Tobacco use is endemic throughout the world. Tobacco can be smoked (as cigarettes, pipes or cigars), chewed (as compressed moist tobacco ‘plug’ or ‘twist’), snuffed (ground into fine powder and sniffed into the nose) or ‘dipped’ (as moist shredded or ground tobacco placed into the space between the gums and cheek) (West & Shiffman, 2004). Cigarette smoking is by far the most dangerous form of use, killing some 4.9 million people each year worldwide, more than 250 000 each year in the USA and more than 100 000 each year in the UK (World Health Organization, 2002). Many factors are involved in the instigation and maintenance of tobacco use but there is a consensus that its ability to deliver nicotine to the brain lies at the heart of the problem (US Department of Health and Human Services, 1988; Royal College of Physicians, 2000).

Health effects of tobacco use

Cigarette smoking in western countries leads to a 15-fold increase in risk of death from lung cancer and chronic obstructive pulmonary disease (COPD) and a 3-fold increase in risk from death from cardiovascular disease (see ‘Cancer: lung’, ‘Chronic obstructive pulmonary disease’ and ‘Coronary heart disease’). It also increases risks of a range of other cancers such as cancer of the bladder, larynx and oral cavity (see ‘Cancer: head and neck’). Smoking increases risk of age-related deafness and blindness, back pain, early menopause, impotence and infertility, gum disease leading to tooth loss, Type II diabetes and visual appearance of early ageing (see Haustein, 2002).