In the mid-twentieth century smoking in the United States was often associated with romance, relaxation, and adventure; movie stars oozed glamour on screen while smoking, and movie tough guys were never more masculine than when lighting up. Songs such as "Smoke Gets in Your Eyes" topped the hit parade. Smoking became a rite of passage for many young males and a sign of increasing independence for women.
Since the 1990s, however, there has been an increase of opposition to tobacco use. Health authorities warn of the dangers of smoking and chewing tobacco, and nonsmokers object to secondhand smoke—because of both the smell and the health dangers of breathing smoke from other people's cigarettes. Today, a smoker is more likely to ask for permission before lighting up, and the answer is often "no." Because of health concerns, smoking has been banned on airplanes, in hospitals, and in many workplaces, restaurants, and bars.
PHYSICAL PROPERTIES OF NICOTINE
Tobacco is a plant native to the Western Hemisphere. It contains nicotine, a drug classified as a stimulant, although it has some depressive effects as well. Nicotine is a poisonous alkaloid that is the major psychoactive (mood-altering) ingredient in tobacco. (Alkaloids are carbon- and nitrogen-containing compounds that are found in some families of plants. They have both poisonous and medicinal properties.)
Nicotine's effects on the body are complex. The drug affects the brain and central nervous system as well as the hypothalamus and pituitary glands of the endocrine (hormone) system. Nicotine easily crosses the blood-brain barrier (a series of capillaries and cells that controls the flow of substances from the blood to the brain), and it accumulates in the brain—faster than caffeine or heroin, but slower than diazepam (a sedative medicine used to treat anxiety). In the brain nicotine imitates the actions of the hormone epinephrine (adrenaline) and the neurotransmitter acetylcholine, both of which heighten awareness. Nicotine also triggers the release of dopamine, which enhances feelings of pleasure, and endorphins, "the brain's natural opiates," which have a calming effect.
As noted earlier, nicotine acts as both a stimulant and a depressant. By stimulating certain nerve cells in the spinal cord, nicotine relaxes the nerves and slows some reactions, such as the knee-jerk reflex. Small amounts of nicotine stimulate some nerve cells, but these cells are depressed by large amounts. In addition, nicotine stimulates the brain cortex (the outer layer of the brain) and affects the functions of the heart and lungs.
TRENDS IN TOBACCO USE
According to the Centers for Disease Control and Prevention (CDC), the consumption of cigarettes, the most widely used tobacco product, has decreased over the past generation among adults. After increasing rather consistently for sixty years, the per capita (per person) consumption of cigarettes peaked in the 1960s at well over four thousand cigarettes per year ("Chronic Disease Notes and Reports," Fall 2001, http://www.cdc.gov/nccdphp/publications/cdnr/pdf/CDNRfall2001.pdf). The steady decline in smoking came shortly after 1964, when the Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (January 1964, http://www.cdc.gov/Tobacco/sgr/sgr_1964/sgr64.htm) concluded that cigarette smoking is a cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis in both genders. By 2006 the annual per capita consumption of cigarettes for those aged eighteen and over was 1,691. (See Table 3.1.)
|Per capita consumption of tobacco products, 1996–2006|
|Year||Per capita 16 years and over||Per capita 18 years and over||Per male 18 years and over|
|Cigarettesa||Snuffb||All tobacco products||Large cigars & cigarillos||Smoking tobaccob||Chewing tobaccob|
|aUnstemmed processing weight.|
|bFinished product weight.|
|Source: Tom Capehart, "Table 2. Per Capita Consumption of Tobacco Products in the United States (including Overseas Forces), 1996–2006," in Tobacco Outlook, U.S. Department of Agriculture, Economic Research Service, September 26, 2006, http://usda.mannlib.cornell.edu/usda/ers/TBS//2000s/2006/TBS-09-26-2006.pdf (accessed October 10, 2006)|
|Percentage of lifetime, past-year, and past-month cigarette users, by age group, gender, and ethnicity, 2004 and 2005|
|Demographic characteristic||Time period|
|Lifetime||Past year||Past month|
|Source: "Table 2.31B. Cigarette Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older, by Demographic Characteristics: Percentages, 2004 and 2005," in Results from the 2005 National Survey on Drug Use and Health: Detailed Tables, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006, http://www.drugabusestatistics.samhsa.gov/NSDUH/2k5NSDUH/Tabs/Sect2peTabs31to36.pdf (accessed October 10, 2006)|
|or 26 older||72.3||71.9||27.3||27.6||24.1||24.3|
|Hispanic origin and race|
|Not Hispanic or Latino||69.4||68.3||29.4||29.3||25.4||25.3|
|Black or African American||56.6||55.7||27.4||27.4||23.5||24.5|
|American Indian or Alaska Native||77.2||69.2||37.1||42.0||31.0||36.0|
|Native Hawaiian or other Pacific Islander||*||64.4||*||35.0||*||28.8|
|Two or more races||74.1||61.7||43.0||35.2||38.3||30.9|
|Hispanic or Latino||52.9||55.3||26.8||27.9||21.3||22.1|
Each year the Substance Abuse and Mental Health Services Administration surveys U.S. households on drug use for the National Survey on Drug Use and Health (NSDUH). The 2005 NSDUH reports that 66.6% of the U.S. population had smoked cigarettes at some time in their lives and that 24.9% were current smokers (meaning that they had smoked within the month prior to the survey). (See Table 3.2.)
In 2005 men (27.4%) were more likely than women (22.5%) to be current smokers. Additionally, whites (26%) were more likely to be current smokers than African-Americans (24.5%), Hispanics (22.1%), or Asian-Americans (13.4%). Those aged eighteen to twenty-five had the highest rates of current smoking at 39%, compared with 10.8% for twelve- to seventeen-year-olds and 24.3% for those aged twenty-six and older. (See Table 3.2.) In general, rates of cigarette smoking remained the same or declined from 2004 to 2005 for most groups. A notable increase in smoking occurred, however, in the American Indian and Alaskan Native group.
The National Health Interview Survey (NHIS), which is conducted annually by the National Center for Health Statistics, reports findings similar to those of the NSDUH. Preliminary findings from the January-March 2006 NHIS show that 21.5% of adults in the United States were current smokers in early 2006, down from 24.7% in 1997. Like the NSDUH, the NHIS finds that men are more likely than women to smoke. Just over 24% of adult men and 19.1% of adult women were current smokers. Women were more likely than men to have never smoked. (See Figure 3.1.)
Although the NHIS uses different age groups than the NHSDA, results of both surveys show that younger people smoke at a higher rate than older people. Figure 3.2 shows that those aged eighteen to forty-four are slightly more likely than those aged forty-five to sixty-four to smoke. The rate of smoking in the sixty-five and over age group was dramatically lower than in either of the two younger groups. Men in all age categories were more likely than women in the same age group to smoke.
Also, like the NHSDA, the NHIS finds that the prevalence of current smoking among various races and ethnicities is highest for non-Hispanic whites (23.5%). Non-Hispanic African-Americans (23.1%) were slightly less likely to smoke, whereas Hispanics (13.8%) were the least likely to smoke. (See Figure 3.3.)
Cigars, Pipes, and Other Forms of Tobacco
According to the NSDUH, 3.2% of those aged twelve and older were current users of smokeless tobacco (chewing tobacco and/or snuff), and 5.6% were current users of cigars. Only 0.9% smoked pipes. These percentages remained relatively constant from 2002 to 2005. (See Figure 3.4.)
According to the U.S. Department of Agriculture, in 2006 the per capita consumption by males aged eighteen and over was 47.8 large cigars and small, narrow cigars called cigarillos. (See Table 3.1.) This figure is much higher than in 1996 when the per capita consumption
among this group was 31.9 cigars and cigarillos. The use of snuff has increased as well, although not as much as cigars. In 2006 the per capita consumption of snuff was 0.38 of a pound. In 1996 the per capita consumption of this tobacco product was 0.31 of a pound. Snuff is powdered tobacco that is inhaled through the nose.
ADDICTIVE NATURE OF NICOTINE
Is tobacco addictive? In The Health Consequences of Smoking—Nicotine Addiction: A Report of the Surgeon General (1988, http://www.cdc.gov/tobacco/sgr/sgr_1988/index.htm), researchers examined this question. They determined that the pharmacological (chemical and physical) effects and behavioral processes that contribute to tobacco addiction are similar to those that contribute in the addiction to drugs such as heroin and cocaine. Many researchers consider nicotine to be as potentially addictive as cocaine and heroin and note that it can create dependence quickly in some users.
Researchers have also discovered that some cigarettes have a "kick," in that they contain thirty-five times more freebase nicotine than other cigarettes. According to the article "'Crack' Nicotine in Cigarettes" (Journal of Chemical Research in Toxicology, July 28, 2003), the danger of this freebase nicotine is that it is in a volatile,
uncombined form that is absorbed by the lungs and brain at a faster rate than standard forms of nicotine. Researchers sometimes refer to this raw form of nicotine as "crack nicotine," because it potentially has the same addictive quality as crack cocaine. (A drug's addictiveness is measured by the speed at which it reaches the brain.)
Cigarette smoking results in rapid distribution of nicotine throughout the body, reaching the brain within ten seconds of inhalation. However, the intense effects of nicotine disappear in a few minutes, causing smokers to continue smoking frequently throughout the day to maintain its pleasurable effects and to prevent withdrawal. Tolerance develops after repeated exposure to nicotine, and higher doses are required to produce the same initial stimulation. Because nicotine is metabolized fairly quickly, disappearing from the body in a few hours, some tolerance is lost overnight. Smokers often report that the first cigarette of the day is the most satisfying. The more cigarettes smoked during the day, the more tolerance develops, and the less effect subsequent cigarettes have.
Is There a Genetic Basis for Nicotine Addiction?
Smoking is influenced by both environment and genetics. The results of many scientific studies, such as Viba Malaiyandi, Edward M. Sellers, and Rachel F. Tyndale's "Implications of CYP2A6 Genetic Variation for Smoking Behaviors and Nicotine Dependence" (Perspectives in Clinical Pharmacology, March 2005), show that about 60% of the initiation of nicotine dependence and about 70% of the maintenance of dependent smoking behavior is genetically influenced.
The Collaborative Study on the Genetics of Alcoholism, in "Co-occurring Risk Factors for Alcohol Dependence and Habitual Smoking" (Alcohol Research and Health, Winter 2000), reports the results that support the hypothesis that some common genetic factors are involved in the susceptibility for developing both alcohol and nicotine addiction. Moreover, studies of twins support the role of common genetic factors in the development of both disorders.
Nicotine May Not Be the Only Addictive Substance in Cigarettes
Research results suggest that nicotine may not be the only psychoactive ingredient in tobacco. Some as-yet-unknown compound in cigarette smoke decreases the levels of monoamine oxidase (MAO), an enzyme responsible for breaking down the brain chemical dopamine. The decrease in MAO results in higher dopamine levels and may be another reason that smokers continue to smoke—to sustain the high dopamine levels that result in pleasurable effects and the desire for repeated cigarette use.
One issue that complicates any efforts by a longtime smoker to quit is nicotine withdrawal, which is often referred to as craving. This urge for nicotine is not well understood by researchers. Withdrawal may begin within a few hours after the last cigarette. According to the National Institute on Drug Abuse, high levels of craving may persist six months or longer. Besides craving, withdrawal can include irritability, attention deficits, interruption of thought processes, sleep disturbances, and increased appetite.
Some researchers also point out the behavioral aspects involved in smoking. The purchasing, handling, and lighting of cigarettes may be just as pleasing psychologically to the user as the chemical properties of tobacco itself.
HEALTH CONSEQUENCES OF TOBACCO USE
Respiratory System Effects
Cigarette smoke contains almost four thousand different chemical compounds, many of which are toxic, mutagenic (capable of increasing the frequency of mutation), and carcinogenic (cancer-causing). At least forty-three carcinogens have been identified in tobacco smoke. Besides nicotine, the most damaging substances are tar and carbon monoxide (CO). Smoke also contains hydrogen cyanide and other chemicals that can damage the respiratory system. These substances and nicotine are absorbed into the body through the linings of the mouth, nose, throat, and lungs. About ten seconds later they are delivered by the bloodstream to the brain.
Tar, which adds to the flavor of cigarettes, is released by the burning of tobacco. As it is inhaled, it enters the alveoli (air cells) of the lungs. There, the tar hampers the action of cilia—small, hairlike extensions of cells that clean foreign substances from the lungs—allowing the substances in cigarette smoke to accumulate.
CO affects the blood's ability to distribute oxygen throughout the body. CO is chemically similar to carbon dioxide (CO2), which bonds with the hemoglobin in blood so that the CO2 can be carried to the lungs for elimination. Hemoglobin has two primary functions: to carry oxygen to all parts of the body and to remove excess CO2 from the body's tissues. CO bonds to hemoglobin more tightly than CO2 and leaves the body more slowly, which allows CO to build up in the hemoglobin, in turn reducing the amount of oxygen the blood can carry. Lack of adequate oxygen is damaging to most of the body's organs, including the heart and brain.
Diseases and Conditions Linked to Tobacco Use
Results of medical research show an association between smoking and cancer, as well as heart and circulatory disease, fetal growth retardation, and low birth weight babies. The 1983 Health Consequences of Smoking—Cardiovascular Disease: Report of the Surgeon General (http://profiles.nlm.nih.gov/NN/B/B/T/D/_/nnbbtd.pdf) linked cigarette smoking to cerebrovascular disease (stroke) and associated it with cancer of the uterine cervix. Two 1992 studies showed that people who smoke double their risk of forming cataracts, the leading cause of blindness. Recent research links smoking to unsuccessful pregnancies, increased infant mortality, and peptic ulcer disease. In 2004 U.S. Surgeon General Richard H. Carmona released a comprehensive report on smoking and health, The Health Consequences of Smoking: A Report of the Surgeon General (http://www.cdc.gov/Tobacco/sgr/sgr_2004/index.htm), revealing for the first time that cigarette smoking causes diseases in nearly every organ of the body. Table 3.3 lists diseases—including cancers—and other adverse health effects for which cigarette smoking is identified as a cause.
The National Cancer Institute, in "Questions and Answers about Cigar Smoking and Cancer" (2000, http://www.cancer.gov/cancertopics/factsheet/Tobacco/cigars), notes that cigar smoking is associated with cancers of the lip, tongue, mouth, throat, larynx (voice box), lungs, and esophagus (food tube). Those who smoke cigars daily and inhale the smoke are at increased risk for developing heart and lung disease.
Smokeless tobacco, which includes chewing tobacco and snuff, also creates health hazards for its users. The 1979 Smoking and Health: A Report of the Surgeon General (http://profiles.nlm.nih.gov/NN/B/C/M/D/_/nnbcmd.pdf) noted that smokeless tobacco was associated with oral cancers; and the 1986 Health Consequences of Involuntary Smoking: A Report of the Surgeon General concluded that it was a cause of these diseases. The nicotine in smokeless tobacco is absorbed into the bloodstream through the lining of the mouth and has been linked to periodontal (gum) disease and, more important, to cancers of the lip, gum, and mouth. The CDC, in "Smokeless Tobacco: Fact Sheet" (November 2005, http://www.cdc.gov/Tobacco/factsheets/smoke lesstobacco.htm), reminds the public that smokeless tobacco can lead to nicotine addiction. Thus, people who use smokeless tobacco are more likely than nontobacco users to become smokers.
Smoking cigarettes contributes to premature aging in a variety of ways. Results of research over two decades, such as Marysia Placzek et al.'s "Tobacco Smoke Is Phototoxic" (British Journal of Dermatology, May 2004), show that smoking enhances facial aging and skin wrinkling. Additionally, smoking has been associated with a decline in overall fitness in women.
Interactions with Other Drugs
Smoking can have adverse effects when combined with over-the-counter (without a prescription) and prescription medications that a smoker may be taking. In many cases tobacco smoking reduces the effectiveness of medications, such as pain relievers (acetaminophen), antidepressants, tranquilizers, sedatives, ulcer medications, and insulin. With estrogen and oral contraceptives, tobacco smoking may increase the risk of heart and blood vessel disease and can cause strokes and blood clots.
SMOKING AND PUBLIC HEALTH
A study in the 1920s found that men who smoked two or more packs of cigarettes per day were twenty-two times more likely than nonsmokers to die of lung cancer. At the time, these results surprised researchers and medical authorities alike. Some forty years ago, the U.S. government first officially recognized the negative health consequences of smoking. In 1964 the Advisory Committee to the Surgeon General released a groundbreaking survey of studies on tobacco use. In Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, U.S. Surgeon General Luther L. Terry reported that cigarette smoking increased overall mortality in men and caused lung and laryngeal cancer, as well as chronic bronchitis. The report concluded, "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action," but what action should be taken was left unspecified at that time.
Later surgeons general issued additional reports on the health effects of smoking and the dangers to nonsmokers of passive or secondhand smoke. Besides general health concerns, the reports have addressed specific health consequences and populations. Table 3.4 shows a listing of reports of the surgeon general and the years in which they were published. The later reports concluded that smoking increased the morbidity (proportion of diseased people in a particular population) and mortality (proportion of deaths in a particular population) of both men and women.
In 1965 Congress passed the Federal Cigarette Labeling and Advertising Act (PL 89-92), which required the following health warning on all cigarette packages: "Caution: Cigarette smoking may be hazardous to your health." The Public Health Cigarette Smoking Act of 1969 (PL 91-222) strengthened the warning to read: "Warning: The Surgeon General has determined that cigarette smoking is dangerous to your health." Still later acts resulted in four different health warnings to be used in rotation.
