Why do people smoke?

"It gives me great joy," said an old friend, a writer who consumes a pack a day. Well—actually more like two. Two packs. He has been smoking since he was a teenager. "There are so few things that bring me joy. The rest of my life is spent in nostalgia for the past and paralyzing anxiety about the future. Smoking is the one time that I live in the present. I love smoking."

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Actually, the first reason he gave me was: "Because I'm addicted." I have composed a eulogy for this friend in my head many times; he is almost 40 now, and I don't expect him to make it much past 50. He is one of the sharpest cultural observers I know, but he once admitted to me that the way he lives is a kind of slow suicide.

It is impossible, he says, to plan ahead; his life is so fundamentally messed up that the prospect of change is overwhelming. Quitting would mean planning for the future. And so he smokes. (Marlboro 100s, if you want to know. All cigarettes taste like shit, he told me, but they have slight variations in what kind of shit they taste like.)

History

Allan Brandt, a historian of American medicine and public health at Harvard, has been researching the history of cigarettes for more than 20 years and recently served as an expert witness for the U.S. Department of Justice in the federal fraud and racketeering case against the tobacco companies. In his new book, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America, Brandt places the cigarette deeply into historical context, showing how it has been the center of major cultural and political debates about risk, responsibility, and human health.

The cigarette is a 20th-century invention. Despite the mythology of tobacco advocates, people did not smoke cigarettes as we know them in Walter Raleigh's day. The difference lies in mass production. Mass production generates large quantities of a uniform product that can be sold cheaply, like Model Ts, canned ham, and trousers. Cigarettes were first mass-produced in 1882 during the enormous transformation in American society between 1880 and 1920 sometimes known as the "incorporation" of American culture; they were among the first mass-produced and mass-marketed consumer items.

"Even though tobacco was tremendously popular before the 20th century, and people chewed and smoked tobacco in pipes and cigars, the idea of mass consumption and national brands is something unknown to any other form of tobacco use," Brandt told me. "The cigarette constitutes a radical break in the popular use and meanings of tobacco."

Mass production requires convincing people to become mass consumers. This required a shift in the way people thought about the objects and goods that made up everyday life. At the turn of the 20th century, people were not accustomed to filling their homes with large quantities of consumer products. Modern advertising, also developed during this period, not only informed people of new products, it also taught them how and why to use them. Significantly, marketers quickly learned that consumers responded much better to messages that relied on emotion and inference rather than facts, especially when they wanted to get people to desire something they had never heard of before.

Before the mass marketing of mass-produced cigarettes started in the late 19th century, almost nobody smoked 40 of them a day. And lung cancer was so rare that it was not even mentioned in medical texts. But around 1900, lung cancer started appearing, and rates starting going up noticeably in the 1930s—lung cancer usually develops 20 to 30 years after regular smoking begins. Today, lung cancer rates are higher than breast cancer, prostate cancer, and colon cancer combined. But lung cancer has no walks and no ribbons because lung cancer victims are seen as responsible for their own deaths: 90 percent of lung cancer cases are caused by smoking.

Lung cancer is now one of the most common cancers worldwide, accounting for 1.2 million new cases annually. Most people die within two years of diagnosis. A mass-produced consumer good that did not exist 130 years ago is now the most prominent cause of premature death and chronic illness among adults around the world. In the United States, 430,000 people die every year from cigarette use.

Individualism

I asked Brandt if smoking is a voluntary act. "The term 'voluntary' is so problematic," he said. "Part of the purpose of my whole argument is to undermine this notion of voluntariness. Which is not to say that I don't think people make decisions to go to the store and purchase a pack of cigarettes. But what I wanted to do is see those types of decisions in a much deeper historical, cultural, social, and even biological context. And the tobacco industry is very active at the cultural, social, and biological level."

Blaming smokers for their own health problems is an American tradition. No one forced them to smoke, right? The tobacco industry has used this idea quite successfully to escape lawsuits.

But, Brandt writes in the Cigarette Century, this attitude is problematic. For one thing, almost all decisions to start smoking are made by children or adolescents. If you're past 21 and you don't smoke, chances are you never will. Tobacco companies, aware of this, have aggressively marketed to the young (known as "replacement smokers") from the beginning. In the 1980s, following a highly successful multibillion-dollar marketing campaign, 3- to 5-year-olds could identify Joe Camel almost as easily as they could identify Mickey Mouse. In 1997, American 8th to 12th graders smoked 890 million packs of cigarettes, which generated $737 million in revenue for the tobacco industry.

