essay on smoking conclusion

Essay on Smoking

500 words essay on smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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How To Write A Smoking Essay That Will Blow Your Classmates out of the Water

Writing a Smoking Essay. Complete Actionable Guide

A smoking essay might not be your first choice, but it is a common enough topic, whether it is assigned by a professor or left to your choice. Today we’ll take you through the paces of creating a compelling piece, share fresh ideas for writing teen smoking essays, and tackle the specifics of the essential parts of any paper, including an introduction and a conclusion.

Why Choose a Smoking Essay?

If you are free to select any topic, why would you open this can of worms? There are several compelling arguments in favor, such as:

A smoking essay can fit any type of writing assignment. You can craft an argumentative essay about smoking, a persuasive piece, or even a narration about someone’s struggle with quitting. It’s a rare case of a one-size-fits-all topic.
There is an endless number of environmental essay topics ideas . From the reasons and history of smoking to health and economic impact, as well as psychological and physiological factors that make quitting so challenging.
A staggering number of reliable sources are available online. You won’t have to dig deep to find medical or economic research, there are thousands of papers published in peer-reviewed journals, ready and waiting for you to use them.

Essential Considerations for Your Essay on Smoking

Whether you are writing a teenage smoking essay or a study of health-related issues, you need to stay objective and avoid including any judgment into your assignment. Even if you are firmly against smoking, do not let emotions direct your writing. You should also keep your language tolerant and free of offensive remarks or generalizations.

The rule of thumb is to keep your piece academic. It is an essay about smoking cigarettes you have to submit to your professor, not a blog post to share with friends.

How to Generate Endless Smoking Essay Topic Ideas

At first, it might seem that every theme has been covered by countless generations of your predecessors. However, there are ways to add a new spin to the dullest of topics. We’ll share a unique approach to generating new ideas and take the teenage smoking essay as an example. To make it fresh and exciting, you can:

Add a historic twist to your topic. For instance, research the teenage smoking statistics through the years and theorize the factors that influence the numbers.
Compare the data across the globe. You can select the best scale for your paper, comparing smoking rates in the neighboring cities, states, or countries.
Look at the question from an unexpected perspective. For instance, research how the adoption of social media influenced smoking or whether music preferences can be related to this habit.

The latter approach on our list will generate endless ideas for writing teen smoking essays. Select the one that fits your interests or is the easiest to research, depending on the time and effort you are willing to put into essay writing .

How To Write An Essay About Smoking Cigarettes

A smoking essay follows the same rules as an academic paper on any other topic. You start with an introduction, fill the body paragraphs with individual points, and wrap up using a conclusion. The filling of your “essay sandwich” will depend on the topic, but we can tell for sure what your opening and closing paragraphs should be like.

Smoking Essay Introduction

Whether you are working on an argumentative essay about smoking or a persuasive paper, your introduction is nothing but a vessel for a thesis statement. It is the core of your essay, and its absence is the first strike against you. Properly constructed thesis sums up your point of view on the economic research topics and lists the critical points you are about to highlight. If you allude to the opposing views in your thesis statement, the professor is sure to add extra points to your grade.

The first sentence is crucial for your essay, as it sets the tone and makes the first impression. Make it surprising, exciting, powerful with facts, statistics, or vivid images, and it will become a hook to lure the reader in deeper.

Round up the introduction with a transition to your first body passage and the point it will make. Otherwise, your essay might seem disjointed and patchy. Alternatively, you can use the first couple of sentences of the body paragraph as a transition.

Smoking Essay Conclusion

Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up your assignment.

Think of the conclusion as a mirror reflection of your introduction. Start with a transition from the last body paragraph, follow it with a retelling of your thesis statement, and complete the passage with a powerful parting thought that will stay with the reader. After all, everyone remembers the first and last points most vividly, and your opening and closing sentences are likely to have a significant influence on the final grade.

Bonus Tips on How to Write a Persuasive Essay About Smoking

With the most challenging parts of the smoking essay out of the way, here are a couple of parting tips to ensure your paper gets the highest grade possible:

Do not rely on samples you find online to guide your writing. You can never tell what grade a random essay about smoking cigarettes received. Unless you use winning submissions from essay competitions, you might copy faulty techniques and data into your paper and get a reduced grade.
Do not forget to include references after the conclusion and cite the sources throughout the paper. Otherwise, you might get accused of academic dishonesty and ruin your academic record. Ask your professor about the appropriate citation style if you are not sure whether you should use APA, MLA, or Chicago.
Do not submit your smoking essay without editing and proofreading first. The best thing you can do is leave the piece alone for a day or two and come back to it with fresh eyes and mind to check for redundancies, illogical argumentation, and irrelevant examples. Professional editing software, such as Grammarly, will help with most typos and glaring errors. Still, it is up to you to go through the paper a couple of times before submission to ensure it is as close to perfection as it can get.
Do not be shy about getting help with writing smoking essays if you are out of time. Professional writers can take over any step of the writing process, from generating ideas to the final round of proofreading. Contact our agents or skip straight to the order form if you need our help to complete this assignment.

We hope our advice and ideas for writing teen smoking essays help you get out of the slump and produce a flawless piece of writing worthy of an A. For extra assistance with choosing the topic, outlining, writing, and editing, reach out to our support managers .

Essay on Stop Smoking

Students are often asked to write an essay on Stop Smoking in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Stop Smoking

Introduction.

Smoking is a dangerous habit that harms our health and environment. It’s crucial to stop smoking for a better life and future.

The Dangers of Smoking

Smoking causes diseases like cancer and heart problems. It also harms others through secondhand smoke.

Ways to Quit

You can stop smoking by seeking help from doctors, using nicotine patches, or joining support groups.

Benefits of Quitting

Quitting smoking improves health, saves money, and protects loved ones from secondhand smoke.

Stopping smoking is challenging but vital. Let’s strive for a smoke-free world for a healthier future.

250 Words Essay on Stop Smoking

The detrimental effects of smoking.

Smoking is a habit that has been ingrained in numerous societies for centuries. Despite its prevalence, the deleterious effects of smoking on health are undeniable. Every puff of smoke inhaled introduces a cocktail of chemicals into the body, many of which are carcinogens. The result is a heightened risk of diseases such as lung cancer, heart disease, and stroke.

Smoking and Its Socioeconomic Impact

Beyond the health implications, smoking also presents significant socioeconomic challenges. The cost of tobacco products and healthcare for smoking-related illnesses can be financially crippling for individuals and families. Moreover, the loss of productivity due to illness and premature death contributes to economic stagnation.

The Power of Prevention

Prevention is the most effective strategy in combating the smoking epidemic. Educational campaigns highlighting the dangers of smoking, combined with regulations limiting tobacco advertising and sales, can significantly reduce smoking rates. Furthermore, support for quitting smoking, like counseling services and nicotine replacement therapies, should be readily accessible.

Personal Responsibility and Collective Action

Ultimately, the decision to stop smoking lies with the individual. However, societal support is crucial in facilitating this decision. Collective action can create an environment that discourages smoking and encourages healthier alternatives.

In conclusion, the negative implications of smoking necessitate immediate action. By understanding the risks, acknowledging the socioeconomic impact, promoting prevention, and encouraging personal responsibility, we can work towards a smoke-free future.

500 Words Essay on Stop Smoking

Smoking is a prevalent habit that has both individual and societal implications. Despite the widespread knowledge of its harmful effects, many individuals continue to smoke, often due to addiction or social pressure. This essay aims to explore the reasons why it is crucial to stop smoking and the benefits that can be derived from it.

The Health Hazards of Smoking

The primary reason to quit smoking revolves around health. Cigarette smoke is a toxic mix of over 7,000 chemicals, many of which are carcinogenic. Smoking is directly linked to lung cancer, heart disease, stroke, and chronic respiratory diseases. Moreover, it weakens the immune system, making smokers more susceptible to diseases. Secondhand smoke also poses severe risks, affecting non-smokers who are exposed to it.

The Economic Impact of Smoking

Smoking also has significant economic implications. The direct cost of smoking, such as the price of cigarettes, is just the tip of the iceberg. The indirect costs, including healthcare expenses and productivity loss due to smoking-related illnesses, are substantial. In the United States alone, the total economic cost of smoking is more than $300 billion a year.

Environmental Consequences

The environmental impact of smoking is often overlooked. Cigarette butts, which are non-biodegradable, are the most littered item worldwide. They contain toxins that can leach into the environment, causing soil, water, and air pollution. The production of tobacco also contributes to deforestation and loss of biodiversity.

The Social Aspect of Smoking

Smoking can also strain relationships. The smell of smoke can be off-putting to non-smokers, and the health risks associated with secondhand smoke can cause tension. Additionally, the time spent on smoking breaks can lead to social exclusion or missed opportunities.

Benefits of Quitting Smoking

Quitting smoking brings immediate and long-term benefits. Within 20 minutes of quitting, heart rate and blood pressure drop. Within a year, the risk of heart disease is halved. Over time, the risk of stroke, lung cancer, and other diseases decrease significantly. Financially, quitting smoking can save individuals thousands of dollars annually. Environmentally, quitting reduces pollution and waste. Socially, it can improve relationships and increase social inclusion.

In conclusion, the reasons to stop smoking are multifaceted, encompassing health, economic, environmental, and social aspects. Each cigarette smoked is a step towards disease, economic loss, environmental degradation, and social isolation. Conversely, each step towards quitting smoking is a step towards better health, financial savings, environmental preservation, and improved social relations. Therefore, it is crucial to promote smoking cessation for a healthier and more sustainable world.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

Essay on Stop Pollution
Essay on Stop Littering
Essay on Stop Hunting Animals

Apart from these, you can look at all the essays by clicking here .

Happy studying!

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned.

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies.

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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Home — Essay Samples — Nursing & Health — Nursing — Smoking Persuasive Speech

Smoking Persuasive Speech

Categories: Nursing

About this sample

Words: 545 |

Published: Mar 13, 2024

Words: 545 | Page: 1 | 3 min read

Centers for Disease Control and Prevention. (2021). Smoking & tobacco use: Fast facts. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
Campaign for Tobacco-Free Kids. (2021). The toll of tobacco in the United States. Retrieved from https://www.tobaccofreekids.org/problem/toll-us
American Lung Association. (2021). Health effects. Retrieved from https://www.lung.org/quit-smoking/smoking-facts/health-effects

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Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence (2010)

Chapter: 8 conclusions and recommendations, 8 conclusions and recommendations.

In this report, the committee has examined three relationships in response to its charge (see Box 8-1 for specific questions):

The association between secondhand-smoke exposure and cardiovascular disease, especially coronary heart disease and not stroke (Question 1).

The association between secondhand-smoke exposure and acute coronary events (Questions 2, 3, and 5).

The association between smoking bans and acute coronary events (Questions 4, 5, 6, 7, and 8).

This chapter summarizes the committee’s review of information relevant to those relationships; presents its findings, conclusions, and recommendations on the basis of the weight of evidence; and presents its responses to the specific questions that it was asked in its task.

SUMMARY OF REPORT

Exposure assessment.

To determine the effect of changes in exposure to secondhand smoke it is necessary to quantify changes in epidemiologic studies. Airborne measures and biomarkers of exposure to secondhand smoke are available; they are complementary and provide different information (see Chapter 2 ). Biomarkers (such as cotinine, the major proximate metabolite of nicotine) in-

tegrate all sources of exposure and inhalation rates, but cannot identify the place where secondhand-smoke exposure occurred and, because of a short half-life they reflect only recent exposures. Airborne measures of exposure can demonstrate the contribution of different sources or venues of exposure and can be used to measure changes in secondhand-smoke concentrations at individual venues, but they do not reflect the true dose. Airborne concentration of nicotine is a specific tracer for secondhand smoke. Particulate matter (PM) can also be used as an indicator of secondhand-smoke exposure, but because there are other sources of PM it is a less specific tracer than nicotine. The concentration of cotinine in serum, saliva, or urine is a specific indicator of integrated exposure to secondhand smoke.

Although in most of the smoking-ban studies the magnitude, frequency, and duration of exposures that occurred before a ban are not known, monitoring studies demonstrate that exposure to secondhand smoke is dramatically reduced in places that are covered by bans. Airborne nicotine

and PM concentrations in regulated venues such as workplaces, bars, and restaurants decreased by more than 80% in most studies; serum, salivary, or urinary cotinine concentrations decreased by 50% or more in most studies, probably reflecting continuing exposures in unregulated venues (for example, in homes and cars).

Pathophysiology

The pathophysiology of the induction of cardiovascular disease by cigarette-smoking and secondhand-smoke exposure is complex and undoubtedly involves multiple agents. Many chemicals in secondhand smoke have been shown to exert cardiovascular toxicity (see Table 3-1 ), and both acute and chronic effects of these chemicals have been identified. Experimental studies in humans, animals, and cell cultures have demonstrated effects of secondhand smoke, its components (such as PM, acrolein, polycyclic

aromatic hydrocarbons [PAHs], and metals), or both on the cardiovascular system (see Figure 3-1 for summary). Those studies have yielded sufficient evidence to support an inference that acute exposure to secondhand smoke induces endothelial dysfunction, increases thrombosis, causes inflammation, and potentially affects plaque stability adversely. Those effects appear at concentrations expected to be experienced by people exposed to secondhand smoke.

Data from animal studies also support a dose–response relationship between secondhand-smoke exposure and cardiovascular effects (see Chapter 3 ). The relationship is consistent with the understanding of the pathophysiology of coronary heart disease and the effects of secondhand smoke on humans, including chamber studies. The association comports with known associations between PM, a major constituent of secondhand smoke, and coronary heart disease.

Overall, the pathophysiologic data indicate that it is biologically plausible for secondhand-smoke exposure to have cardiovascular effects, such as effects that lead to cardiovascular disease and acute myocardial infarction (MI). The exact mechanisms by which such effects occur, however, remain to be elucidated.

Smoking-Ban Background

Characteristics of smoking bans can heavily influence their consequences. Interpretation of the results of epidemiologic studies that involve smoking bans must account for information on the bans and their enforcement.

Secondhand smoke should have been measured before and after implementation of a ban, and locations with and without bans should have been compared. Studies that include self-reported assessments of exposure to secondhand smoke cannot necessarily be compared with each other unless the survey instruments (such as interviews) were similar.

The comparability of the time and length of followup of the studies should be assessed. For example, the impact of a ban in one area may differ from the impact of a ban in another solely because the observation times were different and other activities may have occurred during the same periods. In comparing studies, it may be impossible to separate contextual factors associated with ban legislation—such as public comment periods, information announcing the ban, and notices about the impending changes—from the impact of the ban itself. The committee therefore included such contextual factors in drawing conclusions about the effects of a ban.

Interpretation needs to consider the timeframes in the epidemiologic evidence, for example, the time from onset of a smoking ban to the mea-

surement of incidence of a disease, the timing and nature of enforcement, and the time until changes in cardiovascular-event rates were observed in people who had various baseline risks. Interpretation should account for the extent to which studies assessed possible alternative causes of decreases in hospitalizations for coronary events, including changes in health-care availability and in the standard of practice in cardiac care, such as new diagnostic criteria for acute MI during the period of study. The latter is especially important in making before–after comparisons in the absence of a comparison geographic area in which no ban has been implemented.

When designing and analyzing future studies, researchers should examine the time between the implementation of a smoking ban and changes in rates of hospital admission or cardiac death. Future studies could evaluate whether decreases in admissions are transitory, sustained, or increasing, and ideally they would include information on individual subjects, including prior history of cardiac disease, to answer the questions posed to the committee.

Epidemiologic Studies

Cardiovascular disease is a major public-health concern. The results of dozens of epidemiologic studies of both case–control and cohort design carried out in multiple populations consistently indicate about a 25–30% increase in risk of coronary heart disease from exposure to secondhand smoke (see Chapter 4 ). Epidemiologic studies using serum cotinine concentration as a biomarker of overall exposure to secondhand smoke indicated that the relative risk (RR) of coronary heart disease associated with secondhand smoke is even greater than those estimates. The excess risk is unlikely to be explained by misclassification bias, uncontrolled-for confounding effects, or publication bias. Although few studies have addressed the risk of coronary heart disease posed by secondhand-smoke exposure in the workplace, there is no biologically plausible reason to suppose that the effect of secondhand-smoke exposure at work or in a public building differs from the effect of exposure in the home environment. Epidemiologic studies demonstrate a dose–response relationship between chronic secondhand-smoke exposure as assessed by self-reports of exposure (He et al., 1999) and as assessed by biomarkers (cotinine) and long-term risk of coronary heart disease (Whincup et al., 2004). Dose–response curves show a steep initial rise in risk when going from negligible to low exposure followed by a gradual increase with increasing exposure.

The INTERHEART study, a large case–control study of cases of first acute MI, showed that exposure to secondhand smoke increased the risk of nonfatal acute MI in a graded manner (Teo et al., 2006).

Eleven key epidemiologic studies evaluated the effects of eight smok-

ing bans on the incidence of acute coronary events (see Table 8-1 and Chapter 6 ). The results of those studies show remarkable consistency: all showed decreases in the rate of acute MIs after the implementation of smoking bans (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Pell et al., 2008; Sargent et al., 2004; Seo and Torabi, 2007; Vasselli et al., 2008). Two of the studies (Pell et al., 2008; Seo and Torabi, 2007) examined rates of hospitalization for acute coronary events after the implementation of smoking bans and provided direct evidence of the relationship of secondhand-smoke exposure to acute coronary events by presenting results in nonsmokers.

The decreases in acute MIs in the 11 studies ranged from about 6 to 47%, depending on characteristics of the study, including the method of statistical analysis. The consistency in the direction of change gave the committee confidence that smoking bans result in a decrease in the rate of acute MI. The studies took advantage of bans as “natural experiments” to look at questions about the effects of bans, and indirectly of a decrease in secondhand-smoke exposure, on the incidence of acute cardiac events. As discussed in Assessing the Health Impact of Air Quality Regulations: Concepts and Methods for Accountability Research (HEI Accountability Working Group, 2003) in the context of air-pollution regulations, studies of interventions constitute a more definitive approach than other epidemiologic studies to determining whether regulations result in health benefits. All the studies are relevant and informative with respect to the questions posed to the committee, and overall they support an association between smoking bans and a decrease in acute cardiovascular events. The studies have inherent limitations related to their nature, but they directly evaluated the effects of an intervention (a smoking ban, including any concomitant activities) on a health outcome of interest (acute coronary events).

The committee could not determine the magnitude of effect with any reasonable degree of certainty on the basis of those studies. The variability in study design, implementation, and analysis was so large that the committee concluded that it could not conduct a meta-analysis or combine the information from the studies to calculate a point estimate of the effect. In particular, the committee was unable to determine the overall portion of the effect attributable to decreased smoking by smokers as opposed to decreased exposure of nonsmokers to secondhand smoke because of a lack of information on smoking status in nine of the studies (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Sargent et al., 2004; Seo and Torabi, 2007; Vasselli et al., 2008). The results of the studies are consistent with the findings of the pathophysiologic studies discussed in Chapter 3 and the data on PM discussed in Chapters 3 and 7 . At the population level,

results of the key intervention studies reviewed by the committee are for the most part consistent with a decrease in risk as early as a month following reductions in secondhand-smoke exposure; however, given the variability in the studies and the lack of data on the precise timing of interventions, the smoking-ban studies do not provide adequate information on the time it takes to see decreases in acute MIs.

Plausibility of Effect

The committee considered both the biologic plausibility of a causal relationship between a decrease in secondhand-smoke exposure and a decrease in the incidence of acute MI and the plausibility of the magnitude of the effect seen in the key epidemiologic studies after implementation of smoking bans.

The experimental data reviewed in Chapter 3 demonstrate that several components of secondhand smoke, as well as secondhand smoke itself, exert substantial cardiovascular toxicity. The toxic effects include the induction of endothelial dysfunction, an increase in thrombosis, increased inflammation, and possible reductions in plaque stability. The data provide evidence that it is biologically plausible for secondhand smoke to be a potential causative trigger of acute coronary events. The risk of acute coronary events is likely to be increased if a person has preexisting heart disease. The association comports with findings on air-pollution components, such as diesel exhaust (Mills et al., 2007) and PM (Bhatnagar, 2006).

As a “reality check” on the potential effects of changes in secondhand-smoke exposure, the committee estimated the decrease in risk of cardiovascular disease and specifically heart failure that would be expected on the basis of the risk effects of changes in airborne PM concentrations after implementation of smoking bans seen in the PM literature. The PM in cigarette smoke is not identical with that in air pollution, and the committee did not attempt to estimate the risk attributable to secondhand-smoke exposure through the PM risk estimates but rather found this a useful exercise to see whether the decreases seen in the epidemiologic literature are reasonable, given data on other air pollutants that have some common characteristics. The committee’s estimates on the basis of the PM literature support the possibility that changes in secondhand-smoke exposure after implementation of a smoking ban can have a substantial effect on hospital admissions for heart failure and cardiovascular disease.

SUMMARY OF OVERALL WEIGHT OF EVIDENCE

The committee examined three relationships—of secondhand-smoke exposure and cardiovascular disease, of secondhand-smoke exposure and

TABLE 8-1 Summary of Key Studies (Studies Listed by Smoking-Ban Region in Order of Publication)

acute coronary events, and of smoking bans and acute coronary events. The committee used the criteria of causation described in Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service (U.S. Public Health Service, 1964) in drawing conclusions regarding those relationships. The criteria are often referred to as the Bradford Hill criteria because they were, as stated by Hamill (1997), “later expanded and refined by A. B. Hill” (Hill, 1965). Table 8-2 summarizes the available evidence on secondhand-smoke exposure and coronary events in terms of the Bradford Hill criteria.

