Hand-rolled Tobacco Research Articles

Screening evaluation of the quality of commercially available cigars, cigarillos, and bidis based on emission levels of selected terpenes and terpenoids

The aim of the research was to verify the use of the solvent-free, non-destructive and easy to operate analytical method to study and compare the emissions of 16 representatives of terpenes and terpenoids from commercially available cigars, cigarillos and bidis − a potential screening analysis for the quality of combustible tobacco products. To assess the amount of organic compounds emitted to the gaseous phase from investigated tobacco samples, the stationary emission chambers system (at the sample conditioning stage) and gas chromatography with flame ionization detector (at the final analyte determination stage) were used. Studied samples represented five origins: the Dominican Republic, Nicaragua, Mexico, Cuba, and India and two manufacture approaches: machine-made and handmade. The assessed values of total volatile organic compounds (TVOCs) was from 0.58 to 28 µg·g−1 (at 60 °C) and from 26 to 430 µg·g−1 (at 120 °C). For Dominican products, Camphene and α-Cedrene were characterized by the highest emission level (233 ± 34 ng·g−1 and (3.7 ± 1.4) × 102 ng·g−1, respectively). In a case of Mexican and Cuban products it was noticed that the emission level of determined terpenes and terpenoids is higher in the case of hand-rolled tobacco products than mechanically manufactured ones. In a case of Nicaraguan hand-rolled products, Camphene, L-(−)-Fenchone, and α-Cedrene were characterized by the highest emission rate at 120 °C (213 ± 81 ng·g−1, 191 ± 45 ng·g−1 and 213 ± 84 ng·g−1, respectively). The highest emission level for Indian products in 120 °C was observed for α-Cedrene and Geranyl Acetate – respectively 181.6 ± 4.4 ng·g−1 and 101 ± 13 ng·g−1. The results of this study may indicate that sometimes cheaper products such as cigarillo have an emission profile that classifies them between expensive products such as “large cigars.”

Trends in Daily Cigarette Consumption Among Smokers: A Population Study in England, 2008-2023.

This study aimed to estimate time trends in cigarette consumption among smokers in England between 2008 and 2023 and toexplore differences by key potential moderators. We used data from 57778 adult cigarette smokers participating in a nationally representative monthly cross-sectional survey between January 2008 and September 2023. We estimated monthly time trends in mean daily consumption of (1) any, (2) manufactured, and (3) hand-rolled cigarettes among all smokers and by main type of cigarettes smoked, smoking frequency, age, gender, occupational social grade, region, nicotine replacement therapy use, and vaping status. Overall cigarette consumption fell from 13.6 [95% CI = 13.3 to 13.9] to 10.6 [10.5 to 10.8] per day between January 2008 and October 2019 (a 22% decrease), then remained stable up to September 2023. Over this period, the proportion mainly orexclusively smoking hand-rolled cigarettes increased (from 30.6% [29.1%-32.1%] in 2008 to 52.1% [49.7%-54.5%] in 2023). As a result, manufactured cigarette consumption fell by 47%, from 9.5 [9.2-9.8] per day in January 2008 to 5.0 [4.7-5.3] in September 2023, while hand-rolled cigarette consumption increased by 35%, from 4.2 [3.9-4.4] to 5.6 [5.3-5.9], respectively. The decline in overall cigarette consumption was observed across all subgroups, but was greater among non-daily smokers, younger smokers, and those who vaped. Over the last 15 years, the average number of cigarettes consumed each day by smokers in England has fallen by almost a quarter, but has plateaued since October 2019. There has been a sharp decline in the number of manufactured cigarettes consumed and an increase in the number of hand-rolled cigarettes consumed, as smokers have increasingly shifted towards using hand-rolled tobacco. While average cigarette consumption in England has fallen over the past 15 years, this declining trend has stalled (and reversed in some population groups) since 2019. The availability of cheap, hand-rolled tobacco appears to be undermining policies that aim to reduce smoking by raising the price of tobacco (eg, through taxation) and could be targeted to reignite the decline in cigarette consumption.

Gambaran Nikotin pada Pra Lansia Perokok Linting (Tembakau) di Desa Pohgading Timur Kecamatan Pringgabaya

Background: Cigarettes are a type of tobacco product produced from the Nicotiana Tabacum, Nicotiana Rustica and other species. Cigarettes are cylinder-shaped from paper measuring between 70 – 120 mm long with a diameter of around 10 mm containing chopped tobacco leaves. There are two types of cigarettes, namely hand-rolled cigarettes and electronic cigarettes which are usually called vape or vapor. Objective: To find out the description of nicotine in hand-rolled (tobacco) smokers in East Pohgading village, Pringgabaya subdistrict. Method: The research is a descriptive analytical method. By taking samples using purposive sampling technique. Results: The results of the research that was carried out obtained samples of 42 elderly people who used hand-rolled cigarettes (tobacco), 41 samples were positive and 1 was negative for nicotine. Conclusion: Results from the urine of pre-elderly respondents who smoked hand-rolled (tobacco) were positive for nicotine as many as 41 people and 1 person was negative.

