, though speculation is that the functionality of NACh receptors is so essential to the body and brain, that it is preferable to have excess stimulation than insufficient activation. As a result, relapse after abstinence can cause an immediate spiral to a physical and psychological state prior to abstinence, even after months of being clean. This would be as if the abstinence never occurred, and might help to explain the high incidence of relapse.

Mood and anxiety disorders Data from multiple studies suggest that depression plays a role in cigarette smoking. Depression and the dynamics of smoking. A national perspective A history of regular smoking was observed more frequently among individuals who had experienced a major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Smoking, smoking cessation, and major depression Another study found that the average lifetime daily cigarette consumption was strongly related to lifetime prevalence, and to prospectively assessed one year prevalence of major depression. Smoking and major depression. A causal analysis People with major depression are also much less likely to smoking cessation due to the increased risk of experiencing mild to severe states of depression, including a major depressive episode. Cigarette smoking and major depression. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. Nicotine, negative affect, and depression.

Recent studies have linked smoking to anxiety disorders, suggesting the correlation (and possibly mechanism) may be related to the broad class of anxiety disorders, and not limited to just depression. Current ongoing research are attempting to tweeze apart the addiction-anxiety relationship.

Health benefits of smoking Some studies have discovered health benefits correlated with smoking. These studies observed a reduction in the occurrence of some diseases, but all such studies stressed that the benefits of smoking did not outweigh the risks.

Several types of "Smoker’s Paradoxes", i.e. cases where smoking appears to have specific beneficial effects, have been observed; often the actual mechanism remains undetermined. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI). Risk of ulcerative colitis has been frequently shown to be reduced by smokers on a dose-dependent basis; the effect is eliminated if the individual stops smoking.Longmore, M., Wilkinson, I., Torok, E. Oxford Handbook of Clinical Medicine (Fifth Edition) p. 232 Smoking appears to interfere with development of Kaposi's sarcoma,{{cite news | last = | first = | coauthors = | title = Smoking Cuts Risk of Rare Cancer | work = | pages = | language = English | publisher = UPI | date = March 29, 2001 | url = http://www.data-yard.net/10b/kaposi.htm | accessdate = 2006-11-06--> breast cancer among women carrying the very high risk BRCA gene,{{cite news | last = Recer | first = Paul | coauthors = | title = Cigarettes May Have an Up Side | work = | pages = | language = English | publisher = AP | date = May 19, 1998 | url = http://www.forces.org/evidence/files/brea.htm | accessdate = 2006-11-06--> preeclampsia, and atopys such as allergic asthma. A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an Inflammation and interfering with the disease process.

In mice, studies have shown nicotine can reduce the amount of DOI-induced head twitches (meant to model tics) related to Tourette's Syndrome.

A large body of evidence suggests that the risks of neurology such as Parkinson's disease or Alzheimer's disease might be twice as high for non-smokers than for smokers. Many such papers regarding Alzheimer's disease{{cite web | last = Thompson | first = Carol | authorlink = | coauthors = | title = Alzheimer's disease is associated with non-smoking | work = | date = | url = http://www.forces.org/evidence/carol/carol16.htm | format = | doi = | accessdate =2006-11-06--> and Parkinson's Disease{{cite web | last = Thompson | first = Carol | authorlink = | coauthors = | title = Parkinson's disease is associated with non-smoking | work = | date = | url = http://www.forces.org/evidence/carol/carol36.htm | format = | doi = | accessdate =2006-11-06--> have been published. A plausible explanation for these cases may be the effect of nicotine, a cholinergic stimulant, decreasing the levels of acetylcholine in the smoker's brain; Parkinson's disease occurs when the effect of dopamine is less than that of acetylcholine. Opponents counter by noting that consumption of pure nicotine may be as beneficial as smoking without the risk.

Other Alzheimer's studies, however, challenge these epidemiology studies on methodological grounds. A Epidemiology#Prospective studies Rotterdam Study found that the incidence of Alzheimer's disease is more than double for smokers as compared to non-smokers and the Honolulu Heart Program (a longitudinal Cohort (statistics) study) also found more than twice the risk for Alzheimer's disease among medium and heavy smokers as compared to non-smokers.

Though the negative correlation between smoking and Parkinson's disease is recognized, the causality has not been established. The relationship may be artifact (observational) based on clusters of behavioral and Wiktionary:personality differences in the pre-Parkinsonian population versus the smoking population. Evans AH, Lawrence AD, Potts J, MacGregor L, Katzenschlager R, Shaw K, Zijlmans J, Lees AJ: "Relationship between impulsive sensation seeking traits, smoking, alcohol and caffeine intake, and Parkinson’s disease", Journal of Neurology, Neurosurgery, and Psychiatry, 77(3):317–321,2006 | url = http://jnnp.bmj.com/cgi/content/abstract/77/3/317 | doi = 10.1136/jnnp.2005.065417 | accessdate =2006-12-02

Considering the high rates of physical sickness and deathsSeeman MV. An outcome measure in schizophrenia: mortality. Can J Psychiatry. 2007 Jan;52(1):55-60. PMID 17444079 Auquier P, Lancon C, Rouillon F, Lader M, Holmes C. Mortality in schizophrenia. Pharmacoepidemiol Drug Saf. 2006 Dec;15(12):873-9. PMID 17058327 among persons suffering from schizophrenia, one of smoking's short term benefits is its temporary effect to improve alertness and cognitive functioning in that disease. Compton, Michael T: Cigarette Smoking in Individuals with Schizophrenia, Medscape Psychiatry & Mental Health. 2005;10(2) ©2005 Medscape, Posted 07/30/2004 |url = http://www.medscape.com/viewarticle/516304_print It has been postulated that the mechanism of this effect is that schizophrenics have a disturbance of nicotinic receptor functioning. Ripoll, N; Bronnec, M; Bourin, M: Nicotinic Receptors and Schizophrenia, Curr Med Res Opin 20(7):1057–1074, 2004 © 2004 Librapharm Limited, Posted 07/30/2004 |url = http://www.medscape.com/viewarticle/483888_print