The April 2, 1999, Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr/PDF/wk/mm4812.pdf) included "recognition of tobacco use as a health hazard" as one of the country's ten greatest public health achievements of the twentieth century, along with vaccination, control of infectious diseases, safer and healthier food, healthier mothers and babies, family planning, safer workplaces, motor-vehicle
|Diseases and other adverse health effects caused by cigarette smoking, according to the U.S. Surgeon General, 2004|
|Disease||Highest level conclusion from previous Surgeon General's reports (year)||Conclusion from the 2004 Surgeon General's report|
|Bladder cancer||"Smoking is a cause of bladder cancer; cessation reduces risk by about 50 percent after only a few years, in comparison with continued smoking." (1990)||"The evidence is sufficient to infer a causal relationship between smoking and … bladder cancer."|
|Cervical cancer||"Smoking has been consistently associated with an increased risk for cervical cancer." (2001)||"The evidence is sufficient to infer a causal relationship between smoking and cervical cancer."|
|Esophageal cancer||"Cigarette smoking is a major cause of esophageal cancer in the United States." (1982)||"The evidence is sufficient to infer a causal relationship between smoking and cancers of the esophagus."|
|Kidney cancer||"Cigarette smoking is a contributory factor in the development of kidney cancer in the United States. The term 'contributory factor' by no means excludes the possibility of a causal role for smoking in cancers of this site." (1982)||"The evidence is sufficient to infer a causal relationship between smoking and renal cell, [and] renal pelvis … cancers."|
|Laryngeal cancer||"Cigarette smoking is causally associated with cancer of the lung, larynx, oral cavity, and esophagus in women as well as in men…." (1980)||"The evidence is sufficient to infer a causal relationship between smoking and cancer of the larynx."|
|Leukemia||"Leukemia has recently been implicated as a smoking-related disease … but this observation has not been consistent." (1990)||"The evidence is sufficient to infer a causal relationship between smoking and acute myeloid leukemia."|
|Lung cancer||"Additional epidemiological, pathological, and experimental data not only confirm the conclusion of the Surgeon General's 1964 report regarding lung cancer in men but strengthen the causal relationship of smoking to lung cancer in women." (1967)||"The evidence is sufficient to infer a causal relationship between smoking and lung cancer."|
|Oral cancer||"Cigarette smoking is a major cause of cancers of the oral cavity in the United States." (1982)||"The evidence is sufficient to infer a causal relationship between smoking and cancers of the oral cavity and pharynx."|
|Pancreatic cancer||"Smoking cessation reduces the risk of pancreatic cancer, compared with continued smoking, although this reduction in risk may only be measurable after 10 years of abstinence." (1990)||"The evidence is sufficient to infer a causal relationship between smoking and pancreatic cancer."|
|Stomach cancer||"Data on smoking and cancer of the stomach … are unclear." (2001)||"The evidence is sufficient to infer a causal relationship between smoking and gastric cancers."|
|Abdominal aortic aneurysm||"Death from rupture of an atherosclerotic abdominal aneurysm is more common in cigarette smokers than in nonsmokers." (1983)||"The evidence is sufficient to infer a causal relationship between smoking and abdominal aortic aneurysm."|
|Atherosclerosis||"Cigarette smoking is the most powerful risk factor predisposing to atherosclerotic peripheral vascular disease." (1983)||"The evidence is sufficient to infer a causal relationship between smoking and subclinical atherosclerosis."|
|Cerebrovascular disease||"Cigarette smoking is a major cause of cerebrovascular disease (stroke), the third leading cause of death in the United States." (1989)||"The evidence is sufficient to infer a causal relationship between smoking and stroke."|
|Coronary heart disease||"In summary, for the purposes of preventive medicine, it can be concluded that smoking is causally related to coronary heart disease for both men and women in the United States." (1979)||"The evidence is sufficient to infer a causal relationship between smoking and coronary heart disease."|
|Chronic obstructive pulmonary disease||"Cigarette smoking is the most important of the causes of chronic bronchitis in the United states, and increases the risk of dying from chronic bronchitis." (1964)||"The evidence is sufficient to infer a causal relationship between active smoking and chronic obstructive pulmonary disease morbidity and mortality."|
|Pneumonia||"Smoking cessation reduces rates of respiratory symptoms such as cough, sputum production, and wheezing, and respiratory infections such as bronchitis and pneumonia, compared with continued smoking." (1990)||"The evidence is sufficient to infer a causal relationship between smoking and acute respiratory illnesses, including pneumonia, in persons without underlying smoking-related chronic obstructive lung disease."|
|Respiratory effects in utero||"In utero exposure to maternal smoking is associated with reduced lung function among infants…." (2001)||"The evidence is sufficient to infer a causal relationship between maternal smoking during pregnancy and a reduction of lung function in infants."|
|Respiratory effects in childhood and adolescence||"Cigarette smoking during childhood and adolescence produces significant health problems among young people, including cough and phlegm production, an increased number and severity of respiratory illnesses, decreased physical fitness, an unfavorable lipid profile, and potential retardation in the rate of lung growth and the level of maximum lung function." (1994)||"The evidence is sufficient to infer a causal relationship between active smoking and impaired lung growth during childhood and adolescence."
"The evidence is sufficient to infer a causal relationship between active smoking and the early onset of lung function decline during late adolescence and early adulthood."
"The evidence is sufficient to infer a causal relationship between active smoking and respiratory symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea."
"The evidence is sufficient to infer a causal relationship between active smoking and asthma-related symptoms (i.e., wheezing) in childhood and adolescence."
|Respiratory effects in adulthood||"Cigarette smoking accelerates the age-related decline in lung function that occurs among never smokers. With sustained abstinence from smoking, the rate of decline in pulmonary function among former smokers returns to that of never smokers." (1990)||"The evidence is sufficient to infer a causal relationship between active smoking in adulthood and a premature onset of and an accelerated age-related decline in lung function."
"The evidence is sufficient to infer a causal relationship between active sustained cessation from smoking and a return of the rate of decline in pulmonary function to that of persons who had never smoked."
|Other respiratory effects||"Smoking cessation reduces rates of respiratory symptoms such as cough, sputum production, and wheezing, and respiratory infections such as bronchitis and pneumonia, compared with continued smoking." (1990)||"The evidence is sufficient to infer a causal relationship between active smoking and all major respiratory symptoms among adults, including coughing, phlegm, wheezing, and dyspnea."
The evidence is sufficient to infer a causal relationship between active smoking and poor asthma control."
|Diseases and other adverse health effects caused by cigarette smoking, according to the U.S. Surgeon General, 2004 [contiuned]|
|Disease||Highest level conclusion from previous Surgeon General's reports (year)||Conclusion from the 2004 Surgeon General's report|
|Source: "Table 1.1. Diseases and Other Adverse Health Effects for Which Smoking Is Identified as a Cause in the Current Surgeon General's Report," in The Health Consequences of Smoking: A Report of the Surgeon General, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, http://www.cdc.gov/tobacco/sgr/sgr_2004/pdf/chapter1.pdf (accessed October 10, 2006)|
|Fetal death and stillbirths||"The risk for perinatal mortality—both stillbirth and neonatal deaths—and the risk for sudden infant death syndrome (SIDS) are increased among the offspring of women who smoke during pregnancy." (2001)||"The evidence is sufficient to infer a causal relationship between sudden infant death syndrome and maternal smoking during and after pregnancy."|
|Fertility||"Women who smoke have increased risks for conception delay and for both primary and secondary infertility." (2001)||"The evidence is sufficient to infer a causal relationship between smoking and reduced fertility in women."|
|Low birth weight||"Infants born to women who smoke during pregnancy have a lower average birth weight … than … infants born to women who do not smoke." (2001)||"The evidence is sufficient to infer a causal relationship between maternal active smoking and fetal growth restriction and low birth weight."|
|Pregnancy complications||"Smoking during pregnancy is associated with increased risks for preterm premature rupture of membranes, abruptio placentae, and placenta previa, and with a modest increase in risk for preterm delivery." (2001)||"The evidence is sufficient to infer a casual relationship between maternal active smoking and premature rupture of the membranes, placenta previa, and placental abruption."
"The evidence is sufficient to infer a causal relationship between maternal active smoking and preterm delivery and shortened gestation."
|Cataract||"Women who smoke have an increased risk for cataract." (2001)||"The evidence is sufficient to infer a causal relationship between smoking and nuclear cataract."|
|Diminished health status/morbidity||"Relationships between smoking and cough or phlegm are strong and consistent; they have been amply documented and are judged to be causal…." (1984)
"Consideration of evidence from many different studies has led to the conclusion that cigarette smoking is the overwhelmingly most important cause of cough, sputum, chronic bronchitis, and mucus hypersecretion." (1984)
|"The evidence is sufficient to infer a causal relationship between smoking and diminished health status that may be manifest as increased absenteeism from work and increased use of medical care services."
"The evidence is sufficient to infer a causal relationship between smoking and increased risks for adverse surgical outcomes related to wound healing and respiratory complications."
|Hip fractures||"Women who currently smoke have an increased risk for hip fracture compared with women who do not smoke." (2001)||"The evidence is sufficient to infer a causal relationship between smoking and hip fractures."|
|Low bone density||"Postmenopausal women who currently smoke have lower bone density than do women who do not smoke." (2001)||"In postmenopausal women, the evidence is sufficient to infer a causal relationship between smoking and low bone density."|
|Peptic ulcer disease||"The relationship between cigarette smoking and death rates from peptic ulcer, especially gastric ulcer, is confirmed. In addition, morbidity data suggest a similar relationship exists with the prevalence of reported disease from this cause." (1967)||"The evidence is sufficient to infer a causal relationship between smoking and peptic ulcer disease in persons who are helicobacter pylori positive."|
safety, decline in deaths from coronary heart disease and stroke, and fluoridation of drinking water. These ten accomplishments were chosen based on their contributions to prevention and their impact on illness, disability, and death in the United States.
DEATHS ATTRIBUTED TO TOBACCO USE
According to the Health Consequences of Smoking: A Report of the Surgeon General, cigarette smoking is the leading cause of preventable death in the United States and produces substantial health-related economic costs to society. The report notes that smoking caused an estimated 440,100 deaths in the United States each year from 1995 to 1999. Nationwide, smoking kills more people each year than alcohol, drug abuse, car crashes, murders, suicides, fires, and acquired immune deficiency syndrome combined.
In 2004 diseases linked to smoking accounted for four of the top five leading causes of death in the United States. (See Table 3.5.) According to the CDC, about 655,000 people died of various heart diseases in 2004 (down from about 761,000 in 1980). Approximately 550,000 died of cancer, and cerebrovascular disease (stroke) claimed about 150,000 lives. Chronic lower respiratory diseases, including chronic bronchitis, asthma, and emphysema, claimed nearly 124,000 lives.
In Cancer Facts and Figures, 2006 (2006, http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf), the American Cancer Society estimated that 162,460 Americans died of lung and bronchus cancer in 2006. While not all lung and bronchus cancer deaths are directly attributable to smoking, a large proportion of them are. Lung cancer is the leading cause of cancer mortality in both men and women in the United States. It has been the leading cause of cancer deaths among men since the early 1950s and, in 1987, surpassed breast cancer to become the leading cause of cancer deaths in women.
Secondhand smoke, also known as environmental tobacco smoke (ETS) or passive smoke, is a health hazard for nonsmokers who live or work with smokers. The National Cancer Institute (2006, http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=46431) defines secondhand smoke as "smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers…. Inhaling ETS is called involuntary or passive smoking."
|Twenty-nine Surgeon General's reports on smoking and health, selected years 1964–2006|
|Note: Smoking remains the leading cause of preventable death and has negative health impacts on people at all stages of life. It harms unborn babies, infants, children, adolescents, adults, and seniors.|
|Source: Adapted from "28 Surgeon General's Reports on Smoking and Health, 1964–2004," U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Tobacco Information and Prevention Source (TIPS), http://www.cdc.gov/tobacco/sgr/sgr_2004/Factsheets/11.htm (accessed October 30, 2006), and "The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General," U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf (accessed November 24, 2006)|
|1964||Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service|
|1967||The Health Consequences of Smoking: A Public Health Service Review|
|1968||The Health Consequences of Smoking: 1968 Supplement to the 1967 Public Health Service Review|
|1969||The Health Consequences of Smoking: 1969 Supplement to the 1967 Public Health Service Review|
|1971||The Health Consequences of Smoking|
|1972||The Health Consequences of Smoking|
|1973||The Health Consequences of Smoking|
|1974||The Health Consequences of Smoking|
|1975||The Health Consequences of Smoking|
|1976||The Health Consequences of Smoking|
|1978||The Health Consequences of Smoking, 1977–1978|
|1979||Smoking and Health|
|1980||The Health Consequences of Smoking for Women|
|1981||The Health Consequences of Smoking—The Changing Cigarette|
|1982||The Health Consequences of Smoking—Cancer|
|1983||The Health Consequences of Smoking—Cardiovascular Disease|
|1984||The Health Consequences of Smoking—Chronic Obstructive Lung Disease|
|1985||The Health Consequences of Smoking—Cancer and Chronic Lung Disease in the Workplace|
|1986||The Health Consequences of Involuntary Smoking|
|1988||The Health Consequences of Smoking—Nicotine Addiction|
|1989||Reducing the Health Consequences of Smoking—25 Years of Progress|
|1990||The Health Benefits of Smoking Cessation|
|1992||Smoking and Health in the Americas|
|1994||Preventing Tobacco Use among Young People|
|1998||Tobacco Use among U.S. Racial/Ethnic Minority Groups|
|2000||Reducing Tobacco Use|
|2001||Women and Smoking|
|2004||The Health Consequences of Smoking|
|2006||The Health Consequences of Involuntary Exposure to Tobacco Smoke|
The first scientific paper on the harmful effects of secondhand smoke was Takeshi Hirayama's "Non-smoking Wives of Heavy Smokers Have a Higher Risk of Lung Cancer: A Study from Japan" (British Medical Journal, 1981). Hirayama studied 92,000 nonsmoking wives of smoking husbands and a similarly sized group of women married to nonsmokers. He discovered that nonsmoking wives of husbands who smoked faced a 40% to 90% elevated risk of lung cancer (depending on how frequently their husbands smoked) compared with the wives of nonsmoking husbands.
Other studies have followed. The U.S. Environmental Protection Agency (EPA), in Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders (December 1992, http://cfpub2.epa.gov/ncea/cfm/recordisplay.cfm?deid=2835), concluded that the "widespread exposure to environmental tobacco smoke (ETS) in the United States presents a serious and substantial public health impact." In Elizabeth T. H. Fon-tham et al.'s "Environmental Tobacco Smoke and Lung Cancer in Nonsmoking Women: A Multicenter Study" (Journal of the American Medical Association, June 1994), a large case-control study on secondhand smoke, compelling links were found between passive smoke and lung cancer. In 2000 the Environmental Health Information Service's Ninth Report on Carcinogens classified secondhand smoke as a Group A (Human) Carcinogen—a substance known to cause cancer in humans. According to the EPA, there is no safe level of exposure to such Group A toxins.
In 2005 more evidence accumulated on the risks of passive smoking. In "Environmental Tobacco Smoke and Risk of Respiratory Cancer and Chronic Obstructive Pulmonary Disease in Former Smokers and Never Smokers in the EPIC Prospective Study" (British Medical Journal, 2005), the European Prospective Investigation into Cancer and Nutrition reveals that those who had been exposed to secondhand smoke during childhood for many hours each day had more than triple the risk of developing lung cancer compared with people who were not exposed. In addition, Sarah M. McGhee et al., in "Mortality Associated with Passive Smoking in Hong Kong" (British Medical Journal, January 2005), show that there is a correlation between an increased risk of dying from various causes (including lung cancer and other lung diseases, heart disease, and stroke) and the number of smokers in the home. Risk increased by 24% when one smoker lived in the home and by 74% with two smokers in the household.
In June 2006 the twenty-ninth report of the surgeon general on smoking—The Health Consequences of Involuntary Exposure to Tobacco Smoke (http://www.surgeongeneral.gov/library/secondhandsmoke/report/)—was published. The report notes that:
With regard to the involuntary exposure of nonsmokers to tobacco smoke, the scientific evidence now supports the following major conclusions:
- Secondhand smoke causes premature death and disease in children and in adults who do not smoke.
- Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
- Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
- The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
- Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
- Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.
