Tobacco smoking

A woman smoking a cigarette, the most common method of tobacco smoking
Aztec women are handed flowers and smoking tubes before eating at a banquet, Florentine Codex, 16th century.
Gentlemen Smoking and Playing Backgammon in an Interior by Dirck Hals, 1627
Bonsack's cigarette rolling machine, as shown on U.S. patent 238,640
A lengthy study conducted in order to establish the strong association necessary for legislative action (US cigarette consumption per person blue, male lung cancer rate brown)
Tendu Patta (Leaf) collection for Beedi industries
A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake.
Sigmund Freud, whose doctor assisted his suicide because of oral cancer caused by smoking
Common adverse effects of tobacco smoking. The more common effects are in bold face.
Skull with a burning cigarette, by Vincent van Gogh.
An enclosed smoking area in a Japanese train station. Notice the air vent on the roof.

Practice of burning tobacco and ingesting the smoke that is produced.

- Tobacco smoking
A woman smoking a cigarette, the most common method of tobacco smoking

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Section of a lung showing centrilobular emphysema, with enlarged airspaces in the centre of a lobule usually caused by smoking and a major feature of COPD

Chronic obstructive pulmonary disease

Type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation.

Type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation.

Section of a lung showing centrilobular emphysema, with enlarged airspaces in the centre of a lobule usually caused by smoking and a major feature of COPD
Signs and symptoms of stages of COPD.
Access to clean fuel and clean cooking facilities as of 2016.
Normal lungs shown in upper diagram. Lungs damaged by COPD in lower diagram with an inset showing a cross-section of bronchioles blocked by mucus, and damaged alveoli.
Micrograph showing emphysema (left – large empty spaces) and lung tissue with relative preserved alveoli (right).
A person blowing into a spirometer. Smaller handheld devices are available for office use.
Chronic obstructive pulmonary disease deaths per million persons in 2012
Giovanni Battista Morgagni, who made one of the earliest recorded descriptions of emphysema in 1769
alt=A black and white image, with a small white heart in the middle and large black lungs around it|Chest X-ray demonstrating severe COPD: Note the small heart size in comparison to the lungs.
A lateral chest X-ray of a person with emphysema: Note the barrel chest and flat diaphragm.
Lung bulla as seen on chest X-ray in a person with severe COPD
A severe case of bullous emphysema
Axial CT image of the lung of a person with end-stage bullous emphysema
Very severe emphysema with lung cancer on the left (CT scan)

The most common cause of COPD is tobacco smoking.

Smog in Cairo. Particulate air pollution, including smog, is a substantial cause of human exposure to PAHs.

Polycyclic aromatic hydrocarbon

Hydrocarbon—a chemical compound containing only carbon and hydrogen—that is composed of multiple aromatic rings.

Hydrocarbon—a chemical compound containing only carbon and hydrogen—that is composed of multiple aromatic rings.

Smog in Cairo. Particulate air pollution, including smog, is a substantial cause of human exposure to PAHs.
Crude oil on a beach after a 2007 oil spill in Korea.
An 18th-century drawing of chimney sweeps.
An adduct formed between a DNA strand and an epoxide derived from a benzo[a]pyrene molecule (center); such adducts may interfere with normal DNA replication.
Naphthalene
Biphenyl
Fluorene
Anthracene
Phenanthrene
Phenalene
Tetracene
Chrysene
Triphenylene
Pyrene
Pentacene
Perylene
Benzo[a]pyrene
Corannulene
Benzo[ghi]perylene
Coronene
Ovalene
Benzo[c]fluorene
Phenanthrene
Anthracene
Chrysene

Lower-temperature combustion, such as tobacco smoking or wood-burning, tends to generate low molecular weight PAHs, whereas high-temperature industrial processes typically generate PAHs with higher molecular weights.

Survival from age 35 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 25 and 34 years old.