Secondhand-Smoke Exposure and Cardiovascular Disease

The results of both case–control and cohort studies carried out in multiple populations consistently indicate exposure to secondhand smoke causes about a 25–30% increase in the risk of coronary heart disease; results of some studies indicate a dose–response relationship. Data from animal studies support the dose–response relationship (see Chapter 3 ). Data from experimental studies of animals and cells and from intentional human-dosing studies indicate that a relationship between secondhand-smoke exposure and coronary heart disease is biologically plausible and consistent with understanding of the pathophysiology of coronary heart disease.

Taking all that evidence together, the committee concurs with the conclusions in the 2006 surgeon general’s report (HHS, 2006) that “the evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and increased risks of coronary heart disease morbidity and mortality among both men and women.” Although the committee found strong and consistent evidence of the existence of a positive association between chronic exposure to secondhand smoke and coronary heart disease, determining the magnitude of the risk (the number of cases that are attributable to secondhand-smoke exposure) proved challenging, and the committee has not done it.

Secondhand-Smoke Exposure and Acute Coronary Events

Two of the epidemiologic studies reviewed by the committee that examine rates of hospitalization for acute coronary events after implementation of smoking bans provide direct evidence related to secondhand smoke exposures. The studies either reported events in nonsmokers only (Monroe, Indiana) (Seo and Torabi, 2007) or analyzed nonsmokers and smokers separately on the basis of serum cotinine concentration (Scotland) (Pell et al., 2008). Both studies showed reductions in the RR of acute coronary events in nonsmokers when secondhand-smoke exposure was decreased after implementation of the bans; this indicates an association between a

decrease in exposure to secondhand smoke and a decrease in risk of acute coronary events. Because of differences between and limitations of the two studies (such as in population, population size, and analysis), they do not provide strong sufficient evidence to determine the magnitude of the decrease in RR.

The effect seen after implementation of smoking bans is consistent with data from the INTERHEART study, a case–control study of 15,152 cases of first acute MI in 262 centers in 52 countries (Teo et al., 2006). Increased exposure to secondhand smoke increased the risk of nonfatal acute MI in a graded manner, with adjusted odds ratios of 1.24 (95% confidence interval [CI], 1.17–1.32) and 1.62 (95% CI, 1.45–1.81) in the least exposed people (1–7 hours of exposure per week) and the most exposed (at least 22 hours of exposure per week), respectively. In contrast, a study using data from the Western New York Health Study collected from 1995 to 2001 found that secondhand smoke was not significantly associated with higher risk of MI (Stranges et al., 2007). That study, however, looked at lifetime cumulative exposure to secondhand smoke, a different exposure metric from that in the other studies and one that does not take into account how recent the exposure is.

The other key epidemiologic studies that looked at smoking bans provide indirect evidence of an association between secondhand-smoke exposure and acute coronary events (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Sargent et al., 2004; Vasselli et al., 2008). Although it is not possible to separate the effect of smoking bans in reducing exposure to secondhand smoke and their effect in reducing active smoking in those studies, because they did not report individual smoking status or secondhand-smoke exposure concentrations, monitoring studies of airborne tracers 1 and biomarkers 2 of exposure to secondhand smoke have demonstrated that exposure to secondhand smoke is dramatically reduced after implementation of smoking bans. Those studies therefore provide indirect evidence that at least part of the decrease in acute coronary events seen after implementation of smoking bans could be mediated by a decrease in exposure to secondhand smoke. It is not possible to determine the differential magnitude of the effect that is attributable to changes in nonsmokers and smokers.

Experimental data show that an association between secondhand-

TABLE 8-2 Evaluation of Available Data in Terms of Bradford-Hill Criteria

smoke exposure and acute coronary events is biologically plausible (see Chapter 3 ). Experimental studies in humans, animals, and cell cultures have demonstrated short-term effects of secondhand smoke as a complex mixture or its components individually (such as oxidants, PM, acrolein, PAHs, benzene, and metals) on the cardiovascular system. There is sufficient evidence from such studies to infer that acute exposure to secondhand smoke at concentrations relevant to population exposures induces endothelial dysfunction, increases inflammation, increases thrombosis, and potentially adversely affects plaque stability. Those effects occur at magnitudes relevant to the pathogenesis of acute coronary events. Furthermore, indirect evidence obtained from studies of ambient PM supports the notion that exposure to PM present in secondhand smoke could trigger acute coronary events or induce arrhythmogenesis in a person with a vulnerable myocardium.

Taking all that evidence together, the committee concludes that there is sufficient evidence of a causal relationship between a decrease in secondhand-smoke exposure and a decrease in the risk of acute MI. Given the variability among studies and their limitations, the committee did not provide a quantitative estimate of the magnitude of the effect.

Smoking Bans and Acute Coronary Events

Nine key studies looked at the overall effect of smoking bans on the incidence of acute coronary events in the overall populations—smokers and nonsmokers—studied (Barone-Adesi et al., 2006; Bartecchi et al., 2006; CDC, 2009; Cesaroni et al., 2008; Juster et al., 2007; Khuder et al., 2007; Lemstra et al., 2008; Sargent et al., 2004; Vasselli et al., 2008). Those studies consistently show a decrease in acute MIs after implementation of smoking bans. The combination of experimental data on secondhand-smoke effects discussed above and exposure data that indicate that secondhand-smoke concentrations decrease substantially after implementation of a smoking ban provides evidence that it is biologically plausible for smoking bans to decrease the rate of acute MIs. The committee concludes that there is an association between smoking bans and a reduction in acute coronary events and, given the temporality and biologic plausibility of the effect, that the evidence is consistent with a causal relationship. Although all the studies demonstrated a positive effect of bans in reducing acute MIs, differences among the studies, including the components of the bans and other interventions that promote smoke-free environments that took place during the bans, limited the committee’s confidence in estimating the overall magnitude of the effect. There is little information on how long it would take for such an effect to be seen inasmuch as the studies have not evaluated periods shorter than a month.

DATA GAPS AND RESEARCH RECOMMENDATIONS

Studies of the effect of indoor smoking bans and secondhand-smoke exposure on acute coronary events should be designed to examine the time between an intervention and changes in the effect and to measure the magnitude of the effect. No time to effect can be postulated for individuals on the basis of the available data, and evaluation of population-based effectiveness of a smoking ban depends on societal actions that implement and enforce the ban and on actions that include smoke reduction in homes, cars, and elsewhere. The decrease in secondhand-smoke exposure does not necessarily occur suddenly—it might decline gradually or by steps. In a likely scenario, once a ban is put into place and enforced, a sharp drop in secondhand-smoke exposure might be seen immediately and followed by a slower decrease in exposure as the population becomes more educated about the health consequences of secondhand smoke and exposure becomes less socially acceptable. Future studies that examine the time from initiation of a ban to observation of an effect and that include followup after initiation of enforcement, taking the social aspects into account, would provide better information on how long it takes to see an effect of a ban. Statistical models should clearly articulate a set of assumptions and include sensitivity analyses. Studies that examine whether decreases in hospital admissions for acute coronary events are transitory or sustained would also be informative.

Many factors are likely to influence the effect of a smoking ban on the incidence and prevalence of acute coronary events in a population. They include age, sex, diet, background risk factors and environmental factors for cardiovascular disease, prevalence of smokers in the community, the underlying rate of heart disease in the community (for example, the rate in Italy versus the United States), and the social environment. Future studies should include direct observations on individuals—including their history of cardiac disease, exposure to other environmental agents, and other risk factors for cardiac events—to assess the impact of those factors on study results. Assessment of smoking status is also needed to distinguish between the effects of secondhand smoke in nonsmokers and the effects of a ban that decreases cigarette consumption or promotes smoking cessation in smokers.

Few constituents of secondhand smoke have been adequately studied for cardiotoxicity. Future research should examine the cardiotoxicity of environmental chemicals, including those in secondhand smoke, to define cardiovascular toxicity end points and establish consistent definitions and measurement standards for cardiotoxicity of environmental contaminants. Specifically, information is lacking on the cardiotoxicity of highly reactive smoke constituents, such as acrolein and other oxidants; on techniques for

quantitating those reactive components; and on the toxicity of low concentrations of benzo[ a ]pyrene, of PAHs other than benzo[a]pyrene, and of mixtures of tobacco-smoke toxicants.

Many questions remain with respect to the pathogenesis of cardiovascular disease and acute coronary events and how secondhand-smoke constituents perturb the pathophysiologic mechanisms and result in disease and death. For example, a better understanding of the factors that promote plaque rupture and how they are influenced by tobacco smoke and PM would provide insight into the mechanisms underlying the cardiovascular effects of secondhand smoke and might lead to better methods of detecting preclinical disease and preventing events.

The committee found only sparse data on the prevalence and incidence of cardiovascular disease and acute coronary events at the national level in general compared with other health end points for which there are central data registries and surveillance of all events, such as the Surveillance, Epidemiology, and End Results (SEER) Program for cancer. Although there are national databases that include acute MI patients—such as the National Registry of Myocardial Infarction (Morrow et al., 2001; Rogers et al., 1994), the Health Care Financing Administration database, and the Cooperative Cardiovascular Project (Ellerbeck et al., 1995)—and the Centers for Disease Control and Prevention’s annual National Hospital Discharge Survey and National Health Interview Survey provide some information on cardiovascular end points, these are not comprehensive or inclusive with respect to hospital participation, patient inclusion, or data capture. A national database that captures all cardiovascular end points would facilitate future epidemiologic studies by allowing the tracking of trends and identification of high-risk populations at a more granular level.

A large prospective cohort study could be very helpful in more accurately estimating the magnitude of the risk of cardiovascular disease and acute coronary events posed by secondhand-smoke exposure. It could be a new study specifically designed to assess effects of secondhand smoke or, as was done with the INTERHEART study, take advantage of existing studies—such as the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, the American Cancer Society’s Cancer Prevention Study-3, the European Prospective Investigation into Cancer and Nutrition study, and the Jackson Heart Study—provided that they have adequate information on individual smoking status and secondhand-smoke exposure (or the ability to measure it, for example, in adequate blood samples). If properly designed, such a study could identify subpopulations at highest risk for acute coronary events from secondhand-smoke exposure in relation to such characteristics as age and sex, and concomitant risk factors, such as obesity.

COMMITTEE RESPONSES TO SPECIFIC QUESTIONS

The committee was tasked with responding to eight specific questions. The questions and the committee’s responses are presented below.

What is the current scientific consensus on the relationship between exposure to secondhand smoke and cardiovascular disease? What is the pathophysiology? What is the strength of the relationship?

On the basis of the available studies of chronic exposure to secondhand smoke and cardiovascular disease, the committee concludes that there is scientific consensus that there is a causal relationship between secondhand-smoke exposure and cardiovascular disease. The results of a number of meta-analyses of the epidemiologic studies showed increases of 25–30% in the risk of cardiovascular disease caused by various exposures. The studies include some that use serum cotinine concentration as a biomarker of exposure and show a dose–response relationship. The pathophysiologic data are consistent with that relationship, as are the data from studies of air pollution and PM. The data in support of the relationship are consistent, but the committee could not calculate a point estimate of the magnitude of the effect (that is, the effect size) given the variable strength of the relationship, differences among studies, poor assessment of secondhand-smoke exposure, and variation in concomitant underlying risk factors.

Is there sufficient evidence to support the plausibility of a causal relation between secondhand smoke exposure and acute coronary events such as acute myocardial infarction and unstable angina? If yes, what is the pathophysiology? And what is the strength of the relationship?

The evidence reviewed by the committee is consistent with a causal relationship between secondhand-smoke exposure and acute coronary events, such as acute MI. It is unknown whether acute exposure, chronic exposure, or a combination of the two underlies the occurrence of acute coronary events, inasmuch as the duration or pattern of exposure in individuals is not known. The evidence includes the results of two key studies that have information on individual smoking status and that showed decreases in risks of acute coronary events in nonsmokers after implementation of a smoking ban. Those studies are supported by information from other smoking-ban studies (although these do not have information on individual smoking status, other exposure-assessment studies have demonstrated that secondhand-smoke exposure decreases after implementation of a smoking ban) and by the large body of literature on PM, especially PM 2.5 , a

constituent of secondhand smoke. The evidence is not yet comprehensive enough to determine a detailed mode of action for the relationship between secondhand-smoke exposure and a variety of intervening and preexisting conditions in predisposing to cardiac events. However, experimental studies have shown effects that are consistent with pathogenic factors in acute coronary events. Although the committee has confidence in the evidence of an association between chronic secondhand-smoke exposure and acute coronary events, the evidence on the magnitude of the association is less convincing, so the committee did not estimate that magnitude (that is, the effect size).

Is it biologically plausible that a relatively brief (e.g., under 1 hour) secondhand smoke exposure incident could precipitate an acute coronary event? If yes, what is known or suspected about how this risk may vary based upon absence or presence (and extent) of preexisting coronary artery disease?

There is no direct evidence that a relatively brief exposure to secondhand smoke can precipitate an acute coronary event; few published studies have addressed that question. The circumstantial evidence of such a relationship, however, is compelling. The strongest evidence comes from airpollution research, especially research on PM. Although the source of the PM can affect its toxicity, particle size in secondhand smoke is comparable with that in air pollution, and research has demonstrated a similarity between cardiovascular effects of PM and of secondhand smoke. Some studies have demonstrated rapid effects of brief secondhand-smoke exposure (for example, on platelet aggregation and endothelial function), but more research is necessary to delineate how secondhand smoke produces cardiovascular effects and the role of underlying preexisting coronary arterial disease in determining susceptibility to the effects. Given the data on PM, especially those from time-series studies, which indicate that a relatively brief exposure can precipitate an acute coronary event, and the fact that PM is a major component of secondhand smoke, the committee concludes that it is biologically plausible for a relatively brief exposure to secondhand smoke to precipitate an acute coronary event.

With respect to how the risk might vary in the presence or absence of preexisting coronary arterial disease, it is generally assumed that acute coronary events are more likely to occur in people who have some level of preexisting disease, although that underlying disease is often subclinical. There are not enough data on the presence of pre-existing coronary arterial disease in the populations studied to assess the extent to which the absence or presence of such preexisting disease affects the cardiovascular risk posed by secondhand-smoke exposure.

What is the strength of the evidence for a causal relationship between indoor smoking bans and decreased risk of acute myocardial infarction?

The key intervention studies that have evaluated the effects of indoor smoking bans consistently have shown a decreased risk of heart attack. Research has also indicated that secondhand-smoke exposure is causally related to heart attacks, that smoking bans decrease secondhand-smoke exposure, and that a relationship between secondhand-smoke exposure and acute coronary events is biologically plausible. All the relevant studies have shown an association in a direction consistent with a causal relationship (although the committee was unable to estimate the magnitude of the association), and the committee therefore concludes that the evidence is sufficient to infer a causal relationship.

What is a reasonable latency period between a decrease in secondhand smoke exposure and a decrease in risk of an acute myocardial infarction for an individual? What is a reasonable latency period between a decrease in population secondhand smoke exposure and a measurable decrease in acute myocardial infarction rates for a population?

No direct information is available on the time between a decrease in secondhand-smoke exposure and a decrease in the risk of a heart attack in an individual. Data on PM, however, have shown effects on the heart within 24 hours, and this supports a period of less than 24 hours. At the population level, results of the key intervention studies reviewed by the committee are for the most part consistent with a decrease in risk as early as a month following reductions in secondhand-smoke exposure; however, given the variability in the studies and the lack of data on the precise timing of interventions, the smoking-ban studies do not provide adequate information on the time it takes to see decreases in heart attacks.

What are the strengths and weaknesses of published population-based studies on the risk of acute myocardial infarction following the institution of comprehensive indoor smoking bans? In light of published studies’ strengths and weaknesses, how much confidence is warranted in reported effect size estimates?

Some of the weaknesses of the published population-based studies of the risk of MI after implementation of smoking bans are

Limitations associated with an open study population and, in some cases, with the use of a small sample.

Concurrent interventions that reduce the observed effect of a smoking ban.

Lack of exposure-assessment criteria and measurements.

Lack of information collected on the time between the cessation of exposure to secondhand smoke and changes in disease rates.

Differences between control and intervention groups.

Nonexperimental design of studies (by necessity).

Lack of assessment of the sensitivity of results to the assumptions made in the statistical analysis.

The different studies had different strengths and weaknesses in relation to the assessment of the effects of smoking bans. For example, the Scottish study had such strengths as prospective design and serum cotinine measurements. The Saskatoon study had the advantage of comprehensive hospital records, and the Monroe County study excluded smokers. The population-based studies of the risk of heart attack after the institution of comprehensive smoking bans were consistent in showing an association between the smoking bans and a decrease in the risk of acute coronary events, and this strengthened the committee’s confidence in the existence of the association. However, because of the weaknesses discussed above and the variability among the studies, the committee has little confidence in the magnitude of the effects and, therefore, thought it inappropriate to attempt to estimate an effect size from such disparate designs and measures.

What factors would be expected to influence the effect size? For example, population age distribution, baseline level of secondhand smoke protection among nonsmokers, and level of secondhand smoke protection provided by the smoke-free law .

A number of factors that vary among the key studies can influence effect size. Although some of the studies found different effects in different age groups, these were not consistently identified. One major factor is the size of the difference in secondhand-smoke exposure before and after implementation of a ban, which would vary and depends on: the magnitude of exposure before the ban, which is influenced by the baseline level of smoking and preexisting smoking bans or restrictions; and the magnitude of exposure after implementation of the ban, which is influenced by the extent of the ban, enforcement of and compliance with the ban, changes in social norms of smoking behaviors, and remaining exposure in areas not covered by the ban (for example, in private vehicles and homes). The baseline rate of acute coronary events or cardiovascular disease could influence the effect

size, as would the prevalence of other risk factors for acute coronary events, such as obesity, diabetes, and age.

What are the most critical research gaps that should be addressed to improve our understanding of the impact of indoor air policies on acute coronary events? What studies should be performed to address these gaps?

The committee identified the following gaps and research needs as those most critical for improving understanding of the effect of indoor-air policies on acute coronary events:

The committee found a relative paucity of data on environmental cardiotoxicity of secondhand smoke compared with other disease end points related to secondhand smoke, such as carcinogenicity and reproductive toxicity. Research should develop standard definitions of cardiotoxic end points in pathophysiologic studies (for example, specific results on standard assays) and a classification system for cardiotoxic agents (similar to the International Agency for Research on Cancer classification of carcinogens). Established cardiotoxicity assays for environmental exposures and consistent definitions of adverse outcomes of such tests would improve investigations of the cardiotoxicity of secondhand smoke and its components and identify potential end points for the investigation of the effects of indoor-air policies on acute coronary events.

The committee found a lack of a system for surveillance of the prevalence of cardiovascular disease and of the incidence of acute coronary events in the United States. Surveillance of incidence and prevalence trends would allow secular trends to be taken into account better and to be compared among different populations to establish the effects of indoor-air policies. Although some national databases and surveys include cardiovascular end points, a national database that tracks hospital admission rates and deaths from acute coronary events, similar to the SEER database for cancer, would improve epidemiologic studies.

The committee found a lack of understanding of a mechanism that leads to plaque rupture and from that to an acute coronary event and of how secondhand smoke affects that process. Additional research is necessary to develop reliable biomarkers of early effects on plaque vulnerability to rupture and to improve the design of pathophysiologic studies of secondhand smoke that examine effects of exposure on plaque stability.

All 11 key studies reviewed by the committee have strengths and limitations due to their study design, and none was designed to test the hypothesis that secondhand-smoke exposure causes cardiovascular disease or acute coronary events. Because of those limitations and the consequent variability in results, the committee did not have enough information to estimate the magnitude of the decrease in cardiovascular risk due to smoking bans or to a decrease in secondhand-smoke exposure. A large, well-designed study could permit estimation of the magnitude of the effect. An ideal study would be prospective; would have individual-level data on smoking status; would account for potential confounders, including other risk factors for cardiovascular events (such as obesity and age), would have biomarkers of mainstream and secondhand-smoke exposures (such as blood cotinine concentrations); and would have enough cases to allow separate analyses of smokers and nonsmokers or, ideally, stratification of cases by cotinine concentrations to examine the dose–response relationship. Such a study could be specifically designed for secondhand smoke or potentially could take advantage of existing cohort studies that might have data available or attainable for investigating secondhand-smoke exposure and its cardiovascular effects, such as was done with the INTERHEART study. Existing studies that could be explored to determine their utility and applicability to questions related to secondhand smoke include the Multi-Ethnic Study of Atherosclerosis (MESA) study, the American Cancer Society’s CPS-3, the European Prospective Investigation of Cancer (EPIC), the Framingham Heart Study, and the Jackson Heart Study. Researchers should clearly articulate the assumptions used in their statistical models and include analysis of the sensitivity of results to model choice and assumptions.

Barone-Adesi, F., L. Vizzini, F. Merletti, and L. Richiardi. 2006. Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction. European Heart Journal 27(20):2468-2472.

Bartecchi, C., R. N. Alsever, C. Nevin-Woods, W. M. Thomas, R. O. Estacio, B. B. Bartelson, and M. J. Krantz. 2006. Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Circulation 114(14):1490-1496.

Bhatnagar, A. 2006. Environmental cardiology: Studying mechanistic links between pollution and heart disease. Circulation Research 99(7):692-705.

CDC (Centers for Disease Control and Prevention). 2009. Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance—city of Pueblo, Colorado, 2002–2006. MMWR—Morbidity & Mortality Weekly Report 57(51):1373-1377.

Cesaroni, G., F. Forastiere, N. Agabiti, P. Valente, P. Zuccaro, and C. A. Perucci. 2008. Effect of the Italian smoking ban on population rates of acute coronary events. Circulation 117(9):1183-1188.

