Smoking is the combustion of a substance, usually plant material, and the inhalation of resulting fumes. Today, smoking is mostly practiced by rolling the dried leaves of the tobacco plant into a cigarette. Other forms of tobacco smoking include the use of a smoking tobacco with a pipe or cigar, or using a bong. Cigarette smokers almost always inhale the smoke; most pipe and cigar smokers do not inhale. Smoking is primarily practiced as a route of administration for psychoactive chemicals because the active substances within the burnt, dried plant leaves (or other chemical) can vaporize into a gaseous state and be delivered into the respiratory tract, where they are rapidly absorbed into the bloodstream through the lungs and can reach the central nervous system. In the case of tobacco smoking, these active substances are a mixture of aerosol particles that include the pharmacologically active alkaloid nicotine, which stimulates the nicotinic acetylcholine receptors in the brain, and other non-psychoactive chemicals that result from combustion. Other notable drugs inhaled via smoking include tetrahydrocannabinol (from cannabis), morphine (from opium), cocaine (from crack), and methamphetamine. Designer drugs, or "research chemicals", can also be smoked. Tobacco smoking is the most popular form, being practiced by over one billion people globally, of whom the majority are in the developing countries. Less common drugs for smoking include cannabis and opium. Some of the substances are classified as hard narcotics, like heroin, but the use of these is very limited as they are usually not commercially available. Cigarettes are primarily industrially manufactured but also can be hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, and bongs. Smoking tobacco harms health, and is among the leading causes of many diseases such as lung cancer, heart attack, chronic obstructive pulmonary disease, erectile dysfunction, and birth defects. Diseases related to tobacco smoking have been shown to kill approximately half of long-term smokers when compared to average mortality rates faced by non-smokers. Smoking is estimated to kill more than seven million people worldwide each year, including 1.6 million non-smokers who die due to passive smoking. A 2023 analysis put global tobacco-attributable deaths at just over seven million for that year. The health risks of smoking have caused many countries to tax tobacco products heavily, publish anti-smoking advertisements, limit or ban tobacco advertising, and help smokers to quit. Smoking can be dated as early as 5000 BCE and has been recorded in many different cultures across the world. Early smoking evolved in association with religious ceremonies as offerings to deities, in cleansing rituals, or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americas, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Sub-Saharan Africa, it merged with existing practices of smoking (mostly of cannabis). In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown. Perception surrounding smoking has varied over time and from one place to another: holy and sinful, sophisticated and vulgar, a panacea and deadly health hazard. By the late 20th century, smoking came to be viewed in a decidedly negative light, especially in Western countries.
Health effects
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