TABLE 3.5 Leading causes of death, 1980 and 2004 Rank order 1980 2004 Cause of death Cause of death Source: Adapted from "Table 32. Leading Causes of Death and Numbers of Deaths, according to Sex, Race, and Hispanic Origin: United States, 1980 and 2000," in Health, United States, 2002, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, September 2002, and Arialdi M. Minino, Melonie P. Heron, and Betty L. Smith, "Table 7. Deaths and Death Rates for the 10 Leading Causes of Death in Specified Age Groups: United States, Preliminary 2004," in "Deaths: Preliminary Data for 2004," in National Vital Statistics Reports, vol. 54, no. 19, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, June 28, 2006, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf (accessed October 10, 2006) All causes All causes 1 Diseases of heart 1 Diseases of heart 2 Malignant neoplasmas 2 Malignant neoplasmas 3 Cerebrovascular diseases 3 Cerebrovascular diseases 4 Unintentional injuries 4 Chronic lower respiratory diseases 5 Chronic obstructive pulmonary diseases 5 Accidents (unintentional injuries) 6 Pneumonia and influenza 6 Diabetes mellitus 7 Diabetes mellitus 7 Alzheimer's disease 8 Chronic liver disease and cirrhosis 8 Influenza and pneumonia 9 Atherosclerosis 9 Nephritis, nephrotic syndrome and nephrosis 10 Suicide 10 Septicemia
A MOVEMENT TO BAN SMOKING
Many efforts have been initiated over the years to control public smoking or to separate smokers and nonsmokers. In 1975 the Clean Indoor Air Act in Minnesota became the nation's first statewide law to require the separation of smokers and nonsmokers. The purpose of the law was to protect public health, public comfort, and the environment by banning smoking in public places and at public meetings, except in designated smoking areas.
Other states soon followed Minnesota. In 1977 Berkeley became the first community in California to limit smoking in restaurants and other public places. In 1990 San Luis Obispo, California, became the first city to ban smoking in all public buildings, bars, and restaurants. In 1994 smoking was restricted in many government buildings in California. In that same year the fast-food giant McDonald's banned smoking in all of its establishments. In 1995 New York City banned smoking in the dining areas of all restaurants with more than thirty-five seats. As of July 2003, all public and workplaces in New York City became smoke-free, including bars and restaurants. Laws vary from state to state and from city to city, but by 2005 smoking was banned in most workplaces, hospitals, government buildings, museums, schools, theaters, and many restaurants throughout the United States.
Gallup conducted a poll regarding secondhand smoke after the 2006 surgeon general's report on the subject was published. Gallup notes that the document had "little immediate impact on public attitudes about the risks" of passive smoking. The 2006 poll revealed that 56% of those surveyed perceived the risk of secondhand smoke to be very harmful. Twenty-nine percent believed that secondhand smoke was somewhat harmful, and 12% thought it was not too harmful or not at all harmful in the 2006 survey. (See Figure 3.5.)
The CDC, in "Cigarette Smoking among Adults—United States, 2005" (October 27, 2006, http://www.cdc.gov/mmwr/PDF/wk/mm5542.pdf), estimates that in 2005 there were 45.1 million current smokers. Furthermore, the CDC reports in "Smoking Prevalence among U.S. Adults" (October 2006, http://www.cdc.gov/tobacco/research_data/adults_prev/prevali.htm) that there continues to be a decline in adult smokers. In 1965, 42.4% of adults smoked; by 2005, 20.9% of adults smoked.
Many cigarette smokers are trying to stop smoking—or would at least like to. In the 2006 Gallup poll "Tobacco and Smoking," smokers were asked if they would like to give up smoking. Seventy-five percent answered yes. This figure is down from 82% in 2004 and 76% in 1999 but up from 66% in 1977.
According to the article "U.S. Has New Plan against Smoking" (New York Times, October 5, 1991), the federal government began a massive antismoking campaign in 1991 that was intended to prevent 1.2 million smoking-related deaths. The goal of the multiyear program was to help 4.5 million adults stop smoking, prevent two million youths from starting, and reduce the number of smokers to 15% of the population.
The government reports Reducing Tobacco Use (2000, http://www.cdc.gov/Tobacco/sgr/sgr_2000/FullReport.pdf) and Investment in Tobacco Control State Highlights (2002, http://www.cdc.gov/tobacco/statehi/statehi_2002.htm) say that drug treatment for nicotine addiction, combined with other treatment methods, will enable 20-25% of users to refrain from smoking one year after treatment. Even physicians who simply advise their patients to quit smoking can produce a cessation increase of 5-10%.
Global Efforts to Reduce Tobacco Use
According to the World Health Organization (WHO), in Tobacco: Deadly in Any Form or Disguise (2006, http://www.who.int/tobacco/communications/events/wntd/2006/Tfi_Rapport.pdf), an estimated 1.3 billion adults around the world use tobacco. In addition, the WHO notes that tobacco causes five million deaths per year.
In May 2003 member states of the WHO adopted the world's first international public health treaty for global cooperation in reducing the negative health consequences of tobacco use. The WHO Framework Convention on Tobacco Control is designed to reduce tobacco-related deaths and disease worldwide. In February 2005 the treaty came into force after being ratified by member countries. Each of the 168 countries that signed the treaty must now pass it into law. Although the United States signed the treaty in May 2004, indicating its general acceptance, by the end of 2006 it had not yet ratified (become bound by) the treaty. The treaty has many measures, which include requiring countries to impose restrictions on tobacco advertising, sponsorship, and promotion; establishing new packaging and labeling of tobacco products; establishing clean indoor air controls; and promoting taxation as a way to cut consumption and fight smuggling.
Benefits of Stopping
The Health Benefits of Smoking Cessation: A Report of the Surgeon General (1990, http://profiles.nlm.nih.gov/NN/B/B/C/T/_/nnbbct.pdf) notes that quitting offers major and immediate health benefits for both sexes and for all ages. This first comprehensive report on the benefits of quitting showed that many of the ill effects of smoking can be reversed. The surgeon general's report Health Consequences of Smoking reveals that deaths attributable to smoking can be reduced dramatically if the prevalence of smoking is cut.
According to Arialdi M. Miniño et al. in Deaths: Preliminary Data for 2004 (June 28, 2006, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf), heart disease was the number-one killer of Americans in 2004 and cancer was the number-two killer. Of all cancers, lung cancer is the number-one killer of both men and women. People who quit smoking in middle age or before middle age avoid more than 90% of the lung cancer risk attributable to tobacco. Results of Richard Peto et al.'s "Smoking, Smoking Cessation, and Lung Cancer in the UK since 1950: Combination of National Statistics with Two Case-Control Studies" (British Medical Journal, August 5, 2000) reveal the extent to which smoking cessation lowers lung cancer risk. For men who stopped smoking at aged sixty, fifty, forty, and thirty, the cumulative risks of lung cancer by the age of seventy-five were 10%, 6%, 3%, and 2%, respectively. These results were supported by the findings of Anna Crispo et al., in "The Cumulative Risk of Lung Cancer among Current, Ex- and Never-Smokers in European Men" (British Journal of Cancer, October 2004), that led to the conclusion that, for long-term smokers, giving up smoking in middle age allows people to avoid most of the subsequent risk of lung cancer.
For smokers who quit, the risk of heart disease drops rapidly after smoking cessation. After one year's abstinence from smoking, the risk of heart disease is reduced by about 50% and continues to decline gradually. After five to ten years of smoking cessation, the risk has declined to that of a person who has never smoked. In addition, Gay Sutherland reports in "Smoking: Can We Really Make a Difference?" (Heart, May 2003) that stopping smoking reduces the risk of stroke to that of a nonsmoker after five years of smoking cessation.
The study "Effects of Multiple Attempts to Quit Smoking and Relapses to Smoking on Pulmonary Function" (Journal of Clinical Epidemiology, December 1998) by Robert P. Murray et al. investigated whether short periods of quitting were beneficial to smokers' health. Results revealed that those who made several attempts to quit smoking had less loss of lung function than those who continued to smoke. Therefore, even intermittent lapses in smoking are beneficial.
Quitting and Pregnancy
The 2005 NSDUH finds that from 10.4% to 26.4% of pregnant women smoked cigarettes in the month prior to the survey. Those aged eighteen to twenty-five had the highest percentage of smokers. Nonetheless, in the fifteen- to seventeen-year-old group a higher percentage of pregnant girls smoked than nonpregnant girls, 22.3% versus 18.5%, respectively. (See Figure 3.6.)
Smoking during pregnancy can compromise the health of the developing fetus. The 2004 surgeon general's report Health Consequences of Smoking notes that evidence suggests the possibility of a causal relationship between maternal smoking and ectopic pregnancy, a situation in which the fertilized egg implants in the fallopian tube rather than in the uterus. This situation is quite serious and is life-threatening to the mother. Smoking by pregnant women is also linked to an increased risk of miscarriage, stillbirth, premature delivery, and sudden infant death syndrome, and is a cause of low birth weight in infants. A woman who stops smoking before pregnancy or during her first trimester (three months) of pregnancy significantly reduces her chances of having a low birth weight baby. Research finds that it takes smokers longer to get pregnant than nonsmokers, but that women who quit are as likely to get pregnant as those who have never smoked.
Complaints about Quitting
A major side effect of smoking cessation is nicotine withdrawal. The short-term consequences of nicotine withdrawal may include anxiety, irritability, frustration, anger, difficulty concentrating, and restlessness. Possible long-term consequences are urges to smoke and increased appetite. Nicotine withdrawal symptoms peak in the first few days after quitting and subside during the following weeks. Improved self-esteem and an increased sense of control often accompany long-term abstinence.
One of the most common complaints among former smokers is that they gain weight when they stop smoking. Many reasons explain this weight gain, but two primary reasons are the metabolism changes when nicotine is withdrawn from the body and many former smokers use food in an attempt to manage their withdrawal cravings. To combat weight gain, some former smokers start exercise programs.
Ways to Stop Smoking
Nicotine replacement treatments can be effective for many smokers. Nicotine patches and gum are two types of nicotine replacement therapy (NRT). The nicotine in a patch is absorbed through the skin, and the nicotine in gum is absorbed through the mouth and throat. NRT helps a smoker cope with nicotine withdrawal symptoms that discourage many smokers trying to stop. Nicotine patches and gum are available over the counter. Other NRT products are the nicotine nasal spray and the nicotine inhaler, which are available by prescription.
The nonnicotine therapy bupropion (an antidepressant drug such as Zyban and Wellbutrin) is also available by prescription for the relief of nicotine withdrawal symptoms. In addition, behavioral treatments, such as smoking-cessation programs, are useful for some smokers who want to quit. Behavioral methods are designed to create an aversion to smoking, develop self-monitoring of smoking behavior, and establish alternative coping responses.
Quitting smoking is not easy. Sutherland notes that the expected one-year success rates of quitting smoking vary among stop-smoking interventions. Only 1-2% of smokers trying to quit will remain smoke-free for a year with no advice or support from a doctor or other health care professional and no treatment (NRT or bupropion). Five percent of those who receive three minutes' advice from a health care professional to help them quit will remain smoke-free for a year. Advice plus treatment raises the percentage of those who remain smoke free to 10%. Intensive behavioral support from a specialist plus treatment can lead to a 25% success rate.
For centuries the leaves of the tobacco plant have been used for making smoking tobacco and chewing tobacco. Tobacco contains small amounts of nicotine, a stimulant that acts on the heart and other organs and the nervous system when tobacco is inhaled, ingested, or absorbed. Nicotine's effect on the nervous system causes people to become addicted to it, and the stimulating effects make smoking and chewing tobacco pleasurable. Concentrated amounts of nicotine are poisonous, however. Although the use of tobacco was condemned on occasion in the past, not until the latter half of the twentieth century were concerted efforts made to curb tobacco use in the United States.
Before the arrival of Europeans in America, Native Americans were growing and harvesting tobacco to be smoked in pipes. Europeans exploring America learned of this practice and took tobacco seeds back to Europe where tobacco was grown and used as a medicine to help people relax. European physicians believed that tobacco should be used only for medicinal purposes. Commercial production of tobacco began in the colony of Virginia in the early seventeenth century where it soon became an important crop. The expansion of tobacco farming, especially in the southern colonies, contributed to the demand for and practice of slavery in America. Most tobacco grown in the American colonies was shipped to Europe until the Revolutionary War, when manufacturers began using their crops to produce chewing and smoking tobacco.
The use of tobacco for other than medicinal purposes was controversial: the Puritans in America believed that tobacco was a dangerous narcotic. Nevertheless, chewing and smoking tobacco became increasingly popular. Cigars were first manufactured in the United States in the early nineteenth century. Hand-rolled cigarettes became popular in the mid-nineteenth century, and by the 1880s, a cigarette-making machine had been invented. In the twentieth century tobacco use, especially cigarette smoking, continued to expand in the United States.
By the 1960s, however, scientists had confirmed that smoking could cause lung cancer, heart disease, and other illnesses. Some cigarette manufacturers reacted to these findings by reducing the levels of nicotine and tar in their cigarettes, but the medical community established that these measures did not eliminate the health risks of smoking. Subsequently, extensive research linked cigarette smoking and tobacco chewing to many serious illnesses.
In 2001, the American Lung Association estimated that over 400,000 deaths per year in the United States were directly attributable to smoking, which resulted in health care costs
Cipollone v. Liggett Group, Inc.
Cipollone v. Liggett Group, Inc., 693 F. Supp. 208 (D.N.J. 1988), aff'd in part, rev'd in part, 893 F.2d 541 (3d Cir. [N.J.] 1990), cert. granted, 499 U.S. 935, 111 S. Ct. 1386, 113 L. Ed. 2d 443 (1991), aff'd in part, rev'd in part, 505 U.S. 504, 112 S. Ct. 2608, 120 L. Ed. 2d 407 (1992), was the first case in which a former smoker recovered monetary damages against the U.S. tobacco industry. It is also considered a landmark tobacco case because of the legal precedent it established.
Rose Cipollone smoked cigarettes manufactured by defendant Lorillard for forty years. She started smoking at an early age because she thought it was the cool and grown-up thing to do and soon found that she could not stop the habit. Cipollone developed lung cancer, requiring the removal of her right lung. She died before her case went to trial, but her husband pursued her claims on her behalf.
Cipollone brought fourteen claims against Liggett Group, Inc., Philip Morris, Inc., and Lorillard, including strict liability, negligence, breach of warranty, intentional tort, and conspiracy. The intentional tort claims included the allegation that the tobacco companies had fraudulently misrepresented that smoking was safe through their advertising and conspired to keep the public from learning about the scientific evidence that clearly demonstrated the health hazards of smoking.
The tobacco companies argued that Rose Cipollone knowingly chose to smoke and therefore accepted all of the dangers and health consequences associated with it. On the other hand, the tobacco companies vehemently maintained that there is no medical or scientific basis to show that smoking is linked to cancer or other diseases.
The Cipollonecase lasted ten years and included the filing of one hundred motions, four interlocutory appeals, four months of trial, an appeal from the jury verdict, two petitions of certiorari to the U.S. Supreme Court, and argument and then reargument before the Court. Although the jury in the first trial awarded the plaintiff $400,000 in damages, the verdict was ultimately overturned on appeal due to technical mistakes, and a retrial was ordered. By that time, the three legal firms representing the plaintiff had spent collectively more than $6.2 million on the case and could not afford to continue. In contrast, the defendants spent $40 million and never had to pay one cent to the Cipollones.
This case made history at the pretrial stage because the court ordered the tobacco industry to release thousands of pages of confidential internal documents that the plaintiff needed to prove that the tobacco industry conspired to prevent the public from being informed of the health hazards of smoking (649 F. Supp. 664). The court also held that, because of the enormous public interest in these documents, they could be released to third parties and used in other related cases (113 F.R.D. 86 [D.N.J. 1986]; 822 F.2d 335 [3d Cir. 1987], cert. denied, 479 U.S. 1043, 107 S. Ct. 907, 93 L. Ed. 2d 857 ). However, the defendants were still able to protect the most damaging documents by asserting the attorney-client privilege and the work product doctrine (140 F.R.D. 684). Without those damaging documents, the jury rejected the plaintiff's theories of conspiracy or misrepresentation, but did find in her favor on the claim of breach of the express warranty that cigarettes were safe.
Cipolloneis also the definitive case regarding the preemption of state tort claims by the Federal Cigarette Labeling and Advertising Act (FCLAA) (79 Stat. 282). The Supreme Court held that the FCLAA preempts state law damage claims that are based on a cigarette manufacturer's failure to warn of the health risks of smoking and its neutralization of the federally mandated warnings through advertising techniques, to the extent that those claims rely on omissions or inclusions in the manufacturer's advertisements or promotions (505 U.S. 504, 112 S. Ct. 2608, 120 L. Ed. 2d 407 ). However, the Supreme Court also held that the FCLAA does not preempt claims that are based on strict liability, negligent design, express warranty, intentional fraud and misrepresentation, or conspiracy.
Bajalia, Mark. 1993. "The Supreme Court Renders Its Decision: Federal Preemption, the Cigarette Act and Cipollone." National Trial Lawyer 5 (May).
Fenswick, C.F. 1993. "Supreme Court Takes Middle Ground in Cigarette Litigation." Tulane Law Review 67 (February).
of over $90 billion. Tobacco is responsible for more deaths in the United States than car accidents, acquired immune deficiency syndrome (AIDS), alcohol, illegal drugs, homicides, suicides, and fires combined.
Medical research has not only proven that smoking is injurious to the health of the smoker, but it has also established that nonsmokers can be harmed by inhaling the cigarette smoke of others. This type of smoke is called secondhand smoke, passive smoke, involuntary smoke, or environmental tobacco smoke (ETS). In 1993, the environmental protection agency(EPA) classified ETS as a known human (Group A) carcinogen because it causes lung cancer in adult nonsmokers and impairs the respiratory and cardiovascular health of nonsmoking children. ETS, which is the third leading preventable cause of death in the United States, contains the same carcinogenic compounds as are found in the smoke inhaled by smokers.