Ellerbeck, E. F., S. F. Jencks, M. J. Radford, T. F. Kresowik, A. S. Craig, J. A. Gold, H. M. Krumholz, and R. A. Vogel. 1995. Quality of care for Medicare patients with acute myocardial infarction. A four-state pilot study from the cooperative cardiovascular project. JAMA 273(19):1509-1514.

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Whincup, P. H., J. A. Gilg, J. R. Emberson, M. J. Jarvis, C. Feyerabend, A. Bryant, M. Walker, and D. G. Cook. 2004. Passive smoking and risk of coronary heart disease and stroke: Prospective study with cotinine measurement. BMJ 329(7459):200-205.

Data suggest that exposure to secondhand smoke can result in heart disease in nonsmoking adults. Recently, progress has been made in reducing involuntary exposure to secondhand smoke through legislation banning smoking in workplaces, restaurants, and other public places. The effect of legislation to ban smoking and its effects on the cardiovascular health of nonsmoking adults, however, remains a question.

Secondhand Smoke Exposure and Cardiovascular Effects reviews available scientific literature to assess the relationship between secondhand smoke exposure and acute coronary events. The authors, experts in secondhand smoke exposure and toxicology, clinical cardiology, epidemiology, and statistics, find that there is about a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke. Their findings agree with the 2006 Surgeon General's Report conclusion that there are increased risks of coronary heart disease morbidity and mortality among men and women exposed to secondhand smoke. However, the authors note that the evidence for determining the magnitude of the relationship between chronic secondhand smoke exposure and coronary heart disease is not very strong.

Public health professionals will rely upon Secondhand Smoke Exposure and Cardiovascular Effects for its survey of critical epidemiological studies on the effects of smoking bans and evidence of links between secondhand smoke exposure and cardiovascular events, as well as its findings and recommendations.

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Persuasive Essay Writing

Persuasive Essay About Smoking

Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

Published on: Jan 25, 2023

Last updated on: Jan 29, 2024

Persuasive Essay-Defined

A persuasive essay is a form of academic writing that presents an argument in favor of a particular position, opinion, or viewpoint.

It is usually written to convince the audience to take a certain action or adopt a specific viewpoint.

The primary purpose of this type of essay is to provide evidence and arguments that support the writer's opinion.

In persuasive writing, the writer will often use facts, logic, and emotion to convince the reader that their stance is correct.

The writer can persuade the reader to consider or agree with their point of view by presenting a well-researched and logically structured argument.

The goal of a persuasive essay is not to sway the reader's opinion. It is to rather inform and educate them on a particular topic or issue.

Check this free downloadable example of a persuasive essay about smoking!

Simple Persuasive essay about smoking

Read our extensive guide on persuasive essays to learn more about crafting a masterpiece every time.

Persuasive Essay Examples About Smoking

Are you a student looking for some useful tips to write an effective persuasive essay about the dangers of smoking?

Look no further! Here are several great examples of persuasive essays that masterfully tackle the subject and persuade readers creatively.

Persuasive speech on the smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

For more examples about persuasive essays, check out our blog on persuasive essay examples .

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Argumentative Essay About Smoking Examples

Our examples can help you find the points that work best for your style and argument.

Argumentative essay about smoking introduction

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

10 Tips for Writing a Persuasive Essay About Smoking

Here are a few tips and tricks to make your persuasive essay about smoking stand out:

1. Do Your Research

Before you start writing, make sure to do thorough research on the topic of smoking and its effects.

Look for primary and secondary sources that provide valuable information about the issue.

2. Create an Outline

An outline is essential when organizing your thoughts and ideas into a cohesive structure. This can help you organize your arguments and counterarguments.

Read our blog about creating a persuasive essay outline to master your next essay.

Check out this amazing video here!

3. Clearly Define the Issue

Make sure your writing identifies the problem of smoking and why it should be stopped.

4. Highlight Consequences

Show readers the possible negative impacts of smoking, like cancer, respiratory issues, and addiction.

5. Identity Solutions

Provide viable solutions to the problem, such as cessation programs, cigarette alternatives, and lifestyle changes.

6. Be Research-Oriented

Research facts about smoking and provide sources for those facts that can be used to support your argument.

7. Aim For the Emotions

Use powerful language and vivid imagery to draw readers in and make them feel like you do about smoking.

8. Use Personal Stories

Share personal stories or anecdotes of people who have successfully quit smoking and those negatively impacted by it.

9. Include an Action Plan

Offer step-by-step instructions on how to quit smoking, and provide resources for assistance effectively.

10. Reference Experts

Incorporate quotes and opinions from medical professionals, researchers, or other experts in the field.

These tips can help you write an effective persuasive essay about smoking and its negative effects on the body, mind, and society.

When your next writing assignment has you feeling stuck, don't forget that essay examples about smoking are always available to break through writer's block.

And if you need help getting started, our expert essay writer at CollegeEssay.org is more than happy to assist.

Just give us your details, and our persuasive essay writer will start working on crafting a masterpiece.

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Frequently Asked Questions

What would be a good thesis statement for smoking.

A good thesis statement for smoking could be: "Smoking has serious health risks that outweigh any perceived benefits, and its use should be strongly discouraged."

What are good topics for persuasive essays?

Good topics for persuasive essays include the effects of smoking on health, the dangers of second-hand smoke, the economic implications of tobacco taxes, and ways to reduce teenage smoking.

These topics can be explored differently to provide a unique and engaging argument.

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The Roots of Tobacco: Tracing its Origin and Cultural Impact

This essay about the origins and cultural significance of tobacco traces its roots back to the indigenous peoples of the Americas, where it was first cultivated and revered as a sacred plant. The narrative highlights how Christopher Columbus introduced tobacco to Europe, leading to its widespread use for both medicinal and recreational purposes. As tobacco’s popularity soared, it became a major economic force, influencing the colonial economies and contributing to forced labor practices. Despite its historical significance, the essay also addresses the modern health concerns associated with tobacco use, contrasting its sacred traditional roles in indigenous cultures with its commercial exploitation globally. The piece effectively illustrates tobacco’s complex role in shaping economic, cultural, and health landscapes across the world.

How it works

Tobacco, a plant that has long fascinated and divided societies, finds its humble beginnings in the indigenous cultures of the Americas. Often enveloped in controversy for its health impacts in modern times, tobacco’s rich history is a tapestry of cultural significance, ancient traditions, and botanical wonder. This post delves into the fascinating origins of tobacco, tracing its journey from a sacred plant to a global commodity.

The story of tobacco starts with the native peoples of the Americas, who cultivated and utilized the plant long before the arrival of Europeans.

Archaeological evidence suggests that tobacco use dates back at least 7,000 years. It was primarily grown in the Andean region of South America, from where it spread to the indigenous tribes across the continent. Each tribe had its unique rituals and uses for tobacco, ranging from medicinal purposes to ceremonial practices. The plant held spiritual significance for many tribes, believed to bridge the earthly and spiritual realms, allowing communication with the ancestors and deities.

When Christopher Columbus landed in the New World in 1492, among the many novel sights were the natives’ use of tobacco. Observations noted natives smoking rolled leaves or pipes filled with the mysterious herb. Columbus and his crew were among the first Europeans to encounter tobacco, and they brought it back to Europe, where it quickly became a sensation. Initially used for its supposed medicinal properties, tobacco was claimed to cure a myriad of ailments, from toothaches to the bubonic plague. However, its use rapidly evolved into a leisure activity, with smoking and snuff-taking becoming fashionable across Europe.

The spread of tobacco was meteoric, and it played a pivotal role in the economies of European colonial powers. As demand grew, so did the need for labor-intensive cultivation, which unfortunately contributed to the dark history of forced labor and slavery. Colonies in the Caribbean and North America became the epicenters of tobacco cultivation, turning the crop into a cornerstone of the colonial economy. This economic boom was instrumental in shaping the political landscapes of the colonies and their eventual push for independence.

Despite its significant role in global trade and colonial economics, tobacco’s impact on health slowly came into the spotlight. Scientific studies in the 20th century began linking tobacco use with various health issues, leading to a shift in perception about the once revered plant. Today, tobacco use is a contentious issue, balanced between cultural tradition and health concerns. Numerous countries have enacted stringent regulations to curb its use, reflecting growing health consciousness.

However, in many indigenous cultures today, tobacco still holds a sacred place. It is used in purification rituals, healing ceremonies, and as an offering to spirits or as part of spiritual gatherings. This traditional use contrasts sharply with the commercial smoking practices seen worldwide, providing a glimpse into the plant’s dual nature as both a sacred herb and a profane indulgence.

The history of tobacco is not just the story of a plant, but of humanity’s relationship with nature. It’s a narrative about how a single botanical element can shape economies, cultures, and health paradigms across centuries. As we continue to grapple with the consequences of its use, tobacco remains a potent reminder of the complexities of human civilization.

In conclusion, tobacco is not merely a substance to be smoked, chewed, or vilified. It is a botanical legacy that encapsulates the complexities of human culture, reflecting our capacities for both reverence and exploitation. Its journey from the ancient fields of the Americas to the global stage speaks volumes about the intertwining of natural history and human development. Understanding its origins helps us appreciate the multifaceted roles tobacco has played—and continues to play—in societies around the world.

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Teenage Smoking Essay: Writing Guide & Smoking Essay Topics

Smoking can be viewed as one of the trendy habits. Numerous teenagers try it since they think that it is cool or can help them socialize. Often students start smoking due to stress or mental illnesses. But is it okay?

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Educators tend to give different written assignments, which may disclose this topic. If you have to develop a teenage smoking essay, you should learn the effects and harm that this habit causes.

That’s when our Custom-writing.org writers can help you!In the article, you’ll see how to deal with writing about smoking students. We’ve gathered tips for different paper types and prompts that can inspire you to start. In the end, you’ll find some smoking essay topics as well.

🚬 Argumentative
📈 Cause and Effect
🚭 Persuasive
🔥 Topics & Prompts

🔗 References

✍️ how to write a teenage smoking essay.

Just like any other academic paper, a teen smoking essay should be organized according to its type. You are probably familiar with the following writing ones:

argumentative essay;
cause and effect essay;
persuasive essay.

Below, you can find insightful tips on how to compose a teenage smoking essay, fulfilling the requirements of each type.

🚬 Argumentative Essay on Smoking

An argumentative essay on teenage smoking should give the reader a rational discussion of a specific issue. The ideas are expected to be well-structured and solidified with valid evidence.

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Below, you can find the most useful tips for writing an argumentative teen smoking essay. Don’t hesitate to use them!

Catch the reader’s attention. In the introduction, explain the significance and relatability of the chosen issue. Provide general background and make the reader continue exploring your essay through attention-grabbing elements (impressive statistics, personal stories, etc.).
Express your position clearly. Compose a concise thesis statement , so the reader can quickly get your position. Be as precise as possible! For example, your thesis might look like this: Teenage smoking leads to poor health, psychological and social issues.
The most vivid adverse ramification of teenage smoking is the development of health problems like heart or lung diseases and cancer.
Another disruptive effect of smoking at a young age is the risk of psychological disorders such as anxiety or depression.
The last negative consequence of teenage smoking is the conflict with social norms.
Support your arguments. Your ideas will become stronger if you support them with proof from other sources. But be careful here! Use only reliable sources (academic journals, scholarly articles, books, etc.).
Finish your essay dynamically. In your essay conclusion, restate your thesis statement and synthesize all of your arguments. Motivate your readers on further investigation of your topic. To make your paper even more impressive, finish it with the final memorable thought that would be stuck in your readers’ minds.

📈 Cause and Effect Essay on Smoking

A cause and effect of the teenage smoking essay should answer two questions:

Why do teenagers smoke? (Causes).
What are the consequences of teenage smoking? (Effects).

How to create an excellent cause and effect paper? You can start by checking successful teen smoking essay examples . Then, learn some useful tips here:

Get an idea. The first step of creating a causes effects of teenage smoking essay is brainstorming topics. Think of the common reasons for teens smoking and analyze the possible outcomes. Here are some ideas for you:
Outline your paper. This step helps structure your ideas properly. Create a well-organized plan and add there all the proof and examples. Make sure that everything is logical, and start writing your teenage smoking essay.
Form a clear thesis. In your thesis statement, state your position and introduce the chosen cause and effect of smoking. Here is an example of the thesis for this type of smoking among teenagers essay: Caused by peer pressure, smoking negatively affects teenagers’ health and appearance.
The key cause of teenage nicotine addiction is peer pressure and the fear of becoming an outsider among the friends-smokers.
One of the detrimental effects of cigarettes on teenagers is health problems.
Another adverse consequence of teenage smoking is negative changes in appearance .
Polish your piece of writing. After you finished your first draft, revise and edit your essay. Ensure the absence of grammar and punctuation mistakes and double-check if your paper is coherent.

🚭 Persuasive Essay on Smoking

A persuasive essay about teenage smoking resembles an argumentative one but has a different purpose. Here, you have to convince your reader in your opinion, using evidence and facts. Moreover, in some papers, you have to call your reader to action. For example, to quit or ban smoking . So, see how to do so:

Grab the reader’s attention. To do so, you should know your audience and their preferences. Start your smoking essay by proving to the reader your credibility and the significance of your topic. For example, if you are writing about smoking students, introduce the shocking statistics at the beginning of your paper and convince them to stop smoking.
Show your empathy. An emotional appeal is a powerful tool for gaining the readers’ trust and influencing their opinions. Demonstrate that you understand their emotions and, at the same time, convince them to change their beliefs. To make it more clear, see an example: Although smoking might help teenagers be on the same wavelength as their friends, nicotine has a detrimental effect on health and leads to cancer development.
Include rhetoric questions. This is a useful persuasive trick that makes readers change their minds. For instance, in your smoking essay, you may ask this question: Smoking helps me to relieve stress, but will I be able to overcome lung cancer later?
Highlight your position. In a persuasive essay, you should be incredibly convincing. So, don’t be afraid of exaggeration or even repeating yourself. These tricks may help you to deliver your message to the reader more quickly and effectively.

You have a lot of ways of creating fantastic teen smoking essays. You should just turn around and gather material. Sometimes it lies near your foot.

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To smoke or not to smoke? – This is the question! You should decide what is for you: To be yourself or follow the fashion! It is not difficult to do!

🔥 Smoking Essay Topics

Do you know what the critical secret of a successful essay is? A well-chosen topic!

If you find something you are passionate about, your essay writing process will be much easier. So, take a look at our smoking essay topics. Select one of them or use some to come up with your idea.

Smoking among teenagers : an exaggerated problem or a real threat to the generation?
The influence of nicotine on teenagers’ brain activity.
How smoking parents develop smoking habits in their children.
Vaping : a healthier alternative to regular cigarettes or just another dangerous teenagers’ passion?
Is smoking still a problem among teenagers today – an essay to highlight the issue of cigarette addiction.
The danger of smoking for immature teenagers’ organisms.
If smoking in public places was banned, teenagers would be predisposed to cigarettes less.
Social problems caused by teenage smoking.
The role of parents in dealing with teenage cigarette addiction.
Useful tips to stop smoking .
Why teenagers are influenced by peer pressure , and how to overcome it.
Teenage smoking: a matter of real nicotine addiction or a case of psychological processes inside immature minds?
The danger of smoking and second-hand smoke .
Is e-cigarette a threat or solution?
Analyze the connection between vaping and dental health.
Is it necessary to ban cigarette manufacturers?
Is it possible to prevent teenagers from smoking using anti-smoking posters ?
What are the best ways to persuade young adults to stop smoking?
Discuss the possibility of the global ban on tobacco and its potential outcomes.
Pros and cons of anti-smoking adverts.
Explore the connection between smoking cessation and depression .
Describe the link between smoking and heart disease.
Explain how smoking cessation can improve teenagers’ life.
How to reduce smoking among youth.
What are the different types of cigarette smokers?
Analyze the challenges of each stage of smoking cessation and how to overcome them.
Is smoking an effective method of weight control?
Discuss the impact of smoke on health of primary and secondary smokers.
Do you support the idea of lowering the smoking age in the USA ?
Effect of tobacco use on our body.
Explore the efficiency of the acupuncture method for smoking cessation.
Will the complete prohibition of smoking in cities help to preserve teenagers’ health?
Examine how smoking in movies influences teenagers’ desire to start smoking.
Are nicotine replacement medications necessary for successful smoking cessation?
Reasons to prohibit tobacco products and cigarettes.
Describe the reasons that prevent teenagers from smoking cessation .
Analyze the public image of smoking in the USA.
Discuss the issues connected with the smoking ban.
Antismoking ads and their influence on youth smoking prevalence.
What factors determine the success of anti-smoking persuasive campaigns among teenagers?
Explore the impact of smoking on teenagers’ physical and mental health.
What can you do to motivate your teenage friend to quit smoking?
Why do teenagers start smoking?
Analyze the rates of tobacco smoking among adolescents.
Compare the peculiarities of smoking cessation methods and motivation for teenagers and adolescents.
Examine whether raising cigarette pricing is an effective way to lower smoking rates.

Teenage Smoking Essay Prompts

Here are some writing prompts that you can use for your smoking essay:

What does the data on smoking in different countries say? Compare the age limitations for smoking, attitude to smoking in America and Europe, for example. Where the situation is worst, whether the government tries to fight against this, etc.
The distribution of cigarettes and other types of tobacco. Is it okay that tobacco machines are available all over the world (especially in Europe)? Any child can buy a cigarette and start smoking. You could investigate this problem in your teen smoking essays.
Opinion essay: present your ideas and attitude to smoking. Explain whether you like to see people smoking around you, or you cannot stand when people are gazing at you while you are smoking.
How does media influence teens’ decision-making? When teenagers see their favorite characters getting pleasure from smoking, they may want to try it. Is it a reason to start? In what other ways does mass media affect the problem?

Effects of Teenage Smoking Essay Prompt

Smoking among teenagers is a serious problem that has long-term consequences for their physical and mental health. In your essay, you can dwell on the following ideas:

Analyze the health consequences of tobacco use among young people. In your paper, you can study how tobacco affects youths’ health. Focus on the most widespread problems, such as heart and lung diseases, cancer risk, and others.
Estimate the role of smoking in promoting antisocial behavior among teenagers . Does smoking really encourage aggression and vandalism among teenagers? Use psychological theories and recent research findings to prove your point.
Explain why teenage smoking is associated with an increased risk of suicidal thoughts and urges. To prove your point, you may discuss how nicotine causes depression and neurotransmitter imbalances. Make sure to illustrate your essay with relevant studies and statistical data.
Investigate the economic and social consequences of smoking among young people. Besides high cigarette prices, you can consider lost productivity and healthcare costs. Additionally, write about social issues, such as stigmatization and reduced life opportunities.

Smoking in School Essay Prompt

Despite the implementation of smoke-free policies, a large percentage of teenagers start smoking during their school years. You can write an essay advocating for more effective initiatives to address not only students’ access to cigarettes but also the core causes of teen smoking.

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Check out some more ideas for your “Smoking in School” essay:

Explain why educators should prohibit smoking on school grounds. Smoking is a dangerous habit that damages students’ health and the overall school environment. Even secondhand smoke exposure has harmful consequences. Your essay could provide evidence that proves the effectiveness of smoke-free policies in reducing teenage smoking rates and improving general well-being.
Analyze the effectiveness of school smoking policies in your educational institution. What smoking policies are accepted in your school? Do students comply with them? What disciplinary measures are used? Use student surveys and disciplinary records to prove the effectiveness or ineffectiveness of current policies.
Describe the issue of smoking in schools in your country. Answer the questions: how widespread is this problem? How does it manifest itself? What causes smoking in schools, and how do schools fight it?
Investigate the role of schools in reducing youth smoking. How can schools prevent and reduce smoking among students? Are their programs and campaigns effective? What can families and communities do to support schools in their efforts? Study these questions in your essay.

Peer Pressure Smoking Essay Prompt

Peer pressure is a common reason why teenagers start smoking. Friends, romantic attachments, or other social circles — all have significant effects on teens’ smoking intentions and possible tobacco addiction.

Here are some practical ideas that can help you highlight the role of peer pressure in teenage smoking :

Analyze why adolescents tend to be powerful in influencing their friends to start smoking. Peer pressure often impacts teenagers’ decisions more than parents’ disapproval. To explain this phenomenon, you can examine theories like social contagion and recent studies on peer dynamics.
Provide your own experience of resisting peer pressure to smoke. Have you ever faced peer pressure inducing you to smoke? What helped you to withstand? Try to share some advice for students in a similar situation.
Investigate how social media can amplify peer pressure through online portrayals of smoking as glamorous. We recommend studying images, videos, advertisements, and influencers that depict smoking as stylish and sophisticated. What can be done to prevent smoking glamorization on social media?
Estimate the role of peers in normalizing smoking behavior. Peer influence is more than just direct pressure. Your essay could explain how factors like observational learning and group identity induce teenagers to smoke.

Causes of Smoking Essay Prompt

There are many reasons why people start smoking, ranging from simple curiosity to complicated social and psychological factors, including anxiety, low self-esteem, and domestic violence.

Check out several ideas for an essay about the causes of smoking:

Analyze tobacco or e-cigarette ads that emphasize weight control benefits and explain how these ads encourage teenagers to smoke. Your paper may discuss how tobacco and e-cigarette companies make use of teenagers’ insecurities and social norms regarding body image. Include studies that prove the impact of advertising on youths’ behavior.
Explore why the rising popularity of fashionable electronic “vaping” devices is one of the key causes of teen smoking. Why is vaping so popular among teenagers? How does it appeal to youths’ preferences and lifestyles? What role do sleek design and social media influence play in the devices’ popularity? Answer the questions in your paper.
Describe your or your friend’s experience that forced you to try cigarettes. Have you or your friend ever tried smoking? Share your story in your essay. Reflect on the circumstances and emotions involved. What conclusions did you make from the experience?