For another, tobacco companies have deliberately manipulated the chemicals in tobacco to make nicotine more quickly absorbed and thus cigarettes even more addictive. Nicotine, though it is a poison, is not the most harmful part of smoking. But it is brutally addictive—and keeps that 13-year-old coming back long after he or she has grown up.

But perhaps most manipulative was the industry's 50-year campaign to confuse the fact that smoking causes serious health risks. Brandt makes excellent use of the vast online archives of previously confidential tobacco industry documents at legacy.library.ucsf.edu. Once the risks of smoking became known in the 1950s, and especially after the 1964 U.S. Surgeon General's report confirmed, after exhaustive study, that smoking does cause lung cancer, the tobacco companies set out to cast this report into doubt.

The industry's technique was to repeat, over and over, the message that "more research was needed" to show that cigarettes caused cancer and that no absolute scientific proof had yet been provided. (If this sounds familiar, it's probably because the same strategies have been used to fight public awareness of global warming.) Brandt shows how the tobacco industry, in the face of the development of 20th-century population-based epidemiology (shaped significantly by the investigation into the causes of lung cancer), deliberately manipulated the process by which scientific research moves from theory to fact in the public mind.

Then there's the incredible ability of industry lawyers to manipulate every apparent victory by antismoking activists to their advantage. You know the warning label on cigarettes telling you that "smoking may be hazardous to your health"? It was worded by the tobacco companies to stave off litigation. By using the word "may," they left open the possibility that smoking did not cause cancer and not only threw doubt into smokers' minds but allowed them to skirt charges that they were knowingly selling a hazardous product.

The filter, which actually does very little to protect smokers, is merely another marketing tool, introduced during the first wave of public awareness of the health hazards of smoking and used to reassure smokers into thinking cigarettes are less deadly than they are. The most important part of the filter design is its ability to produce that reassuring brown stain. But the stain is a lie.

Finally, and most enduringly, the tobacco industry set out to make a powerful appeal to American anti-intellectualism, and promote the idea that smoking was an individual choice, made for reasons irrelevant to what a bunch of puritanical nerds were proclaiming with charts and numbers. An important character in this campaign was the Marlboro Man, who was invented to rebrand the product in the 1950s and became an American cultural icon by the end of the 1960s. (Marlboro had formerly been an upscale women's cigarette.) Representing what Stephen Colbert might now describe as "gut" feelings, he became an essential part of the tobacco industry's campaign to discredit and confuse the definitive studies showing the connection between cigarettes and lung cancer. The Marlboro campaign would dispense with copy almost entirely and, as Brandt writes, "convey message and meaning exclusively through image."

What was Marlboro Country like? A place where there was no epidemiology, only strong, silent men wandering alone. "The Marlboro cowboy suggested a mythic time, not only before the bureaucratization and urbanization of the 20th century, but a time of simple pleasures, before the midcentury discovery that smoking brought risk and disease," Brandt writes. Marlboro Country "offered images rich in denial and escapism, in reassurance and immortality."

"Smokers," he writes, "who are easy to stigmatize and condemn, assure our sense of a world in which individuals do make decisions, exercise agency, and control their destinies." People who smoke American Spirit brand think of themselves as being different from people who smoke the bigger brands, even though R.J. Reynolds owns both of them. "Keeping smoking essentially unregulated assists us in a larger denial of forces over which we may have little control. In this sense, we need the cigarette and the smoker to make sense of our world."

The worst is yet to come. The last section of The Cigarette Century describes how the tobacco industry—aided by the American government—is in the process of creating a public-health disaster in the developing world. Philip Morris and company are exporting smoking to the rest of the world at rates that make the American experience look mild. The projected figure for smoking-related deaths worldwide in the 21st century is one billion people, 70 percent of them in the developing world. In the 20th century, there were 100 million smoking-related deaths. By 2020, almost a quarter of all adult deaths will be due to smoking.

Smoking rates are falling in the United States—about 20 percent of Americans are smokers these days, down from 46 percent in 1950—but, after lobbying hard for free trade and to be excluded from any international health legislation, Marlboro and company can now advertise with abandon almost anywhere they want, and they are certainly doing so. By 2001, the tobacco industry was spending $11.1 billion a year to promote smoking. The market is four to five times more profitable in developing countries than it is here.

Brandt told me, "Where the cigarette spreads, we see in its wake cardiovascular disease, lung cancer, emphysema, and many other cancers and systemic chronic diseases associated with smoking. There was this perception that countries go through this transition from infectious diseases to these diseases that are chronic and systemic like in the U.S. But what we're really doing by spreading tobacco is putting nations that are already vulnerable, that don't have strong health-care infrastructures, at risk for dealing with infectious diseases like malaria, TB, and especially HIV, at the same time that they will be dealing with cardiovascular disease, stroke, and lung cancer. Our country never went through these risks simultaneously, but many countries now will be facing this burden of disease. It's a giant burden."