As these research findings have appeared, concern over tobacco's effect on health has played an important role in encouraging government regulation of tobacco. At the same time, however, the popularity of tobacco use has resulted in considerable political and financial strength for the tobacco industry. By the 1990s tobacco had become the seventh largest cash crop in the United States, and tobacco growers and manufacturers were realizing $47 billion annually. With such revenues available, the tobacco industry has been able to exert significant influence over tobacco regulation. In a report released by the Campaign for Tobacco-Free Kids, the American Heart Association, and the American Lung Association, the tobacco industry contributed more than $3 million in "soft money" funds to political candidates and political committees, in 2001. Because the industry is also central to the economies of many tobacco-producing states, members of Congress from those states have opposed restrictions on tobacco companies.
Despite the tobacco companies' efforts, the industry is subject to extensive federal and state regulation. Among the federal agencies with minor regulatory interests in tobacco and tobacco products are the bureau of alcohol, tobacco, firearms, and explosives, the Tax and Trade Bureau, the health and human services department, the Agriculture Department, and the internal revenue service. Federal agencies with broader power to regulate tobacco include the federal trade commission (FTC), the federal communications commission (FCC), and, the most recent to assert jurisdiction, the food and drug administration (FDA).
Federal Regulation of Tobacco Advertising and Labeling
In the 1950s, the federal government began to regulate the sale and production of chewing and smoking tobacco because of the growing concern over its adverse effects on the health of consumers. Traditionally, the FTC was the federal agency primarily responsible for the regulation of tobacco products, especially with regard to labeling and advertising. In 1955, the FTC promulgated guidelines that prohibited cigarette advertisements from carrying therapeutic health claims. In 1964, the commission issued a Trade Regulation Rule on Cigarette Labeling and Advertising that strictly controlled the advertising and labeling of tobacco products. The FTC claimed that the failure to warn consumers of the dangers of smoking constituted an unfair and deceptive trade practice under the Federal Trade Commission Act (15 U.S.C.A. § 41 ).
Shortly after the FTC issued its trade regulation rule, Congress intervened by enacting the Federal Cigarette Labeling and Advertising Act (FCLAA) (15 U.S.C.A. §§ 1331 et seq. ), which was more moderate than the FTC regulation and preempted agency action. The FCLAA required that a health warning be conspicuously displayed on all packages and cartons of cigarettes. As originally enacted, the FCLAA required only the warning, "Caution: Cigarette Smoking May Be Hazardous to Your Health." Subsequently, however, this act was amended to require more explicit warnings. Under amendments added in 1984, cigarette manufacturers must use one of the following labels to satisfy the health warning requirement:
SURGEON GENERAL'S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy.
SURGEON GENERAL'S WARNING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health.
SURGEON GENERAL'S WARNING: Smoking by Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight.
SURGEON GENERAL'S WARNING: Cigarette Smoke Contains Carbon Monoxide.
The warning labels must also appear on all cigarette advertising, including magazine advertisements and billboards.
In 1986, Congress enacted the Comprehensive Smokeless Tobacco Health Education Act (CSTHEA) (15 U.S.C.A. §§ 4401 et seq.), which requires smokeless tobacco products to carry one of the following warning labels:
"WARNING: THIS PRODUCT MAY CAUSE MOUTH CANCER"
"WARNING: THIS PRODUCT MAY CAUSE GUM DISEASE AND TOOTH LOSS"
"WARNING: THIS PRODUCT IS NOT A SAFE ALTERNATIVE TO CIGARETTES."
National Clean Air Debate
On April 5, 1994, the Occupational Safety and Health Administration (OSHA) published proposed nationwide indoor air quality regulations that would prevent smoking in all indoor workplaces, including office buildings, government buildings, restaurants, stores, and bars, except in designated smoking areas with separate ventilation systems (59 Fed. Reg. 15,968–16,039). OSHA provided a public comment period followed by public hearings, which were extended a number of times, and finally closed the hearings in January 1996. OSHA also sought post-hearing comments, but by the end of 1997 the administration had not announced when, or whether, it would issue its final rules addressing this controversial topic. The dispute over the OSHA regulations frames the larger debate between advocates and opponents of smoking regulations.
Proponents of the indoor air quality regulations argue that if people are freely allowed to smoke in the workplace, they contaminate the air that nonsmokers breathe, subjecting everyone around them to severe health consequences. Proponents cite decades of scientific and medical studies that demonstrate the health effects of environmental tobacco smoke (ETS). They refer to studies that show that ETS causes lung cancer and heart disease in adults and various respiratory disorders in children.
Various government agencies support OSHA's proposed regulations. The U.S. surgeon general has published numerous reports warning of the dangers of ETS. The labor department reported to OSHA that 83 percent of all worker health complaints related to indoor air quality are linked to ETS. Since 1992, the U.S. environmental protection agency has classified ETS as a known Group A human carcinogen. Various other medical and research organizations support the proposed regulations as well. The National Academy of Sciences has warned of the dangers of ETS. A 1995 study published in the Journal of the American Medical Association found that nicotine levels in the air at work sites with no restrictions on smoking were triple the amount considered hazardous by U.S. regulatory standards.
Proponents of the regulations are concerned for the health of the non-smokers, but they also cite many economic reasons for instituting the indoor air quality regulations nationwide. For example, employers must pay more for health insurance for their employees when their employees smoke or are exposed to ETS. Employers also suffer productivity losses when their employees are sick or disabled due to smokingrelated illnesses. Smoking also causes premature deaths in employees, which results in a productivity loss to the employer. When smoking is allowed in the workplace, there is more trash, such as cigarette butts, to clean up. Proponents of the smoking regulations also argue that computer equipment, carpets, furniture, and other furnishings need more maintenance and must be replaced more frequently when smoking is permitted in the workplace. Finally, employers who are forced to choose between the rights of smoking workers and the rights of nonsmoking workers fear that they will be liable for nonsmoker injuries. For example, under the Americans with Disabilities Act, 104 Stat. 327, if ETS prevents a worker from being able to perform her job, the employer may be responsible for allowing the ETS in the workplace.
Opponents of the indoor air quality regulations include restaurant, bar, and hotel owners, trade associations, cigarette manufacturers, smokers, and those who seek to protect individual freedoms from government regulation. Activist organizations that promote smokers' rights include the National Smokers Alliance, the United Smokers Association, and the American Puffer Alliance. These groups point out that their numbers are large; in fact, there are approximately 52 million Americans who do not support the crusade to stop smoking. Further, many of these groups stand for principles of tolerance, fairness, and inclusion and seek to promote accommodation of the wishes of smokers as well as nonsmokers.
Opponents of the regulations argue that exposure to ETS really is not as dangerous to nonsmokers as many anti-smoker groups contend. In fact, the opponents have scientific research to support their theories. In addition, they attack contrary studies as being statistically flawed and claim that any conclusions showing an association between ETS and disease are really due to confounding variables in the studies. Other opponents, particularly restaurant, bar, and hotel owners, reject the proposed workplace smoking ban as overly restrictive and likely to lead to a serious financial loss to business owners. Some opponents of the regulations focus on the fact that their freedom to smoke is a liberty interest and a privacy right that is being impinged.
A large opponent of the proposed indoor air quality regulations is the Center for Indoor Air Research (CIAR), a nonprofit, independent research organization founded in 1988 by three large tobacco companies. CIAR has been instrumental in providing research results to refute those that suggest that ETS is harmful. A 1992 study conducted by CIAR concluded that moderate amounts of smoking indoors will not interfere with acceptable air quality. CIAR also conducted a study to determine the quantities of ETS that people are actually exposed to in the workplace. Finding that most people are exposed to very little ETS on the job, CIAR concluded that the federal government does not need to regulate smoking in the workplace. Another CIAR study that examined workplace smoking policies, ventilation, and indoor air quality concluded that the role ETS plays in contributing to poor indoor air quality is very minor, if it plays any role at all. The findings from this study show that OSHA's proposal to require separate ventilation systems for smoking areas is unnecessarily restrictive. Another CIAR study concerning indoor air quality, published in 1992, and criticized by a congressional subcommittee in 1994 as being flawed due to falsified or fabricated data, concluded that the levels of ETS in "light smoking" rooms were very similar to the levels of ETS in "nonsmoking" rooms within hundreds of different office buildings.
In addition to quoting studies conducted by CIAR and other tobacco-industry-funded organizations, opponents of the OSHA regulations cite to studies that were not funded by the tobacco industry and thus do not convey the appearance of bias. For example, a 1995 study by the congressional research service (CRS), the research arm of the library of congress, found no statistically significant correlation between ETS and lung cancer.
Restaurant and bar owners nationwide fear that the regulations will cause a decline in their business and result in serious financial consequences for them. In fact, these groups can already demonstrate the validity of their fears: studies of restaurants in cities and states that already have smoking bans have shown that these businesses have suffered an average decline of 24 percent in sales.
Others argue that banning smoking in the workplace is an infringement of personal rights. Specifically, they argue that workplace smoking bans violate the right to privacy and liberty interests protected by the Constitution. Opponents of the proposed nationwide ban can cite to judicial decisions that hold that federal regulations imposed on smoking employees must have a rational basis related to on-the-job performance. (In Grusendorf v. Oklahoma City, 816 F.2d 539 [10th Cir. 1987], a one-year smoking ban for firefighter trainees was upheld.) Other courts have held that employers cannot prohibit all smoking on their property if a ban violates a collective bargaining agreement (Johns-Manville Sales Corp. v. International Ass'n of Machinists, 621 F.2d 756 [5th Cir. 1980]). In addition, several states have enacted "smokers' rights laws" that stop employers from regulating off-duty smoking habits of employees and from discriminating against employees or job applicants based on their smoking habits outside the workplace. Opponents of OSHA's proposed indoor air quality regulations argue that employers likewise have no right to impinge upon their employees' freedom to smoke while at work.
Smokers also argue that their decision to smoke and the risks involved are no different from other personal lifestyle choices. If smoking is banned in the workplace, then there is no limit as to what other risky, but legal, behaviors may be banned in the workplace. For example, employers could prohibit the consumption of fatty foods. The crux of the issue, argue opponents, is that smoking is a legal activity and smokers should be left alone in deciding which risks they want to take in their lives.
The CSTHEA also requires all manufacturers, packagers, and importers of smokeless tobacco to provide the secretary of the health and human services department with a list of all ingredients used in the manufacture of the product, as well as the quantity of nicotine contained in the product. The act further requires the secretary to report biennially to Congress with a summary of research on the health effects of smokeless tobacco, information about whether its ingredients pose a health risk, and recommendations for legislative or administrative action. Finally, the act requires the FTC to report biennially to Congress about the state of smokeless tobacco sales, advertising, and marketing practices and also to make recommendations for legislative or administrative action. Amendments to the FCLAA require similar reports on smoking tobacco products.
In 1967, the FCC decided to act upon citizen complaints it had received regarding broadcast cigarette advertising. The FCC implemented a rule requiring any station that broadcasts cigarette advertising to also air public service announcements prepared by various health organizations in an effort to inform listeners and viewers of the dangers of smoking. This FCC regulation was challenged in the courts but upheld under the fairness doctrine, which requires broadcasters to provide a balanced representation and fair coverage of controversial issues of public importance (Banzhaf v. FCC,405 F.2d 1082 [D.C. Cir. 1968]).
A few years later, Congress also intervened on the issue of broadcast advertising, electing to ban all television and radio advertising of cigarettes. Congress enacted the Public Health Cigarette Smoking Act of 1969 (Pub. L. No. 91-222, § 6, 84 Stat. 87, 89), which was codified as an amendment to the earlier FCLAA. The new regulations took effect in 1971 and prohibited all advertising of cigarettes and small cigars via electronic communication, subject to the jurisdiction of the FCC (15 U.S.C.A. § 1335). The tobacco companies challenged the constitutionality of the Public Health Cigarette Smoking Act, but it was upheld by the courts (Capital Broadcasting Co. v. Mitchell, 333 F. Supp. 582 [D.D.C. 1971], aff'd mem., 405 U.S. 1000, 92 S. Ct. 1289, 321 L. Ed. 2d 472 ). Beginning in 1986, Congress also made it illegal to advertise smokeless tobacco on any medium of electronic communication that is subject to the jurisdiction of the FCC (15 U.S.C.A. § 4402(f)).
The FCLAA, as amended by the Public Health Cigarette Smoking Act of 1969, did not work wholly to the detriment of the tobacco industry. Some legal commentators argue that it actually benefited the tobacco companies. The warning labels that were required to help inform consumers of the health risks associated with tobacco worked to provide the manufacturers with a shield against tort liability. In fact, before the matter was taken up by the U.S. Supreme Court in 1992, several circuit courts held that the FCLAA had preempted (previously addressed) state claims against the tobacco companies based on a failure-to-warn legal theory (Pennington v. Vistron Corp., 876 F.2d 414 [5th Cir. 1989]; Roysdon v. R. J. Reynolds Tobacco Co., 849 F.2d 230 [6th Cir. 1988]; Palmer v. Liggett Group, 825 F.2d 620 [1st Cir. 1987]; Stephen v. American Brands, 825 F.2d 312 [11th Cir. 1987]).
In cipollone v. liggett group, 505 U.S. 504, 112 S. Ct. 2608, 120 L. Ed. 2d 407 , the U.S. Supreme Court held that the FCLAA had preempted state law damage. In effect, because tobacco companies were federally mandated to include warning labels on their products, they were essentially immune from product-liability suits. The Supreme Court held, however, that the FCLAA did not preempt claims based on strict liability, negligent design, express warranty, intentional fraud and misrepresentation, or conspiracy. This means that companies could be sued for knowingly withholding or falsifying information about health risks associated with the use of tobacco products.
The tobacco industry also benefited indirectly from the FCLAA's ban on advertising because when television advertising ceased, so did the antismoking public service messages that broadcasters were previously required to air. In fact, Judge Skelly Wright, the author of the dissenting opinion in Capital Broadcasting Co., noted that the Public Health Cigarette Smoking Act of 1969 was a legislative coup on the part of the tobacco industry. Wright accurately predicted that the loss of the broadcast antismoking messages would result in a rise in cigarette consumption.
Federal and State Regulation of Tobacco through Taxation
Even though cigarettes cannot be advertised on radio or television, they are the most heavily advertised product in the United States. In the early 1990s, in an attempt to raise revenue for the federal government, bills were introduced in Congress to restrict the amount of advertising expenses that tobacco manufacturers could deduct from their gross income. (In 1993, tobacco companies deducted an estimated $1 billion from their gross income for advertising expenses.) The proposed bills would have used the extra revenue to fund education programs to stop underage smokers and to reduce the federal deficit. The bills did not become law, however.
States have long collected excise taxes on sales of cigarettes. As of 2003, New Jersey imposed the highest excise tax, at $2.05 per pack, and Kentucky (a tobacco-producing state) had the lowest, at 3 cents per pack. Excise taxes were also imposed on chewing tobacco products. Studies completed in the 1980s demonstrated that as the price of chewing and smoking tobacco increases, consumption of those products decreases.
Federal Regulation of Tobacco as a Drug
In 1988, the surgeon general of the United States issued a report detailing the addictive effects of nicotine. Later scientific studies confirmed this finding. Despite this research the tobacco companies continued to deny that any relation existed between smoking and disease or that smoking was addictive. In an April 1994 congressional hearing on nicotine manipulation, the chief executive officers of seven tobacco companies testified under oath that they believed nicotine is not addictive and that smoking has not been shown to cause cancer. Later, however, some former tobacco company officials publicly confessed that cigarette manufacturers had long known about the health hazards of smoking and had deliberately concealed that information from the public.
The first and perhaps best known of these officials was Jeffrey Wigand, the former head of research at Brown and Williamson, one of the large tobacco companies. Voluminous internal records showing that cigarette manufacturers were aware of the dangers of smoking, including the addictive properties of nicotine, were also leaked to the public. One paralegal at Brown and Williamson copied more than four thousand documents and provided them to tobacco opponents. An annotated compilation of those documents was published, in 1996, under the title The Cigarette Papers. As a direct result of this growing body of information demonstrating that the manufacturers knew that nicotine in smoking and chewing tobacco can lead to addiction, the FDA, in 1994, began examining whether nicotine qualified as a drug under the Food, Drug and Cosmetic Act (21 U.S.C.A. §§ 301 et seq.), and thus could be regulated as such by the FDA.
The FDA had formerly asserted jurisdiction over tobacco products only to the extent that they carried therapeutic claims. By 1996, however, the FDA had determined that cigarettes and other tobacco products are intended by their manufacturers to be delivery devices for nicotine, a drug resulting in significant pharmacological effects on the body, including addiction. Based on the Food, Drug and Cosmetic Act definition of a drug as an article "intended to affect the structure or any function of the body" and on the FDA's determination that the cigarette and smokeless tobacco manufacturers "intend" these effects, the FDA declared, in August 1996, that it had jurisdiction to regulate tobacco products.
The FDA then announced that it would begin by regulating the sale and distribution of cigarettes and smokeless tobacco products to children and adolescents. The issue of children smoking has aroused widespread concern. Studies in the 1990s demonstrated that despite state laws prohibiting the use of tobacco before the age of 18, children had easy access to tobacco products and many had become regular smokers before their eighteenth birthday. In 1996, the FDA estimated that 4.5 million children and adolescents in the United States smoke and that another 1 million children use smokeless tobacco. Accordingly, the FDA promulgated a proposed rule to reduce children's access to tobacco and limit its appeal to them. The final FDA rule treated nicotine addiction as a pediatric disease because the use of tobacco products and the resulting nicotine addiction begin predominantly in children and adolescents. The FDA concluded that children do not fully understand the risks associated with consuming tobacco and that they are vulnerable to the sophisticated marketing techniques used by the tobacco industry. As a result, the FDA regulations governed tobacco products' promotion, labeling, and accessibility to children and adolescents.