Effects of the habit and industry on society Link between tobacco use and use of illicit drugs Tobacco, cannabis (drug), and alcoholic beverage are "gateway drugs" according to a 1994 report from the Center on Addiction and Substance Abuse at Columbia University Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use, Center on Addiction and Substance Abuse at Colombia University, October 1994, retrieved 17 July 2007 which stated that there is a consistent relationship between the use of cigarettes and alcohol and the subsequent use of cannabis. Cigarettes, alcohol and cannabis use and the subsequent use of illicit drugs like cocaine is also linked, regardless of the age, sex, ethnicity or race of the individuals involved. This may also be affected by each individual person's personality and or attitude toward their life style. There are many people that smoke marijuana and/or cigarettes without ever becoming addicted or even trying other drugs. The 1994 report also found that when younger children use these gateway drugs, the more often they use them, the more likely they are to use cocaine, heroin, hallucinogens and other illicit drugs. The report concludes that the data is already robust enough to make a strong case to step up efforts to prevent childhood use of cigarettes, alcohol and cannabis and to take firm steps to reduce children’s access to these gateway drugs. Betty Ford Center - Dr. James West Public Q&A Page. URL Accessed October, 2006

People who abuse drugs are likely to be cigarette smokers also. More than two-thirds of drug users are regular tobacco smokers, a rate more than double of that in the general population. National Institute on Drug Abuse researchers have found that craving for nicotine also increases craving for illicit drugs among drug abusers who smoke tobacco, and this suggests that smokers in drug rehabilitation programs may be less successful than nonsmokers in staying off drugs. The National Institute on Drug Abuse (NIDA), part of the NIH, a component of the U.S. Department of Health and Human Services. - Nicotine Craving and Heavy Smoking May Contribute to Increased Use of Cocaine and Heroin - Patrick Zickler, NIDA NOTES Staff Writer. URL Accessed October, 2006 NIDA is a controversial organization.{{cite web|url=http://www.mpp.org/site/apps/nl/content2.asp?c=glKZLeMQIsG&b=1173735&ct=1973329 |title=MPP Responds to Release of 2001 National Household Survey on Drug Abuse |publisher=[Marijuana Policy Project (MPP) |data=September 5 [ --> Many drug policy organizations, such as the RAND Drug Policy Research Center have released information, on studies performed, in stark contrast to the claims made by NIDA.

The "gateway" theory regarding substance abuse has come under a great deal of criticism. The statistics mentioned above only establish a correlation between tobacco smoking and illicit drug use, and do not establish that one causes the other. For example, it is entirely possible that people who smoke cigarettes have a higher incidence of cocaine use, and that a third variable (such as income) causes both, creating the illusion that smoking cigarettes causes cocaine use. It is commonly known that "correlation does not imply causation", and it is a frequent misconception that correlational evidence is "proof".

In 2002, the RAND Drug Policy Research Center released a paper on one of their studies stating that it "casts doubt on claims that marijuana acts as a "gateway" to the use of cocaine and heroin, challenging an assumption that has guided U.S. drug policies since the 1950s." These findings of the RAND Drug Policy Research Center's study are in contradiction to the claims made by NIDA.

Effect on healthcare costs In countries where there is a public health system, society pays for the medical care of smokers who become ill through increased taxes. Two arguments exist on this front, the "pro-smoking" argument suggesting that heavy smokers generally don't live long enough to develop the costly and chronic illnesses which affect the elderly, reducing society's healthcare burden. The "anti-smoking" argument suggests that the healthcare burden is increased because smokers get chronic illnesses younger and at a higher rate than the general population.

Data on both positions is limited, although the Centers for Disease Control and Prevention published research in 2002 claiming that the cost of each pack of cigarettes sold in the United States was more than $7 in medical care and lost productivity. Cigarettes Cost U.S. $7 Per Pack Sold, Study Says The cost may be higher, with another study putting it as high as $41 per pack. Study: Cigarettes cost families, society $41 per pack

By contrast, some non-scientific studies, including one conducted by Philip Morris in the Czech Republic and another by the Cato Institute, support the opposite position. Neither study was peer-reviewed nor published in a scientific journal, and the Cato Institute have received funding from tobacco companies in the past. Philip Morris have explicitly apologised for the former study, saying: "The funding and public release of this study which, among other things, detailed purported cost savings to the Czech Republic due to premature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptable disregard of basic human values. For one of our tobacco companies to commission this study was not just a terrible mistake, it was wrong. All of us at Philip Morris, no matter where we work, are extremely sorry for this. No one benefits from the very real, serious and significant diseases caused by smoking."

Tobacco advertising Before the 1970s, most tobacco advertising was legal in the United States and most European nations. In the United States, in the 1950s and 1960s, cigarette brands were frequently sponsors of television shows—most notably shows such as To Tell the Truth and I've Got a Secret. One of the most famous television jingles of the era came from an advertisement for Winston (cigarette) cigarettes. The slogan "Winston tastes good like a cigarette should!" proved to be catchy, and is still quoted today. Another popular slogan from the 1960s was "Us Tareyton smokers would rather fight than switch!," which was used to advertise Tareyton cigarettes.

Many nations, including Russia, Greece and Romania, still allow billboards advertising tobacco use. Tobacco smoking is still advertised in special magazines, during sporting events, in gas stations and stores, and in more rare cases on television.

In the United States, it was believed by many that tobacco companies are marketing tobacco smoking to minors. Behind the Smokescreen: Tobacco Marketing to Kids For example, Reynolds American Inc. used the Joe Camel cartoon character to advertise Camel cigarettes. Other brands such as Virginia Slims targeted women with slogans like "You've Come a Long Way Baby".

Some nations, including the UK and Australia, have begun anti-smoking advertisements to counter the effects of tobacco advertising.

The actual effectiveness of tobacco advertisement is widely documented. According to an opinion piece by Henry Saffer, public health experts say that tobacco advertising increases cigarette consumption and there is much empirical literature that finds a significant effect of tobacco advertising on smoking, especially in children. Smoking behavior of adolescents exposed to cigarette advertising. Public Health Rep. 1993 Mar–Apr; 108(2): 217–224. Influence of Tobacco Marketing and Exposure to Smokers on Adolescent Susceptibility to Smoking;Journal of the National Cancer Institute, Vol. 87, No. 20, 1538–1545, October 18, 1995 The Last Straw? Cigarette Advertising and Realized Market Shares among Youths and Adults, 1979–1993 Richard W. Pollay, S. Siddarth, Michael Siegel, Anne Haddix, Robert K. Merritt, Gary A. Giovino, Michael P. Eriksen Journal of Marketing, Vol. 60, No. 2 (Apr., 1996), pp. 1–16 doi:10.2307/1251927 Tob Control 1998;7:129–133 ( Summer ) Adolescents' responses to cigarette advertisements: links between exposure, liking, and the appeal of smoking Jeffrey Jensen Arnetta, George Terhanian American Journal of Public Health, Vol 90, Issue 3 407–411, Tobacco marketing and adolescent smoking: more support for a causal inference, L Biener and M Siegel, Center for Survey Research, University of Massachusetts at Boston 02125, USA. Tobacco Advertisements: One of the Strongest Risk Factors for Smoking in Hong Kong Students.American Journal of Preventive Medicine, Volume 14, Issue 3, Pages 217–223 T. Lam J Prev Med. 2002 May;22(4):228-3 is the most common method of smoking tobacco. Tobacco smoking is the act of burning the dried or cured leaves of the tobacco plant and smoking for pleasure, for ritualistic or social purposes, self-medication, or simply to satisfy physical dependence. Tobacco use by Indigenous peoples of the Americas throughout North and South America dates back to 2000BC and there are depictions of ancient Mayans smoking a crude cigar. The practice was brought back to Europe by the crew of Christopher Columbus. Tobacco Smoking took hold in Spain and was introduced to the rest of the world, via trade.