Smoking Is Bad for Health Essay Prompt

Cigarette smoking impacts nearly every organ in the body, causes a variety of diseases, and worsens smokers’ overall health.

In your essay, you can expand on the following ideas to show the severe consequences of smoking on human well-being:

Analyze why cigarette smoking is the leading cause of preventable death in the United States. Here, you can examine factors like addiction and chronic diseases cigarettes provoke. Add statistical data and emphasize the preventable nature of smoking-related illnesses and deaths.
Examine passive smoking as a serious threat to health, especially for children, pregnant women, and people with chronic diseases. Your essay could analyze research and case studies proving that secondhand smoke is as dangerous to human health as smoking itself. Underline its harm to vulnerable populations, such as children, pregnant women, and people with chronic diseases.
Investigate the impact of cigarettes on mental health, including their contribution to the development of depression and anxiety. In this paper, you can examine nicotine’s effect on neurotransmitters involved in mood regulation, such as dopamine and serotonin. Support your point with evidence from peer-reviewed studies.
Research the possible diseases that smoking can provoke, including cancer, cardiovascular diseases, and respiratory illnesses. How does smoking contribute to the development and progress of these diseases? Use epidemiological data and medical research to answer this question.

Is Smoking Still a Problem Among Teenagers: Argumentative Essay Prompt

According to the CDC, in 2023, 1 out of every 100 middle school students and nearly 2 out of every 100 high school students had smoked cigarettes in the past 30 days . Public health experts are especially concerned about e-cigarettes since flavorings in tobacco products can make cigarettes more appealing to teenagers.

To evaluate the current situation with smoking among teens, dwell on the following ideas in your essay:

Analyze your country’s or world’s statistics on teen smoking in recent decades. Do you see any changes? Why did they happen? What do these changes mean in terms of public health? Examine these questions in your essay.
Describe your own observations of teenagers’ smoking habits. Contrast what you witnessed in the past with the current situation. Do you think teenagers’ smoking habits changed? What makes you think so? Provide real-life examples to back up your opinion.
Examine data on e-cigarette use among teenagers. Your essay could compare ordinary cigarette smoking and e-cigarette use trends among teenagers. Which type prevails, and why? What impact does it have on teenagers’ health? What can be done to lower smoking and vaping rates among teenagers?

Thanks for reading till the end! Make sure to leave your opinion about the article below. Send it to your friends who may need our tips.

Bar Exam Success Guide

Introduction.

State Specific Bar Exam Resources
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Multi-State Essay Exam (MEE)
Georgia Essays

Instructions for Essay Answer - Georgia

Subjects tested, sample essays, georgia essays study aids.

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Most states' bar exams have an essay portion. Georgia has four essay questions prepared and graded by the Board of Bar Examiners. Applicants will be provided 45 minutes to answer each question.

Assume that the questions arise under the laws of Georgia, unless otherwise indicated.
Each answer should show: an understanding of the facts; a recognition of the issues involved; the principles of law applicable; and the reasoning by which you arrived at your conclusions. The value of an answer depends not so much upon the correctness of the conclusions as upon the presence and quality of the elements above-mentioned.
Clearness and conciseness will count but make your answers complete. Do not volunteer irrelevant or immaterial information.
Demonstrate not merely your memory, but your ability to think and analyze the issues.
Read each question carefully and understand it before answering.

Essay questions prepared by the Board of Bar Examiners shall be drawn from the following list of subjects:

Georgia Bar Exam Essays For exams February 2000 to July 2012 there are 4 questions, each with a corresponding page of sample answers.

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What I’ve Learned From My Students’ College Essays

The genre is often maligned for being formulaic and melodramatic, but it’s more important than you think.

An illustration of a high school student with blue hair, dreaming of what to write in their college essay.

By Nell Freudenberger

Most high school seniors approach the college essay with dread. Either their upbringing hasn’t supplied them with several hundred words of adversity, or worse, they’re afraid that packaging the genuine trauma they’ve experienced is the only way to secure their future. The college counselor at the Brooklyn high school where I’m a writing tutor advises against trauma porn. “Keep it brief , ” she says, “and show how you rose above it.”

I started volunteering in New York City schools in my 20s, before I had kids of my own. At the time, I liked hanging out with teenagers, whom I sometimes had more interesting conversations with than I did my peers. Often I worked with students who spoke English as a second language or who used slang in their writing, and at first I was hung up on grammar. Should I correct any deviation from “standard English” to appeal to some Wizard of Oz behind the curtains of a college admissions office? Or should I encourage students to write the way they speak, in pursuit of an authentic voice, that most elusive of literary qualities?

In fact, I was missing the point. One of many lessons the students have taught me is to let the story dictate the voice of the essay. A few years ago, I worked with a boy who claimed to have nothing to write about. His life had been ordinary, he said; nothing had happened to him. I asked if he wanted to try writing about a family member, his favorite school subject, a summer job? He glanced at his phone, his posture and expression suggesting that he’d rather be anywhere but in front of a computer with me. “Hobbies?” I suggested, without much hope. He gave me a shy glance. “I like to box,” he said.

I’ve had this experience with reluctant writers again and again — when a topic clicks with a student, an essay can unfurl spontaneously. Of course the primary goal of a college essay is to help its author get an education that leads to a career. Changes in testing policies and financial aid have made applying to college more confusing than ever, but essays have remained basically the same. I would argue that they’re much more than an onerous task or rote exercise, and that unlike standardized tests they are infinitely variable and sometimes beautiful. College essays also provide an opportunity to learn precision, clarity and the process of working toward the truth through multiple revisions.

When a topic clicks with a student, an essay can unfurl spontaneously.

Even if writing doesn’t end up being fundamental to their future professions, students learn to choose language carefully and to be suspicious of the first words that come to mind. Especially now, as college students shoulder so much of the country’s ethical responsibility for war with their protest movement, essay writing teaches prospective students an increasingly urgent lesson: that choosing their own words over ready-made phrases is the only reliable way to ensure they’re thinking for themselves.

Teenagers are ideal writers for several reasons. They’re usually free of preconceptions about writing, and they tend not to use self-consciously ‘‘literary’’ language. They’re allergic to hypocrisy and are generally unfiltered: They overshare, ask personal questions and call you out for microaggressions as well as less egregious (but still mortifying) verbal errors, such as referring to weed as ‘‘pot.’’ Most important, they have yet to put down their best stories in a finished form.

I can imagine an essay taking a risk and distinguishing itself formally — a poem or a one-act play — but most kids use a more straightforward model: a hook followed by a narrative built around “small moments” that lead to a concluding lesson or aspiration for the future. I never get tired of working with students on these essays because each one is different, and the short, rigid form sometimes makes an emotional story even more powerful. Before I read Javier Zamora’s wrenching “Solito,” I worked with a student who had been transported by a coyote into the U.S. and was reunited with his mother in the parking lot of a big-box store. I don’t remember whether this essay focused on specific skills or coping mechanisms that he gained from his ordeal. I remember only the bliss of the parent-and-child reunion in that uninspiring setting. If I were making a case to an admissions officer, I would suggest that simply being able to convey that experience demonstrates the kind of resilience that any college should admire.

The essays that have stayed with me over the years don’t follow a pattern. There are some narratives on very predictable topics — living up to the expectations of immigrant parents, or suffering from depression in 2020 — that are moving because of the attention with which the student describes the experience. One girl determined to become an engineer while watching her father build furniture from scraps after work; a boy, grieving for his mother during lockdown, began taking pictures of the sky.

If, as Lorrie Moore said, “a short story is a love affair; a novel is a marriage,” what is a college essay? Every once in a while I sit down next to a student and start reading, and I have to suppress my excitement, because there on the Google Doc in front of me is a real writer’s voice. One of the first students I ever worked with wrote about falling in love with another girl in dance class, the absolute magic of watching her move and the terror in the conflict between her feelings and the instruction of her religious middle school. She made me think that college essays are less like love than limerence: one-sided, obsessive, idiosyncratic but profound, the first draft of the most personal story their writers will ever tell.

Nell Freudenberger’s novel “The Limits” was published by Knopf last month. She volunteers through the PEN America Writers in the Schools program.

Episodes from poet’s life are recounted in essays | DON NOBLE

Students at the University of Alabama in the late ’60s and early ’70s will remember James Seay. Tall, slender, with long brown hair, and a black eye patch over his right eye, Seay taught poetry writing and was a presence.

His first book, “Let Not Your Hart,” won the prestigious Wesleyan Prize for poetry in 1970. The verse is luminously accessible, a miracle by today’s standards, and many concern his childhood in Mississippi, in Panola County — just east of the Delta.

More: Novel explores apocalypse and religion in Mississippi | DON NOBLE

Seay wrote of poverty. A poem about fishing for catfish by hand, grabbling in Yokna Bottom, concludes “The well-fed do not wade this low river.”

There are poems of hard work, often amusing and admiring.

“Kelly Dug a Hole” is a hymn of praise to simple tasks done perfectly. “Kelly’s hole was true.” If, one day, the building collapses, the last part to fail will be where Kelly dug.

And there is of course a poem about shopping, with his father, for a glass eye after losing his eye to a lawn mower. The boy knows the salesman “would not find my soft brown eye, not in a thousand leather trays.”

Now, half a century and six volumes of poetry later, James Seay has published a book of 20 essays, “Come! Come! Where? Where?: Essays.”

The first — and the last — speak of a loss even greater than the loss of his eye. Seay and his ex-wife, Lee Smith, lost their son Josh to mental illness and early death at 33.

Several return to the themes of “Let Not Your Hart.” Some recount stories of laboring and as foreman of laborers.

In the ironically titled “Big Boss Man,” set in 1959, he is supervising a crew of Black and white workers constructing a classroom building at Ole Miss. The racial and class currents are almost too complex to relate. The Black workers work with and are separate from the white workers. The blue-collar whites resent Seay, the educated boy and their boss. But he concludes, generously, that the surliest among them is just trying to feed his family.

The essays are scattered through time and space.

There are several accounts of fishing trips, a few of literary commentary, and a fresh essay on some places in Faulkner that are Seay’s own places.

The funniest piece is “Avian Voices: Trying Not To Kill a Mockingbird.” In addition to giving musical pleasure, mockingbirds can be very irritating

One favorite is his 1987 visit or attempted visit to Chekhov’s grave. That day there happened to be a funeral for a Soviet official. The guard was under orders to allow no one else into the cemetery.

Seay explained, pled, that he might never again be in the country. “Nyet.”

Desperate to be admitted, Seay has his translator tell the guard “I am a relative of Chekhov”: “My adult life has been given to the cause of literature.”

And that’s the truth.

Don Noble’s newest book is Alabama Noir, a collection of original stories by Winston Groom, Ace Atkins, Carolyn Haines, Brad Watson, and eleven other Alabama authors.

“Come! Come! Where? Where?: Essays”

Author: James Seay

Publisher: The University of North Carolina Press, Chapel Hill, North Carolina, 2024

Price: $22.95

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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2016.

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E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General [Internet].

Chapter 1 introduction, conclusions, and historical background relative to e-cigarettes.

Introduction

Although conventional cigarette smoking has declined markedly over the past several decades among youth and young adults in the United States ( U.S. Department of Health and Human Services [USDHHS] 2012 ), there have been substantial increases in the use of emerging tobacco products among these populations in recent years ( Centers for Disease Control and Prevention [CDC] 2015c ). Among these increases has been a dramatic rise in electronic cigarette (e-cigarette) use among youth and young adults. It is crucial that the progress made in reducing cigarette smoking among youth and young adults not be compromised by the initiation and use of e-cigarettes. This Surgeon General’s report focuses on the history, epidemiology, and health effects of e-cigarette use among youth and young adults; the companies involved with marketing and promoting these products; and existing and proposed public health policies regarding the use of these products by youth and young adults.

E-cigarettes include a diverse group of devices that allow users to inhale an aerosol, which typically contains nicotine, flavorings, and other additives. E-cigarettes vary widely in design and appearance, but generally operate in a similar manner and are composed of similar components ( Figure 1.1 ). A key challenge for surveillance of the products and understanding their patterns of use is the diverse and nonstandard nomenclature for the devices ( Alexander et al. 2016 ). These devices are referred to, by the companies themselves, and by consumers, as “e-cigarettes,” “e-cigs,” “cigalikes,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.” In this report, the term “e-cigarette” is used to represent all of the various products in this rapidly diversifying product category. The terms may differ by geographic region or simply by the prevailing preferences among young users. For example, some refer to all cigarette-shaped products as “e-cigarettes” or as “cigalikes,” and some may refer to the pen-style e-cigarettes as “hookah pens” or “vape pens” ( Richtel 2014 ; Lempert et al. 2016 ).

Diversity of e-cigarette products. Source: Photo by Mandie Mills, CDC.

This report focuses on research conducted among youth and young adults because of the implications of e-cigarette use in this population, particularly the potential for future public health problems. Understanding e-cigarette use among young persons is critical because previous research suggests that about 9 in 10 adult smokers first try conventional cigarettes during adolescence ( USDHHS 2012 ). Similarly, youth e-cigarette experimentation and use could also extend into adulthood; however, e-cigarette use in this population has not been examined in previous reports of the Surgeon General. The first Surgeon General’s report on the health consequences of smoking was published in 1964; of the subsequent reports, those published in 1994 and 2012 focused solely on youth and young adults ( USDHHS 1994 , 2012 ). More recently, the 2012 report documented the evidence regarding tobacco use among youth and young adults, concluding that declines in cigarette smoking had slowed and that decreases in the use of smokeless tobacco had stalled. That report also found that the tobacco industry’s advertising and promotional activities are causal to the onset of smoking in youth and young adults and the continuation of such use as adults ( USDHHS 2012 ). However, the 2012 report was prepared before e-cigarettes were as widely promoted and used in the United States as they are now. Therefore, this 2016 report documents the scientific literature on these new products and their marketing, within the context of youth and young adults. This report also looks to the future by examining the potential impact of e-cigarette use among youth and young adults, while also summarizing the research on current use, health consequences, and marketing as it applies to youth and young adults.

Evidence for this report was gathered from studies that included one or more of three age groups. We defined these age groups to be young adolescents (11–13 years of age), adolescents (14–17 years of age), and young adults (18–24 years of age). Some studies refer to the younger groups more generally as youth. Despite important issues related to e-cigarette use in adult populations, clinical and otherwise (e. g ., their potential for use in conventional smoking cessation), that literature will generally not be included in this report unless it also discusses youth and young adults ( Farsalinos and Polosa 2014 ; Franck et al. 2014 ; Grana et al. 2014 ).

Given the recency of the research that pertains to e-cigarettes, compared with the decades of research on cigarette smoking, the “precautionary principle” is used to guide actions to address e-cigarette use among youth and young adults. This principle supports intervention to avoid possible health risks when the potential risks remain uncertain and have been as yet partially undefined ( Bialous and Sarma 2014 ; Saitta et al. 2014 ; Hagopian et al. 2015 ). Still, the report underscores and draws its conclusions from the known health risks of e-cigarette use in this age group.

Organization of the Report

This chapter presents a brief introduction to this report and includes its major conclusions followed by the conclusions of the chapters, the historical background of e-cigarettes, descriptions of the products, a review of the marketing and promotional activities of e-cigarette companies, and the current status of regulations from the U.S. Food and Drug Administration ( FDA ). Chapter 2 (“Patterns of E-Cigarette Use Among U.S. Youth and Young Adults”) describes the epidemiology of e-cigarette use, including current use (i.e., past 30 day); ever use; co-occurrence of using e-cigarettes with other tobacco products, like cigarettes; and psychosocial factors associated with using e-cigarettes, relying on data from the most recent nationally representative studies available at the time this report was prepared. Chapter 3 (“Health Effects of E-Cigarette Use Among U.S. Youth and Young Adults”) documents the evidence related to the health effects of e-cigarette use, including those that are associated with direct aerosol inhalation by users, the indirect health effects of e-cigarette use, other non-aerosol health effects of e-cigarette use, and secondhand exposure to constituents of the aerosol. Chapter 4 (“Activities of the E-Cigarette Companies”) describes e-cigarette companies’ influences on e-cigarette use and considers manufacturing and price; the impact of price on sales and use; the rapid changes in the industry, particularly the e-cigarette companies; and the marketing and promotion of e-cigarettes. Chapter 5 (“E-Cigarette Policy and Practice Implications”) discusses the implications for policy and practice at the national, state, and local levels. The report ends with a Call to Action to stakeholders—including policymakers, public health practitioners and clinicians, researchers, and the public—to work to prevent harms from e-cigarette use and secondhand aerosol exposure among youth and young adults.

Preparation of this Report

This Surgeon General’s report was prepared by the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC , which is part of USDHHS . The initial drafts of the chapters were written by 27 experts who were selected for their knowledge of the topics addressed. These contributions are summarized in five chapters that were evaluated by approximately 30 peer reviewers. After peer review, the entire manuscript was sent to more than 20 scientists and other experts, who examined it for its scientific integrity. After each review cycle, the drafts were revised by the report’s scientific editors on the basis of reviewers’ comments. Subsequently, the report was reviewed by various institutes and agencies within USDHHS.

Scientific Basis of the Report

The statements and conclusions throughout this report are documented by the citation of studies published in the scientific literature. Publication lags have prevented an up-to-the-minute inclusion of all recently published articles and data. This overall report primarily cites peer-reviewed journal articles, including reviews that integrate findings from numerous studies and books that were published through December 2015. However, selected studies from 2016 have been added during the review process that provide further support for the conclusions in this report. When a cited study has been accepted for publication, but the publication has not yet occurred because of the delay between acceptance and final publication, the study is referred to as “in press.” This report also refers, on occasion, to unpublished research, such as presentations at a professional meeting, personal communications from a researcher, or information available in various media. These references are employed when acknowledged by the editors and reviewers as being from reliable sources, which add to the emerging literature on a topic.

Major Conclusions
E-cigarettes are a rapidly emerging and diversified product class. These devices typically deliver nicotine, flavorings, and other additives to users via an inhaled aerosol. These devices are referred to by a variety of names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.”
E-cigarette use among youth and young adults has become a public health concern. In 2014, current use of e-cigarettes by young adults 18–24 years of age surpassed that of adults 25 years of age and older.
E-cigarettes are now the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014. E-cigarette use is strongly associated with the use of other tobacco products among youth and young adults, including combustible tobacco products.
The use of products containing nicotine poses dangers to youth, pregnant women, and fetuses. The use of products containing nicotine in any form among youth, including in e-cigarettes, is unsafe.
E-cigarette aerosol is not harmless. It can contain harmful and potentially harmful constituents, including nicotine. Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.
E-cigarettes are marketed by promoting flavors and using a wide variety of media channels and approaches that have been used in the past for marketing conventional tobacco products to youth and young adults.
Action can be taken at the national, state, local, tribal, and territorial levels to address e-cigarette use among youth and young adults. Actions could include incorporating e-cigarettes into smokefree policies, preventing access to e-cigarettes by youth, price and tax policies, retail licensure, regulation of e-cigarette marketing likely to attract youth, and educational initiatives targeting youth and young adults.
Chapter Conclusions

Chapter 1. Introduction, Conclusions, and Historical Background Relative to E-Cigarettes

E-cigarettes are devices that typically deliver nicotine, flavorings, and other additives to users via an inhaled aerosol. These devices are referred to by a variety of names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.”
E-cigarettes represent an evolution in a long history of tobacco products in the United States, including conventional cigarettes.
In May 2016, the Food and Drug Administration issued the deeming rule, exercising its regulatory authority over e-cigarettes as a tobacco product.

Chapter 2. Patterns of E-Cigarette Use Among U.S. Youth and Young Adults

Among middle and high school students, both ever and past-30-day e-cigarette use have more than tripled since 2011. Among young adults 18–24 years of age, ever e-cigarette use more than doubled from 2013 to 2014 following a period of relative stability from 2011 to 2013.
The most recent data available show that the prevalence of past-30-day use of e-cigarettes is similar among high school students (16% in 2015, 13.4% in 2014) and young adults 18–24 years of age (13.6% in 2013–2014) compared to middle school students (5.3% in 2015, 3.9% in 2014) and adults 25 years of age and older (5.7% in 2013–2014).
Exclusive, past-30-day use of e-cigarettes among 8th-, 10th-, and 12th-grade students (6.8%, 10.4%, and 10.4%, respectively) exceeded exclusive, past-30-day use of conventional cigarettes in 2015 (1.4%, 2.2%, and 5.3%, respectively). In contrast—in 2013–2014 among young adults 18–24 years of age—exclusive, past-30-day use of conventional cigarettes (9.6%) exceeded exclusive, past-30-day use of e-cigarettes (6.1%). For both age groups, dual use of these products is common.
E-cigarette use is strongly associated with the use of other tobacco products among youth and young adults, particularly the use of combustible tobacco products. For example, in 2015, 58.8% of high school students who were current users of combustible tobacco products were also current users of e-cigarettes.
Among youth—older students, Hispanics, and Whites are more likely to use e-cigarettes than younger students and Blacks. Among young adults—males, Hispanics, Whites, and those with lower levels of education are more likely to use e-cigarettes than females, Blacks, and those with higher levels of education.
The most commonly cited reasons for using e-cigarettes among both youth and young adults are curiosity, flavoring/taste, and low perceived harm compared to other tobacco products. The use of e-cigarettes as an aid to quit conventional cigarettes is not reported as a primary reason for use among youth and young adults.
Flavored e-cigarette use among young adult current users (18–24 years of age) exceeds that of older adult current users (25 years of age and older). Moreover, among youth who have ever tried an e-cigarette, a majority used a flavored product the first time they tried an e-cigarette.
E-cigarette products can be used as a delivery system for cannabinoids and potentially for other illicit drugs. More specific surveillance measures are needed to assess the use of drugs other than nicotine in e-cigarettes.