British Doctors Study

Survival from age 35 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 25 and 34 years old.
Survival from age 40 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 35 and 44 years old.
Survival from age 50 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 45 and 54 years old.
Survival from age 60 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 55 and 64 years old.

The British Doctors' Study was a prospective cohort study which ran from 1951 to 2001, and in 1956 provided convincing statistical proof that tobacco smoking increased the risk of lung cancer.

Diagram showing the position of the pancreas, behind the stomach (which is transparent in this schematic).

Pancreatic cancer

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass.

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass.

Diagram showing the position of the pancreas, behind the stomach (which is transparent in this schematic).
The pancreas has many functions, served by the endocrine cells in the islets of Langerhans and the exocrine acinar cells. Pancreatic cancer may arise from any of these and disrupt any of their functions.
Jaundice can be a symptom, due to biliary obstruction from a pancreatic tumor.
Cross-section of a human liver, at autopsy, showing many large pale tumor deposits, that are secondary tumors derived from pancreatic cancer
Micrograph of pancreatic ductal adenocarcinoma (the most common type of pancreatic cancer), H&E stain
Micrographs of normal pancreas, pancreatic intraepithelial neoplasia (precursors to pancreatic carcinoma) and pancreatic carcinoma. H&E stain
The head, body, and tail of the pancreas: The stomach is faded out in this image to show the entire pancreas, of which the body and tail lie behind the stomach, and the neck partially behind.
Axial CT image with IV contrast and added color: Cross lines towards top left surround a macrocystic adenocarcinoma of the pancreatic head.
Abdominal ultrasonography of pancreatic cancer (presumably adenocarcinoma), with a dilated pancreatic duct to the right.
Fine needle aspiration of well-differentiated pancreatic adenocarcinoma, showing a flat sheet with prominent honeycombing. The disorganization, nuclear overlapping, and lack of uniform nuclear spacing provides a clue that is this adenocarcinoma (as opposed to non-neoplastic duct epithelium).
Pancreatic cancer metastasized – stage M1
Parts of the body removed in Whipple's operation
How the pancreas and bowel are joined back together after a Whipple's operation
Deaths from pancreatic cancer per million persons in 2012
Stage T1 pancreatic cancer
Stage T2 pancreatic cancer
Stage T3 pancreatic cancer
Stage T4 pancreatic cancer
Pancreatic cancer in nearby lymph nodes – Stage N1

Risk factors for pancreatic cancer include tobacco smoking, obesity, diabetes, and certain rare genetic conditions.

A woman smoking a tobacco cigarette, the most common method of smoking

Smoking

Practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream.

Practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream.