The tobacco companies sued in federal court, arguing that the FDA lacked the statutory authority to impose regulations on tobacco The Supreme Court, in FDA v. Brown & Williamson Tobacco Corp. 529 U.S. 120, 120 S. Ct. 1291, 146 L. Ed. 2d 121 (2000), struck down the FDA regulations. The Court, in a 5–4 decision, held that the Food, Drug, and Cosmetic Act, read as a whole, along with recent tobacco legislation passed by Congress, clearly showed that the FDA did not have the authority to regulate tobacco products. The Court acknowledged that the case involved "one of the most troubling public health problems facing our Nation today: the thousands of premature deaths that occur each year because of tobacco use." Yet, the Court also pointed out that "Congress, for better or for worse, has created a distinct regulatory scheme for tobacco products," and that it has "repeatedly acted to preclude any agency from exercising significant policymaking authority in the area."
State Regulation of Tobacco
State and local governments are also involved in the regulation of tobacco and tobacco products. Such regulations typically restrict the use of tobacco by minors, require licenses for those who sell tobacco products, and restrict vending machine and individual cigarette sales. The scope of state and local regulation is limited, however, because it may not extend to areas already being regulated by the federal government. For example, because the FCLAA regulates advertising based on smoking and health considerations, states and localities can restrict advertising only for other reasons, such as to protect citizens' aesthetic sensibilities, to control the location or types of cigarette displays, or to protect children from promotions blatantly aimed at them as consumers.
Whether the FCLAA preempts state regulation of promotions aimed at children has been disputed in the courts. In Penn Advertising v. City of Baltimore, 862 F. Supp. 1402 (D. Md. 1994), aff'd, 63 F.3d 1318 (4th Cir. 1995), vacated by Penn Advertising v. Schmoke, 518 U.S. 1030, 116 S. Ct. 2575, 135 L. Ed. 2d 1090, the court held that the FCLAA did not preempt a local ordinance that barred cigarette advertising in certain locations where children were likely to be found, such as near schools.
However, in Lorillard Tobacco Corp. v. Reilly, 533 U.S. 525, 121 S. Ct. 2404, 150 L. Ed. 2d 532 (2001), the Supreme Court struck down a state regulation that prohibited tobacco ads within one thousand feet of public playgrounds, parks, and schools. The Court reaffirmed its holding that the FCLAA preempted most state regulation of advertising. States were free to use zoning restrictions to limit the size and location of advertisements of all products, not just tobacco products. The state regulation in this case was invalid because it dealt only with tobacco advertising. In addition, the regulation violated the first amendment because it unduly restricted commercial free speech.
Clean Indoor Air Acts
Armed with information showing the effects of ETS, the federal, state, and local governments began considering statutes to prohibit smoking in nonresidential buildings. Federal laws were passed to restrict smoking in transportation systems (49 C.F.R. § 1061.1 ), in government buildings (41 C.F.R. § 101-20.105-3 ), and aboard domestic airline flights (14 C.F.R. § 129.29). Federal regulation of private-sector workplaces has yet to take effect. Federal legislation was proposed, but the tobacco industry was able to muster great resistance to it.
States and localities have responded to the concern over ETS by regulating smoking in various public areas. In 2003, 41 states and the District of Columbia had some form of regulation in place. A minority of states have enacted indoor air quality acts, similar to the rules proposed by the Occupational Safety and Health Administration (OSHA). Some local governments have passed laws restricting smoking in places of entertainment, restaurants, and workplaces and on public transportation. Most of the state and local smoking regulations do not ban smoking in the workplace entirely, but limit smoking to designated areas or private offices.
Many private employers have voluntarily restricted smoking in the workplace. A 1985 survey found that more than 33 percent of employers were already regulating smoking in the workplace, and by 1991 that number had grown to 85 percent. By the late 1990s many private businesses had established policies that made it nearly impossible for employees to work and smoke. For example, some businesses do not allow anyone who has smoked within a certain time period to enter the building. Other businesses raised rates for health insurance for employees who smoke. Indeed, businesses are motivated to regulate smoking in part because of the higher absenteeism and increased health care costs of employees who smoke.
Tobacco litigation can be divided into three distinct time frames based on the types of claims pursued and the legal theories on which those claims were based. The first wave of tobacco litigation (1954–1973) involved cases based mainly on the theories of deceit, breach of express and implied warranties, and negligence. Cases filed during the second wave of tobacco litigation (1983–1992) were based on the legal theories of failure to warn and strict liability. Neither of the first two waves of litigation proved to be successful for the plaintiffs.
The first wave of litigation was characterized by the tobacco industry's adamant claims that smoking and chewing tobacco products were not harmful to consumers. Plaintiffs during that time did not have the extensive medical studies demonstrating serious health consequences that are available today to support their claims. Thus, plaintiffs had a difficult time establishing the essential element of proximate cause (causal connection to the injury) in their tort cases. By the time of the second wave of tobacco litigation, the connection between smoking and illness had been firmly established, but the tobacco industry was still able to argue with great success that smokers assumed the risks of smoking by freely deciding to smoke. The FCLAA's requirement that a warning label be placed on all cigarette packaging and advertising supported the tobacco companies' defenses of contributory negligence and assumption of the risk.
During the first two waves of litigation, the tobacco companies were also successful in using their size and financial strength to make litigation as difficult as possible for the plaintiffs. The tobacco industry filed and argued every conceivable motion, took countless depositions, and sent out extensive interrogatories. As a result, it was extremely burdensome and expensive for plaintiffs and their attorneys to pursue their cases.
The third wave of tobacco litigation began in the early 1990s and consisted of class action suits brought by those injured by tobacco products, and medical cost reimbursement suits brought by states and insurance companies. The claims in the third wave were based on proven medical theories. First, plaintiffs could demonstrate that tobacco companies knew that nicotine is pharmacologically active and highly addictive but hid that knowledge and, in fact, denied it under oath. Second, plaintiffs could show that tobacco companies manipulated nicotine levels in their products in an attempt to foster addiction in their consumers. Common legal theories used in the third wave of litigation included fraud, intentional and negligent misrepresentation, emotional distress, violation of consumer protection statutes, breach of express and implied warranties, strict liability, conspiracy, antitrust, negligent performance of a voluntary undertaking, unjust enrichment or indemnity, civil claims under the Federal racketeer influenced and corrupt organizations (rico) act (18 U.S.C.A. §§ 1961 et seq. ), and various criminal theories.
Litigation began with the certification of two class action suits (Broin v. Philip Morris, 641 So. 2d 888 [Fla. App. 3d Dist. 1994], review denied, Philip Morris Inc. v. Broin, 654 So. 2d 919 [Fla. 1995], and Castano v. American Tobacco, 84 F.3d 734 [5th Cir. 1996]). The class members in Broin were nonsmoking flight attendants who claimed that they suffered from various illnesses caused by their exposure to ETS from air travelers' cigarettes. Castano was based on plaintiffs' claims that tobacco companies intentionally manipulated nicotine levels, even though the companies knew that nicotine was a hazardous and addictive substance. The Castano class consisted of all nicotine-dependent persons or their estates, heirs, family members, or "significant others" in the United States and its territories and possessions, who have bought and smoked cigarettes manufactured by the defendants.
Because of the breadth of the class, the U.S. Court of Appeals for the Fifth Circuit ruled that the plaintiffs in Castano should not have been certified as a class; had the court allowed the case to proceed, it would likely have become the largest class action in U.S. history. After the decertification of the Castano class, plaintiffs' lawyers decided to pursue statewide class action suits in state courts around the nation.
Lawsuits since Castano have sought to eliminate the problem of certifying a large class. For example, Engle v. R. J. Reynolds, 672 So. 2d 39 [Ct. App. Fla. 3d Dist. 1996], review denied, 682 So. 2d 1100 (Fla. 1996), involved essentially the same claims as Castano, but the class was much smaller. The class certified in Engle consisted of Florida citizens and residents, and their survivors, who had suffered, presently suffer, or have died from diseases and other medical conditions caused by their addiction to cigarettes. The Engle class action was allowed to proceed, which made it the first class action lawsuit against tobacco companies to go to trial. In 2000, a six-person jury awarded the class members a record $145 billion in punitive damages.
A wave of state reimbursement suits began in 1994, when the state of Mississippi filed an unprecedented lawsuit on behalf of the state's taxpayers against the tobacco industry to recoup the state's share of medicaid costs incurred as a result of tobacco-related illnesses (Moore v. American Tobacco, No. 94-1429 [Miss. Chan. Ct. 1994]). The state of Mississippi proceeded on legal theories of unjust enrichment and restitution, based on the fact that the state's taxpayers had been directly injured by the actions of the tobacco industry because they were forced to pay Medicaid costs associated with tobacco-related illnesses.
In 1994, the state of Minnesota filed a medical cost reimbursement suit, with the insurance company Blue Cross-Blue Shield of Minnesota as co-plaintiff. When West Virginia filed its medical reimbursement lawsuit, it named as defendants not only tobacco companies, but also the Kimberly-Clarke Corporation, developer of the tobacco reconstitution process that enables tobacco companies to manipulate nicotine levels. In 1995, the state of Florida filed a lawsuit against the tobacco industry under Florida's Medicaid Third-Party Liability Act, effectively preventing tobacco industry defendants from prevailing under defenses of assumption of risk and contributory negligence. Texas filed suit, in 1996, and brought claims based in part on the RICO Act and on theories of mail and wire fraud, antitrust violations, and public nuisance. The state of Washington additionally sued the law firms that had represented the tobacco companies for many years, arguing that they unlawfully helped their clients keep certain documents confidential.
Eventually, the tobacco companies were forced to seek a national settlement of all state tobacco claims. In 1996, the Brooke Group and Liggett Group, two of the largest U.S. tobacco companies, settled with the states of West Virginia, Florida, Mississippi, Massachusetts, and Louisiana. This settlement was noteworthy because it represented the end of the tobacco industry's unified effort to avoid paying out monetary damages. After this settlement the major tobacco companies began intensive negotiations with all 50 state attorneys general.
By 1998, the states of Florida, Minnesota, Mississippi, and Texas had negotiated individual settlements worth billions of dollars to each state. The remaining 46 states continued to negotiate with the tobacco companies and, in November 1998, a deal was reached. The key elements of the settlement included the payment to the states of $206 billion over a 25-year period, funding to support research on programs to reduce youth smoking, limitations on advertising and sporting event sponsorship, and a ban on cartoon characters in advertising and "branded" merchandise (e.g., T-shirts). In addition, the companies agreed to disband the tobacco institute, the Council for Tobacco Research, and the Council for Indoor Air Research. While supposedly neutral, these groups disseminated false information about the safety of tobacco products and lobbied against increased tobacco regulation. The companies also agreed to establish a website that would contain all documents produced in state and other smoking and health-related lawsuits.
The federal government has also pursued a similar course against the tobacco industry, seeking billions of dollars in damages. The government filed suit, in 1998, asserting that smoking causes cancer and other serious illnesses. These illnesses cost the federal government $25 billion annually in health care claims. It sought to recover more than four decades' worth of expenses, plus damages. In 2001, a federal district court dismissed two of the three claims, allowing only the RICO theory of liability to move forward (United States v. Philip Morris Inc., 153 F. Supp. 2d 32 [D.D.C.2001]). By 2003, the government and the companies had not resolved the litigation and it was unclear whether a settlement might be reached.
Despite the national settlement with the states, the tobacco companies continue to defend themselves in lawsuits waged by individuals claiming health problems caused by either smoking or breathing secondhand smoke. In order to obtain the maximum benefit, plaintiffs' attorneys organize and work together. Plaintiffs also have access to new evidence obtained from internal tobacco company documents and former tobacco industry researchers to significantly bolster their cases. For example, the Minnesota Court of Appeals decided in State ex rel. Humphrey v. Philip Morris Inc., 606 N.W.2d 676 (Minn. App.2000), that tobacco company documents could be released to the public. During the initial Minnesota tobacco trial, the judge ordered the companies to release many internal documents. Since the parties settled before a verdict was reached, the tobacco companies sought to prevent public access to the documents given to the plaintiffs. The appeals court ruled that the trial court had properly examined the issues and that the documents could be released to the public. The appeals court also pointed out that many of the documents had already been disseminated publicly. The ruling cleared the way for a massive release of internal documents and indices that would aid other plaintiffs in their pending lawsuits against tobacco companies.
Barnes, Deborah E., and Lisa A. Bero. 1996. "Industry-Funded Research and Conflict of Interest: An Analysis of Research Sponsored by the Tobacco Industry through the Center for Indoor Air Research." Journal of Health Politics, Policy and Law 21.
Boyd, Margaret A. 1996. "Butt Out!! Why the FDA Lacks Jurisdiction to Curb Smoking of Adolescents and Children." Journal of Contemporary Health Law and Policy 13.
Correia, Edward O. 1997. "State and Local Regulation of Cigarette Advertising." Journal of Legislation 23.
"Costs Due to Tobacco Use: Fact Sheet." 2002. Missouri Department of Health & Senior Services, Bureau of Health Promotion. Available online at <www.health.state.mo.us/SmokingAndTobacco/COSTS.html> (accessed November 21, 2003).
Glantz, Stanton A., and Edith D. Balbach. 2000. Tobacco War: Inside the California Battles. Berkeley: Univ. of California Press.
Green, Michael D. 1997. "Cipollone Revisited: A Not So Little Secret About the Scope of Cigarette Preemption." Iowa Law Review 82.
Hatfield, Christine. 1996. "The Privilege Doctrines—Are They Just Another Discovery Tool Utilized by the Tobacco Industry to Conceal Damaging Information?" Pace Law Review 16.
Hymes, Christine. 1995. "Clean Indoor Air: Who Has It and How to Get It—A Functional Approach to Environmental Tobacco Smoke." Missouri Environmental Law and Policy Review 2.
Jeruchimowitz, Howard K. 1997. "Tobacco Advertisements and Commercial Speech Balancing: A Potential Cancer to Truthful, Nonmisleading Advertisements of Lawful Products." Cornell Law Review 82.
Kelder, Graham E., Jr., and Richard A. Daynard. 1997. "The Role of Litigation in the Effective Control of the Sale and Use of Tobacco." Stanford Law and Policy Review 8.
Kessler, David. 2002. A Question of Intent: A Great American Battle with a Deadly Industry. New York: Public Affairs.
Kluger, Richard. 1996. Ashes to Ashes: America's Hundred-Year Cigarette War. New York: Knopf.
Krulwich, Andrew S. 1996. "The FDA's Attempt to Regulate Cigarettes Exceeds Its Authority." Food and Drug Law Journal 51.
Kuhlengel, Kimberly K. 1995. "A Failure to Preempt an Unfair Advertising Claim May Result in Undue Restrictions on Cigarette Manufacturers." Southern Illinois University Law Journal 19.
Lars, Noah. 1996. "Statutory 'Smoke' and Mirrors." Food and Drug Law Journal 51.
Lee, Theodora R. 1997. "Privacy Issues in the Workplace." Practising Law Institute/Literature 558.
Ludwikowski, Mark R. 1996. "Proposed Government Regulation of Tobacco Advertising Uses Teens to Disguise First Amendment Violations." CommLaw Conspectus 4.
Morris, Frank C., Jr. 1997. Privacy and Defamation in Employment. SB42 ALI-ABA 201.
Richards, Jef I. 1996. "Politicizing Cigarette Advertising." Catholic University Law Review 45.
Rimer, Darren S. 1995. "Secondhand Smoke Damages: Extending a Cause of Action for Battery Against a Tobacco Manufacturer." Southwestern University Law Review 24.
Sablone, Kathleen. 1996. "A Spark in the Battle Between Smokers and Nonsmokers: Johannesen v. New York City Department of Housing Preservation and Development." Boston College Law Review 36.
Scharf, Irene. 1995. "Breathe Deeply: The Tort of Smokers' Battery." Houston Law Review 32.
Sculco, Thomas W. 1992. "Smokers' Rights Legislation: Should the State 'Butt Out' of the Workplace?" Boston College Law Review 22.
Sergis, Diana K. 2001. Cipollone v. Liggett Group: Suing Tobacco Companies. Berkeley Heights, N.J.: Enslow.
Vallone, Melissa A. 1996. "Employer Liability for Workplace Environmental Tobacco Smoke: Get Out of the Fog." Valparaiso University Law Review 30.
Whatley, Michael. 1996. "The FDA v. Joe Camel: An Analysis of the FDA's Attempt to Regulate Tobacco and Tobacco Products under the Federal Food, Drug and Cosmetic Act." Journal of Legislation 22.
TOBACCO . Now used recreationally throughout the world, tobacco originated in South America as long as eight thousand years ago as a product of two cultivated hybrid species of the genus Nicotiana, N. rustica and N. tabacum. The genus, which belongs to the nightshade or potato family (Solanaceae), occurs naturally in many parts of the world, including North and South America, Australia, some of the South Pacific Islands, and—with but a single species—Africa. The greatest number is native to North and South America, but even with this relative abundance of nicotine-bearing species, only in one small area of the New World, most likely fertile valleys located between Peru and Ecuador, did early food cultivators discover and make use of the extraordinary effects on mind and body of the powerful alkaloid from which the genus derives its name.