Chapter 3. Health Effects of E-Cigarette Use Among U.S. Youth and Young Adults

Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.
Nicotine can cross the placenta and has known effects on fetal and postnatal development. Therefore, nicotine delivered by e-cigarettes during pregnancy can result in multiple adverse consequences, including sudden infant death syndrome, and could result in altered corpus callosum, deficits in auditory processing, and obesity.
E-cigarettes can expose users to several chemicals, including nicotine, carbonyl compounds, and volatile organic compounds, known to have adverse health effects. The health effects and potentially harmful doses of heated and aerosolized constituents of e-cigarette liquids, including solvents, flavorants, and toxicants, are not completely understood.
E-cigarette aerosol is not harmless “water vapor,” although it generally contains fewer toxicants than combustible tobacco products.
Ingestion of e-cigarette liquids containing nicotine can cause acute toxicity and possibly death if the contents of refill cartridges or bottles containing nicotine are consumed.

Chapter 4. Activities of the E-Cigarette Companies

The e-cigarette market has grown and changed rapidly, with notable increases in total sales of e-cigarette products, types of products, consolidation of companies, marketing expenses, and sales channels.
Prices of e-cigarette products are inversely related to sales volume: as prices have declined, sales have sharply increased.
E-cigarette products are marketed in a wide variety of channels that have broad reach among youth and young adults, including television, point-of-sale, magazines, promotional activities, radio, and the Internet.
Themes in e-cigarette marketing, including sexual content and customer satisfaction, are parallel to themes and techniques that have been found to be appealing to youth and young adults in conventional cigarette advertising and promotion.

Chapter 5. E-Cigarette Policy and Practice Implications

The dynamic nature of the e-cigarette landscape calls for expansion and enhancement of tobacco-related surveillance to include (a) tracking patterns of use in priority populations; (b) monitoring the characteristics of the retail market; (c) examining policies at the national, state, local, tribal, and territorial levels; (d) examining the channels and messaging for marketing e-cigarettes in order to more fully understand the impact future regulations could have; and (e) searching for sentinel health events in youth and young adult e-cigarette users, while longer-term health consequences are tracked.
Strategic, comprehensive research is critical to identify and characterize the potential health risks from e-cigarette use, particularly among youth and young adults.
The adoption of public health strategies that are precautionary to protect youth and young adults from adverse effects related to e-cigarettes is justified.
A broad program of behavioral, communications, and educational research is crucial to assess how youth perceive e-cigarettes and associated marketing messages, and to determine what kinds of tobacco control communication strategies and channels are most effective.
Health professionals represent an important channel for education about e-cigarettes, particularly for youth and young adults.
Diverse actions, modeled after evidence-based tobacco control strategies, can be taken at the state, local, tribal, and territorial levels to address e-cigarette use among youth and young adults, including incorporating e-cigarettes into smoke-free policies; preventing the access of youth to e-cigarettes; price and tax policies; retail licensure; regulation of e-cigarette marketing that is likely to attract youth and young adults, to the extent feasible under the law; and educational initiatives targeting youth and young adults. Among others, research focused on policy, economics, and the e-cigarette industry will aid in the development and implementation of evidence-based strategies and best practices.
Historical Background

Understanding the role of e-cigarettes requires understanding the long history of tobacco use in the United States, including the role of nicotine delivery, the multiple examples of “reduced-harm” products and associated health claims, and the impact of using tobacco products on the public’s health. Since the late nineteenth century, when the “modern” cigarette came into use, scientists and public health officials have linked cigarette smoking to a remarkable number of adverse effects, and it is now recognized as the primary cause of premature death in the United States ( USDHHS 2014 ). Correspondingly, for a century, manufacturers, scientists, entrepreneurs, and public health leaders have promoted or recommended product changes that might remove some of the harmful elements in cigarette smoke. E-cigarettes are among the latest products.

E-cigarettes are designed for users to inhale nicotine, flavorings, and other additives through an aerosol. The claims and marketing strategies employed by the e-cigarette companies, and the efforts made by others to develop scientific and regulatory tools to deal with these new products, both contribute to the current discourse on e-cigarettes. Many lessons for assessing the potential (and future) consequences of these products can be learned from examining the relevant experiences of the past century, especially the introduction of novel products (including e-cigarettes as well as other tobacco and nicotine products) and the claims of reduced exposure to toxins made by the industry and elsewhere.

Early Efforts to Modify Cigarettes

In the 1880s and 1890s, entrepreneurs promoted novel products that allegedly blocked nicotine and other constituents of conventional cigarettes believed to be poisonous. Dr. Scott’s Electric Cigarettes, advertised in Harper’s Weekly, claimed not only to light without matches but also to contain a cotton filter that “strains and eliminates the injurious qualities from the smoke,” including nicotine ( Harper’s Weekly 1887 ). Nicotine delivery was essential to the development of the modern cigarette in the twentieth century; early on, this substance was thought to be addicting and thus vital to retaining customers. In 1913, the Camel brand was a new kind of cigarette that introduced high-nicotine content by using burley tobacco, which was generally too harsh to inhale into the lungs, but was made more inhalable through the addition of casings (e. g ., sugars, licorice) ( Tindall 1992 ; Proctor 2011 ). In 1916, American Tobacco introduced its Lucky Strike blended cigarette, and in 1918 Liggett & Myers ( L &M) reformulated its Chesterfield brand to make it more palatable to users. As the market grew, advertisements for major brands routinely included health-related statements and testimonials from physicians. During the 1930s and 1940s, prominent advertising campaigns included claims like “Not a cough in a carload” (Old Gold) ( Federal Trade Commission [FTC] 1964 , p. LBA-5); “We removed from the tobacco harmful corrosive ACRIDS (pungent irritants) present in cigarettes manufactured in the old-fashioned way” (Lucky Strike) ( FTC 1964 , p. LBA-2); and “Smoking Camels stimulates the natural flow of digestive fluids … increases alkalinity” (Camel) ( FTC 1964 , p. LBA-1a). Thus, early modifications to the cigarette were made so that it was more palatable, had a higher nicotine delivery and uptake, and could be marketed as “safe” ( FTC 1964 ; Calfee 1985 ).

Filters, Tar Reduction, and Light and Low-Tar Cigarettes

The landmark 1964 Surgeon General’s report on smoking and health concluded that cigarette smoking contributed substantially to mortality from certain specific diseases, including lung cancer ( U.S. Department of Health, Education, and Welfare 1964 ). Although the 1964 report considered the topic, it found the evidence insufficient to assess the potential health benefits of cigarette filters. Cigarettes with filters became the norm by the 1960s, and marketing them with an overt message about harm reduction became the standard ( National Cancer Institute [NCI] 1996 ). However, the Surgeon General convened another group of experts on June 1, 1966, to review the evidence on the role played by the tar and nicotine content in health. The group concluded that “[t]he preponderance of scientific evidence strongly suggests that the lower the ‘tar’ and nicotine content of cigarette smoke, the less harmful are the effects” ( Horn 1966 , p. 16,168). Subsequent studies have repeatedly failed to demonstrate health benefits of smoking light and low-tar cigarettes versus full-flavor cigarettes ( Herning et al. 1981 ; Russell et al. 1982 ; Benowitz et al. 1983 , NCI 2001 ).

Over the years, the tobacco industry used multiple methods to reduce the machine-tested yields of tar and nicotine in cigarettes as a way to claim “healthier” cigarettes. Beginning in the 1970s, tobacco companies advertised the tar and nicotine levels for their cigarettes, which encouraged smokers to believe, without substantiation, they could reduce their risk of exposure to these constituents ( Cummings et al. 2002 ; Pollay and Dewhirst 2002 ). In 1996, the FTC issued a statement that it would allow cigarette companies to include statements about tar and nicotine content in their advertising as long as they used a standardized machine-testing method ( Peeler 1996 ).

The Role of Nicotine and Nicotine Delivery

Although the public health community understood early on that nicotine was the primary psycho-active ingredient in cigarette smoke, before the 1980s, little was known about the importance of nicotine in the addiction process beyond what the cigarette manufacturers had learned from their own research. Some scientists warned that due to nicotine addiction, a reduction in nicotine yields, along with decreases in tar, could lead smokers to change their smoking behavior, such as by smoking a greater number of cigarettes to maintain their nicotine intake or changing their behavior in more subtle ways, such as varying the depth of inhalation or smoking more of the cigarette ( Jarvis et al. 2001 ; National Cancer Institute 2001 ; Thun and Burns 2001 ). Not until the 1970s and 1980s, as researchers studying other forms of drug abuse began to apply their research methods to cigarette smoking, did it become apparent that nicotine was similar in its addictive capability to other drugs of abuse, such as heroin and cocaine ( USDHHS 1981 , 1988 ). As described in the 1988 Surgeon General’s report and in subsequent research, symptoms associated with nicotine addiction include craving, withdrawal, and unconscious behaviors to ensure consistent intake of nicotine ( USDHHS 1988 ; al’Absi et al. 2002 ; Hughes 2007 ).

Although the tobacco industry has long understood the importance of nicotine to maintain long-term cigarette smokers through addiction, public health officials did not fully appreciate this in a broad sense until the 1988 Surgeon General’s report, The Health Consequences of Smoking: Nicotine Addiction ( USDHHS 1988 ).

FDA and Nicotine Regulation

In 1988 (and again in 1994), the Coalition on Smoking OR Health and other public-interest organizations petitioned FDA to classify low-tar and nicotine products as drugs and to classify Premier, the short-lived “smokeless cigarette product” from R.J. Reynolds, as an alternative nicotine-delivery system ( Stratton et al. 2001 ). The Coalition on Smoking OR Health cited indirect claims made through advertising and marketing as evidence of R. J. Reynolds’s intent to have the product used for the mitigation or prevention of disease ( Slade and Ballin 1993 ). Meanwhile, FDA launched an investigation into the practices of the tobacco industry, including the manipulation of nicotine delivery. FDA asserted its jurisdiction over cigarettes and smokeless tobacco and issued certain rules governing access to and promotion of these products ( Federal Register 1996 ). On March 21, 2000, the U.S. Supreme Court ruled 5-4 that Congress had not yet given FDA the necessary statutory authority to issue any rules pertaining to tobacco products ( Gottleib 2000 ; FDA v. Brown & Williamson Tobacco Corp. 2000 ). The subsequent debate over control of nicotine products, including their potential impact on youth, ultimately led to the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, which gave FDA authority to regulate tobacco products. Thus, discussions about the introduction of novel nicotine-containing tobacco products in the market during the 1980s and 1990s helped shape the current regulation of tobacco and nicotine products.

New products introduced in the 1990s or later included modified tobacco cigarettes (e. g ., Advance, Omni); cigarette-like products, also called cigalikes (e.g., Eclipse, Accord); and smokeless tobacco products (e.g., Ariva, Exalt, Revel, snus). Advance, made by Brown and Williamson, was test-marketed with the slogan “All of the taste … Less of the toxins.” Vector launched a national advertising campaign for its Omni cigarette with the slogan “Reduced carcinogens. Premium taste.” In addition to the question of whether the claims were supported by sufficient evidence, scientists and tobacco control leaders raised concerns about the potential for adverse consequences associated with novel nicotine and tobacco products marketed for harm reduction, such as a reduction in cessation rates or increased experimentation by children ( Warner and Martin 2003 ; Joseph et al. 2004 ; Caraballo et al. 2006 ). Studies have shown that smokers are interested in trying novel “reduced-exposure” products and perceive them to have lower health risks, even when advertising messages do not make explicit health claims ( Hamilton et al. 2004 ; O’Connor et al. 2005 ; Caraballo et al. 2006 ; Choi et al. 2012 ; Pearson et al. 2012 ).

At FDA ’s request, the Institute of Medicine ( IOM [now the National Academy of Medicine]) convened a committee of experts to formulate scientific methods and standards by which potentially reduced-exposure products (PREPs), whether the purported reduction was pharmaceutical or tobacco related, could be assessed. The committee concluded that “[f]or many diseases attributable to tobacco use, reducing risk of disease by reducing exposure to tobacco toxicants is feasible” ( Stratton et al. 2001 , p. 232). However, it also cautioned that “PREPs have not yet been evaluated comprehensively enough (including for a sufficient time) to provide a scientific basis for concluding that they are associated with a reduced risk of dis ease compared to conventional tobacco use” ( Stratton et al. 2001 , p. 232). The committee added that “the major concern for public health is that tobacco users who might otherwise quit will use PREPs instead, or others may initiate smoking, feeling that PREPs are safe. That will lead to less harm reduction for a population (as well as less risk reduction for that individual) than would occur without the PREP , and possibly to an adverse effect on the population” ( Stratton et al. 2001 , p. 235). Subsequently, in 2006, Judge Kessler cited these findings in her decision which demanded the removal of light and low-tar labeling due to the misleading nature of these claims ( United States v. Philip Morris 2006 ).

The E-Cigarette

Invention of the E-Cigarette

An early approximation of the current e-cigarette appeared in a U.S. patent application submitted in 1963 by Herbert A. Gilbert and was patented in August 1965 (U.S. Patent No. 3,200,819) ( Gilbert 1965 ). The application was for a “smokeless nontobacco cigarette,” with the aim of providing “a safe and harmless means for and method of smoking” by replacing burning tobacco and paper with heated, moist, flavored air. A battery-powered heating element would heat the flavor elements without combustion ( Gilbert 1965 ). The Favor cigarette, introduced in 1986, was another early noncombustible product promoted as an alternative nicotine-containing tobacco product ( United Press International 1986 ; Ling and Glantz 2005 ).

The first device in the recent innovation in e-cigarettes was developed in 2003 by the Chinese pharmacist Hon Lik, a former deputy director of the Institute of Chinese Medicine in Liaoning Province. Lik’s patent application described a kind of electronic atomizing cigarette ( Hon 2013 ). With support from Chinese investors, in 2004 the product was introduced on the Chinese market under the company name Ruyan ( Sanford and Goebel 2014 ). The product gained some attention among Chinese smokers early on as a potential cessation device or an alternative cigarette product.

The e-cigarette was part of the U.S. market by the mid-2000s, and by 2010 additional brands started to appear in the nation’s marketplace, including Ruyan and Janty ( Regan et al. 2013 ). Ruyan gained a U.S. patent for its product with the application stating that the product is “an electronic atomization cigarette that functions as substitutes (sic) for quitting smoking and cigarette substitutes.” (U.S. Patent No. 8,490,628 B2, 2013). In August 2013, Imperial Tobacco Group purchased the intellectual property behind the Ruyan e-cigarette for $75 million. As of 2014 an estimated 90% of the world’s production of e-cigarette technology and products came from mainland China, mainly Guangdong Province and Zhejiang Province ( Barboza 2014 ).

Sales of e-cigarettes in the United States have risen rapidly since 2007. Widespread advertising via television commercials and through print advertisements for popular brands, often featuring celebrities, has contributed to a large increase in e-cigarette use by both adults and youth since 2010 ( Felberbaum 2013 ; King et al. 2013 ; Regan et al. 2013 ). Additionally, marketing through social media, as well as other forms of Internet marketing, has been employed to market these devices ( Huang et al. 2014 ; Kim et al. 2014 ).

In 2013, an estimated 13.1 million middle school and high school students were aware of e-cigarettes ( Wang et al. 2014 ). According to data from the National Youth Tobacco Survey, in 2011 the prevalence of current e-cigarette use (defined as use during at least 1 day in the past 30 days) among high school students was 1.5%; prevalence increased dramatically, however, to 16% by 2015, surpassing the rate of conventional-cigarette use among high school students ( CDC 2016b ; see Chapter 2 ). This equates to 2.4 million high school students and 620,000 middle school students having used an e-cigarette at least one time in the past 30 days in 2015 ( CDC 2016b ).

These trends have led to substantial concern and discussion within public health communities, including state and national public health agencies, professional organizations, and school administrators and teachers. A primary concern is the potential for nicotine addiction among nonsmokers, especially youth and young adults, and that this exposure to nicotine among youth and young adults is harmful. The diversity and novelty of e-cigarette products on the market and ongoing product innovations make assessments of the biological effects of current e-cigarettes under actual conditions of use—such as their long-term harmfulness—difficult to measure. Unanswered questions remain about the risk profile of these devices, their potential use by young people as a first step to other nicotine products, and their total impact on public health. There are diverging opinions about the potential public health impact of these new products. Some public health scientists have highlighted the potential for alternative nicotine products to serve as a substitute for conventional cigarettes and thus a harm reduction tool ( Henningfield et al. 2003 ; Abrams 2014 ). Others have cautioned that the use of alternative nicotine products might become a bridge that may lead to greater tobacco product use—including dual- or multiple-product use—or initiate nicotine addiction among nonsmokers, especially youth ( Cobb et al. 2010 ; Wagener et al. 2012 ; Benowitz and Goniewicz 2013 ; Britton 2013 ; Chapman 2013 ; Etter 2013 ; USDHHS 2014 ). Current evidence is insufficient to reject either of these hypotheses.

E-Cigarette Products

Components and devices.

E-cigarette devices are composed of a battery, a reservoir for holding a solution that typically contains nicotine, a heating element or an atomizer, and a mouthpiece through which the user puffs ( Figure 1.2 ). The device heats a liquid solution (often called e-liquid or e-juice) into an aerosol that is inhaled by the user. E-liquid typically uses propylene glycol and/or glycerin as a solvent for the nicotine and flavoring chemicals

Parts of an e-cigarette device. Source: Photo by Mandie Mills, CDC.

Flavors and E-Cigarettes

The e-liquids in e-cigarettes are most often flavored; a study estimated that 7,700 unique flavors exist ( Zhu et al. 2014 ) and that most of them are fruit or candy flavors ( Figure 1.3 ). A content analysis of the products available via online retail websites documented that tobacco, mint, coffee, and fruit flavors were most common, followed by candy (e. g ., bubble gum), unique flavors (e.g., Belgian waffle), and alcoholic drink flavors (e.g., strawberry daiquiri) ( Grana and Ling 2014 ). Some retail stores are also manufacturers that create custom flavors, which increases the variety of flavors available.

Examples of e-liquid flavors. Source: Photo by Mandie Mills, CDC.

The widespread availability and popularity of flavored e-cigarettes is a key concern regarding the potential public health implications of the products. The concern, among youth, is that the availability of e-cigarettes with sweet flavors will facilitate nicotine addiction and simulated smoking behavior—which will lead to the use of conventional tobacco products ( Kong et al. 2015 ; Krishnan-Sarin et al. 2015 ). Flavors have been used for decades to attract youth to tobacco products and to mask the flavor and harshness of tobacco ( USDHHS 2012 ). Industry documents show that tobacco companies marketed flavored little cigars and cigarillos to youth and to African Americans to facilitate their uptake of cigarettes ( Kostygina et al. 2014 ). Companies also intended flavored smokeless tobacco products to facilitate “graduation” to unflavored products that more easily deliver more nicotine to the user ( USDHHS 2012 ). Various studies have shown that youth are more likely than adults to choose flavored cigarettes and cigars ( CDC 2015b ). Concern over these findings led Congress to include a ban on characterizing flavors for cigarettes, other than tobacco or menthol, in the Tobacco Control Act. A similar concern exists about e-cigarettes, and this concern is supported by studies indicating that youth and young adults who have ever used e-cigarettes begin their use with sweet flavors rather than tobacco flavors ( Kong et al. 2015 ; Krishnan-Sarin et al. 2015 ). Notably, 81.5% of current youth e-cigarette users said they used e-cigarettes “because they come in flavors I like” ( Ambrose et al. 2015 ).

E-Cigarette Devices

First-generation e-cigarettes were often similar in size and shape to conventional cigarettes, with a design that also simulated a traditional cigarette in terms of the colors used (e. g ., a white body with tan mouthpiece). These devices were often called cigalikes, but there were other products designed to simulate a cigar or pipe. Other cigalikes were slightly longer or narrower than a cigarette; they may combine white with tan or may be black or colored brightly. These newer models use a cartridge design for the part of the device that holds the e-liquid, which is either prefilled with the liquid or empty and ready to be filled. The user then squeezes drops of the e-liquid onto a wick (or bit of cotton or polyfil) connected to the heating element and atomizer ( Figure 1.4 ). As e-cigarettes have become more popular, their designs have become more diverse, as have the types of venues where they are sold ( Noel et al. 2011 ; Zhu et al. 2014 ).

E-liquids being poured into an e-cigarette device. Source: Photo by Mandie Mills, CDC.

Second-generation devices include products that are shaped like pens, are comparatively larger and cylindrical, and are often referred to as “tank systems” in a nod to the transparent reservoir that holds larger amounts of e-liquid than previous cartridge-containing models. Third- and fourth-generation devices represent a diverse set of products and, aesthetically, constitute the greatest departure from the traditional cigarette shape, as many are square or rectangular and feature customizable and rebuildable atomizers and batteries. In addition, since the beginning of the availability of e-cigarettes and their component parts, users have been modifying the devices or building their own devices, which are often referred to as “mods.” The differences in design and engineering of the products are key factors in the size, distribution, and amount of aerosol particles and the variability in levels of chemicals and nicotine present in the e-liquid/aerosol and delivered to the user ( Brown and Cheng 2014 ).

E-Cigarette Product Components and Risks

One of the primary features of the more recent generation of devices is that they contain larger batteries and are capable of heating the liquid to a higher temperature, potentially releasing more nicotine, forming additional toxicants, and creating larger clouds of particulate matter ( Bhatnagar et al. 2014 ; Kosmider et al. 2014 ). For instance, one study demonstrated that, at high temperatures (150°C), exceedingly high levels of formaldehyde—a carcinogen (found to be 10 times higher than at ambient temperatures)—are present that are formed through the heating of the e-liquid solvents (propylene glycol and glycerin), although the level of tolerance of actual users to the taste of the aerosol heated to this temperature is debated ( Kosmider et al. 2014 ; CDC 2015a ; Flavor and Extract Manufacturers Association of the United States 2015 ; Pankow et al. 2015 ). There is also concern regarding the safety of inhaling e-cigarette flavorings. Although some manufacturers have claimed their flavorants are generally recognized as safe for food additives (i.e., to be used in preparing foods for eating), little is known about the long-term health effects of inhaling these substances into the lungs ( CDC 2015a ).