A woman smoking a tobacco cigarette, the most common method of smoking
A man smoking cannabis in Kolkata, India
A woman smoking crack cocaine
Aztec women are handed flowers and smoking tubes before eating at a banquet, Florentine Codex, 1500
A Persian girl smoking by Muhammad Qasim, 17th century.
Bonsack's cigarette rolling machine, as shown on U.S. patent 238,640
An illustration of an opium den on the cover of Le Petit Journal, 5 July 1903
A lengthy study conducted in order to establish the strong association necessary for legislative action (US cigarette consumption per person blue, male lung cancer rate green)
An elaborately decorated pipe
A diagram of the human body showing some of the diseases caused by smoking
A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake
Sigmund Freud, whose doctor assisted with his suicide because of oral cancer caused by smoking
Prevalence of daily smoking in 2012
The share adults who smoke any tobacco product on a daily or non-daily basis in 2016.
An Apothecary Smoking in an Interior by Adriaen van Ostade, oil on panel, 1646
Skull with a Burning Cigarette by Vincent van Gogh, oil on canvas, 1885
Film star and iconic smoker Humphrey Bogart
The cover of My Lady Nicotine: A Study in Smoke (1896) by J.M. Barrie, otherwise best known for his play Peter Pan
Share of deaths from smoking, 2017<ref>{{cite web |title=Share of deaths from smoking |url=https://ourworldindata.org/grapher/share-deaths-smoking |website=Our World in Data |access-date=5 March 2020}}</ref>
The number of deaths attributed to smoking per 100,000 people in 2017<ref>{{cite web |title=Death rate from smoking |url=https://ourworldindata.org/grapher/death-rate-smoking?tab=map |website=Our World in Data |access-date=5 March 2020}}</ref>
Average price of a pack of 20 cigarettes, measured in international dollars in 2014.<ref>{{cite web |title=Average price of a pack of cigarettes |url=https://ourworldindata.org/grapher/average-price-of-a-pack-of-cigarettes |website=Our World in Data |access-date=5 March 2020}}</ref>
Taxes as a share of cigarette price, 2014<ref>{{cite web |title=Taxes as a share of cigarette price |url=https://ourworldindata.org/grapher/taxes-as-share-of-cigarette-price |website=Our World in Data |access-date=5 March 2020}}</ref>
Types of bans on tobacco advertising, 2014<ref>{{cite web |title=Enforcement of bans on tobacco advertising |url=https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising |website=Our World in Data |access-date=5 March 2020}}</ref>
Support to help quit tobacco use, 2014<ref>{{cite web |title=Support to help quit tobacco use |url=https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use |website=Our World in Data |access-date=5 March 2020}}</ref>

Diseases related to tobacco smoking have been shown to kill approximately half of long-term smokers when compared to average mortality rates faced by non-smokers.

Oral cancer on the side of the tongue, a common site along with the floor of the mouth

Oral cancer

Cancer of the lining of the lips, mouth, or upper throat.

Cancer of the lining of the lips, mouth, or upper throat.

Oral cancer on the side of the tongue, a common site along with the floor of the mouth
Swelling of the right neck from the spread of oral cancer.
Ulceration on the left lower lip caused by cancer
Stall selling betel quid
Oral leukoplakia (white patch) on the left tongue. Proven to be severe dysplasia on biopsy
A large squamous cell carcinoma of the tongue as seen on CT imaging
Histopathologic appearance of a poorly differentiated squamous cell carcinoma specimen. Hematoxylin-eosin stain. p16 positive, EBV negative
Spread of cancer beyond the capsule of a lymph node (ENE+).
Post-operative image after removal of oral cancer with part of the mandible (feeding tube in nose)
Common scar line after cervical lymph node dissection
Radiation treatment
Deaths from mouth and oropharynx cancers per million people in 2012
A beagle with oral cancer.

Risk factors include tobacco and alcohol use.

The three most common sites of intestinal involvement in Crohn's disease (left) compared to the areas affected by colitis ulcerosa (right).

Crohn's disease

Type of inflammatory bowel disease that may affect any segment of the gastrointestinal tract.

Type of inflammatory bowel disease that may affect any segment of the gastrointestinal tract.

The three most common sites of intestinal involvement in Crohn's disease (left) compared to the areas affected by colitis ulcerosa (right).
An aphthous ulcer on the mucous membrane of the mouth in Crohn's disease.
A single lesion of erythema nodosum
Endoscopic image of colon cancer identified in the sigmoid colon on screening colonoscopy for Crohn's disease
NOD2 protein model with schematic diagram. Two N-terminal CARD domains (red) connected via helical linker (blue) with central NBD domain (green). At C-terminus LRR domain (cyan) is located. Additionally, some mutations which are associated with certain disease patterns in Crohn's disease are marked in red wire representation.
Distribution of gastrointestinal Crohn's disease.
Endoscopic image of Crohn's colitis showing deep ulceration
CT scan showing Crohn's disease in the fundus of the stomach
Endoscopic biopsy showing granulomatous inflammation of the colon in a case of Crohn's disease.
Section of colectomy showing transmural inflammation
Resected ileum from a person with Crohn's disease

Smoking increases the risk of the return of active disease (flares).