Tobacco smoke contains nicotine, an addiction stimulant and Euphoriant. The effect of nicotine in first time or irregular users is an increase in alertness and memory, and mild euphoria. In chronic users, nicotine simply relieves the symptoms of nicotine withdrawal: confusion, restlessness, anxiety, insomnia, and dysphoria. Withdrawal symptoms in chronic users begin to appear approximately 30 minutes after every dose. Nicotine also disturbs metabolism and suppresses appetite. This is because nicotine, like many stimulants, increases blood sugar.

It has been determined that all forms of tobacco use are addictive.

Medical research has determined that chronic tobacco smoking can lead to many health problems, particularly lung cancer, emphysema, and cardiovascular disease. List of health effects by CDC List of health effects by Australia's myDr Methods of smoking Cigarette Cigarette smoking is the most common form of tobacco consumption. It leads all other methods by more than a factor of 10-- but nearly 99% of all tobacco advertising is to promote cigarettes, indicating that the industry finds this format most profitable . A cigarette is a product manufactured from cured and cut tobacco leaves, which are rolled and/or stuffed into a paper-wrapped cylinder. Because of the curing process, the smoke is mild enough to inhale in overdose quantities, unlike cigar or pipe tobacco. The largest state of tobacco production in the United States is North Carolina. Cigarettes also contain a number of additives, particularly to enhance taste. The cigarette is lit, usually with a match or lighter at one end and allowed to burn for the purpose of inhalation of its smoke from the other (usually cigarette filter) end, which is inserted in the mouth. "Roll ups" are also very popular, particularly in European countries; these are prepared from loose tobacco, cigarette papers and filters all bought separately. Cigarettes are smoked by some with a cigarette holder. (See also Beedi).

Cigar A cigar is a cylinder of tobacco rolled in tobacco leaves for smoking and generally puffed, not inhaled. They come in many shapes and sizes, the most common being the "Corona", "Cigarillo", "Blunt" and "Robusto". The tobacco used is grown throughout the Caribbean in places such as the Dominican Republic, Nicaragua, Honduras, Jamaica, and Cuba. A popular light colored "shade" wrappers is from Connecticut whereas darker Maduro wrappers come from the Caribbean. Cigars manufactured in Cuba have historically been considered to be without peer..

Pipe A pipe for smoking typically consists of a small chamber (bowl) for combustion of the substance to be smoked and a thin stem (shank) that ends in a mouthpiece (also called a bit). Pipes are made from a variety of materials (some obscure): briar, corncob, meerschaum, clay, wood, glass, gourd, bamboo, and various other materials, such as metal. Tobacco used for smoking pipes is often chemically treated and altered to change smell and taste (both functions are affected negatively in humans by smoking) not available in other tobacco products sold commercially. Many of these are mixtures using staple ingredients of variously cured Burley and Virginia tobaccos which are mixed with tobaccos from different areas, such as Oriental or Balkan locations. Latakia (tobacco) (a fire-cured tobacco of Cypriot or Syrian origin), Perique (only grown in St. James Parish, Louisiana) or combinations of Virginia and Burley tobaccos of African, Indian, or South American origins. Traditionally, many U.S. tobaccos are made of American Burley with artificial sweeteners and flavorings added to create an artificial "aromatic" smell, whereas "English" blends are based on natural Virginia tobaccos enhanced with Oriental and other natural tobaccos. There is a growing tendency towards "natural" tobaccos which derive their aromas from blending with spice tobaccos alone and historically-based curing processes.

Pipes can range from the very simple machine-made briar pipe to handmade and artful implements created by pipe-makers which can be very expensive collector's items. The popularity of pipe smoking in Western countries has declined in recent years under the onslaught of cigarette advertising. However, it has also enjoyed a resurgence of late among younger and middle aged smokers who find its contemplative nature and age-transcendent status as "hobby not habit" to be both thoroughly enjoyable and stress-relieving. As many pipe-smokers say, "We don't inhale."

Hookah A hookah (or sheesha) is a type of traditional Middle Eastern and South Asian water pipe, a pipe which operates by water-filtration and indirect heat. Hookahs are most popular in the Middle East, but form a niche market in many other places. In many situations, hookahs are loaded with hashish or opium. In the Far East opium and cannabis are also among the traditional drugs used.

Typically, tobacco is smoked from a hookah by placing richly flavored tobaccos in the smoking bowl, covering it with foil, and placing a coal on top of the foil. This keeps the tobacco from burning, and allows it to bake. The resulting vapors are further cooled by the hookah water, resulting in a moist, warm smoke. The Al-Waha, Al Fakher, and Nakhla tobacco companies compete for market share in the Middle East by producing increasingly luxurious flavored tobaccos for use in the hookah. Currently available flavors include the traditional apple, grape, double apple, orange, strawberry, cherry, mango, vanilla, and melon flavors; as well as the modern cola, coconut, cappuccino, and banana milk flavors.

Popular myth suggests that hookah smoking is considered to be safer than other forms of smoking. However, water is not effective for removing all relevant toxins, e.g. the carcinogenic aromatic hydrocarbons are not water-soluble. Several serious negative health effects are linked to hookah smoking and studies indicate that it is likely to be more harmful to health than cigarettes, due in part to the volume of smoke inhaled. One study found hookah smoke to be both clastogenic and genotoxic for human beings, Genetic risk assessment in hookah smokers. while another study showed that the carbon monoxide hazard is as high with hookah smoking as with cigarette smoking. Carbon monoxide fractions in cigarette and hookah (hubble bubble) smoke. In addition to the cancer risk, there is some risk of infectious disease resulting from pipe sharing, and other risks associated with the common addition of other psychoactive drugs to the tobacco. Water-Pipe (Narghile) Smoking: An Emerging Health Risk Behavior

Health effects As the use of tobacco became popular in Europe, some people became concerned about its possible ill effects on the health of its users. One of the first was James I of England. In 1604, he wrote A Counterblaste to Tobacco in which he asked his subjects A Counterblaste to Tobacco, by King James I of England

You have not reason then to be ashamed, and to forbeare this filthie noveltie, so basely grounded, so foolishly received and so grossly mistaken in the right use thereof? In your abuse thereof sinning against God, harming your selves both in persons and goods, and raking also thereby the marks and notes of vanitie upon you: by the custome thereof making your selves to be wondered at by all forraine civil Nations, and by all strangers that come among you, to be scorned and contemned. A custom loathsome to the eye, hateful to the Nose, harmful to the brain, dangerous to the Lungs, and in the blacke stinking fume thereof, neerest resembling the horrible Stigian smoke of the pit that is bottomelesse.