Many devices can be readily customized by their users, which is also leading to the concern that these devices are often being used to deliver drugs other than nicotine ( Brown and Cheng 2014 ). Most commonly reported in the news media, on blogs, and by user anecdote is the use of certain types of e-cigarette-related products for delivering different forms of marijuana ( Morean et al. 2015 ; Schauer et al. 2016 ). The tank systems, for example, have been used with liquid tetrahydrocannabinol ( THC ) or hash oil. Some personal vaporizer devices can be used with marijuana plant material or a concentrated resin form of marijuana called “wax.” One study describes the use, in Europe, of e-cigarette devices to smoke marijuana ( Etter 2015 ).

The various e-cigarette products, viewed as a group, lack standardization in terms of design, capacity for safely holding e-liquid, packaging of the e-liquid, and features designed to minimize hazards with use ( Yang et al. 2014 ). All of these design features may have implications for the health impact of e-cigarette use. Notably, from 2010 to 2014, calls to poison control centers in the United States about exposures related to e-cigarettes increased dramatically. According to the American Association of Poison Control Centers (2015) , 271 cases were reported in 2011, but 3,783 calls were reported in 2014. Among all calls, 51% involved exposure among children younger than 5 years of age ( CDC 2014 ). Most poisonings appear to have been caused by exposure to nicotine-containing liquid ( CDC 2014 ). The lack of a requirement for child-resistant packaging for e-liquid containers may have contributed to these poisonings. Since these data were released, one death in the United States has been confirmed in a child who drank e-liquid containing nicotine ( Mohney 2014 ). Additionally, serious adverse reactions, including at least two deaths, have been reported to FDA in cases that could be attributed to the use of e-cigarettes ( FDA 2013 ). This increase in poisonings prompted the Child Nicotine Poisoning Prevention Act of 2015 (2016) , which was enacted in January 2016. This law requires any container of liquid nicotine that is sold, manufactured, distributed, or imported into the United States to be placed in packaging that is difficult to open by children under 5 years of age.

Secondary risks are also of concern regarding e-cigarettes, including passive exposure to nicotine and other chemicals, and adverse events due to device malfunction. Nicotine is a neuroteratogen, and its use by pregnant women exposes a developing fetus to risks that are well documented in the 50th-anniversary Surgeon General’s report on smoking ( USDHHS 2014 ) and include impaired brain development ( England et al. 2015 ) and other serious consequences. Finally, another consequence of the lack of device regulation is the occurrence of battery failures and subsequent explosions. Explosions have typically occurred during charging, resulting in house and car fires, and sometimes causing injuries to those involved. From 2009 to late 2014, 25 incidents of explosions and fires involving e-cigarettes occurred in the United States ( Chen 2013 ; U.S. Fire Administration 2014 ; FDA 2013 ).

E-Cigarette Companies

E-cigarette companies include manufacturers, wholesalers, importers, retailers, distributors, and some other groups that overlap with these entities ( Barboza 2014 ; Whelan 2015 ). Currently, most of the products are manufactured in Shenzhen, Guangdong Province, China ( Cobb et al. 2010 ; Grana et al. 2014 ; Zhu et al. 2014 ). One study placed the number of brands at 466 in January 2014 and found a net increase of 10.5 brands per month ( Zhu et al. 2014 ). All the major tobacco companies (e. g ., Reynolds American, Altria; Table 1.1 ) and many smaller, independent companies are now in the business. When e-cigarettes first entered the U.S. market, they were sold primarily by independent companies via the Internet and in shopping malls at kiosks where those interested could sample the products. A unique feature of the e-cigarette industry, compared to other tobacco and nicotine products, is the recruitment of visitors to their websites as “affiliates” or distributors to help market the products and, in turn, receive commissions on sales ( Grana and Ling 2014 ; Cobb et al. 2015 ). For example, some companies offer a way for users to earn a commission by advertising the products (e.g., a banner ad is placed on one’s website, and when someone clicks on the link and subsequently purchases a product, the website owner gets a percentage commission). Some companies also offer rewards programs for recruiting new customers or for brand loyalty, with web-site users earning points for free or reduced-price products ( Richardson et al. 2015 ).

Multinational tobacco companies with e-cigarette brands.

E-cigarettes are now in widespread national distribution through convenience stores, tobacco stores, pharmacies, “big box” retail chains such as Costco, online retailers, and shops devoted to e-cigarette products (often called “vape shops”) ( Giovenco et al. 2015 ; Public Health Law Center 2015 ). The “vape shops” offer a place to buy customizable devices and e-liquid solutions in many flavors and sometimes include a café or other elements that promote socializing, essentially making such places like a lounge. With the rapid increase in distribution and marketing in the industry, sales have increased rapidly and were projected to reach $2.5 billion in 2014 and $3.5 billion in 2015, including projections for retail and online channels, as well as “vape shops” ( Wells Fargo Securities 2015 ).

The advertising and marketing of e-cigarette products has engendered skepticism among public health professionals and legislators, who have noted many similarities to the advertising claims and promotional tactics used for decades by the tobacco industry to sell conventional tobacco products ( Campaign for Tobacco-Free Kids 2013 ; CDC 2016a ). Indeed, several of the e-cigarette marketing themes have been reprised from the most memorable cigarette advertising, including those focused on freedom, rebellion, and glamor ( Grana and Ling 2014 ). E-cigarette products are marketed with a variety of unsubstantiated health and cessation messages, with some websites featuring videos of endorsements by physicians (another reprisal of old tobacco industry advertising) ( Grana and Ling 2014 ; Zhu et al. 2014 ). Unlike conventional cigarettes, for which advertising has been prohibited from radio and television since 1971, e-cigarette products are advertised on both radio and television, with many ads featuring celebrities. E-cigarettes also are promoted through sports and music festival sponsorships, in contrast to conventional cigarettes and smokeless tobacco products, which have been prohibited from such sponsorships since the Master Settlement Agreement in 1998. E-cigarettes also appear as product placements in television shows and movies ( Grana et al. 2011 ; Grana and Ling 2014 ).

Another key avenue for e-cigarette promotion is social media, such as Twitter, Facebook, YouTube, and Instagram. As is true in the tobacco industry, the e-cigarette industry organizes users through advocacy groups ( Noel et al. 2011 ; Harris et al. 2014 ; Saitta et al. 2014 ; Caponnetto et al. 2015 ). The extensive marketing and advocacy through various channels broadens exposure to e-cigarette marketing messages and products; such activity may encourage nonsmokers, particularly youth and young adults, to perceive e-cigarette use as socially normative. The plethora of unregulated advertising is of particular concern, as exposure to advertising for tobacco products among youth is associated with cigarette smoking in a dose-response fashion ( USDHHS 2012 ).

Federal Regulation of E-Cigarettes

A “Two-Pronged” Approach to Comprehensive Tobacco Control

Since the passage of the Tobacco Control Act in 2009, FDA has had the authority to regulate the manufacturing, distribution, and marketing of tobacco products sold in the United States. FDA had immediate jurisdiction over cigarettes, roll-your-own cigarette tobacco, and smokeless tobacco. In May 2016, FDA asserted jurisdiction over products that meet the statutory definition of a tobacco product, including e-cigarettes, except accessories of these products ( Federal Register 2016 ). That regulation is currently under litigation.

The IOM ’s 2007 report, Ending the Tobacco Problem: A Blueprint for the Nation, established a “two-pronged” strategy for comprehensive tobacco control: (1) full implementation of proven, traditional tobacco control measures such as clean indoor air laws, taxation, and countermarketing campaigns; and (2) “strong federal regulation of tobacco products and their marketing and distribution” ( Bonnie et al. 2007 , p. 1).

Included in FDA ’s broad authority are the restriction of marketing and sales to youth, requiring disclosure of ingredients and harmful and potentially harmful constituents, setting product standards (e. g ., requiring the reduction or elimination of ingredients or constituents), requiring premarket approval of new tobacco products and review of modified-risk tobacco products, and requiring health warnings. The standard for FDA to use many of its regulatory authorities is whether such an action is appropriate for the protection of public health ( Federal Food, Drug, and Cosmetic Act , § 907(a)(3)(A)). The public health standard in the Tobacco Control Act also requires FDA to consider the health impact of certain regulatory actions at both the individual and population levels, including their impact on nonusers, and on initiation and cessation ( Federal Food, Drug, and Cosmetic Act , § 907(a)(3)(B)).

Importantly, the Tobacco Control Act preserves the authority of state, local, tribal, and territorial governments to enact any policy “in addition to, or more stringent than” requirements established under the Tobacco Control Act “relating to or prohibiting the sale, distribution, possession, exposure to, access to, advertising and promotion of, or use of tobacco products by individuals of any age” ( Federal Food, Drug, and Cosmetic Act , § 916(a)(1)). This preservation of state and local authority ensures the continuation of more local-level, comprehensive tobacco control. However, the statute expressly preempts states and localities from establishing or continuing requirements that are different from or in addition to FDA requirements regarding standards for tobacco products, premarket review, adulteration, misbranding, labeling, registration, good manufacturing practices, or modified-risk tobacco products ( Federal Food, Drug, and Cosmetic Act , § 916(a)(2)(A)). But this express preemption provision does not apply to state and local authority to impose requirements relating to the “sale, distribution, possession, information reporting to the State, exposure to, access to, the advertising and promotion of, or use of, tobacco products by individuals of any age …” ( Federal Food, Drug, and Cosmetic Act , § 916(a)(2)(b)). The interaction of these complex provisions related to federal preemption of state law has been the subject of challenges by the tobacco industry to state and local laws. Thus far, courts have upheld certain local ordinances restricting the sale of flavored tobacco products ( National Association of Tobacco Outlets, Inc. v. City of Providence 2013 ; U.S. Smokeless Tobacco Manufacturing Co. v. City of New York 2013 ).

Legal Basis for Regulating E-Cigarettes as Tobacco Products

In the United States, e-cigarettes can be regulated either as products marketed for therapeutic purposes or as tobacco products. Since the advent of e-cigarettes in the United States around 2007, manufacturers have had the option to apply to FDA ’s Center for Drug Evaluation and Research ( CDER ) or Center for Devices and Radiological Health (CDRH) for approval to market e-cigarettes for therapeutic purposes; as of August 2016, no e-cigarette manufacturers have received approval through this avenue.

In 2008 and early 2009, FDA detained multiple shipments of e-cigarettes from overseas manufacturers and denied them entry into the United States on the grounds that e-cigarettes were unapproved drug-device combination products ( FDA 2011 ). Sottera, Inc., which now does business as NJOY, challenged that determination ( Smoking Everywhere, Inc. and Sottera, Inc., d/b/a NJOY v. U.S. Food and Drug Administration, et al. 2010 ; Bloomberg Business 2015 ). Between the filing of the lawsuit and a decision on the motion for preliminary injunction, Congress passed the Tobacco Control Act and the President signed it into law. The Tobacco Control Act defines the term “tobacco product,” in part, as any product, including component parts or accessories, “made or derived from tobacco” that is not a “drug,” “device,” or “combination product” as defined by the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(rr)) ( Family Smoking Prevention and Tobacco Control Act 2009 , § 101(a)). The District Court subsequently granted a preliminary injunction relying on the Supreme Court’s decision in Brown and Williamson (1996) and the recently enacted Tobacco Control Act. FDA appealed the decision and the U.S. Court of Appeals for the D.C. Circuit held that e-cigarettes and, therefore, other products “made or derived from tobacco” are not drug/device combinations unless they are marketed for therapeutic purposes, but can be regulated by FDA as tobacco products under the Tobacco Control Act ( Sottera, Inc. v. Food & Drug Administration 2010 ).

On September 25, 2015, FDA proposed regulations to describe the circumstances in which a product made or derived from tobacco that is intended for human consumption will be subject to regulation as a drug, device, or a combination product. The comment period for this proposed regulation closed on November 24, 2015.

Most e-cigarettes marketed and sold in the United States today contain nicotine made or derived from tobacco. Although some e-cigarettes claim that they contain nicotine not derived from tobacco, or that they contain no nicotine at all ( Lempert et al. 2016 ), there may be reason to doubt some of these claims. Currently, synthetic nicotine and nicotine derived from genetically modified, nontobacco plants are cost-prohibitive for e-cigarette manufacturers, although technological advances could eventually increase the cost-effectiveness of using nicotine that was not derived from tobacco ( Lempert et al. 2016 ). The health effects of passive exposure to e-cigarettes with no nicotine, as well as their actual use and the extent of exposure to these products, have just begun to be studied ( Hall et al. 2014 ; Marini et al. 2014 ; Schweitzer et al. 2015 ) and some states and localities are taking steps to regulate e-cigarettes that do not contain nicotine or tobacco ( Lempert et al. 2016 ).

Deeming Rule

The Tobacco Control Act added a new chapter to the Federal Food, Drug, and Cosmetic Act , which provides FDA with authority over tobacco products. The new chapter applied immediately to all cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco; and the law included “any other tobacco products that the Secretary of Health and Human Services by regulation deems to be subject to this chapter” ( Federal Food, Drug, and Cosmetic Act , §901 (b)). Therefore, to regulate e-cigarettes as tobacco products, FDA was required to undertake a rulemaking process to extend its regulatory authority to include e-cigarettes.

Prohibitions on adulterated and misbranded products;
Required disclosure of existing health information, including lists of ingredients and documents on health effects;
Required registration of manufacturers;
Required disclosure of a list of all tobacco products, including information related to labeling and advertising;
Premarket review of new tobacco products (i.e., those not on the market on February 15, 2007);
Restrictions on products marketed with claims about modified risk.
Minimum age restrictions to prevent sales to minors;
Requirements to include a nicotine warning; and
Prohibitions on vending machine sales, unless in a facility that never admits youth.

Future Regulatory Options

Product standards, including restrictions on flavors;
Restrictions on promotion, marketing, and advertising, and prohibitions on brand-name sponsorship of events;
Minimum package sizes;
Prohibitions on self-service displays;
Child-resistant packaging and the inclusion of health warnings; and
Regulation of nicotine levels in products.

Despite this broad authority, FDA is prohibited from certain regulatory actions, even if those actions may be appropriate for the protection of public health. Specifically, FDA generally cannot restrict tobacco use in public places, levy taxes on tobacco products, prohibit sales by a specific category of retail outlet (e. g ., pharmacies), completely eliminate nicotine in tobacco products, require prescriptions for tobacco products unless it is marketed for therapeutic purposes, or establish a federal minimum age of sale for tobacco products above 18 years of age. Thus, even if FDA fully exercises all of its existing authority over e-cigarettes, regulation will still need to be complemented at the state and local levels, including efforts previously shown to be effective for conventional tobacco products, such as comprehensive smokefree laws at the state and local levels, pricing strategies, raising the minimum age of sales to minors to 21, and high-impact countermarketing campaigns. In the current context of rising rates of use by youth, localities and states can also implement policies and programs that minimize the individual- and population-level harms of e-cigarettes (see Chapter 5 ).

This chapter presents the major conclusions of this Surgeon General’s report and the conclusions of each chapter. E-cigarettes are presented within their historical context, with an overview of the components of these devices and the types of products. In 2016, FDA announced its final rule to regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act. The chapter outlines options for the regulation of e-cigarettes, particularly as they relate to youth and young adults, based on successful smoking policies. The need to protect youth and young adults from initiating or continuing the use of nicotine-containing products forms a strong basis for the need to regulate e-cigarettes at the local, state, and national levels in the future.

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Joseph Epstein, conservative provocateur, tells his life story in full

In two new books, the longtime essayist and culture warrior shows off his wry observations about himself and the world

Humorous, common-sensical, temperamentally conservative, Joseph Epstein may be the best familiar — that is casual, personal — essayist of the last half-century. Not, as he might point out, that there’s a lot of competition. Though occasionally a scourge of modern society’s errancies, Epstein sees himself as essentially a serious reader and “a hedonist of the intellect.” His writing is playful and bookish, the reflections of a wry observer alternately amused and appalled by the world’s never-ending carnival.

Now 87, Epstein has just published his autobiography, “ Never Say You’ve Had a Lucky Life: Especially if You’ve Had a Lucky Life ,” in tandem with “ Familiarity Breeds Content: New and Selected Essays .” This pair of books brings the Epstein oeuvre up to around 30 volumes of sophisticated literary entertainment. While there are some short-story collections (“The Goldin Boys,” “Fabulous Small Jews”), all the other books focus on writers, observations on American life, and topics as various as ambition, envy, snobbery, friendship, charm and gossip. For the record, let me add that I own 14 volumes of Epstein’s views and reviews and would like to own them all.

Little wonder, then, that Epstein’s idea of a good time is an afternoon spent hunched over Herodotus’s “Histories,” Marguerite Yourcenar’s “Memoirs of Hadrian” or almost anything by Henry James, with an occasional break to enjoy the latest issue of one of the magazines he subscribes to. In his younger days, there were as many as 25, and most of them probably featured Epstein’s literary journalism at one time or another. In the case of Commentary, he has been contributing pieces for more than 60 years.

As Epstein tells it, no one would have predicted this sort of intellectual life for a kid from Chicago whose main interests while growing up were sports, hanging out, smoking Lucky Strikes and sex. A lackadaisical C student, Myron Joseph Epstein placed 169th in a high school graduating class of 213. Still, he did go on to college — the University of Illinois at Urbana-Champaign — because that’s what was expected of a son from an upper-middle-class Jewish family. But Urbana-Champaign wasn’t a good fit for a jokester and slacker: As he points out, the president of his college fraternity “had all the playfulness of a member of the president’s Council of Economic Advisers.” No matter. Caught peddling stolen copies of an upcoming accounting exam for $5 a pop, Epstein was summarily expelled.

Fortunately, our lad had already applied for a transfer to the University of Chicago, to which he was admitted the next fall. Given his record, this shows a surprising laxity of standards by that distinguished institution, but for Epstein the move was life-changing. In short order, he underwent a spiritual conversion from good ol’ boy to European intellectual in the making. In the years to come, he would count the novelist Saul Bellow and the sociologist Edward Shils among his close friends, edit the American Scholar, and teach at Northwestern University. His students, he recalls, were “good at school, a skill without any necessary carry-over, like being good at pole-vaulting or playing the harmonica.”

Note the edge to that remark. While “Never Say You’ve Had a Lucky Life” is nostalgia-laden, there’s a hard nut at its center. Epstein feels utter contempt for our nation’s “radical change from a traditionally moral culture to a therapeutic one.” As he explains: “Our parents’ culture and that which came long before them was about the formation of character; the therapeutic culture was about achieving happiness. The former was about courage and honor, the latter about self-esteem and freedom from stress.” This view of America’s current ethos may come across as curmudgeonly and reductionist, but many readers — whatever their political and cultural leanings — would agree with it. Still, such comments have sometimes made their author the focus of nearly histrionic vilification.

Throughout his autobiography, this lifelong Chicagoan seems able to remember the full names of everyone he’s ever met, which suggests Epstein started keeping a journal at an early age. He forthrightly despises several older writers rather similar to himself, calling Clifton Fadiman, author of “The Lifetime Reading Plan,” pretentious, then quite cruelly comparing Mortimer J. Adler, general editor of the “Great Books of the Western World” series, with Sir William Haley, one of those deft, widely read English journalists who make all Americans feel provincial. To Epstein, “no two men were more unalike; Sir William, modest, suave, intellectually sophisticated; Mortimer vain, coarse, intellectually crude.” In effect, Fadiman and Adler are both presented as cultural snake-oil salesmen. Of course, both authors were popularizers and adept at marketing their work, but helping to enrich the intellectual lives of ordinary people doesn’t strike me as an ignoble purpose.

In his own work, Epstein regularly employs humor, bits of slang or wordplay, and brief anecdotes to keep his readers smiling. For instance, in a chapter about an editorial stint at the Encyclopaedia Britannica, Epstein relates this story about a colleague named Martin Self:

“During those days, when anti-Vietnam War protests were rife, a young woman in the office wearing a protester’s black armband, asked Martin if he were going to that afternoon’s protest march. ‘No, Naomi,’ he said, ‘afternoons such as this I generally spend at the graveside of George Santayana.’”

Learned wit, no doubt, but everything — syntax, diction, the choice of the philosopher Santayana for reverence — is just perfect.

But Epstein can be earthier, too. Another colleague “was a skirt-chaser extraordinaire," a man "you would not feel safe leaving alone with your great-grandmother.” And of himself, he declares: “I don’t for a moment wish to give the impression that I live unrelievedly on the highbrow level of culture. I live there with a great deal of relief.”

In his many essays, including the sampling in “Familiarity Breeds Content,” Epstein is also markedly “quotacious,” often citing passages from his wide reading to add authority to an argument or simply to share his pleasure in a well-turned observation. Oddly enough, such borrowed finery is largely absent from “Never Say You’ve Had a Happy Life.” One partial exception might be the unpronounceable adjective “immitigable,” which appears all too often. It means unable to be mitigated or softened, and Epstein almost certainly stole it from his friend Shils, who was fond of the word.

Despite his autobiography’s jaunty title, Epstein has seen his share of trouble. As a young man working for an anti-poverty program in Little Rock, he married a waitress after she became pregnant with his child. When they separated a decade later, he found himself with four sons to care for — two from her previous marriage, two from theirs. Burt, the youngest, lost an eye in an accident while a toddler, couldn’t keep a job, fathered a child out of wedlock and eventually died of an opioid overdose at 28. Initially hesitant, Epstein came to adore Burt’s daughter, Annabelle, as did his second wife, Barbara, whom he married when they were both just past 40.