Example of historical public health recommendations from 1918 in New Haven, Connecticut, United States

Public health

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals".

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals".

Example of historical public health recommendations from 1918 in New Haven, Connecticut, United States
Community health workers
The WHO is the predominant agency associated with global health
Newspaper headlines from around the world about polio vaccine tests (13 April 1955)
Three former directors of the Global Smallpox Eradication Program reading the news that smallpox had been globally eradicated, 1980
A village health worker in Zimbabwe conducting a pediatric examination
A community health worker in Korail Basti, a slum in Dhaka, Bangladesh
A malaria test in Kenya. Despite being preventable and curable, malaria is a leading cause of death in many developing nations.
A Cuban doctor performs an open air operation in Guinea-Bissau. Cuba sends more medical personnel to the developing world than all G8 countries combined.
Mass burials during the second plague pandemic (a.k.a. the Black Death; 1346–1353) intensified urban responses to disaster on the basis of earlier practices. Miniature from "The Chronicles of Gilles Li Muisis" (1272–1352). Bibliothèque royale de Belgique, MS 13076–77, f. 24v.
A depiction of Aztec smallpox victims
Sir Edwin Chadwick was a pivotal influence on the early public health campaign.
Early epidemiologist John Snow mapped clusters of cholera cases in London
Paul-Louis Simond injecting a plague vaccine in Karachi, 1898
The London School of Hygiene & Tropical Medicine is the oldest school of public health in the Anglosphere
Ghanaian children receive insecticide-treated bed nets to prevent exposure to malaria transmitting mosquitos

Another is the control of tobacco smoking.

Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.

Cardiovascular disease

Class of diseases that involve the heart or blood vessels.

Class of diseases that involve the heart or blood vessels.

Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain.
Calcified heart of an older woman with cardiomegaly
Density-Dependent Colour Scanning Electron Micrograph SEM (DDC-SEM) of cardiovascular calcification, showing in orange calcium phosphate spherical particles (denser material) and, in green, the extracellular matrix (less dense material)
Cardiovascular diseases deaths per million persons in 2012

This may be caused by high blood pressure, smoking, diabetes mellitus, lack of exercise, obesity, high blood cholesterol, poor diet, excessive alcohol consumption, and poor sleep, among other things.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.

Stroke

Medical condition in which poor blood flow to the brain causes cell death.

Medical condition in which poor blood flow to the brain causes cell death.

CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.
There are two main categories of strokes. Ischemic (top), typically caused by a blood clot in an artery (1a) resulting in brain death to the affected area (2a). Hemorrhagic (bottom), caused by blood leaking into or around the brain from a ruptured blood vessel (1b) allowing blood to pool in the affected area (2b) thus increasing the pressure on the brain.
A slice of brain from the autopsy of a person who had an acute middle cerebral artery (MCA) stroke
CT scan of an intraparenchymal bleed (bottom arrow) with surrounding edema (top arrow)
Illustration of an embolic stroke, showing a blockage lodged in a blood vessel.
Histopathology at high magnification of a normal neuron, and an ischemic stroke at approximately 24 hours on H&E stain: The neurons become hypereosinophilic and there is an infiltrate of neutrophils. There is slight edema and loss of normal architecture in the surrounding neuropil.
A CT showing early signs of a middle cerebral artery stroke with loss of definition of the gyri and grey white boundary
Dens media sign in a patient with middle cerebral artery infarction shown on the left. Right image after 7 hours.
12-lead ECG of a patient with a stroke, showing large deeply inverted T-waves. Various ECG changes may occur in people with strokes and other brain disorders.
Walking with an orthosis after a stroke
Stroke deaths per million persons in 2012
Hippocrates first described the sudden paralysis that is often associated with stroke.

Other risk factors include high blood cholesterol, tobacco smoking, obesity, diabetes mellitus, a previous TIA, end-stage kidney disease, and atrial fibrillation.