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Learning Objectives

  1. How did worldwide cigarette consumption change over the last 100 years?

  2. Has the risk of lung cancer due to cigarette smoking changed over the last 50 years?

Tobacco is the single most preventable risk to health worldwide according to the World Health Organization.1 The tobacco plant, Nicotiana tabacum/rustica, was first cultivated more than 3,000 years ago in Central America.2 The Spanish conquistadores brought tobacco to Europe. In 1559, it was planted in “Los Cigarrales”, Spain, from where it acquired its modern names cigars and cigarettes.

Tobacco was very important for the economy of the US colonies. The agricultural needs of planting and harvesting tobacco determined much of the economy of the early colonies and is mentioned as a reason for slavery at that time.3

Tobacco was used up the late 19th century mainly in pipes, cigars, and chewable form. A change in curing the tobacco allowed more tobacco to be better tolerated when inhaled. Also, the invention of the safety match facilitated the increased use of cigarettes.

The mass production of cigarettes started in the late 1800s after James Albert Bonsack (1859-1924) patented the cigarette-rolling machine in 1880. The cigarette-rolling machine was able to produce cigarettes 100-fold faster than manual cigarette rolling at that time (Figure 4-1).

Figure 4-1.

Bonsack’s machine for cigarette mass production (1882).

Industrial mass production, helped by an effective marketing method, led to several tobacco producer monopolies. The US American Tobacco Company (ATC) combined several US companies, with Buck Duke as chairman, in 1889. The ATC then combined forces with the United Kingdom’s Imperial Tobacco to form British American Tobacco (BAT). BAT now is based in the United Kingdom and has the widest international network. Philip Morris started as a cigarette shop in the 1850s in London and transformed into multinational Altria, now among the largest tobacco companies, next to BAT, Japan Tobacco Industry, and state monopolies, such as China Tobacco.

Cigarette consumption increased after 1900 and peaked in 1960 in the United States. There is a significant difference in tobacco use epidemiology between men and women and societies of different economic wealth4,5 (Figure 4-2).

Figure 4-2.

Prevalence of daily tobacco smoking. (Adapted with permission from World Health Organization (WHO). Global Status Report on Noncommunicable Diseases 2010. Geneva, Switzerland: World Health Organization; 2011. Copyright © World Health Organization 2011.)


In the 20th century, tobacco caused the death of 100 million and is predicted to cause the death of a billion people in the 21st century.1,6 In 1949, Ernest Wynder and Evarts Graham ...

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