In 1761, English doctor John Hill published "Cautions against the Immoderate Use of Snuff" in which he warned snuff users that they were vulnerable to cancers of the nose. http://books.nap.edu/openbook.php?record_id=10029&page=593 Tobacco Timeline: The Eighteenth Century -- Snuff Holds Sway In 1795, American Samuel Thomas von Soemmering reported on cancers of the lip in pipe smokers. The late-19th century invention of automated cigarette making machinery in the American South made possible mass production of cigarettes at low cost; the profits endowed Duke University, and cigarettes became elegant and fashionable among society men as the Victorian era gave way to the Edwardian. In 1912, American Dr. Isaac Adler was the first to strongly suggest that lung cancer is related to smoking. Isaac Adler. Primary Malignant Growth of the Lung and Bronchi. New York, Longmans, Green and Company, 1912, pp. 3-12. Reprinted in 1980 by A Cancer Journal for Clinicians In 1929, Fritz Lickint of Dresden, Germany, published a formal statistical evidence of a lung cancer–tobacco link, based on a study showing that lung cancer sufferers were likely to be smokers. http://ije.oxfordjournals.org/cgi/content/full/30/1/31 Lickint also argued that tobacco use was the best way to explain the fact that lung cancer struck men four or five times more often than women (since women smoked much less). Many American and other servicemen began smoking during World War I and World War II when cigarettes were included in military rations and distributed by charitable organizations.

In 1950, Dr. Richard Doll published research in a 1950 issue of the British Medical Journal showing a close link between smoking and lung cancer. Four years later, in 1954 the British Doctors Study, a study of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related. The British Doctors Study lasted till 2001, with result published every ten years and final results published in 2004. Reader's Digest was a major crusader and for decades published many anti-smoking articles. In 1964, Luther L. Terry, M.D., Surgeon General of the United States, released the report of the Surgeon General's Advisory Committee on Smoking and Health. It was based on over 7000 scientific articles that linked tobacco use with cancer and other diseases. This report led to laws requiring warning labels on tobacco products and to restrictions on tobacco advertisements. As these began to come into force, tobacco marketing became more subtle, with sweets shaped like cigarettes put on the market, and a number of adverts designed to appeal to children, particularly those featuring Joe Camel resulting in increased awareness and uptake of smoking among childrenWhile D, Kelly S, Huang W, Charlton A. Cigarette advertising and onset of smoking in children: questionnaire survey. BMJ. 1996 Aug 17;313(7054):398-9. PMID 8761227. However, restrictions did have an effect on adult quit rates, with its use declining to the point that by 2004, nearly half of all Americans who had ever smoked had quit. Cigarette Smoking Among Adults — United States, 2004 MMWR Weekly, November 11, 2005. In the 1950s, manufacturers began adding filter tips to cigarettes to remove some of the tar and nicotine as they were smoked. "Safer", "less potent" cigarette brands were also introduced. Light cigarettes became so popular that, as of 2004, half of American smokers preferred them over regular cigarettes. Light but just as deadly, by Peter Lavelle. The Pulse, October 21, 2004. in spite the fact that the idea of a "safer" cigarette is a myth. Cigarettes that offer, "low tar and nicotine" cause the smoker to smoke more or to inhale more deeply to get the same level of nicotine. According to The Federal Government’s National Cancer Institute (NCI), light cigarettes provide no benefit to smoker's health. The Truth About "Light" Cigarettes: Questions and Answers, from the National Cancer Institute factsheet 'Safer' cigarette myth goes up in smoke, by Andy Coghlan. New Scientist, 2004

Health risks of smoking The health effects of tobacco smoking are related to direct tobacco smoking, as well as passive smoking, inhalation of environmental or secondhand tobacco smoke. A British Doctors Study showed that nonsmokers lived about 10 years longer than smokers. For those born between 1920 and 1929 the Mortality rate between the ages of 35 and 69 for nonsmokers was 15% and for smokers was 45%, three times as great. Claims that personalities of smokers account for these differences are not convincing in light of the fact that the heavy smokers were about 25 times more likely to die of lung cancer or chronic obstructive pulmonary disease than the nonsmokers. Another source claims smoking is responsible for 87% of lung cancer deaths.

The main health risks in tobacco pertain to diseases of the cardiovascular system, in particular myocardial infarction (heart attack), diseases of the respiratory system such as Chronic Obstructive Pulmonary Disease (COPD), asthmaGilliland FD, Islam T, Berhane K, Gauderman WJ, McConnell R, Avol E, Peters JM. Regular smoking and asthma incidence in adolescents. Am J Respir Crit Care Med. 2006 Nov 15;174(10):1094-100. PMID 16973983, emphysema, and cancer, particularly lung cancer and cancers of the larynx and tongue. Prior to World War I, lung cancer was considered to be a rare disease, which most physicians would never see during their careerWitschi 2001, A Short History of Lung Cancer. Toxicol Sci. 2001 Nov;64(1):4-6. PMID 11606795 Adler I. Primary malignant growths of the lungs and bronchi. New York: Longmans, Green, and Company; 1912., cited in Spiro SG, Silvestri GA. One hundred years of lung cancer. Am J Respir Crit Care Med. 2005 Sep 1;172(5):523-9. PMID 15961694. With the postwar rise in popularity of cigarette smoking, however, came a virtual epidemic of lung cancer.

A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker. The health risks of smoking are not uniform across all smokers. Risks vary according to amount of tobacco smoked, with those who smoke more at greater risk. Light smoking is still a health risk.

According to the Surgeon General of The United States, mortality rates for pipe smokers and cigar smokers who smoke less than five cigars per day are roughly the same as for non-smokers. The data regarding smoking to date focuses primarily on cigarette smoking, which even by conservative estimates increases mortality rates by 40%. Men who smoke 10-19 cigarettes a day have a 70% increase in mortality rates, men who smoke 20-39 cigarettes a day have an increase in mortality rate by 90%, for men smoking two packs a day or more, their mortality rates increased 120%.http://profiles.nlm.nih.gov/NN/B/B/K/M/_/nnbbkm.pdf 1967 Surgeon General's Report on Smoking

According to the Canadian Lung Association, tobacco kills between 40,000–45,000 Canadians per year, more than the total number of deaths from AIDS, traffic accidents, suicide, murder, fires and accidental poisoning. Smoking and Teens, Canadian Lung Association, Newspaper articles, Canada, Canadian Cancer Society Allan Rock announces collaborative research initiative on smoking The United States' Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide".