More than likely the early experiments with cross-fertilization that resulted in the two cultivated hybrid species of tobacco, Nicotiana rustica and N. tabacum, were products of that moment in time when some South American Indians turned from a pure hunting and gathering economy to food cultivation, beginning with the root crop cassava, or manioc. Although all species of the genus contain nicotine, that alkaloid is present in much greater amounts in the two cultigens of ancient lineage, N. tabacum, the progenitor of commercial blends, and N. rustica. The former is the more variable, with percentages of nicotine content in the leaf ranging from only 0.6 percent to 9.0 percent. In contrast, in a Mexican species of N. rustica, the percentage of nicotine was as high as 19 to 20 percent. Although, as Johannes Wilbert notes in his pathbreaking book Tobacco and Shamanism in South America (1987), nicotine is distributed throughout the plant, in both species the leaves contain the highest amount, those of N. rustica far outstripping the milder species in its capacity to inebriate and addict. Little wonder, then, that the leaves were used either whole or dried and crushed and that N. rustica achieved by far the widest distribution as a sacred ecstatic intoxicant among many Native American peoples. Often, especially in South America, it serves as the exclusive vehicle of the shamanic trance, and sometimes it is one of several herbal preparations employed for the altered mental state in which the shaman, it is believed, travels out-of-body to consult with the spirits of the deceased and the gods or to do battle with disease demons and other negative forces on behalf of his or her clients.
Tobacco is sometimes also employed to create an especially receptive state of mind for the application of another psychoactive species with even greater ramifications in the intellectual culture. Thus, to cite just two examples, on their peyote pilgrimages to the north-central Mexican desert, the Huichol Indians of northwestern Mexico, whose most sacred and supernaturally charged plant is peyote, smoke N. rustica tobacco wrapped in cornhusks to intensify the effects of the psychoactive cactus. Far to the south, on the north coast of Peru, Mestizo curanderos combine tobacco syrup administered through the nostrils with infusions of San Pedro (Trichocereus pachanoi ), the popular name for a tall, columnar cactus that, like peyote, has mescaline as its primary alkaloid and whose place in Andean shamanism is archaeologically documented as reaching back at least three and half millennia.
It should be emphasized that as many as two hundred major and minor species have been identified in the visionary-therapeutic pharmacopoeias of Native American shamans, the majority in the tropics. Of these, tobacco had the widest distribution even before it became a major item of commerce as a recreational drug in the centuries after Christopher Columbus arrived in the New World. Curiously, despite the rapid pre-Columbian diffusion of tobacco through the Indian Americas, tobacco's cultural role as a visionary intoxicant seems to have stopped at the shores of the Atlantic and the Pacific. Tobacco and the custom of smoking reached West Africa in the 1500s, not long after Columbus's first landfall in the Western Hemisphere, and spread on that continent so quickly that some students of the phenomenon assumed it to be African in origin, reaching the New World with the slave trade, rather than the other way round.
In parts of Africa, notably the Cameroons and Nigeria, tobacco pipes of terra-cotta, metal, and other materials evolved into great sculpture, real masterpieces of portable art and objects of prestige associated with the nobility, great warriors, and priests, with long stems and complex chimneys rivaling in size and volume the monumental pipes of the so-called Mound Builder cultures of prehistoric North America. Both men and women smoked pipes, some with sculptural bowls whose interiors exceed the size of large teacups or coffee cups. Even if the tobacco was of the milder kind, it is hard to believe that the amount of nicotine the smoker absorbed would not have had some effect on consciousness. And yet if African medicine men or shamans used tobacco to contact the spirits, no evidence for it exists. The only possible hint that there was more to African smoking than pleasure or sociability comes from a report by the French anthropologist and Africanist Marcel Griaule (1898–1956). During field research with the Dogon people of Mali, Griaule met an old blind hunter named Ogotemmêli, who was especially knowledgeable in the cosmology and religion of his people. "Having sat down on his threshold," Griaule recounts, "Ogotemmêli scraped in his tobacco pouch and gathered some yellowish dust on the flap. 'Tobacco,' he said, 'clears up the sense of judgment.' And he began to reconstruct the system of the world, for one had to begin with the very beginnings of things" (Griaule, 1970, p. 16).
Tobacco was introduced into Siberia by trade from Russia's possessions in Alaska and the Aleutians—or even earlier; that is, at least by the 1700s. But there are no reliable reports that Siberian shamans adopted it as a ritual intoxicant alongside, or even instead of, the fly agaric mushroom, Amanita muscaria. In the Himalayas, on the other hand, Nepalese shamans have added N. rustica tobacco to a long list of psychoactive species they classify as "traveling plants" belonging to the god Śiva—"traveling" because they enable the shaman to travel to other worlds. N. tabacum, in contrast, is regarded as merely "pleasurable." Both species were introduced in colonial times.
A common theme in the origin mythology of tobacco among Native Americans is that this most widely distributed psychoactive species in the New World was given to the first people by the gods. The gods themselves were believed to require tobacco as their sacred, and even only proper, food. But in making it a gift to humanity they neglected to keep any for their own use—"not even one pipeful," in the words of an elder of the Fox tribe of Wisconsin (Michelson, 1932, p. 127). So they must rely on human beings to give it to them. In exchange, the gods listen to petitions and confer their blessings or, conversely, withhold evil. Reciprocity is thus extended from the social realm to interaction between the spirit world and human beings, whose control over a spirit food fervently desired by the supernaturals gives them some leverage, for the gods are said to be unable to resist it.
The craving for tobacco attributed to the supernaturals can thus also be understood as an extrapolation from human experience, in this case nicotine addiction, especially among tribes whose shamans regularly intoxicated themselves with tobacco. The use of tobacco as smoke, snuff, cuds mixed with lime, or liquid infusions to induce "drunkenness" for the purpose of "communicating with demons" is repeatedly described by sixteenth-century sources from the Caribbean, Mexico, and South America, though in some cases the intoxicating substance was probably not tobacco but another of the many botanical hallucinogens then and now in ritual use.
Wilbert found a particularly complex variety of "tobacco shamanism" among the Venezuelan Warao, whose sacred geography and cosmic architecture are virtually constructed of tobacco smoke and whose shamans smoke themselves into "out-of-body" ecstatic trance states with cane cigarettes three and four feet long. Warao shamans travel to the House of Tobacco Smoke in the eastern part of the universe over a celestial bridge of tobacco smoke conceived of as a channel of energy that guarantees health and abundance on earth as long as the supernaturals continue to be properly fed with tobacco smoke. Wilbert reports that Warao shamans crave tobacco smoke with such "tremendous physiological and psychological urgency" that they are literally sick without it. They believe that the gods likewise await their gift of tobacco with the craving of an addict and will inevitably enter into mutually beneficial relationships with human beings as long as humans provide the gift.
This attribution of addictive craving to the gods probably diffused together with cultivated tobacco itself. The notion dominates tobacco mythology and ritual even among peoples who, like those of the North American Plains and Prairies, customarily reduced the potency of tobacco with such nonpsychoactive plant materials as red willow bark and who, in any event, smoked only small quantities ceremonially in sacred pipes with chimneys of limited interior diameter to please gods and spirits and sanctify the spoken word, never to the point of intoxication.
A significant dichotomy may be noted between the origin mythologies of the cultivated hybrid species Nicotiana rustica and the less potent and less widely distributed N. tabacum, on the one hand, and the wild species (N. attenuata, N. bigelovii, and N. trigonophylla ) of aboriginal western North America, on the other. While the origin of the Indian species is commonly credited to the divine realm, the latter two species are frequently attributed to the dead, perhaps because, as casuals, these species (like the daturas, which also belong to the Solonaceae) are sometimes seen to grow in disturbed soil (e.g., on graves). In California and the Great Basin they are often highly valued as gifts of the ancestors, but in transitional areas, where both wild and cultivated species are available, the wild varieties are sometimes feared for their association with death.
The oldest evidence thought to point to smoking comes from California, where conical stone pipes dating to circa 4000 bce have been excavated and where wild tobaccos were widely employed for shamanistic, magico-religious, and medicinal procedures, including the ecstatic trance. The Shoshonean (Uto-Aztecan) Kawaiisu of south-central California used virtually every technique of ingestion reported from South America, including smoking, snuffing, licking, chewing, and swallowing. Likewise, the prophylactic, therapeutic, and metaphysical uses for cultivated species in South America and eastern North America were paralleled by these and other California tribes with the native wild species. The most common method was mixing the pulverized, dried leaves with slaked and powdered lime and either swallowing the mixture dry or liquified or licking and sucking it.
The Kawaiisu participated in the ecstatic-initiatory toloache (Datura inoxia) religion common to other California Indians, but tobacco, whose magical potency was given to the first people by the trickster culture hero Coyote, was much more generally employed by them and their neighbors. They used it as a mild-to-potent dream-inducing soporific; as a shamanistic and initiatory intoxicant; or for preventing and curing illness; repelling and killing rattlesnakes; driving away ghosts, monsters, and other threatening supernatural beings; and divining and manipulating the weather.
In North America the widespread function of tobacco to please the spirits is particularly well documented among the Iroquois and Algonquin of the Eastern Woodlands and the Plains and Prairie tribes. Seneca mythology attributes the origin of tobacco (Nicotiana rustica ) to Awen'hai'i (ancient bodied one), the pregnant daughter of the Great Chief in the Sky, who stripped the heavens of tobacco when she fell onto the newly created earth island through a hole in the sky. This left not only the heavenly powers but the vast company of other spirits that manifest themselves in nature without their most essential divine sustenance. To induce these spirits, which included masters and mistresses of animals and plants as well as the "faces" that appear to hunters in the forest or in dreams and that are represented by the wooden masks of the shamanistic medicine societies of the Iroquois, to act on one's behalf requires the indispensable gift of tobacco.
Though widely employed to trigger the ecstatic visionary trance that is one of the cornerstones of shamanism, tobacco was also deeply embedded in native therapeutics. Almost certainly this was in large part based on observation and experience with the pharmacological effects of nicotine, not only on the human organism but other phenomena in the environment. Answering his own question whether pharmacological science corroborates nicotine therapy and curing practices with tobacco of South American shamans, Wilbert, in a paper published in 1991, lists a whole series of tobacco administrations by shamans that at first sight might be considered "magical" but whose therapeutic efficacy can be pharmacologically demonstrated.
Take, for example, the shaman's breath. Not only in the Americas but wherever shamanism survives, the shaman's breath is considered to have curative, purifying, and strengthening powers. Except in the Arctic, breath is of course invisible, but in the American tropics it is often given form by tobacco smoke. This phenomenon of shamanic practice was noted by the earliest European explorers. Shamans blow both their breath alone and thick clouds of tobacco smoke over their patient and his or her relatives and also fumigate the house. Blowing tobacco smoke is especially valued at the planting season. Before putting their seeds in the ground, farmers ask their shaman to "purify" their seed stock with tobacco smoke to assure a good harvest. Of course, tobacco smoke is sacred and feeds the spirits. But there is more to it than magic or religion: nicotine is a powerful insecticide and vermifuge. German experimenters found that fully 8 percent of the insecticides in tobacco are transferred into tobacco smoke. Seeds fumigated with nicotine against insect pests have in fact been observed to do better than those not so treated.
In treating their patients, shamans not only blow thick clouds of smoke but "capture" the smoke in their cupped hands; direct it into a wound, an aching or extracted tooth, eyes, nose, and mouth; and then massage the affected body parts. In addition curers blow nicotine-laden spittle and soothe aches and pains with tobacco juice. "Looking at these therapeutic practices from the point of view of drug administration," writes Wilbert, one recognizes in them more or less sustained-release mechanisms of application. Tobacco leaves are also used as plasters or compacts. Tobacco therapy thus involves the respiratory, dermal, and even gastrointestinal routes.
In both South America and Mexico, tobacco was also employed in the form of therapeutic enemas. In addition to tobacco, other plants that native peoples invested with sacred power and even divinity were so used. For example, a seventeenth-century Spanish colonial account of therapeutic practices and incantations in a community of speakers of Nahuatl (Aztec) in Guerrero, Mexico, lists therapeutic enemas not only of piciétl (tobacco, Nicotiana rustica ) but of peyote (Lophophora williamsii ), the little cactus of the north-central Mexican desert whose most important visionary alkaloid is mescaline; an aquatic species of Datura ; and ololiuhqui, the Nahuatl name for the potent seeds of the white-flowering morning glory Turbina (form. Rivea ) corymbosa, whose active principles are lysergic acid derivatives related to synthetic LSD.
Native American tobacco lore and therapy thus run counter to modern experience with the effects of tobacco on human health. Of course, Indian tobaccos are truly "organic"—they are cultivated, processed, and ritually employed without chemicals. Shamans often reach great age, including those for whom tobacco is the primary avenue of ecstasy. Whatever negative effects tobacco intoxication has on the vocal cords, visual acuity, color perception, and so on—and Wilbert lists many of these—have, by way of natural modeling, long since been processed into desirable qualities in the intellectual world of tobacco shamanism. Still, there are no statistics to show whether tobacco shamans fall victim to lung cancer, heart disease, emphysema, or any of the other ills associated in the West with smoking. That Native American peoples are well aware that tobacco can kill is obvious from the many traditions of symbolic death and resurrection through the experience of initiatory intoxication. But there is also the reverse: revitalization, bringing the dead back to life by means of tobacco. This desirable end is dramatically illustrated in the following Seneca myth from upstate New York (Hewitt, 1918):
In his travels a youth encounters a skeletonized man in a place heaped with the bones of dead people. Skeleton Man tells the youth that the only thing he desires is tobacco, but his pipe and pouch are empty. He sends the youth on a harrowing journey, past or through dangerous obstacles and variations of an ordeal familiar from heroic, funerary, and shamanic mythology—the Symplegades-like "paradoxical passage," that is, clashing rocks, islands, or icebergs that open and close in an instant and through which the hero, the soul, or the shaman must pass. The Seneca youth survives these ordeals and finally reaches a distant place where tobacco is guarded by Seven Sisters and their terrible old mother. Using his orenda (spirit power) and trickery, he succeeds in entering the lodge of the female spirits, evading their war clubs and escaping with the magical tobacco. When he returns and fills Skeleton Man's pipe, the bones of the dead people are reclothed with flesh, and the people return to life.
Griaule, Marcel. Conversions with Ogototemmêli: An Introduction to Dogon Religious Ideas. London, 1970.
Hewitt, J. N. B., ed. "Seneca Fiction, Legends, and Myths: Part 1." In Thirty-second Annual Report of the Bureau of American Ethnology, pp. 37–813. Washington, D.C., 1918. The first volume of a comprehensive collection of Seneca Iroquois oral traditions by a Smithsonian Institution ethnologist and linguist who was a Tuscaloosa, one of the nations of the Iroquois Confederacy.
Meyer, Laure. Art and Craft in Africa. Paris, 1995. With numerous photographs in full color, a noted French art historian surveys the high technical and aesthetic qualities of everyday and court arts of one hundred African tribes.
Michelson, Truman. Notes on the Fox Wapanowiweni. Smithsonian Institution, Bureau of American Ethnology, Bulletin 105. Washington, D.C., 1932.
Müller-Ebeling, Claudia, Christian Rätsch, and Surenda Bahadur Shahi. Shamanism and Tantra in the Himalayas. Rochester, Vt., 2002. With 605 color and black-and-white illustrations, this is a popular but authoritative overview of Nepalese shamans and tantrikas and their practices, with special emphasis on psychoactive plants.
Parker, Arthur C. Seneca Myths and Folk Tales. Buffalo, N.Y., 1923. An important collection of the oral traditions of his own people, the Iroqouian Seneca of upstate New York, by an ethnologist and New York State archaeologist who served for many years as director of the New York State Museum.
Robicsek, Francis. The Smoking Gods: Tobacco in Maya Art, History, and Religion. Norman, Okla., 1978. A richly illustrated study of tobacco and smoking in ancient Maya art, history, and religion.
Ruiz de Alarcón, Hernando. Treatise on the Heathen Superstitions That Today Live among the Indians of This New Spain, 1629. Translated and edited by J. Richard Andrews and Ross Hassig. Norman, Okla., 1984.
Wilbert, Johannes. "Tobacco and Shamanistic Ecstasy among the Warao Indians of Venezuela." In Flesh of the Gods: The Ritual Use of Hallucinogens, edited by Peter T. Furst, pp. 55–83. New York, 1972. New ed., Prospect Heights, Ill., 1990. A pioneering essay on Warao tobacco shamanism and tobacco cosmology, proposing for the first time that tobacco belongs in the category of the "true" hallucinogens.
Wilbert, Johannes. Tobacco and Shamanism in South America. New Haven, Conn., 1987. A pathbreaking study of the ethnology, ethnobotany, and pharmacology of tobacco, the physiological effects of nicotine, and their incorporation in the ideology and practice of shamanism across the South American continent by a UCLA ethnologist whose fieldwork among Indian peoples spans five decades.
Wilbert, Johannes. "Does Pharmacology Corroborate the Nicotine Therapy and Practice of South American Shamanism?" Journal of Ethnopharmacology 32 (1991): 179–186. An examination of empirical ethnographic data on indigenous nicotine therapy shows it to compare favorably against experimental clinical studies of nicotine pharmacology and its effects on the human body.