Some pages of “Never Say You’ve Had a Lucky Life” will be familiar to inveterate readers of Epstein’s literary journalism, all of which carries a strong first-person vibe. Not surprisingly, however, the recycled anecdotage feels less sharp or witty the second time around. But overall, this look back over a long life is consistently entertaining, certainly more page-turner than page-stopper. To enjoy Epstein at his very best, though, you should seek out his earlier essay collections such as “The Middle of My Tether,” “Partial Payments” and “A Line Out for a Walk.” Whether he writes about napping or name-dropping or a neglected writer such as Somerset Maugham, his real subject is always, at heart, the wonder and strangeness of human nature.

Never Say You’ve Had a Lucky Life

Especially if You’ve Had a Lucky Life

By Joseph Epstein

Free Press. 304 pp. $29.99

Familiarity Breeds Content

New and Selected Essays

Simon & Schuster. 464 pp. $20.99

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235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

🏆 Best Smoking Essay Examples & Topic Ideas

🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

You should also discuss the various consequences of cigarette use, such as lung cancer, and identify their relationship with the habit. By discussing both sides of the issue, you will be able to write an excellent essay.

Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

Find smoking essay samples and other useful paper samples on IvyPanda, where we have a collection of professionally written materials!

Conclusion of Smoking Should Be Banned on College Campuses Essay However, it is hard to impose such a ban in some colleges because of the mixed reactions that are held by different stakeholders about the issue of smoking, and the existing campus policies which give […]
Should Smoking Be Banned in Public Places? Besides, smoking is an environmental hazard as much of the content in the cigarette contains chemicals and hydrocarbons that are considered to be dangerous to both life and environment.
How Smoking Is Harmful to Your Health The primary purpose of the present speech is to inform the audience about the detrimental effects of smoking. The first system of the human body that suffers from cigarettes is the cardiovascular system.
Smoking: Problems and Solutions To solve the problem, I would impose laws that restrict adults from smoking in the presence of children. In recognition of the problems that tobacco causes in the country, The Canadian government has taken steps […]
Causes and Effects of Smoking Some people continue smoking as a result of the psychological addiction that is associated with nicotine that is present in cigarettes.
Smoking Cigarette Should Be Banned Ban on tobacco smoking has resulted to a decline in the number of smokers as the world is sensitized on the consequences incurred on 31st May.
On Why One Should Stop Smoking Thesis and preview: today I am privileged to have your audience and I intend to talk to you about the effects of smoking, and also I propose to give a talk on how to solve […]
Smoking: Effects, Reasons and Solutions This presentation provides harmful health effects of smoking, reasons for smoking, and solutions to smoking. Combination therapy that engages the drug Zyban, the concurrent using of NRT and counseling of smokers under smoking cessation program […]
Advertisements on the Effect of Smoking Do not Smoke” the campaign was meant to discourage the act of smoking among the youngsters, and to encourage them to think beyond and see the repercussions of smoking.
Smoking and Its Negative Effects on Human Beings Therefore, people need to be made aware of dental and other health problems they are likely to experience as a result of smoking.
Smoking Among Teenagers as Highlighted in Articles The use of tobacco through smoking is a trend among adolescents and teenagers with the number of young people who involve themselves in smoking is growing each day.
Smoking and Youth Culture in Germany The report also assailed the Federal Government for siding the interest of the cigarette industry instead of the health of the citizens.
Health Promotion Plan: Smokers in Mississippi The main strategies of the training session are to reduce the number of smokers in Mississippi, conduct a training program on the dangers of smoking and work with tobacco producers.
Public Health Education: Anti-smoking Project The workshop initiative aimed to achieve the following objectives: To assess the issues related to smoking and tobacco use. To enhance the health advantages of clean air spaces.
Smoking and Its Effects on Human Body The investigators explain the effects of smoking on the breath as follows: the rapid pulse rate of smokers decreases the stroke volume during rest since the venous return is not affected and the ventricles lose […]
Causes and Effects of Smoking in Public The research has further indicated that the carcinogens are in higher concentrations in the second hand smoke rather than in the mainstream smoke which makes it more harmful for people to smoke publicly.
Smoking Habit, Its Causes and Effects Smoking is one of the factors that are considered the leading causes of several health problems in the current society. Smoking is a habit that may be easy to start, but getting out of this […]
“Thank You For Smoking” by Jason Reitman Film Analysis Despite the fact that by the end of the film the character changes his job, his nature remains the same: he believes himself to be born to talk and convince people.
Summary of “Smokers Get a Raw Deal” by Stanley Scott Lafayette explains that people who make laws and influence other people to exercise these laws are obviously at the top of the ladder and should be able to understand the difference between the harm sugar […]
Aspects of Anti-Smoking Advertising Thus, it is safe to say that the authors’ main and intended audience is the creators of anti-smoking public health advertisements.
Introducing Smoking Cessation Program: 5 A’s Intervention Plan The second problem arises in an attempt to solve the issue of the lack of counseling in the unit by referring patients to the outpatient counseling center post-hospital discharge to continue the cessation program.
Teenage Smoking and Solution to This Problem Overall, the attempts made by anti-smoking campaigners hardly yield any results, because they mostly focus on harmfulness of tobacco smoking and the publics’ awareness of the problem, itself, but they do not eradicate the underlying […]
Smoking Qualitative Research: Critical Analysis Qualitative research allows researchers to explore a wide array of dimensions of the social world, including the texture and weave of everyday life, the understandings, experiences and imaginings of our research participants, the way that […]
Tobacco Debates in “Thank You for Smoking” The advantage of Nick’s strategy is that it offers the consumer a role model to follow: if smoking is considered to be ‘cool’, more people, especially young ones, will try to become ‘cool’ using cigarettes.
The Change of my Smoking Behavior With the above understanding of my social class and peer friends, I was able to create a plan to avoid them in the instances that they were smoking.
Health Promotion for Smokers The purpose of this paper is to show the negative health complications that stem from tobacco use, more specifically coronary heart disease, and how the health belief model can help healthcare professionals emphasize the importance […]
Gender-Based Assessment of Cigarette Smoking Harm Thus, the following hypothesis is tested: Women are more likely than men to believe that smoking is more harmful to health.
Hazards of Smoking and Benefits of Cessation Prabhat Jha is the author of the article “The Hazards of Smoking and the Benefits of Cessation,” published in a not-for-profit scientific journal, eLife, in 2020.
The Impact of Warning Labels on Cigarette Smoking The regulations requiring tobacco companies to include warning labels are founded on the need to reduce nicotine intake, limit cigarette dependence, and mitigate the adverse effects associated with addiction to smoking.
Psilocybin as a Smoking Addiction Remedy Additionally, the biotech company hopes to seek approval from FDA for psilocybin-based therapy treatment as a cigarette smoking addiction long-term remedy.
Tobacco Smoking: The Health Outcomes Tobacco smoke passing through the upper respiratory tract irritates the membrane of the nasopharynx, and other organism parts, generating copious separation of mucus and saliva.
Investing Savings from Quitting Smoking: A Financial Analysis The progression of interest is approximately $50 per year, and if we assume n equal to 45 using the formula of the first n-terms of the arithmetic progression, then it comes out to about 105 […]
Smoking as a Community Issue: The Influence of Smoking A review of the literature shows the use of tobacco declined between 1980 and 2012, but the number of people using tobacco in the world is increasing because of the rise in the global population.
Smoking Public Education Campaign Assessment The major influence of the real cost campaign was to prevent the initiation of smoking among the youth and prevent the prevalence of lifelong smokers.
Smoking Cessation Therapy: Effectiveness of Electronic Cigarettes Based on the practical experiments, the changes in the patients’ vascular health using nicotine and electronic cigarettes are improved within one-month time period. The usage only of electronic cigarettes is efficient compared to when people […]
Quitting Smoking and Related Health Benefits The regeneration of the lungs will begin: the process will touch the cells called acini, from which the mucous membrane is built. Therefore, quitting the habit of smoking a person can radically change his life […]
Smoking and Stress Among Veterans The topic is significant to explore because of the misconception that smoking can alleviate the emotional burden of stress and anxiety when in reality, it has an exacerbating effect on emotional stress.
Smoking as a Predictor of Underachievement By comparing two groups smoking and non-smoking adolescents through a parametric t-test, it is possible to examine this assumption and draw conclusions based on the resulting p-value.
Smoking and the Pandemic in West Virginia In this case, the use of the income variable is an additional facet of the hypothesis described, allowing us to evaluate whether there is any divergence in trends between the rich and the poor.
Anti-Smoking Policy in Australia and the US The anti-smoking policy is to discourage people from smoking through various means and promotion of a healthy lifestyle, as well as to prevent the spread of the desire to smoke.
Smoking Prevalence in Bankstown, Australia The secondary objective of the project was to gather and analyze a sufficient amount of auxiliary scholarly sources on smoking cessation initiatives and smoking prevalence in Australia.
Drug Addiction in Teenagers: Smoking and Other Lifestyles In the first part of this assignment, the health problem of drug addiction was considered among teens and the most vulnerable group was established.
Anti-Smoking Communication Campaign’s Analysis Defining the target audience for an anti-smoking campaign is complicated by the different layers of adherence to the issue of the general audience of young adults.
Smoking as a Risk Factor for Lung Cancer Lung cancer is one of the most frequent types of the condition, and with the low recovery rates. If the problem is detected early and the malignant cells are contained to a small region, surgery […]
Smoking Cessation Project Implementation In addition, the review will include the strengths and weaknesses of the evidence presented in the literature while identifying gaps and limitations.
Smoking Cessation and Health Promotion Plan Patients addicted to tobacco are one of the major concerns of up-to-date medicine as constant nicotine intake leads to various disorders and worsens the health state and life quality of the users.
Maternal and Infant Health: Smoking Prevention Strategies It is known that many women know the dangers of smoking when pregnant and they always try to quit smoking to protect the lives of themselves and the child.
A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.
Tackling Teenage Smoking in Community The study of the problem should be comprehensive and should not be limited by the medical aspect of the issue. The study of the psychological factor is aimed at identifying the behavioral characteristics of smoking […]
Peer Pressure and Smoking Influence on Teenagers The study results indicate that teenagers understand the health and social implications of smoking, but peer pressure contributes to the activity’s uptake.
Smoking Cessation Programs Through the Wheel of Community Organizing The first step of the wheel is to listen to the community’s members and trying to understand their needs. After the organizer and the person receiving treatment make the connection, they need to understand how […]
Smoking: Benefits or Harms? Hundreds of smokers every day are looking for a way to get rid of the noose, which is a yoke around the neck, a cigarette.
The Culture of Smoking Changed in Poland In the 1980-90s, Poland faced the challenge of being a country with the highest rates of smoking, associated lung cancer, and premature mortality in the world.
The Stop Smoking Movement Analysis The paper discusses the ideology, objective, characteristics, context, special techniques, organization culture, target audience, media strategies, audience reaction, counter-propaganda and the effectiveness of the “Stop Smoking” Movement.”The Stop Smoking” campaign is a prevalent example of […]
Smoking Health Problem Assessment The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
Integration of Smoking Cessation Into Daily Nursing Practice Generally, smoking cessation refers to a process structured to help a person to discontinue inhaling smoked substances. It can also be referred to as quitting smoking.
E-Cigarettes and Smoking Cessation Many people argue that e-cigarettes do not produce secondhand smoke. They believe that the e-fluids contained in such cigarettes produce vapor and not smoke.
Outdoor Smoking Ban in Public Areas of the Community These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their […]
Nicotine Replacement Therapy for Adult Smokers With a Psychiatric Disorder The qualitative research methodology underlines the issue of the lack of relevant findings in the field of nicotine replacement therapy in people and the necessity of treatment, especially in the early stages of implementation.
Smoking and Drinking: Age Factor in the US As smoking and drinking behavior were both strongly related to age, it could be the case that the observed relationship is due to the fact that older pupils were more likely to smoke and drink […]
Poland’s Smoking Culture From Nursing Perspective Per Kinder, the nation’s status as one of Europe’s largest tobacco producers and the overall increase in smoking across the developing nations of Central and Eastern Europe caused its massive tobacco consumption issues.
Smoking Cessation Clinic Analysis The main aim of this project is to establish a smoking cessation clinic that will guide smoker through the process of quitting smoking.
Cigarette Smoking Among Teenagers in the Baltimore Community, Maryland The paper uses the Baltimore community in Maryland as the area to focus the event of creating awareness of cigarette smoking among the teens of this community.
Advocating for Smoking Cessation: Health Professional Role Health professionals can contribute significantly to tobacco control in Australia and the health of the community by providing opportunities for smoking patients to quit smoking.
Lifestyle Management While Quitting Smoking Realistically, not all of the set goals can be achieved; this is due to laxity in implementing them and the associated difficulty in letting go of the past lifestyle.
Smoking in the Actuality The current use of aggressive marketing and advertising strategies has continued to support the smoking of e-cigarettes. The study has also indicated that “the use of such e-cigarettes may contribute to the normalization of smoking”.
Analysis of the Family Smoking Prevention and Tobacco Control Act The law ensures that the FDA has the power to tackle issues of interest to the public such as the use of tobacco by minors.
“50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al. Thun is affiliated with the American Cancer Society, but his research interests cover several areas. Carter is affiliated with the American Cancer Society, Epidemiology Research Program.
Pulmonology: Emphysema Caused by Smoking The further development of emphysema in CH can lead to such complications caused by described pathological processes as pneumothorax that is associated with the air surrounding the lungs.
Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
Health Promotion and Smoking Cessation I will also complete a wide range of activities in an attempt to support the agency’s goals. As well, new studies will be conducted in order to support the proposed programs.
Maternal Mental Health and Prenatal Smoking It was important to determine the variables that may lead to postpartum relapse or a relapse during the period of pregnancy. It is important to note that the findings are also consistent with the popular […]
Nursing Interventions for Smoking Cessation For instance, the authors are able to recognize the need to classify the level of intensity in respect to the intervention that is employed by nurses towards smoking cessation.
Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
Marketing Plan: Creating a Smoking Cessation Program for Newton Healthcare Center The fourth objective is to integrate a smoking cessation program that covers the diagnosis of smoking, counseling of smokers, and patient care system to help the smokers quit their smoking habits. The comprehensive healthcare needs […]
Smoking Among the Youth Population Between 12-25 Years I will use the theory to strengthen the group’s beliefs and ideas about smoking. I will inform the group about the relationship between smoking and human health.
Risks of Smoking Cigarettes Among Preteens Despite the good news that the number of preteen smokers has been significantly reducing since the 1990s, there is still much to be done as the effects of smoking are increasingly building an unhealthy population […]
Healthy People Program: Smoking Issue in Wisconsin That is why to respond to the program’s effective realization, it is important to discuss the particular features of the target population in the definite community of Wisconsin; to focus on the community-based response to […]
Health Campaign: Smoking in the USA and How to Reduce It That is why, the government is oriented to complete such objectives associated with the tobacco use within the nation as the reduction of tobacco use by adults and adolescents, reduction of initiation of tobacco use […]
Smoking Differentials Across Social Classes The author inferred her affirmations from the participant’s words and therefore came to the right conclusion; that low income workers had the least justification for smoking and therefore took on a passive approach to their […]
Cigarette Smoking Side Effects Nicotine is a highly venomous and addictive substance absorbed through the mucous membrane in the mouth as well as alveoli in the lungs.
Long-Term Effects of Smoking The difference between passive smoking and active smoking lies in the fact that, the former involves the exposure of people to environmental tobacco smoke while the latter involves people who smoke directly.
Smoking Cessation Program Evaluation in Dubai The most important program of this campaign is the Quit and Win campaign, which is a unique idea, launched by the DHCC and is in the form of an open contest.
Preterm Birth and Maternal Smoking in Pregnancy The major finding of the discussed research is that both preterm birth and maternal smoking during pregnancy contribute, although independently, to the aortic narrowing of adolescents.
Enforcement of Michigan’s Non-Smoking Law This paper is aimed at identifying a plan and strategy for the enforcement of the Michigan non-smoking law that has recently been signed by the governor of this state.
Smoking Cessation for Patients With Cardio Disorders It highlights the key role of nurses in the success of such programs and the importance of their awareness and initiative in determining prognosis.
Legalizing Electronic Vaping as the Means of Curbing the Rates of Smoking However, due to significantly less harmful effects that vaping produces on health and physical development, I can be considered a legitimate solution to reducing the levels of smoking, which is why it needs to be […]
Drinking, Smoking, and Violence in Queer Community Consequently, the inequality and discrimination against LGBTQ + students in high school harm their mental, emotional, and physical health due to the high level of stress and abuse of various substances that it causes.
Self-Efficacy and Smoking Urges in Homeless Individuals Pinsker et al.point out that the levels of self-efficacy and the severity of smoking urges change significantly during the smoking cessation treatment.
“Cigarette Smoking: An Overview” by Ellen Bailey and Nancy Sprague The authors of the article mentioned above have presented a fair argument about the effects of cigarette smoking and debate on banning the production and use of tobacco in America.
“The Smoking Plant” Project: Artist Statement It is the case when the art is used to pass the important message to the observer. The live cigarette may symbolize the smokers while the plant is used to denote those who do not […]
Dangers of Smoking While Pregnant In this respect, T-test results show that mean birthweight of baby of the non-smoking mother is 3647 grams, while the birthweight of smoking mother is 3373 grams. Results show that gestation value and smoking habit […]
The Cultural Differences of the Tobacco Smoking The Middle East culture is connected to the hookah, the Native American cultures use pipes, and the Canadian culture is linked to cigarettes.
Ban on Smoking in Enclosed Public Places in Scotland The theory of externality explains the benefit or cost incurred by a third party who was not a party to the reasoning behind the benefit or cost. This will also lead to offer of a […]
How Smoking Cigarettes Effects Your Health Cigarette smoking largely aggravates the condition of the heart and the lung. In addition, the presence of nicotine makes the blood to be sticky and thick leading to damage to the lining of the blood […]
Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
Smoking Prohibition: Local Issues, Personal Views This is due to the weakening of blood vessels in the penis. For example, death rate due to smoking is higher in Kentucky than in other parts of the country.
Smoking During Pregnancy Issues Three things to be learned from the research are the impact of smoking on a woman, possible dangers and complications and the importance of smoking cessation interventions.
The Smoking Problem: Mortality, Control, and Prevention The article presents smoking as one of the central problems for many countries throughout the world; the most shocking are the figures related to smoking rate among students. Summary: The article is dedicated to the […]
Tobacco Smoking: Bootleggers and Baptists Legislation or Regulation The issue is based on the fact that tobacco smoking also reduces the quality of life and ruins the body in numerous ways.
Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
Smoking Behavior Under Clinical Observation The physiological aspect that influences smokers and is perceived as the immediate effect of smoking can be summarized as follows: Within ten seconds of the first inhalation, nicotine, a potent alkaloid, passes into the bloodstream, […]
Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
Post Smoking Cessation Weight Gain The aim of this paper is to present, in brief, the correlation between smoking cessation and weigh gain from biological and psychological viewpoints.
Marketing a Smoking Cessation Program In the case of the smoking cessation program, the target group is made up of smokers who can be further subdivided into segments such as heavy, medium, and light smokers.
Smoking Cessation for Ages 15-30 The Encyclopedia of Surgery defines the term “Smoking Cessation” as an effort to “quit smoking” or “withdrawal from smoking”. I aim to discuss the importance of the issue by highlighting the most recent statistics as […]
Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
“Passive Smoking Greater Health Hazard: Nimhans” by Stephen David The article focuses on analyzing the findings of the study and compares them to the reactions to the ban on public smoking.
Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
Cigar Smoking and Relation to Disease The article “Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease and cancer in Men” by Iribarren et al.is a longitudinal study of cigar smokers and the impact of cigar […]
Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
The Importance of Nurses in Smoking-Cessation Programs When a patient is admitted to the hospital, the nursing staff has the best opportunity to assist them in quitting in part because of the inability to smoke in the hospital combined with the educational […]
New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
Female Smokers Study: Inferential Statistics Article The article “Differential Effects of a Body Image Exposure Session on Smoking Urge between Physically Active and Sedentary Female Smokers” deepens the behavioral mechanisms that correlate urge to smoke, body image, and physical activity among […]
Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
Smoking in the US: Statistics and Healthcare Costs According to the Centers for Disease Control and Prevention, tobacco smoking is the greatest preventable cause of death in the US.
Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
Teenagers Motivated to Smoking While the rest of the factors also matter much in the process of shaping the habit of smoking, it is the necessity to mimic the company members, the leader, or any other authority that defines […]
Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
Stopping Tobacco Smoking: Lifestyle Management Plan In addition, to set objective goals, I have learned that undertaking my plan with reference to the modifying behaviour is essential for the achievement of the intended goals. The main intention of the plan is […]
Smoking Epidemiology Among High School Students In this way, with the help of a cross-sectional study, professionals can minimalize the risk of students being afraid to reveal the fact that they smoke. In this way, the number of students who smoke […]
Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
Vancouver Coastal Health Smoking Cessation Program The present paper provides an evaluation of the Vancouver Coastal Health smoking cessation program from the viewpoint of the social cognitive theory and the theory of planned behavior.
Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
Tobacco Smoking and Its Dangers Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders.
Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
Cigarette Smoking and Parkinson’s Disease Risk Therefore, given the knowledge that cigarette smoking protects against the disease, it is necessary to determine the validity of these observations by finding the precise relationship between nicotine and PD.
Tuberculosis Statistics Among Cigarette Smokers The proposal outlines the statistical applications of one-way ANOVA, the study participants, the variables, study methods, expected results and biases, and the practical significance of the expected results.
Smoking Ban and UK’s Beer Industry However, there is an intricate type of relationship between the UK beer sector, the smoking ban, and the authorities that one can only understand by going through the study in detail The history of smoking […]
Status of Smoking around the World Economic factors and level of education have contributed a lot to the shift of balance in the status of smoking in the world.
Redwood Associates Company’s Smoking Ethical Issues Although employees are expected to know what morally they are supposed to undertake at their work place, it is the responsibility of the management and generally the Redwood’s hiring authority to give direction to its […]
Smokers’ Campaign: Finding a Home for Ciggy Butts When carrying out the campaign, it is important to know what the situation on the ground is to be able to address the root cause of the problem facing the population.
Mobile Applications to Quit Smoking A critical insight that can be gleaned from the said report is that one of the major factors linked to failure is the fact that smokers were unable to quit the habit on their own […]
Behavior Modification Technique: Smoking Cessation Some of its advantages include: its mode of application is in a way similar to the act of smoking and it has very few side effects.
Quitting Smoking: Strategies and Consequences Thus, for the world to realize a common positive improvement in population health, people must know the consequences of smoking not only for the smoker but also the society. The first step towards quitting smoking […]
Effects of Thought Suppression on Smoking Behavior In the article under analysis called I suppress, Therefore I smoke: Effects of Thought Suppression on Smoking Behavior, the authors dedicate their study to the evaluation of human behavior as well as the influence of […]
Suppressing Smoking Behavior and Its Effects The researchers observed that during the first and the second weeks of the suppressed behavior, the participants successfully managed to reduce their intake of cigarettes.
Smoking Cessation Methods These methods are a part of NRT or nicotine replacement therapy, they work according to the principle of providing the smoker with small portions of nicotine to minimize the addiction gradually and at the same […]
Understanding Advertising: Second-Hand Smoking The image of the boy caught by the smoke is in the center of the picture, and it is in contrast with the deep black background.
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A Love Letter To LA, From A Brit Who Never Thought She’d Fit In

A light skinned woman with brown hair and glasses is wearing a white shirt and jeans; she's standing in the waves as water laps around her

The miracle of backyard oranges

Ditching the stereotype, collective marveling, l.a. lessons.