Tobacco smoke has been shown to contain trace amounts of the radioactive isotope Polonium 210, which is around 250 thousand times as toxic as hydrogen cyanide.

Infant mortality Tobacco smoke reduces the delivery of oxygen to the fetus through the presence of carbon monoxide, cyanide, and aromatic hydrocarbons. Nicotine and other substances in tobacco smoke cause reduction in placental blood flow, creating further reductions in oxygen delivery as well as reductions in nutrients to the unborn baby. Secondhand smoke exposure during pregnancy produces twice the risk of low birth weight babies. Smoking is the single largest modifiable risk factor in intrauterine growth retardation.

Carcinogenicity Smoke, or any partially burnt organic matter, is carcinogenic (cancer-causing). Lung cancer rates are linked to the number of people who smoke. It is noted that an increase in deaths from lung cancer appeared 20 years after an increase in cigarette consumption. The damage a continuing smoker does to their lungs can take up to 20 years before its physical manifestation in lung cancer. Women began smoking later than men, so the rise in death rate amongst women did not appear until later. The male lung cancer death rate decreased in 1975 — roughly 20 years after the fall in cigarette consumption in men. A fall in consumption in women also began in 1975 but by 1991 had not manifested in a decrease in lung cancer related mortalities amongst women.

, a polynuclear aromatic hydrocarbon, produced by burning tobacco.The primary carcinogens are the pyrolysis products of tobacco leaves. Any partially burnt material, tobacco or not, contains polycyclic aromatic hydrocarbons, particularly benzopyrene. The mechanism of their carcinogenity is well-known: oxidation produces an epoxide, which binds to DNA covalently and distorts it. If the cell cannot repair its DNA damage prior to undergoing mitotic division, the daughter cells carry a greater risk of becoming carcinogenic. DNA damage is one of the causes of cancer, because if the poison damages the programmed cell death system severely enough (usually requiring more than one mutation), damaged cells cannot kill themselves and begin to divide uncontrollably. This results in the formation of tumors that have the potential of becoming cancerous. The DNA oxidative damage is non-specific, so oncogenes and tumor suppressor genes (both genes associated with tumorgenicity) aren't always targeted. This results in an essentially random occurrence of cancer, where the probability increases with increasing exposure. In this respect, the mechanism of carcinogenicity closely resembles that of mustard gas, aflatoxin and other DNA alkylating agents.

Tobacco smoke also contains various carcinogens other than polynuclear aromatic hydrocarbons, such as traces of radioactive elements. Smoking is therefore an important route of exposure to ionizing radiation.

For example, smoke from tobacco grown with phosphate fertilizers contains polonium 210. Polonium 210 is an emitter of alpha particles, which cannot penetrate skin and are harmless outside the body, but destructive when present in the lungs. Some researchers have estimated that polonium 210 carries a cancer risk of 4 per 10000 smokers Alpha Radioactivity (210 Polonium) and Tobacco Smoke, while others have estimated the mortality rate to be 18 per million.

The carcinogenity of tobacco smoke is not explained by nicotine per se, which is not carcinogenic or mutagenic. However, it inhibits apoptosis, therefore accelerating existing cancers. Also, NNK, a nicotine derivative converted from nicotine, can be carcinogenic.

Tobacco disease Chronic obstructive pulmonary disease (COPD) caused by smoking, known as tobacco disease, is a permanent, incurable reduction of pulmonary capacity characterized by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis. Smokers have a 26% risk of developing COPD.

The chronic cough associated with smoking is largely due to paralysis of the cilia which sweep mucus and debris out of the lungs (the mucociliary escalator) and up the trachea to the pharynx, from where they are swallowed. Impairment of this system means that mucus collects in the lung bases, and the "Smoker's cough" is an attempt to clear this. It cannot be treated, but tends to resolve if the smoker can quit.

Effects on the heart Smoking contributes to the risk of developing heart disease. All smoke contains very fine particulates that are able to penetrate the alveolar wall into the blood and exert their effects on the heart in a short time.

Inhalation of tobacco smoke causes several immediate responses within the heart and blood vessels. Within one minute the heart rate begins to rise, increasing by as much as 30 percent during the first 10 minutes of smoking. Carbon monoxide in tobacco smoke exerts its negative effects by reducing the blood’s ability to carry oxygen.

Smoking tends to increase blood cholesterol levels. Furthermore, the ratio of high-density lipoprotein (the “good” cholesterol) to low-density lipoprotein (the “bad” cholesterol) tends to be lower in smokers compared to non-smokers. Smoking also raises the levels of fibrinogen and increases platelet production (both involved in blood clotting) which makes the blood viscous. Carbon monoxide binds to haemoglobin (the oxygen-carrying component in red blood cells), resulting in a much stabler complex than haemoglobin bound with oxygen or carbon dioxide--the result is permanent loss of blood cell functionality. Blood cells are naturally recycled after a certain period of time, allowing for the creation of new, functional erythrocytes. However, if carbon monoxide exposure reaches a certain point before they can be recycled, hypoxia (and later death) occurs. All these factors make smokers more at risk of developing various forms of arteriosclerosis. As the arteriosclerosis progresses, blood flows less easily through rigid and narrowed blood vessels, making the blood more likely to form a thrombosis (clot). Sudden blockage of a blood vessel may lead to an infarction (e.g. stroke). However, it is also worth noting that the effects of smoking on the heart may be more subtle. These conditions may develop gradually given the smoking-healing cycle (the human body heals itself between periods of smoking), and therefore a smoker may develop less significant disorders such as worsening or maintenance of unpleasant dermatological conditions, e.g. eczema, due to reduced blood supply. Smoking also increases blood pressure and weakens blood vessels.

Nicotine Nicotine is a powerful, addictive stimulant and is one of the main factors leading to continued tobacco smoking. Although the percentage of the nicotine inhaled with tobacco smoke is quite small (most of the substance is destroyed by the heat) it is still sufficient to cause physical and/or psychological chemical dependency.

Smokers' attitudes Prior to habituation, tobacco smokers often focus on the reinforcing properties of smoking rather than the associated health risks. The diseases caused by smoking surface relatively later in life. As a result, they do not serve to deter smoking given the immediate gratification offered by smoking.