Zigmond, Maurice L. Kawaiisu Ethnobotany. Salt Lake City, 1981.
Peter T. Furst (2005)
TOBACCO. Tobacco first attracted attention in Europe as an Amerindian curiosity. Christopher Columbus, Amerigo Vespucci, Jacques Cartier, and other European explorers reported the apparently omnipresent but varied use of a green herb by the people they encountered. For recreational, spiritual, and medicinal reasons, tobacco was externally applied to wounds, chewed (alone or with other substances), inhaled as a powder, or smoked (through canes, as rolled up leaves, or stuffed into a reed or a pipe). In the mid-sixteenth century, European scholars described the strange New World plant as part of the botanical renaissance. By the late 1560s, tobacco's medicinal properties were being widely investigated by people such as Conrad Gessner in Zurich, Pietro Mattioli in Bohemia and, most famously, by the French ambassador to Lisbon, Jean Nicot. In 1571, Nicolás Monardes, a physician of Seville, presented an influential assessment of the medical use of Nicotiana. His text, the English translation of which was entitled Joyfull Newes out of the Newe Founde Worlde (1577), became a standard medical textbook across Europe. Monardes told physicians that tobacco had antiseptic and analgesic properties and could tackle a host of conditions from chilblains to intestinal worms and from halitosis to gout. Tobacco was used in a variety of ointments and poultices, formulas, and concoctions.
SMOKERS AND SMOKING
While European science was discovering the medicinal potential of tobacco, Europeans in the New World were experimenting with more medicinally ambiguous patterns and modes of ingestion by smoking, snuffing, and chewing tobacco as part of their everyday lives. By 1550 smoking was prevalent in Spanish, Portuguese, and French colonial outposts. Sailors and adventurers returning from the New World brought their tobacco-consuming habits back with them to European ports. Particularly in London in the 1590s, putting dried leaves from a faraway land "in a pipe set on fire and suckt into the stomacke, and thrust foorth again at the nosthrils" became a popular pastime (Gerard, p. 287). Smokers such as Sir Walter Raleigh and Christopher Marlowe made smoking fashionable, particularly in male society. Numerous depictions of smoking soon appeared in poems and plays, such as Ben Jonson's Every Man out of His Humour (1600), in which smoking was often seen as a gentlemanly recreation. Perceptions of women smoking were generally negative but, as numerous seventeenth-century Dutch paintings, and plays such as Jonson's Bartholomew Fair (1611) illustrate, some women did smoke.
Smoking spread in England as a social activity (often in alehouses) and was commonly referred to as "drinking" tobacco. The practice quickly became controversial, prompting a medical and moral debate in the early seventeenth century. Smokers proclaimed tobacco's medicinal benefits: "nothing that harmes a man inwardly from his girdle upward, but may be taken away with a moderate use of Tabacco" (Chute, p. 19). Critics such as King James I & VI, who wrote A Counterblaste to Tobacco in 1604, condemned smokers for their wanton abuse of the new medicine and for their patently non-medicinal, wasteful, and apparently compulsive consumption. Smoking had been identified as a vice. English physicians, while confirming the medicinal power of tobacco, warned against unnecessary and excessive smoking because it could disrupt humoral balance, provoking death "before either Nature urge, Maladie enforce, or Age require it" (Gardiner). Some commentators argued that smoking bred soot and cobwebs in the body, leading to enfeeblement, infertility, and a thirst for alcohol.
Despite such warnings, in the first half of the seventeenth century smoking and other recreational forms of tobacco use continued to spread in England and across Europe. The Dutch were particularly avid smokers and were soon growing tobacco and manufacturing distinctive pipes, such as the meerschaum. In France, state-regulated tobacco cultivation supplied French smokers and snuff-takers. By 1650, the use of tobacco as a medicine was widely accepted throughout Europe, but in many countries attempts were made to curb its recreational use. In Sicily, the pipe was declared illegal. In Denmark, Sweden, parts of Germany, Switzerland, Austria, and Hungary attempts were made to prohibit smoking, prevent tobacco cultivation, and inhibit its importation. The Russian patriarch considered smoking a deadly sin and in 1634 banned it on pain of execution for persistent offenders. In 1642, following a complaint by the dean of Seville that the entrance to his church was being defiled by tobacco juice, Pope Urban VIII threatened both clergy and congregation with excommunication if they smoked, chewed, or snuffed tobacco in church. Pope Innocent X issued another antismoking bull in 1650.
TOBACCO AND ECONOMIES
Persistent and growing demand for tobacco in Europe promoted increasing crop cultivation in the New World. Spanish, Portuguese, and English colonies thrived by exporting vast quantities of the plant grown by slaves and indentured servants on large plantations. In 1626, 500,000 pounds of Virginia tobacco reached England. By the late 1630s, millions of pounds of tobacco were being shipped each year from Virginia, Maryland, and the English Caribbean, much of it re-exported to mainland Europe and beyond. As production increased, prices fell, making tobacco more readily available to all social classes. The growing international trade in tobacco attracted mercantile investment and presented governments with tax-raising opportunities. In England, where tobacco growing had been prohibited since 1619 (to aid colonial producers), substantial revenues were generated from customs and other duties on tobacco. Ongoing complaints about the dangers of smoking to body and soul were subsumed by the vested interests of the governments, colonists, and merchants responsible for supplying tobacco to consumers.
Throughout the seventeenth and eighteenth centuries, Europeans continued to find medical uses for tobacco and to consume it for pleasure. Ornate tobacco pipes and snuffboxes were produced, offering opportunities for the display of status and refinement. In eighteenth-century England, snuff became particularly popular. Later, the cigars favored by Spanish consumers distinguished the gentlemen from the more plebeian smokers of clay pipes. Whatever the status of the consumer or the mode of ingestion, tobacco had become as integrated into European culture and society as it had been in pre-Columbian America. Like tea, coffee, and sugar, tobacco had become an integral part of European lifestyles.
See also British Colonies: North America ; Commerce and Markets ; Consumption ; Medicine ; Public Health .
Chute, Anthony. Tabacco. London, 1595.
Gardiner, Edmund. The Triall of Tabacco. London, 1611. Original title: Phisicall and Approved Medicines, 1610.
Gerard, John. The Herball, or, Generall Historie of Plantes: Gathered by John Gerarde. London, 1597.
James I & VI, King. A Counterblaste to Tobacco. London, 1604.
Monardes, Nicolás. Joyfull Newes out of the Newe Founde Worlde. London, 1577.
Dickson, Sarah A. Panacea or Precious Bane: Tobacco in Sixteenth Century Literature. New York, 1954.
Price, Jacob M. Tobacco in Atlantic Trade: The Chesapeake, London, and Glasgow, 1675–1775. Aldershot, 1995.
Stewart, Grace. "A History of the Medicinal Use of Tobacco 1492–1860." Medical History 11 (1967): 228–268.
Walton, James, ed. The Faber Book of Smoking. London, 2000.
A. R. Rowley
Before the European discovery of America, tobacco and smoking were known to Native Americans in many areas of North and South America. The Spaniards became acquainted with the leaf fairly early on the north coast of South America. Their pleasure in this product led to the development of market-oriented production in a zone embracing the present Venezuelan province of Barinas and adjacent areas to the east of Lake Maracaibo. As the Spanish merchant purchasers and later monopolists did not offer a price sufficiently attractive to the cultivators, an illicit trade developed for smuggling this tobacco out of the Spanish Main to the nearby Dutch island of Curaçao. From there, merchants shipped the tobacco home, where it became a regular item traded in the Amsterdam market and a re-export to many countries including France and Britain. The English referred to it as Verinas tobacco; to the French it was tabac de Vérine.
Another market-oriented production developed in Brazil in the modern provinces of Bahia and Maranhao (Marignan in French). This Brazilian tobacco supplied Portugal and the Portuguese slave trade on the west coast of Africa. So preferred was this variety in Africa that Dutch, English, and French traders had to purchase supplies from the Brazilians for their own slave trade there. The Spanish, French, and English also introduced market-oriented tobacco cultivation into their islands in the West Indies. The Spanish in Cuba created a major production of tobacco of recognized superior quality. For the French and English, tobacco was only briefly important in the early days of their Antilles colonies until the local economies turned to sugar. Much more important was the introduction by the English of a West Indian variety of tobacco (nicotiana tabacum) into the Chesapeake colonies of Virginia and Maryland, replacing the less desirable indigenous variety (nicotiana rustica). Its cultivation and trade grew rapidly in the seventeenth century so that by the century's end, shipments from the Chesapeake to Europe exceeded those from all other transatlantic colonies combined. So substantial were these shipments that at the end of the seventeenth century, two-thirds of English imports could be re-exported to Ireland and the continent; by the early 1770s, fully 85 percent of Britain's tobacco imports was re-exported.
In Europe, the demand for tobacco at first came from sailors and the more raffish elements in the urban male population. It was also sought by soldiers to assuage the rigors of campaigning. During the Thirty Years' War (1618–1648), the movement of armies would have introduced it into new areas. Its use was at first prohibited in some jurisdictions but these bans were soon lifted as tobacco's availability for taxation became evident. The last major jurisdiction prohibiting it was Russia, but Peter the Great, at the time of his visit to the West in 1697, authorized tobacco consumption in his realm and granted an import monopoly to an influential English syndicate. In practice, the monopoly could not be enforced because the leaf was soon being cultivated in the Ukraine and elsewhere in Peter's realm. Even so, monopoly became a preferred fiscal strategy in many jurisdictions, including France, Spain, and Sweden. Because imported tobacco was more efficiently taxed than home-grown, internal cultivation was banned in Britain, France, Spain, and other Europeans states, but tolerated in the Netherlands, parts of the Rhineland, and Alsace. A significant production also developed in the Ottoman Empire with the trade centered at Thessaloniki.
In the Caribbean, tobacco was processed by spinning or twisting into ropes preserved in molasses and wound into rolls for shipment. Tobacconists or consumers could chop up lengths of this roll tobacco for smoking. More often, tobacconists pressed the spun tobacco into briques suitable for chewing or carottes wrapped in cord (tabac ficelé) suitable for conversion into snuff. In the Chesapeake, however, tobacco leaf was dried in sheds and then pressed tightly (prized) into hogsheads of ever-increasing weight, reaching about 1,000 pounds by 1775. Because staves were cheaper in well-wooded North America, hogsheads were economical in the Chesapeake, and its leaf appealed to snuff makers in much of Europe. Whereas the French processed leaf tobacco into carottes before conversion into snuff, the British and Dutch used water mills and windmills to grind leaf directly into snuff. This ground product was then sold to retail snuffmen who added distinctive perfumes. Snuff could be taken by ladies in polite society, and was the socially preferred mode of consumption in the eighteenth century, though it is likely that less fashionable smoking accounted for a greater weight consumed.
Tobacco in the Chesapeake was cultivated on both small and large holdings. In the seventeenth century most was grown by free labor. However, from the end of that century and continuing in the eighteenth, production became concentrated increasingly on larger holdings staffed by slaves. About 60 to 70 percent of tobacco grown in the Chesapeake around 1770 was sold by planters to local "stores" from which they obtained their needed supplies; most of the remainder was consigned by larger planters to commission merchants in England. A store could be operated by a local trader or a factor for a Glasgow or other British firm. In Britain the great Glasgow firms and others who imported tobacco on their own account were free to sell scores of hogsheads at a time at a uniform price to the French monopoly and other large-scale buyers. Commission merchants who received smaller shipments from numerous consigners in the Chesapeake were expected to sell each hogshead separately for a price reflecting its quality. Sometimes, though, they were forced by market pressures to make multi-hogshead sales at a flat price. In such cases, the more conscientious merchants engaged a tobacco broker to evaluate each hogs-head sold and adjust the sale price reported to reflect the quality differences. These London tobacco brokers, frequently Dutch Jews, provided an important technical service between sellers and buyers who themselves may not have been sufficiently expert in tobacco.
The Chesapeake-British tobacco trade was at a secular peak on the eve of the American Revolution. The war disrupted it severely as much was destroyed and only limited quantities exported to help pay for the American war effort. (The French monopoly had to look to the Ukraine for possible alternative supplies.) After the war American exports lagged below their prewar level, reflecting the wartime depletion of the labor force by slaves escaping or being carried away by British ships. Then, too, in the postwar decades some of the planters migrated with their slaves to the Deep South and turned to producing cotton. It was not until the late 1830s that U.S. leaf tobacco exports re-attained the level of the early 1770s. By then the major zone of production had shifted from the Chesapeake southward to North Carolina and westward to the Ohio Valley. In the nineteenth century, of course, the growth of population in the United States made the domestic market increasingly important for tobacco growers. In the same century, the process of tobacco cultivation was brought by colonists into Rhodesia. Less is known about the introduction of its cultivation into India, China, Japan, and Korea.
In the seventeenth and eighteenth centuries government regulation of the tobacco trade was directed in great part by a desire to maximize tobacco's tax yields: 3.6 percent of British state revenues in the 1790s; 7.3 percent for France in 1789; and up to 25 percent for Spain in the 1760s. In the nineteenth and twentieth centuries government tobacco revenues soared owing to the rise in population and per capita consumption. At the end of the eighteenth century tax-paying tobacco consumption was about 1.3 pounds per head per annum in Britain and 1 pound in France. Only in the last quarter of the nineteenth century did British consumption rise significantly, reaching 2 pounds per head per annum in 1919, and 4 pounds in 1938. Recent data show consumption of 3pounds per head per annum in France, 4.5 to 6 pounds for the United Kingdom, the Netherlands, Belgium, Denmark, and Canada, and 7.5 pounds for the United States.
This surge in consumption is associated with the decline in snuff usage and the increasing demand for cigars and cigarettes. Snuff continued to be used by special populations: for example employees not permitted to strike matches in their workplace and Orthodox Jews who could not strike a match on the Sabbath. Legend has it that cigars were made fashionable in England by army officers returning from the Iberia Peninsula Campaign. Cigarettes are reported to have been used first in Eastern Europe and introduced into the United States by immigrants. Their great breakthrough came from the development of a cigarette-making machine in 1872. Such machinery facilitated the growth of very large tobacco manufacturing companies (including the much expanded French tobacco monopoly) that were able to spend millions on advertising. Cigarettes by the 1920s had also become as acceptable for women as snuff had been in the eighteenth century—a development which by itself can explain much of the growth in per capita consumption reported above.
The twentieth century, however, saw a shift in public attitudes toward tobacco. In the first half of the century, tobacco continued to be accepted as a normal part of everyday life. Thus, during World War II, tax-free cigarettes were sold to members of the United States armed forces for as little as 5 cents for a pack of twenty. Attitudes changed in the second half of the century when public authorities, particularly in North America and Europe, started propaganda campaigns against tobacco and in the United States initiated lawsuits against tobacco companies for endangering public health. At present, it can only be said that tobacco consumption has reached something of a plateau.
Goodman, Jordan; Lovejoy, Paul E.; and Andrew Sherratt. Consuming Habits: Drugs in History and Anthropology. London and New York: Routledge, 1995.
McNeill, John Robert. Atlantic Empires of France and Spain: Louisbourg and Havana 1700–1763. Chapel Hill: University of North Carolina Press, 1985.
Price, Jacob M. France and the Chesapeake: A History of the French Tobacco Monopoly, 1674–1791, and of Its Relationship to the British and American Tobacco Trades, 2 vols. Ann Arbor: University of Michigan Press, 1973.
Price, Jacob M. Tobacco in Atlantic Trade: The Chesapeake, London, and Glasgow, 1675–1775. Aldershot, U.K. and Brookfield, VT: Variorum, 1995.
Rogozinski, Jan. Smokeless Tobacco in the Western World, 1550–1950. New York: Praeger, 1990.
Jacob M. Price
cigarettes and industrialization
On the eve of the French Revolution, some 250 years after its introduction from the Americas, tobacco (Nicotiana tabacum) was used as a recreational stimulant throughout Europe. It was an important article of trade between Europe and the rest of the world and a significant source of income for many European governments. In Spain, France, Portugal, and Austria the supply of tobacco was subject to a government monopoly; in every other European country its import, processing, or sale was controlled by some form of fiscal legislation.
State control of the tobacco supply was challenged at various times during the period, notably in France, where both taxation and the government monopoly were abolished during the Revolution (although both were subsequently reinstated); in Berlin in 1848, when the right to smoke in public places was a demand of and concession made to the revolutionaries; and in Italy in 1848, where protests against an Austrian monopoly led to open revolt in Lombardy, Venice, and Piedmont.
The principal source of tobacco was the Americas, with the United States the largest supplier followed by Brazil and Cuba. Tobacco was also imported to Europe from Sri Lanka and the Philippines in the Far East and Egypt and the Ottoman Empire in the Near East. Tobacco cultivation was banned in many European countries, including Great Britain, in order to protect national monopolies or customs revenues. However, it was grown on a commercial scale in Russia, the Netherlands, and a number of Germany principalities.
