With the modernization of cigarette production compounded with the increased life expectancies during the 1920s, adverse health effects began to become more prevalent. In
, anti-smoking groups, often associated with anti-liquor groups, first published advocacy against the consumption of tobacco in the journal Der Tabakgegner (The Tobacco Opponent) in 1912 and 1932. In 1929, Fritz Lickint of Germany , published a paper containing formal statistical evidence of a lung cancer–tobacco link. During the Great depression Adolf Hitler condemned his earlier smoking habit as a waste of money, and later with stronger assertions. This movement was further strengthened with Nazi reproductive policy as women who smoked were viewed as unsuitable to be wives and mothers in a German family. Dresden, Germany
The movement in Nazi Germany did reach across enemy lines during the Second World War, as anti-smoking groups quickly lost popular support. By the end of the Second World War, American cigarette manufactures quickly reentered the German black market. Illegal smuggling of tobacco became prevalent, and leaders of the Nazi anti-smoking campaign were assassinated. As part of the
Marshall plan, the United States shipped free tobacco to ; with 24,000 tons in 1948 and 69,000 tons in 1949. Per capita yearly cigarette consumption in post-war Germany steadily rose from 460 in 1950 to 1,523 in 1963. By the end of the 20th century, anti-smoking campaigns in Germany were unable to exceed the effectiveness of the Nazi-era climax in the years 1939–41 and German tobacco health research was described by Robert N. Proctor as "muted". Germany
Richard Doll in 1950 published research in the British Medical Journal showing a close link between smoking and lung cancer. Four years later, in 1954 the British Doctors Study, a study of some 40 thousand doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related. In 1964 the United States Surgeon General 's Report on Smoking and Health likewise began suggesting the relationship between smoking and cancer, which confirmed its suggestions 20 years later in the 1980s.
As scientific evidence mounted in the 1980s, tobacco companies claimed contributory negligence as the adverse health effects were previously unknown or lacked substantial credibility. Health authorities sided with these claims up until 1998, from which they reversed their position. The Tobacco Master Settlement Agreement, originally between the four largest
US tobacco companies and the Attorneys General of 46 states, restricted certain types of tobacco advertisement and required payments for health compensation; which later amounted to the largest civil settlement in history. United States
From 1965 to 2006, rates of smoking in the
have declined from 42% to 20.8%. A significant majority of those who quit were professional, affluent men. Despite this decrease in the prevalence of consumption, the average number of cigarettes consumed per person per day increased from 22 in 1954 to 30 in 1978. This paradoxical event suggests that those who quit smoked less, while those who continued to smoke moved to smoke more light cigarettes. This trend has been paralleled by many industrialized nations as rates have either leveled-off or declined. In the developing world, however, tobacco consumption continues to rise at 3.4% in 2002. In United States Africa, smoking is in most areas considered to be modern, and many of the strong adverse opinions that prevail in the West receive much less attention. Today Russia leads as the top consumer of tobacco followed by Indonesia, Laos, Ukraine, Belarus, Greece , Jordan, and . The World Health Organization has begun a program known as the Tobacco Free Initiative (TFI) in order to reduce rates of consumption in the developing world. China
Because they are engaging in an activity that has negative effects on health, people who smoke tend to rationalize their behavior. In other words, they develop convincing, if not necessarily logical reasons why smoking is acceptable for them to do. For example, a smoker could justify his or her behavior by concluding that everyone dies and so cigarettes do not actually change anything. Or a person could believe that smoking relieves stress or has other benefits that justify its risks.
The reasons given by smokers for this activity are broadly categorized as addictive smoking, pleasure from smoking, tension reduction / relaxation, social smoking, stimulation, habit / automatism, and handling. There are gender differences in how much each of these reasons contribute, with females more likely than males to cite tension reduction / relaxation, stimulation and social smoking.
Some smokers argue that the depressant effect of smoking allows them to calm their nerves, often allowing for increased concentration. However, according to the Imperial College London, "Nicotine seems to provide both a stimulant and a depressant effect, and it is likely that the effect it has at any time is determined by the mood of the user, the environment and the circumstances of use. Studies have suggested that low doses have a depressant effect, while higher doses have stimulant effect."
The lack of deterrence by the deleterious health effects is a prototypical example of optimism bias.
A number of studies have established that cigarette sales and smoking follow distinct time-related patterns. For example, cigarette sales in the
have been shown to follow a strongly seasonal pattern, with the high months being the months of summer, and the low months being the winter months. United States of America
Similarly, smoking has been shown to follow distinct circadian patterns during the waking day—with the high point usually occurring shortly after waking in the morning, and shortly before going to sleep at night