Some smokers claim that the depressant effect of smoking allows them to calm their nerves, often allowing for increased concentration. This, however, is only partly true. According to the Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, whilst higher doses have stimulant effect." Nicotine However, it is impossible to differentiate a drug effect brought on by nicotine use, and the alleviation of nicotine withdrawal.

Passive smoking , a common complaint from those concerned with passive smoking.Passive or involuntary smoking occurs when the exhaled and ambient smoke (otherwise known as environmental or secondhand smoke) from one person's cigarette is inhaled by other people. Passive smoking involves inhaling carcinogens, as well as other toxic components, that are present in secondhand tobacco smoke.

Secondhand smoke is also known to harm children, infants and reproductive health through acute lower respiratory tract illness, asthma induction and exacerbation, chronic respiratory symptoms, middle ear infection, lower birth weight babies, and Sudden infant death syndrome. Effective Tobacco Control Measures In a study released on February 12, 2007 warning signs for cardiovascular disease are higher in people exposed to secondhand tobacco smoke, adding to the link between "passive smoke" and heart disease. "Our study provides further evidence to suggest low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease," said Dr. Andrea Venn of University of Nottingham in Britain, lead author of the study." Secondhand Smoke Raises Heart Disease Risk". Reuters, February 12, 2007.

Passive smoking has long been known as a risk to the health of people with conditions such as asthma, but as recently as the early 1990s few people believed that it was a killer which had the same effect on non-smokers as it did on smokers. United Kingdom entertainer Roy Castle, who died of cancer in 1994, blamed his illness on spending years playing the trumpet in smoky jazz clubs.

In June 2006, U.S. Surgeon General Richard H. Carmona called the evidence of the effects of passive smoke "indisputable" and said "The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and non-smoking adults.". Surgeon General Warns of Secondhand Smoke Passive smoking is one of the key issues that have led to introduction of smoking bans, particularly in workplaces.

The composition of environmental tobacco smoke (ETS) is similar to fossil fuel combustion products that contribute to air pollution, and has been shown to be responsible for indoor particulate matter (PM) levels far exceeding official outdoor limits. Particulate matter from tobacco versus diesel car exhaust: an educational perspective

A presentation at the American Thoracic Society's 2007 conference suggested that children of smokers who show no signs of respiratory problems may still be experiencing damaging changes in their airways.

Sudden infant death syndrome According to the U.S. Surgeon General’s Report ( Chapter 5; pages 180–194), secondhand smoke is connected to SIDS. Infants who die from SIDS tend to have higher concentrations of nicotine and cotinine (a biological marker for secondhand smoke exposure) in their lungs than those who die from other causes. Infants exposed to secondhand smoke after birth are also at a greater risk of SIDS.

Somatic and psychological effects of nicotine Tobacco smoke contains nicotine. Nicotine acts as an agonist that binds to nicotinic acetylcholine receptor sites in the brain and body. Some of these neurons influence respiration, heart rate, memory, alertness, and muscle movement, and are therefore affected by nicotine.

Nicotine's effect in the body results in desensitization of acetylcholine receptors in the brain and body— a physiological response to excess stimulation of nicotinic acetylcholine receptors. This desensitization can become problematic when a smoker stops smoking, as lower levels of acetylcholine receptor stimulation can affect respiration, heart rate, memory, alertness, and muscle movement until the receptors are resensitized or restimulated.

Recent evidence has shown that smoking tobacco increases the release of dopamine in the brain, specifically in the mesolimbic pathway, the same neuro-reward circuit activated by drugs of abuse such as heroin and cocaine. This suggests nicotine use has a pleasurable effect that triggers positive reinforcement. Nicotine and the Brain One study found that smokers exhibit better reaction-time and memory performance compared to non-smokers, which is consistent with increased activation of dopamine receptors. The effects of cigarette smoking on overnight performance Neurologically, rodent studies have found that nicotine self-administration causes lowering of reward thresholds--a finding opposite that of most other drugs of abuse (e.g. cocaine and heroin). This increase in reward circuit sensitivity persisted months after the self-administration ended, suggesting that nicotine's alteration of brain reward function is either long lasting or permanent. Furthermore, it has been found that nicotine can activate long term potentiation in vivo and in vitro. These studies suggests nicotine’s "trace memory" may contribute to difficulties in nicotine abstinence.

Somatic and psychological addiction Nicotine, a component of tobacco smoke, is one of the most addictive psychoactive chemicals. When tobacco is smoked, most of the nicotine is Pyrolysis; a dose sufficient to cause mild somatic dependency and mild to strong psychological dependency remains. According to studies by Henningfield and Benowitz, overall nicotine is more addictive than Cannabis (drug), caffeine, ethanol, cocaine, and heroin when considering both somatic and psychological dependence. However, due to the stronger withdrawal effects of ethanol, cocaine and heroin, nicotine may have a lower potential for somatic dependence than these substances. A study by Perrine concludes that nicotine's potential for psychological dependency exceeds all other studied drugs ProCon.org - Addiction Chart - even ethanol, an extremely physically addictive substance with severe Delirium tremens symptoms that can be fatal. About half of Canadians who currently smoke have tried to quit. AADAC |Truth About Tobacco - Addiction McGill University health professor Jennifer O'Loughlin stated that nicotine addiction can occur as soon as five months after the start of smoking. Cigarette addiction faster than expected. The London Free Press (August 2, 2006).

It can be difficult to quit smoking due to the withdrawal symptoms which include insomnia, irritability, anxiety, decreased heart rate, weight gain, and nicotine cravings. The relapse rate for quitters is high: about 60% relapse within three months. In addition, nicotine users typically do not associate the aversive properties to nicotine as these develop long after the positive associations have been made.

A component of both somatic and psychological addiction is the lowering of reward thresholds associated with nicotine use. Studies from The Scripps Research Institute have shown that acute and chronic nicotine use lowers reward thresholds, sensitizing this neurocircuit. Though nicotinic acetylcholine receptors are being desensitized, the body compensates for the compensatory mechanism by up-regulating the number these receptors. The reason for this is not known, though speculation is that the functionality of NACh receptors is so essential to the body and brain, that it is preferable to have excess stimulation than insufficient activation. As a result, relapse after abstinence can cause an immediate spiral to a physical and psychological state prior to abstinence, even after months of being clean. This would be as if the abstinence never occurred, and might help to explain the high incidence of relapse.