The sublime

But none of this entirely answers the question, "Why do people smoke?" It is interesting to read Brandt's book alongside a 1993 classic, Richard Klein's Cigarettes Are Sublime. Sublime was written in order to help Klein, a Cornell professor, understand what he was giving up as he quit smoking. His thesis is that the danger of smoking is exactly what makes it alluring. "Cigarettes are not positively beautiful, but they are sublime by virtue of their charming power to propose what Kant would call 'a negative pleasure': a darkly beautiful, inevitably painful pleasure that arises from some intimation of eternity."

The "sublime" is an 18th- and 19th-century Romantic idea characterizing the experience of beholding something so immense and powerful that it could cause your death. (Time has watered down this sense of "sublime," and it is now used to describe things like chocolate cake.) It is hard to read Klein and not be convinced that smoking really does have a transformative effect on the smoker and in one's perception of the smoker—and not merely in a health-related sense. Klein writes that cigarettes make the user beautiful and interesting. His book is filled with photos of culturally influential people smoking: Jean Cocteau, Jean-Paul Sartre (who kept smoking even with the prospect of having his feet amputated from smoking-related illness), Marguerite Duras. (It is also hard to read Klein and not wonder whether he was paid off by the tobacco industry, like several historians have now been. But, as he told me, "I have never been approached by tobacco companies, no doubt because I have always expressed my disdain for their hypocrisy and disgust at their criminal misrepresentations.")

Klein relates tobacco to the development of modern consciousness. Smoking was "enthusiastically taken up by modernity as a drug for easing the anxiety arising from the shock of successive assaults on old certainties and the prospect of greater unknowns... its use is an index of whatever revolution in consciousness may have occurred to transform the culture and the mores, the ethics and principles, of antiquity." It should not be surprising that smoking has been seen as a feminist statement and marketed as such by the industry.

But Klein also attests to the suicidal nature of smoking. He describes the last cigarette smoked by someone about to be executed, and reminds us, as does Brandt, of the connection between smoking and soldiers. Along with its spectacular production of consumer goods, the 20th century will be remembered for the almost incomprehensible scale of its wartime destruction. "The sublimity of smoking lies in its capacity to promote the illusion that we are viewing our own death, determining it from outside ourselves... Assuming a death of one's own choosing is more desirable than suffering a life over which one has no control."

I know a theater artist, now also the mother of two children, known for transgressive and experimental work. She started smoking a pack a day as a teenager "because I thought it was cool, serious, and matched by aspiring emotional and intellectual complexity," but quit smoking on her 27th birthday, prior to her first pregnancy. It didn't last. I hadn't seen her in a while when she visited one day, during her first child's toddlerhood. I watched her push her stroller down the city streets with a pack of Marlboros stashed in the stroller's cargo pocket and a burning fag in her mouth—for me, more shocking than any work she had created before.

She has quit (again) since then, after she discovered she was going to have a second child. She told me: "I don't smoke anymore, not at all. When I quit I did so because it seemed like a basic trial of will: If I cannot stop smoking—a very well-defined physical act—how could I ever act in more complicated ways on more difficult tasks—being honest, perceptive, responsible, responsive? It was the hardest thing I ever did."

She had quit the first time after breaking off a long-term relationship. "I realized that it was a lot like that feeling, giving up something that was a part of yourself, almost impossible to leave. Like grief but infinitely harder, because all you have to do is walk back through the door again. I would chant to myself that if I smoked even one small cigarette, it was over and I would smoke until death.

"I quit again when I found out I was pregnant. I took the pregnancy test five times, inhaling smoke desperately while I did it."

After cigarettes

America is no longer a nation of smokers. About a fifth of American adults still smoke, but the number seems to be going down all the time. What will it mean when Americans, the inventors of the mass-produced cigarette, no longer smoke? Does this mean we are growing up? Will we no longer be modern?

I have another friend who rolls his own cigarettes now. He is a musician, a woodworker, and the father of a 4-year-old, and has smoked on and off since the fifth grade. With hand rolling, he says, smoking is not only a lot cheaper, but "you can make a big one, you can make a small one. You have much more control over what you want. There's some craft to it. It's so much more satisfying to make your own. If you're going to talk about taste, they're much better.

"I'm doing it because I like it. It has less to do with time than with space. It's more about cementing me into a place, experiencing that place in that moment. It's like signing your name on a wall. 'I was here.'"

He smokes two cigarettes a day. recommended