T hat first smell of the air — it is sweeter out here, I swear. The feel of sand in my toes. My first farmers market with coconut tortillas and jackfruit carnitas.

From the time we landed, I was hooked.

I’d grown up in London. I’d been happily living on the East Coast for 10 years. The L.A. I thought I knew was for other people, not me. But the minute we arrived it felt like I’d stumbled on paradise.

Gone baby, gone. It’s remained this way ever since. A decade in, I still look up as I cross the street and wonder — wait, who put those palm trees there? And I clutch myself with glee.

That first week is still vivid. Each morning I’d get up, pad outside in my bare feet and stand there, face turned up to the sun, marveling that such a life existed.

No wonder Californians seemed so damn happy and healthy all the time! The young me back in damp, cold London could only have dreamed of such things (and did, enviously watching Baywatch and 90210 ).

A close up of an orange tree, with bright oranges and green leaves

We’d moved into a house that had an orange tree in the yard — a miracle. In England, oranges strictly arrived in supermarkets, slightly sullen from their arduous journey from Florida.

Back home, they were reserved for unimaginative fruit salads or quartered for mid-game refreshment at cricket matches. Here, the lushness, the proliferation, the goddamn extravagance of the fruit — I mean, you could just reach out and have one for breakfast!

Which brings me to food. Such a variety! Yes, I’d lived in New York with its plethora of choices, but somehow here there was a glee about the diversity, a pride in all the different cultures rubbing up against each other.

Japanese and Korean and Ethiopian and Persian, as well as more tacos than you could possibly try in one lifetime. And the pushing of food frontiers, the willingness to blend, the “Hey, why not mix Mexican and Korean food?” When I first saw a Kogi food truck I stood in disbelief …and reverence.

A light skinned woman with wind-blown dark hair and glasses is standing on the beach in late afternoon light. She's is looking thoughtfully into the camera

Over the years I’ve learned to let go of my preconceptions. On the East Coast I grabbed my husband and said, “I can’t move to Los Angeles! All the women are so gorgeous! I’ll just never fit in. They’ve all had work done, and their teeth are so perfect!” (Actually this is true — I’m still embarrassed by my British teeth and somehow Angeleno teeth gleam whiter in the sunshine).

Then we moved to the Westside and suddenly I’m awash in yogis in leggings and no makeup, wafting through the farmers market holding a perfectly situated bunch of sunflowers, with little thought to fashion or dressing up.

How can you reduce 10 million people to a stereotype? You can’t.

In fact dressing up seemed to consist of stepping out of Birkenstocks and putting on some Uggs. (My favorite look remains a fleece and flip flops. What would be an unimaginable combo in, say, New York or London just seems to make perfect sense here).

When I did finally make it to Beverly Hills, I found the L.A. of my imagination. Walking behind women in Chanel suits, men in cashmere sweaters and dogs in sequined collars and realizing … aha ... It’s all about the neighborhoods. There are so many. And each is different.

Downtown with its lofts and the Eastside with its hipster enclaves and Pasadena pressed up against the mountains and up through the 405 to a vast landscape of valley-ness laid out below, and out east to the desert … what an array of different experiences. I had no idea. How can you reduce 10 million people to a stereotype? You can’t.

There are some ways, though, that Angelenos who grew up here do betray themselves. Early on I was in Starbucks when the barista paused mid-pour. “Wow,” he said, staring through the big glass windows to the street. “Is that what I think it is?” Customers around me right and left turned to look, and each, too, became awestruck at the sight. What was it?

Rain was falling from the sky.

(As a child of London, I spent so much time in the rain that my shoes constantly squelched and my umbrella became surgically attached to my hand.)

Still, to be fair, my family had arrived during a period of drought. I, too, had grown unfamiliar with the appearance of rain. But even now, when we’ve had plenty of rain-filled winters, it seems to catch people off guard. I’ve become so assimilated that one day I actually thought, “Wait, what is that water falling from the sky?” and looked around to see if any sprinklers had gone rogue.

What else have I absorbed? That a 6 p.m. dinner reservation is perfectly acceptable. That going to sleep at 10 p.m. on New Year’s Eve is fine. That it’s not a big deal to stay inside for three days straight because hey, the sun is going to come out tomorrow anyway.

A wide shot of snowy mountains in the background, with different colors of vegetation in golds and greens in the foreground

That there are seasons here, and that during fall, the colors of the changing leaves on the trees can be as beautiful as Vermont, and that during winter it can feel damn cold because homes have no insulation.

That people really do surf before work, sun-silhouetted palm trees will make an appearance most nights, the impossibly good-looking waiter is likely an actor and that if you have to go somewhere five blocks away, driving is totally OK.

That there will always be a food truck wherever you go, there are geckos hanging out in the sun outside your house, and yes, the produce really does taste much better here — especially strawberries, even though there are two painful weeks each year when they’re just not available at farmers markets.

That there will always be someone grilling at the park, that skateboards are a legit form of transportation, and vegan soul food is not an oxymoron. And ultimately, that the sun makes you happy, the mountains are often snow-capped, and the wide horizon of the Pacific gives you room to dream.

A young Latino man with glasses in Mexico City in front of the Angel de Independencia

E. B. White is one of the most famous children’s book authors. But he should be better known for his essays.

I was well into adulthood before I realized the co-author of my battered copy of The Elements of Style was also the author of Stuart Little and Charlotte’s Web . That’s right, the White of the revered style manual that everyone knew as “Strunk and White” also wrote children’s books…as well as some of the best essays in the English language.

If you’re of a certain age, you might well remember E. B. White’s pointers in The Elements of Style :

Place yourself in the background; write in a way that comes naturally; work from a suitable design; write with nouns and verbs; do not overwrite; do not overstate; avoid the use of qualifiers; do not affect a breezy style; use orthodox spelling; do not explain too much; avoid fancy words; do not take shortcuts at the cost of clarity; prefer the standard to the offbeat; make sure the reader knows who is speaking; do not use dialect; revise and rewrite.

That’s some good advice, much better than the terrible counsel offered on Page 76: “Avoid the elaborate, the pretentious, the coy, and the cute.” Thanks, E. B., I do what I want. ☹️

Born in 1899 in Mount Vernon, N.Y., Elwyn Brooks White attended Cornell University, where he earned the nickname “Andy.” (Weird historical fact: If your last name was White, you were automatically an Andy at Cornell, in honor of the school’s co-founder, Andrew Dickson White. There is no connection to fellow Cornell alum Andy Bernard .) After graduation, White worked as a journalist and an advertising copywriter for several years. He published his first article in The New Yorker the year it was founded, 1925.

White became a staff writer at The New Yorker in 1927, but was an early enthusiast of the work-from-home movement, initially refusing to come to the office and eventually agreeing to come in only on Thursdays. In those days, he shared a small office (“a sort of elongated closet,” he called it) with James Thurber.

His famous officemate later recalled that White had an odd a brilliant habit: When visitors were announced, he would climb out the office window and scamper down the fire escape. “He has avoided the Man in the Reception Room as he has avoided the interviewer, the photographer, the microphone, the rostrum, the literary tea, and the Stork Club,” Thurber later remembered of the chronically shy author. “His life is his own.”

In 1929, White and Thurber co-authored their first book, Is Sex Necessary? Or, Why You Feel the Way You Do . (Don’t worry: It was comic essays.) That same year, White married Katharine Angell, The New Yorker’s fiction editor from its inaugural year until 1960. She was the mother of Roger Angell , the famed essayist and baseball writer who himself became a fiction editor at The New Yorker in the 1950s.

In 1938, White and Katharine moved permanently to a farm in Maine they had purchased five years before. If you’re wondering about the inspiration for 1952’s Charlotte’s Web , look no further than White’s 1948 essay for The Atlantic, “ Death of a Pig .” (He bought the pig with the intention of fattening it for slaughter; instead, he later nursed it through a fatal illness and buried it on the farm.)

Stuart Little had been published seven years before Charlotte’s Web . Along with 1970’s The Trumpet of the Swan , these books have made White one of the nation’s best-known children’s authors. I’m sure White didn’t mind, but by all rights, he should be better known for his essays. He authored over 20 collections of such classics as “Once More to the Lake,” “The Sea and The Wind That Blow,” “The Ring of Time,” “A Slight Sound at Evening” and “Farewell, My Lovely!” Endlessly anthologized, many are also taught in writing workshops to this day.

In 1949, White published Here Is New York , a short book developed from an essay about the pros and cons of living in New York City. In a 2012 essay for America , literary editor Raymond Schroth, S.J., noted White’s juxtaposition in Here Is New York of technological terrors like nuclear bombers (the Soviet Union detonated its first atomic bomb in 1949) with the simple beauties of nature:

Grand Central Terminal has become honky tonk, the great mansions are in decline, and there is generally more tension, irritability and great speed. The subtlest change is that the city is now destructible. A single flight of planes no bigger than a flock of geese could end this island fantasy, burn the towers and crumble the bridges. But the United Nations will make this the capital of the world. The perfect target may become the perfect “demonstration of nonviolence and racial brotherhood.” A block away in an interior garden was an old willow tree. This tree, symbol of the city, White said, must survive.

“It is a battered tree, long suffering and much climbed, held together by strands of wire but beloved of those who know it,” White wrote in Here Is New York . “In a way it symbolizes the city: life under difficulties, growth against odds, sap-rise in the midst of concrete, and the steady reaching for the sun. Whenever I look at it nowadays, and feel the cold shadow of the planes, I think: ‘This must be saved, this particular thing, this very tree.’”

The tree lasted for another six decades —two more than the Cold War, in fact—before finally being chopped down in 2009.

In a 1954 review of books by White and James Michener, America literary editor Harold C. Gardiner, S.J. , said White “has one of the most distinctive styles discernible on the American literary scene.” Since even the most cursory review of Father Gardiner’s many years of commentary shows he hated almost everything, it was quite a compliment. (Later in the review, he noted that “Mr. Michener, who has done better in his other books, comes a cropper here mainly because his style is wooden, sententious and dull.”)

In 1963, White received the Presidential Medal of Freedom for his writings. Fifteen years later, he was awarded a special Pulitzer Prize for “his letters, essays, and the full body of his work.” In 2005, the composer Nico Muhly debuted a song cycle based on The Elements of Style at the New York Public Library. Among its signature moments was a tenor offering more of White’s good advice, this time in song:

Do not use a hyphen between words that can be better written as one word .

White died in 1985 at his farm in Maine. His wife Katharine had died eight years earlier. His obituary in The New York Times quoted William Shawn, the legendary editor of The New Yorker:

His literary style was as pure as any in our language. It was singular, colloquial, clear, unforced, thoroughly American and utterly beautiful. Because of his quiet influence, several generations of this country's writers write better than they might have done. He never wrote a mean or careless sentence. He was impervious to literary, intellectual and political fashion. He was ageless, and his writing was timeless.

Our poetry selection for this week is “ Another Doubting Sonnet ,” by Renee Emerson. Readers can view all of America ’s published poems here .

Also, news from the Catholic Book Club: We are reading Norwegian novelist and 2023 Nobel Prize winner Jon Fosse’s multi-volume work Septology . Click here to buy the book, and click here to sign up for our Facebook discussion group .

In this space every week, America features reviews of and literary commentary on one particular writer or group of writers (both new and old; our archives span more than a century), as well as poetry and other offerings from America Media. We hope this will give us a chance to provide you with more in-depth coverage of our literary offerings. It also allows us to alert digital subscribers to some of our online content that doesn’t make it into our newsletters.

Other Catholic Book Club columns:

The spiritual depths of Toni Morrison

What’s all the fuss about Teilhard de Chardin?

Moira Walsh and the art of a brutal movie review

Who’s in hell? Hans Urs von Balthasar had thoughts.

Happy reading!

James T. Keane

James T. Keane is a senior editor at America.

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Essay on Smoking in English for Students
Get the huge list of more than 500 Essay Topics and Ideas. Conclusion of the Essay on Smoking. Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of ...
Introduction, Summary, and Conclusions
Introduction. Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation's public and economic health in the future (Perry et al. 1994; Kessler 1995).The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of ...
Introduction, Conclusions, and the Evolving Landscape of Smoking
Introduction. Tobacco smoking is the leading cause of preventable disease, disability, and death in the United States (U.S. Department of Health and Human Services [USDHHS] 2014).Smoking harms nearly every organ in the body and costs the United States billions of dollars in direct medical costs each year (USDHHS 2014).Although considerable progress has been made in reducing cigarette smoking ...
Essays About Smoking
In conclusion, a smoking persuasive essay is a powerful tool to persuade readers to take action against smoking. With the right research, evidence, and persuasive language, it is possible to change attitudes and behaviors related to smoking. Conclusion Writing an essay on smoking can be a difficult endeavor.
Conclusion of Smoking Should Be Banned
Campus Smoking: Conclusion of the Essay. In conclusion, smoking should be totally banned in campuses and colleges because of its severe health risks to both smokers and non-smokers. The health risks are much more to non-smokers because they may double up especially to those who already suffer from other ailments such as heart and lung problems.
Smoking: Effects, Reasons and Solutions
This damages the blood vessels. Smoking can result in stroke and heart attacks since it hinders blood flow, interrupting oxygen to various parts of the body, such as feet and hands. Introduction of cigarettes with low tar does not reduce these effects since smokers often prefer deeper puffs and hold the smoke in lungs for a long period.
Introduction, Summary, and Conclusions
The topic of passive or involuntary smoking was first addressed in the 1972 U.S. Surgeon General's report (The Health Consequences of Smoking, U.S. Department of Health, Education, and Welfare [USDHEW] 1972), only eight years after the first Surgeon General's report on the health consequences of active smoking (USDHEW 1964). Surgeon General Dr. Jesse Steinfeld had raised concerns about ...
Tobacco Smoking and Its Dangers
Introduction. Tobacco use, including smoking, has become a universally recognized issue that endangers the health of the population of our entire planet through both active and second-hand smoking. Pro-tobacco arguments are next to non-existent, while its harm is well-documented and proven through past and contemporary studies (Jha et al., 2013).
Writing a Smoking Essay. Complete Actionable Guide
Smoking Essay Conclusion. Any argumentative and persuasive essay on smoking must include a short conclusion. In the final passage, return to your thesis statement and repeat it in other words, highlighting the points you have made throughout the body paragraphs. You can also add final thoughts or even a personal opinion at the end to round up ...
Essay on Stop Smoking
Conclusion. Stopping smoking is challenging but vital. Let's strive for a smoke-free world for a healthier future. 250 Words Essay on Stop Smoking The Detrimental Effects of Smoking. Smoking is a habit that has been ingrained in numerous societies for centuries. Despite its prevalence, the deleterious effects of smoking on health are undeniable.
Argumentative Essay on Smoking Cigarettes
The dangers of smoking cigarettes have been well-documented, yet millions of people continue to engage in this harmful habit. The debate over the impact of smoking on public health is ongoing, with some arguing for stricter regulations and others advocating for personal freedom. In this essay, we will explore the various arguments surrounding smoking cigarettes and ultimately make the case for ...
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Persuasive Essay Examples About Smoking. Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally. A lot has been written on topics related ...
Essay on Smoking for Students and Children in English 500 words
Smoking has a multitude of detrimental physiological, psychological, and social effects that can have a significant negative impact on a person's life. Smoking can have a negative impact on our health. Smoking has a major negative influence on the lungs. Smoking is the primary cause of one-third of all cancer cases.
Smoking Persuasive Speech: [Essay Example], 545 words
Conclusion. In conclusion, the evidence overwhelmingly supports the argument that smoking is a harmful and addictive habit with far-reaching implications. The impact on individual health, financial burden, secondhand smoke exposure, and deceptive marketing tactics all underscore the urgent need for smoking cessation.
Smoking Free Essay Examples And Topic Ideas
42 essay samples found. Smoking refers to the inhalation of the smoke of burned tobacco encased in cigarettes, pipes, and cigars. Essays on smoking could discuss its health implications, the sociological factors contributing to smoking, the economics of tobacco industry, and the effectiveness of public health campaigns and policies aimed at ...
8 Conclusions and Recommendations
The committee used the criteria of causation described in Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service (U.S. Public Health Service, 1964) in drawing conclusions regarding those relationships. The criteria are often referred to as the Bradford Hill criteria because they were, as stated ...
Sample Conclusion About Smoking
Smoking" is the inhalation of smoke coming from an encased tobacco which contains nicotine. 2.". Penalized" is the act of giving punishment. 3. "Government" is the group of people ruling a state or a nation. 4. "Health" is the state of well-being of an individual. 5. "Environment" is the place where living and non-living ...
10+ Top Persuasive essay about smoking examples
Aim For the Emotions. Use powerful language and vivid imagery to draw readers in and make them feel like you do about smoking. 8. Use Personal Stories. Share personal stories or anecdotes of people who have successfully quit smoking and those negatively impacted by it. 9. Include an Action Plan.
The Roots of Tobacco: Tracing its Origin and Cultural Impact
Essay Example: Tobacco, a plant that has long fascinated and divided societies, finds its humble beginnings in the indigenous cultures of the Americas. ... This traditional use contrasts sharply with the commercial smoking practices seen worldwide, providing a glimpse into the plant's dual nature as both a sacred herb and a profane indulgence ...
Smoking: Causes and Effects
Smoking: Causes and Effects Essay. Exclusively available on IvyPanda. Among numerous bad habits of modern society smoking seems to be of the greatest importance. Not only does it affect the person who smokes, but also those who are around him. Many people argue about the appropriate definition of smoking, whether it is a disease or just a bad ...
Teenage Smoking Essay: Writing Guide & Smoking Essay Topics
Get an idea. The first step of creating a causes effects of teenage smoking essay is brainstorming topics. Think of the common reasons for teens smoking and analyze the possible outcomes. Here are some ideas for you: Causes. Effects. peer pressure (a desire to be as "cool" as friends); to relieve stress;
The Harmful Effects of Smoking
Human body is very vulnerable to harmful effects of smoking, and it can harm our heart, lungs, blood circulation, bones, stomach, mouth, eyes, skin, reproduction and fertility. Smoking effect on heart and lung in very serious manner, in case of heart nicotine raises blood pressure and blood gets clot easily. Carbon monoxide raids the blood of ...
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Introduction, Conclusions, and Historical Background Relative to E
Introduction. Although conventional cigarette smoking has declined markedly over the past several decades among youth and young adults in the United States (U.S. Department of Health and Human Services [USDHHS] 2012), there have been substantial increases in the use of emerging tobacco products among these populations in recent years (Centers for Disease Control and Prevention [CDC] 2015c).
Joseph Epstein recalls his lucky life in a memoir and essays
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235 Smoking Essay Topics & Titles for Smoking Essay + Examples
Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend. You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they ...
A Love Letter To LA, From A Brit Who Never Thought She'd Fit In
Rain was falling from the sky. (As a child of London, I spent so much time in the rain that my shoes constantly squelched and my umbrella became surgically attached to my hand.) Still, to be fair ...
E. B. White is one of the most famous children's book authors. But he
Fifteen years later, he was awarded a special Pulitzer Prize for "his letters, essays, and the full body of his work." In 2005, the composer Nico Muhly debuted a song cycle based on The ...

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Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence (2010)

SUMMARY OF REPORT

Pathophysiology

Smoking-Ban Background

Epidemiologic Studies

Plausibility of Effect

SUMMARY OF OVERALL WEIGHT OF EVIDENCE

Secondhand-Smoke Exposure and Cardiovascular Disease

Secondhand-Smoke Exposure and Acute Coronary Events

Smoking Bans and Acute Coronary Events

DATA GAPS AND RESEARCH RECOMMENDATIONS

COMMITTEE RESPONSES TO SPECIFIC QUESTIONS

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