Mood and anxiety disorders Data from multiple studies suggest that depression plays a role in cigarette smoking. Depression and the dynamics of smoking. A national perspective A history of regular smoking was observed more frequently among individuals who had experienced a major depressive disorder at some time in their lives than among individuals who had never experienced major depression or among individuals with no psychiatric diagnosis. Smoking, smoking cessation, and major depression Another study found that the average lifetime daily cigarette consumption was strongly related to lifetime prevalence, and to prospectively assessed one year prevalence of major depression. Smoking and major depression. A causal analysis People with major depression are also much less likely to smoking cessation due to the increased risk of experiencing mild to severe states of depression, including a major depressive episode. Cigarette smoking and major depression. Depressed smokers appear to experience more withdrawal symptoms on quitting, are less likely to be successful at quitting, and are more likely to relapse. Nicotine, negative affect, and depression.

Recent studies have linked smoking to anxiety disorders, suggesting the correlation (and possibly mechanism) may be related to the broad class of anxiety disorders, and not limited to just depression. Current ongoing research are attempting to tweeze apart the addiction-anxiety relationship.

Health benefits of smoking Some studies have discovered health benefits correlated with smoking. These studies observed a reduction in the occurrence of some diseases, but all such studies stressed that the benefits of smoking did not outweigh the risks.

Several types of "Smoker’s Paradoxes", i.e. cases where smoking appears to have specific beneficial effects, have been observed; often the actual mechanism remains undetermined. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI). Risk of ulcerative colitis has been frequently shown to be reduced by smokers on a dose-dependent basis; the effect is eliminated if the individual stops smoking.Longmore, M., Wilkinson, I., Torok, E. Oxford Handbook of Clinical Medicine (Fifth Edition) p. 232 Smoking appears to interfere with development of Kaposi's sarcoma,{{cite news | last = | first = | coauthors = | title = Smoking Cuts Risk of Rare Cancer | work = | pages = | language = English | publisher = UPI | date = March 29, 2001 | url = http://www.data-yard.net/10b/kaposi.htm | accessdate = 2006-11-06--> breast cancer among women carrying the very high risk BRCA gene,{{cite news | last = Recer | first = Paul | coauthors = | title = Cigarettes May Have an Up Side | work = | pages = | language = English | publisher = AP | date = May 19, 1998 | url = http://www.forces.org/evidence/files/brea.htm | accessdate = 2006-11-06--> preeclampsia, and atopys such as allergic asthma. A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an Inflammation and interfering with the disease process.

In mice, studies have shown nicotine can reduce the amount of DOI-induced head twitches (meant to model tics) related to Tourette's Syndrome.

A large body of evidence suggests that the risks of neurology such as Parkinson's disease or Alzheimer's disease might be twice as high for non-smokers than for smokers. Many such papers regarding Alzheimer's disease{{cite web | last = Thompson | first = Carol | authorlink = | coauthors = | title = Alzheimer's disease is associated with non-smoking | work = | date = | url = http://www.forces.org/evidence/carol/carol16.htm | format = | doi = | accessdate =2006-11-06--> and Parkinson's Disease{{cite web | last = Thompson | first = Carol | authorlink = | coauthors = | title = Parkinson's disease is associated with non-smoking | work = | date = | url = http://www.forces.org/evidence/carol/carol36.htm | format = | doi = | accessdate =2006-11-06--> have been published. A plausible explanation for these cases may be the effect of nicotine, a cholinergic stimulant, decreasing the levels of acetylcholine in the smoker's brain; Parkinson's disease occurs when the effect of dopamine is less than that of acetylcholine. Opponents counter by noting that consumption of pure nicotine may be as beneficial as smoking without the risk.

Other Alzheimer's studies, however, challenge these epidemiology studies on methodological grounds. A Epidemiology#Prospective studies Rotterdam Study found that the incidence of Alzheimer's disease is more than double for smokers as compared to non-smokers and the Honolulu Heart Program (a longitudinal Cohort (statistics) study) also found more than twice the risk for Alzheimer's disease among medium and heavy smokers as compared to non-smokers.

Though the negative correlation between smoking and Parkinson's disease is recognized, the causality has not been established. The relationship may be artifact (observational) based on clusters of behavioral and Wiktionary:personality differences in the pre-Parkinsonian population versus the smoking population. Evans AH, Lawrence AD, Potts J, MacGregor L, Katzenschlager R, Shaw K, Zijlmans J, Lees AJ: "Relationship between impulsive sensation seeking traits, smoking, alcohol and caffeine intake, and Parkinson’s disease", Journal of Neurology, Neurosurgery, and Psychiatry, 77(3):317–321,2006 | url = http://jnnp.bmj.com/cgi/content/abstract/77/3/317 | doi = 10.1136/jnnp.2005.065417 | accessdate =2006-12-02

Considering the high rates of physical sickness and deathsSeeman MV. An outcome measure in schizophrenia: mortality. Can J Psychiatry. 2007 Jan;52(1):55-60. PMID 17444079 Auquier P, Lancon C, Rouillon F, Lader M, Holmes C. Mortality in schizophrenia. Pharmacoepidemiol Drug Saf. 2006 Dec;15(12):873-9. PMID 17058327 among persons suffering from schizophrenia, one of smoking's short term benefits is its temporary effect to improve alertness and cognitive functioning in that disease. Compton, Michael T: Cigarette Smoking in Individuals with Schizophrenia, Medscape Psychiatry & Mental Health. 2005;10(2) ©2005 Medscape, Posted 07/30/2004 |url = http://www.medscape.com/viewarticle/516304_print It has been postulated that the mechanism of this effect is that schizophrenics have a disturbance of nicotinic receptor functioning. Ripoll, N; Bronnec, M; Bourin, M: Nicotinic Receptors and Schizophrenia, Curr Med Res Opin 20(7):1057–1074, 2004 © 2004 Librapharm Limited, Posted 07/30/2004 |url = http://www.medscape.com/viewarticle/483888_print

Effects of the habit and industry on society Link between tobacco use and use of illicit drugs Tobacco, cannabis (drug), and alcoholic beverage are "gateway drugs" according to a 1994 report from the Center on Addiction and Substance Abuse at Columbia University Cigarettes, Alcohol, Marijuana: Gateways to Illicit Drug Use, Center on Addiction and Substance Abuse at Colombia University, October 1994, retrieved 17 July 2007 which stated that there is a consistent relationship between the use of cigarettes and alcohol and the subsequent use of cannabis. Cigarettes, alcohol and cannabis use and the subsequent use of illicit drugs like cocaine is also linked, regardless of the age, sex, ethnicity or race of the individuals involved. This may also be affected by each individual person's personality and or attitude toward their life style. There are many people that smoke marijuana and/or cigarettes without ever becoming addicted or even trying other drugs. The 1994 report also found that when younger children use these gateway drugs, the more often they use them, the more likely they are to use cocaine, heroin, hallucinogens and other illicit drugs. The report concludes that the data is already robust enough to make a strong case to step up efforts to prevent childhood use of cigarettes, alcohol and cannabis and to take firm steps to reduce children’s access to these gateway drugs. Betty Ford Center - Dr. James West Public Q&A Page. URL Accessed October, 2006