At the beginning of the nineteenth century the usual way in which tobacco was consumed throughout Europe was as snuff—dried, flavored, powdered tobacco, sniffed by the pinch as a stimulant. Over the next half-century, as a general trend across the Continent, snuffing was replaced by smoking. In some countries such as Great Britain and Holland the trend was a revival, but in others, such as Prussia, the habit was new. The switch from snuff taking to smoking commenced in the Napoleonic Wars, when the British soldiers who served in Spain during the Peninsula campaign were introduced to cigars, hitherto a Spanish or South American method of tobacco consumption, and brought the habit home with them, where it quickly spread: in 1800 Britain imported twenty-six pounds of cigars; in 1830, two hundred fifty thousand pounds. Contemporaneously with the introduction of cigars, Britain also witnessed a revival of pipe smoking, which had been the principal form of tobacco use in the sixteenth and seventeenth centuries. The revival, however, was accompanied by new social attitudes to smoking and a new etiquette for smokers. It was accepted that the smell of tobacco smoke might cause offense, and so space was dedicated, in both private houses and public institutions, to the creation of smoking rooms. Moreover, while snuff had been used by both sexes at every level of society, smoking was considered to be a masculine habit, and except among the poor, women who smoked were the subjects of moral opprobrium (although perhaps not in "bohemian" circles).
The pan-European drift toward smoking was uneven: the first year in which more tobacco was sold in France for smoking rather than snuffing was 1830, whereas in Venice the change did not occur until 1860. As a consequence, a variety of tobacco habits coexisted side by side in many European countries, and the particular habit any individual possessed often reflected his or her social class. The ability to determine a person's background by how they used tobacco was employed by novelists as an aid to characterization: Charles Dickens in Great Britain and Honoré de Balzac in France were both careful to specify the tobacco habits of their characters. In Britain, in particular, clear literary conventions were established: the amoral or ostentatious rich smoked cigars; the dependable middle class and intellectuals enjoyed pipes; old people and mill workers took snuff. Tobacco and smoking were also the subject of artistic works in their own right. For instance, Charles Baudelaire included a poem dedicated to his pipe in Les Fleurs du Mal (1857).
Attitudes toward tobacco generally were very positive. It was associated with thinking as well as relaxation and considered to be a mental stimulant. Among the poor it was used to suppress appetite. Despite advances in chemistry and the isolation, in 1828 in Heidelberg, of the alkaloid nicotine—the chemical soul of tobacco—which was found to be highly toxic, neither smoking nor snuffing were thought to be injurious. Criticism usually focused on sanitary matters (the odor of tobacco smoke tainted clothes) or safety: in Prussia, wire cigar guards were employed to protect smokers and their surroundings from ash and burning embers. Opposition to tobacco use gained some momentum in Great Britain with the advent of the temperance movement, which attacked smoking as being godless and wasteful. However such sentiments were rare and were contrary to received opinion.
Although tobacco was mass consumed, for much of the nineteenth century its conversion into a consumer product was unsophisticated: it was processed rather than manufactured, and the principal cost of production in every European country was labor. The Royal Tobacco Factory in Seville, Spain, was the largest industrial building in Europe at the beginning of the period, yet it lacked all but the most rudimentary of machinery. The snuff, cigars, and loose tobacco it produced were handmade by a largely female workforce. The loose tobacco was destined for the urban poor, who smoked it rolled in scraps of paper. This manner of smoking was adopted by French travelers who carried it to Paris, where the little hand-rolled paper and tobacco cigar was named the "cigarette" by the writer Théophile Gautier in 1833. Cigarettes acquired romantic associations in France. Works such as Prosper Mérimée's Carmen (1845) put them into the mouths of tempting young women and the men who wished to seduce them. In response to evident demand, the French tobacco monopoly started manufacturing cigarettes by hand in 1845.
In Great Britain, by contrast, cigarettes were a luxury item and their consumption was thought to be effete. They had been introduced to the country in 1856 by a veteran of the Crimean War, were produced in limited quantities by exclusive tobacconists such as Philip Morris of Bond Street, and
were smoked by people of equivocal social standing such as the playwright Oscar Wilde. Matters changed in 1883 with the introduction of mechanization, which enabled British suppliers to produce a cheap and uniform product. Machine-made cigarettes did not displace existing tobacco products but rather created their own market. Unlike pipes they were simple to use, in contrast to cigars they were mild to smoke, and above all, they were consistent in quality. Such attributes made cigarettes appealing to the ever-increasing number of clerical workers; they were also attractive to women and to minors.
Cigarettes inspired the first popular opposition to smoking in Great Britain. It was perceived that such cheap branded products were irresistible to children, and in 1908 the Children and Young Persons Act was passed, which made it illegal to sell tobacco to those under sixteen years of age—an implicit acknowledgment that tobacco use might pose a risk to health. Notwithstanding such reservations, tobacco rations were supplied to British troops and to the soldiers of every other one of the principal combatant nations at the outbreak of World War I, and tobacco consumption throughout Europe ended the period on a rising trend.
Barrie, J. M. My Lady Nicotine. London, 1890.
Gately, Iain. Tobacco—A Cultural History of How an Exotic Plant Seduced Civilization. New York, 2002.
Goodman, Jordan. Tobacco in History. London, 1993.
Hilton, Matthew. Smoking in British Popular Culture, 1800–2000. Manchester, U.K., 2000.
Tobacco (Nicotiana tabacum ) is an herbaceous plant cultivated around the world for its leaves, which can be rolled into cigars, shredded for cigarettes and pipes, processed for chewing, or ground into snuff. Tobacco leaves are the source of commercial nicotine, a component of many pesticides. The tobacco plant is fast-growing with a stem from 4–8 ft (1–3 m) in height.
Native to the Americas, tobacco was cultivated by Native Americans, and Christopher Columbus found them using it in much the same manner as today. American Indians believed it to possess medicinal properties, and it was important in the ceremonies of the plains tribes.
Tobacco was introduced into Europe in the mid-1500s on the basis of its purported medicinal qualities. Tobacco culture by European settlers in America began in 1612 at Jamestown, and it soon became the chief commodity exchanged by colonists for articles manufactured in Europe.
The leading tobacco-growing countries in the world today are China and the United States, followed by India, Brazil, and Turkey, as well as certain countries in the former Soviet Union. Although about one-third of the annual production in the United States is exported, the country also imports about half as much tobacco as it exports. The leading tobacco-growing state is North Carolina, followed by Kentucky, South Carolina, Tennessee, Virginia, and Georgia.
Nicotine occurs in tobacco along with related alkaloids and organic acids such as malic and citric. Nicotine content is determined by the species , variety, and strain of tobacco; it is also affected by the growing conditions, methods of culture and cure, and the position on the plant from which the leaves are taken. Tobacco is high in ash content, which can range from 15–25% of the leaf. Flue-cured tobacco is rich in sugar, and cigar tobaccos are high in nitrogenous compounds but almost free of starch and sugars.
Most tobacco products are manufactured by blending various types of leaves, as well as leaves of different origins, grades, and crop years. Cigarette manufacturers usually add sweetening preparations and other flavorings, but the preparation of tobaccos for pipe smoking and chewing is as varied as the assortment of products themselves. Snuff is made by fermenting fire-cured leaves and stems and grinding them before adding salts and other flavorings. Cigars are made by wrapping a binder leaf around a bunch of cut filler leaf and overwrapping with a fine wrapper leaf.
In the United States and elsewhere, stems and scraps of tobacco are used for nicotine extractions. They can also be ground down and made into a reconstituted sheet in a process like papermaking, which is used as a substitute cigar binder or wrapper or cut to supplement the natural tobacco in cigarettes.
[Linda Rehkopf ]
Chandler, W. U. Banishing Tobacco. Washington, DC: Worldwatch Institute, 1986.
Heise, L. "Unhealthy Alliance: With U.S. Government Help, Tobacco Firms Push Their Goods Overseas." World Watch (September-October 1988): 19–28.
National Academy of Sciences. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: National Academy Press, 1986.
Boeken v. Philip Morris Incorporated
Smokers of cigarettes have filed many civil lawsuits against tobacco companies seeking damages for injuries caused by tobacco. These lawsuits typically allege negligence, strict product liability, and fraudulent misrepresentation. A California case, Boeken v. Philip Morris Incorporated, 127 Cal.App.4th 1640, 26 Cal.Rptr.3d 638 (2005), drew national attention when the California Court of Appeals ruled that the plaintiff could use a "consumer expectations test" to show that "light" cigarettes were a defective product. In addition, the court reduced the $100 million punitive damages award to $50 million, signaling the need to follow a U.S. Supreme Court case that sought to curtail excessive punitive damages awards.
Richard Boeken started smoking cigarettes when he was 10-years old and continued to smoke until his death at age 57 from lung cancer in 2002. Boeken and his heirs sued Philip Morris Incorporated, the maker of Marlboro and Marlboro Light cigarettes, which Boeken smoked throughout his life. A California jury awarded Boeken over $5 million in compensatory damages and $5 billion in punitive damages. Punitive damages are a quasi-criminal remedy that seeks to punish the defendant for offensive and reprehensible conduct. The trial court reduced the punitive damages award to $100 million but Philip Morris appealed the verdict.
The California Court of Appeals for the Second District upheld the findings of negligence, product liability, and fraud. Justice J. Gary Hastings, writing for the court, traced the growing rate of lung cancer in the United States from the early twentieth century to the present. Lung cancer was a rare disease until the introduction of pre-rolled cigarettes in 1913. By the 1930s there was a sharp increase in the number of diagnosed lung cancer cases, a number that increased 20-fold by 1945. In the late 1940s scientists started to make statistical connections between smoking and cancer. In the 1950s the tobacco companies started a public relations campaign that tried to create public doubt about the linkage between smoking and cancer, though they did not issue actual denials. In 1969 Congress enacted a law that required cigarette manufacturers to place a health warning on every cigarette package but the manufacturers continued to question the linkage between smoking and cancer. For example, in 1994 a group of tobacco executives denied under oath that smoking was addictive or that it caused cancer. Boeken testified that he seen part of these 1994 hearings and he believed they would not lie to Congress under oath. Boeken also testified to his unsuccessful attempts to quit smoking. Though he was able to end both a heroin and an alcohol addiction, he never stopped smoking for more than 30 or 40 days. In 1981 Boeken began to smoke Marlboro Light cigarettes, because they were lower in tar and nicotine. He later switched to Marlboro Ultralights. He did not find out until much later in his life that these new brands contained accelerants, additives, or chemicals that were added to increase their addictiveness. At trial Boeken testified that if Philip Morris had made clear in the 1960s, 1970s or 1980s that cigarettes caused lung cancer he would have quit smoking or made an "honest effort" to quit. In addition, he claimed he would have stopped smoking if the company had revealed it had added ingredients to increase their addictiveness.
Justice Hastings rejected the company's claim that there was not sufficient evidence to support the jury's finding that Marlboro Lights were a defective product under the consumer expectation test. This test is met when the evidence shows that "the product failed to perform as safely as an ordinary consumer would expect when used in an intended or reasonably foreseeable manner." A medical expert had testified that Marlboro Lights and Ultralights were not light at all because they delivered nicotine and tar to smokers in a way that led smokers to "compensate." Smokers compensate when they adjust the way they smoke to get a "satisfying amount of nicotine, by covering the holes in the filter, sucking harder, drawing the smoke further into the lungs, and keeping it in longer." Most smokers thought that light cigarettes were safer and did not know they compensated. As a consequence, these smokers drew carcinogens further into their lungs, which is more likely to produce a more aggressive form of lung cancer than those "more prevalent among smokers of regular cigarettes." Philip Morris argued that this test was based on a failure to warn, which was preempted by the federal Public Health Cigarettes Smoking Act of 1969. The appeals court agreed that a failure-to-warn claim would be preempted by the law but concluded that the consumer expectations test was a different cause of action that was not preempted.
The appeals court agreed with Philip Morris that the punitive damages award of $100 million was too high. The U.S. Supreme Court, in State Farm Mutual Automobile Insurance Co. v. Campbell, 538 U.S. 408, 123 S.Ct. 1513, 155 L.Ed.2d 585 (2003), sought to curtail excessive punitive damages awards by setting out several factors for courts to help determine the degree of reprehensibility. The appeals court found that these factors supported the jury's conclusion "that a substantial punitive damages award was appropriate in this case." The State Farm decision also stated that the computation of punitive damages should be calculated by multiplying the compensatory award by a single-digit multiplier. The appeals court ruled that despite the company's "40 years of fraud", a multiplier of 9 was justified. Multiplying the compensatory award by 9 and rounding it off led to a $50 million punitive damages award.
Tobacco is an American plant, which is a member of the nightshade family. When Christopher Columbus (1451–1506) arrived in the West Indies (islands in the Caribbean Ocean) in 1492, he found the native inhabitants smoking rolls of tobacco leaves, called taino. (The word tobacco is derived from the Spanish tabaco, which is probably from taino. ) The practice of "drinking smoke" was observed to have a relaxing effect. Upon returning to Spain, Columbus took seeds of the plant with him. By 1531 tobacco was being cultivated on a commercial scale in the Spanish colonies of the West Indies. In 1565 English naval commander John Hawkins (1532–95) introduced tobacco to England, where smoking was ultimately condemned as a "vile and stinking custom" by King James I (1566–1625) decades later.
Tobacco was not commercially cultivated on the North American mainland until English colonist John Rolfe (1585–1622) carried seeds from the West Indies to Jamestown, Virginia, where he settled in 1610. By 1612 he had successfully cultivated tobacco and discovered a method of curing the plant, making it a viable export item. Jamestown, Virginia, became a boom-town and England's King James, who collected export duties, changed his mind about the habit of smoking. The coastal regions of Virginia, Maryland, and North Carolina were soon dominated by tobacco plantations, and the crop became the backbone of the economies in these colonies. Cultivation of tobacco did not require the same extent of land or slave labor as did other locally grown crops such as rice and indigo. But it depleted the nutrients of soil more rapidly, causing growers to expand their lands westward into the Piedmont region (the plain lying just east of the Blue Ridge and Appalachian mountains). In 1660 British Parliament passed the Second Navigation Act, declaring that tobacco and other articles from England's American colonies could only be exported to the British Isles. Tobacco prices dropped in response to the legislation and the colonial economies were weakened, causing political discontent with the mother country. But, despite the Second Navigation Act, European demand was not diminished and the colonists soon resumed exports. By 1765 colonial exports of tobacco were nearly twice the value of exports of bread and flour. The crop helped define the plantation economy of the South, which prevailed until the outbreak of the American Civil War (1861–65). During the 1800s companies such as R. J. Reynolds Tobacco and American Tobacco were founded. Tobacco has remained an important crop in the American south and the manufacture of tobacco continued to be an important industry.
Tobacco, Nicotiana tabacum (family Solanaceae), is grown in over one hundred countries around the world, in both temperate and tropical climates. It is a stout, rapidly growing annual, 1 to 2 meters tall. It has large, ovate to oblong leaves and produces numerous white-pinkish flowers with corollas about 2 centimeters long. Tobacco seeds are minute, so in commercial production seedlings are generally produced in plant beds or in greenhouses and transferred to the field. Production and harvesting methods differ widely depending on the type of tobacco being produced, but most tobacco types require significant inputs of time, labor, and pest management. Both underfertilization and overfertilization may cause inferior quality leaves. Commonly, whole plants of air-cured tobaccos are cut off just above the ground and hung in barns for several months until cured. Leaves of bright, flue-cured tobaccos are typically harvested individually as they ripen. These leaves are cured by heating them up slowly through yellowing, drying, and stem-drying steps. Piles of cured tobacco leaves are generally sold at auction in large, well-lighted warehouses.
Tobacco is believed to have originated in northwestern Argentina and adjacent Bolivia. Native peoples undoubtedly used it for centuries before Europeans colonized the Americas. Christopher Columbus was introduced to tobacco by the Arawaks on October 11, 1492, when he first visited the Caribbean islands. Tobacco smoking spread throughout Europe in the second half of the sixteenth century. Tobacco soon became the most important commercial crop in Colonial America, and the tobacco trade directly contributed to the success of the first permanent English settlement at Jamestown, Virginia.
Differences in cultural practices and diverse climatic and soil conditions produce several different types of tobacco that are used in various smoking and chewing products. The major types of tobacco are bright (flue-cured), light air-cured (burley), dark air-cured, fire-cured, oriental, cigar wrapper, and cigar filler. Burley and flue-cured tobaccos are the primary tobacco types used in the manufacture of cigarettes, and they account for most of the U.S. production. Over 90 percent of the tobacco grown in the United States is from North Carolina and Kentucky, but Maryland, South Carolina, Virginia, Georgia, Florida, Ohio, and Tennessee also produce substantial amounts of this crop.
Tobacco leaves are covered with trichomes (hairs) that have multicellular glands on their tips. These glandular trichomes produce a sticky resinous material that contains many of the flavor and aroma components. Tobacco also produces many internal, secondary components, including pyridine alkaloids . The most important alkaloid is nicotine, which acts as a stimulant to the user and is addictive. Nicotine is quite toxic, and products containing nicotine were used as early insecticides. The adverse health effects of smoking, including nicotine addiction and the increased risks of cancer, emphysema, and heart attack, are well documented.
Tobacco has been extensively used as a model system in many basic scientific studies. Pioneering work in quantitative genetics, tissue culture techniques, plant physiology , and genetic engineering have utilized the unique characteristics of tobacco, which has been referred to as "the white rat of the plant world."
see also Alkaloids; Economic Importance of Plants; Poisonous Plants; Psychoactive Plants; Solanaceae.
D. Michael Jackson
Goodspeed, T. H. The Genus Nicotiana. Waltham, MA: Chronica Botanica Co., 1954.
Tso, T. C. Production, Physiology, and Biochemistry of the Tobacco Plant. Beltsville, MD: Ideals, Inc., 1990.