People who abuse drugs are likely to be cigarette smokers also. More than two-thirds of drug users are regular tobacco smokers, a rate more than double of that in the general population. National Institute on Drug Abuse researchers have found that craving for nicotine also increases craving for illicit drugs among drug abusers who smoke tobacco, and this suggests that smokers in drug rehabilitation programs may be less successful than nonsmokers in staying off drugs. The National Institute on Drug Abuse (NIDA), part of the NIH, a component of the U.S. Department of Health and Human Services. - Nicotine Craving and Heavy Smoking May Contribute to Increased Use of Cocaine and Heroin - Patrick Zickler, NIDA NOTES Staff Writer. URL Accessed October, 2006 NIDA is a controversial organization.{{cite web|url=http://www.mpp.org/site/apps/nl/content2.asp?c=glKZLeMQIsG&b=1173735&ct=1973329 |title=MPP Responds to Release of 2001 National Household Survey on Drug Abuse |publisher=[Marijuana Policy Project (MPP) |data=September 5 [ --> Many drug policy organizations, such as the RAND Drug Policy Research Center have released information, on studies performed, in stark contrast to the claims made by NIDA.

The "gateway" theory regarding substance abuse has come under a great deal of criticism. The statistics mentioned above only establish a correlation between tobacco smoking and illicit drug use, and do not establish that one causes the other. For example, it is entirely possible that people who smoke cigarettes have a higher incidence of cocaine use, and that a third variable (such as income) causes both, creating the illusion that smoking cigarettes causes cocaine use. It is commonly known that "correlation does not imply causation", and it is a frequent misconception that correlational evidence is "proof".

In 2002, the RAND Drug Policy Research Center released a paper on one of their studies stating that it "casts doubt on claims that marijuana acts as a "gateway" to the use of cocaine and heroin, challenging an assumption that has guided U.S. drug policies since the 1950s." These findings of the RAND Drug Policy Research Center's study are in contradiction to the claims made by NIDA.

Effect on healthcare costs In countries where there is a public health system, society pays for the medical care of smokers who become ill through increased taxes. Two arguments exist on this front, the "pro-smoking" argument suggesting that heavy smokers generally don't live long enough to develop the costly and chronic illnesses which affect the elderly, reducing society's healthcare burden. The "anti-smoking" argument suggests that the healthcare burden is increased because smokers get chronic illnesses younger and at a higher rate than the general population.

Data on both positions is limited, although the Centers for Disease Control and Prevention published research in 2002 claiming that the cost of each pack of cigarettes sold in the United States was more than $7 in medical care and lost productivity. Cigarettes Cost U.S. $7 Per Pack Sold, Study Says The cost may be higher, with another study putting it as high as $41 per pack. Study: Cigarettes cost families, society $41 per pack

By contrast, some non-scientific studies, including one conducted by Philip Morris in the Czech Republic and another by the Cato Institute, support the opposite position. Neither study was peer-reviewed nor published in a scientific journal, and the Cato Institute have received funding from tobacco companies in the past. Philip Morris have explicitly apologised for the former study, saying: "The funding and public release of this study which, among other things, detailed purported cost savings to the Czech Republic due to premature deaths of smokers, exhibited terrible judgment as well as a complete and unacceptable disregard of basic human values. For one of our tobacco companies to commission this study was not just a terrible mistake, it was wrong. All of us at Philip Morris, no matter where we work, are extremely sorry for this. No one benefits from the very real, serious and significant diseases caused by smoking."

Tobacco advertising Before the 1970s, most tobacco advertising was legal in the United States and most European nations. In the United States, in the 1950s and 1960s, cigarette brands were frequently sponsors of television shows—most notably shows such as To Tell the Truth and I've Got a Secret. One of the most famous television jingles of the era came from an advertisement for Winston (cigarette) cigarettes. The slogan "Winston tastes good like a cigarette should!" proved to be catchy, and is still quoted today. Another popular slogan from the 1960s was "Us Tareyton smokers would rather fight than switch!," which was used to advertise Tareyton cigarettes.

Many nations, including Russia, Greece and Romania, still allow billboards advertising tobacco use. Tobacco smoking is still advertised in special magazines, during sporting events, in gas stations and stores, and in more rare cases on television.

In the United States, it was believed by many that tobacco companies are marketing tobacco smoking to minors. Behind the Smokescreen: Tobacco Marketing to Kids For example, Reynolds American Inc. used the Joe Camel cartoon character to advertise Camel cigarettes. Other brands such as Virginia Slims targeted women with slogans like "You've Come a Long Way Baby".

Some nations, including the UK and Australia, have begun anti-smoking advertisements to counter the effects of tobacco advertising.

The actual effectiveness of tobacco advertisement is widely documented. According to an opinion piece by Henry Saffer, public health experts say that tobacco advertising increases cigarette consumption and there is much empirical literature that finds a significant effect of tobacco advertising on smoking, especially in children. Smoking behavior of adolescents exposed to cigarette advertising. Public Health Rep. 1993 Mar–Apr; 108(2): 217–224. Influence of Tobacco Marketing and Exposure to Smokers on Adolescent Susceptibility to Smoking;Journal of the National Cancer Institute, Vol. 87, No. 20, 1538–1545, October 18, 1995 The Last Straw? Cigarette Advertising and Realized Market Shares among Youths and Adults, 1979–1993 Richard W. Pollay, S. Siddarth, Michael Siegel, Anne Haddix, Robert K. Merritt, Gary A. Giovino, Michael P. Eriksen Journal of Marketing, Vol. 60, No. 2 (Apr., 1996), pp. 1–16 doi:10.2307/1251927 Tob Control 1998;7:129–133 ( Summer ) Adolescents' responses to cigarette advertisements: links between exposure, liking, and the appeal of smoking Jeffrey Jensen Arnetta, George Terhanian American Journal of Public Health, Vol 90, Issue 3 407–411, Tobacco marketing and adolescent smoking: more support for a causal inference, L Biener and M Siegel, Center for Survey Research, University of Massachusetts at Boston 02125, USA. Tobacco Advertisements: One of the Strongest Risk Factors for Smoking in Hong Kong Students.American Journal of Preventive Medicine, Volume 14, Issue 3, Pages 217–223 T. Lam J Prev Med. 2002 May;22(4):228-3

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