Options for modifying UK alcohol and tobacco tax: A rapid scoping review of the evidence over the period 1997–2018

Background Increased taxation is recognised worldwide as one of the most effective interventions for decreasing tobacco and harmful alcohol use, with many variations of policy options available. This rapid scoping review was part of a NIHR-funded project (‘SYNTAX’ 16/105/26) and was undertaken during 2018 to inform interviews to be conducted with UK public health stakeholders with expertise in alcohol and tobacco pricing policy. Methods Objectives: To synthesise evidence and debates on current and potential alcohol and tobacco taxation options for the UK, and report on the underlying objectives, evidence of effects and mediating factors. Eligibility criteria: Peer-reviewed and grey literature; published 1997–2018; English language; UK-focused; include taxation interventions for alcohol, tobacco, or both. Sources of evidence: PubMed, Scopus, Cochrane Library, Google, stakeholder and colleague recommendations. Charting methods Excel spreadsheet structured using PICO framework, recording source characteristics and content. Results Ninety-one sources qualified for inclusion: 49 alcohol, 36 tobacco, 6 both. Analysis identified four policy themes: changes to excise duty within existing tax structures, structural reforms, industry measures, and hypothecation of tax revenue for public benefits. For alcohol, policy options focused on raising the price of cheap, high-strength alcohol. For tobacco, policy options focused on raising the price of all tobacco products, especially the cheapest products, which are hand-rolling tobacco. For alcohol and tobacco, there were options such as levies that take money from the industries to help reduce the societal costs of their products. Due to the perceived social and economic importance of alcohol in contrast to tobacco, policy options also discussed supporting pubs and small breweries. Conclusions This review has identified a set of tax policy options for tobacco and alcohol, their objectives, evidence of effects and related mediating factors. The differences between alcohol and tobacco tax policy options and debates suggest an opportunity for cross-substance policy learning.

Options for modifying UK alcohol and tobacco tax: A rapid scoping review of the evidence over the period 1997-2018.

Increased taxation is recognised worldwide as one of the most effective interventions for decreasing tobacco and harmful alcohol use, with many variations of policy options available. This rapid scoping review was part of a NIHR-funded project ('SYNTAX' 16/105/26) and was undertaken during 2018 to inform interviews to be conducted with UK public health stakeholders with expertise in alcohol and tobacco pricing policy. Objectives: To synthesise evidence and debates on current and potential alcohol and tobacco taxation options for the UK, and report on the underlying objectives, evidence of effects and mediating factors. Eligibility criteria: Peer-reviewed and grey literature; published 1997-2018; English language; UK-focused; include taxation interventions for alcohol, tobacco, or both. Sources of evidence: PubMed, Scopus, Cochrane Library, Google, stakeholder and colleague recommendations. Excel spreadsheet structured using PICO framework, recording source characteristics and content. Ninety-one sources qualified for inclusion: 49 alcohol, 36 tobacco, 6 both. Analysis identified four policy themes: changes to excise duty within existing tax structures, structural reforms, industry measures, and hypothecation of tax revenue for public benefits. For alcohol, policy options focused on raising the price of cheap, high-strength alcohol. For tobacco, policy options focused on raising the price of all tobacco products, especially the cheapest products, which are hand-rolling tobacco. For alcohol and tobacco, there were options such as levies that take money from the industries to help reduce the societal costs of their products. Due to the perceived social and economic importance of alcohol in contrast to tobacco, policy options also discussed supporting pubs and small breweries. This review has identified a set of tax policy options for tobacco and alcohol, their objectives, evidence of effects and related mediating factors. The differences between alcohol and tobacco tax policy options and debates suggest an opportunity for cross-substance policy learning.

Options for modifying UK alcohol and tobacco tax: A rapid scoping review of the evidence over the period 1997–2018

Background: Increased taxation is recognised worldwide as one of the most effective interventions for decreasing tobacco and harmful alcohol use, with many variations of policy options available. This rapid scoping review was part of a NIHR-funded project (‘SYNTAX’ 16/105/26) and was undertaken during 2018 to inform interviews to be conducted with UK public health stakeholders with expertise in alcohol and tobacco pricing policy. Methods: Objectives: To synthesise evidence and debates on current and potential alcohol and tobacco taxation options for the UK, and report on the underlying objectives, evidence of effects and mediating factors. Eligibility criteria: Peer-reviewed and grey literature; published 1997–2018; English language; UK-focused; include taxation interventions for alcohol, tobacco, or both. Sources of evidence: PubMed, Scopus, Cochrane Library, Google, stakeholder and colleague recommendations. Charting methods: Excel spreadsheet structured using PICO framework, recording source characteristics and content. Results: Ninety-one sources qualified for inclusion: 49 alcohol, 36 tobacco, 6 both. Analysis identified four policy themes: changes to excise duty within existing tax structures, structural reforms, industry measures, and hypothecation of tax revenue for public benefits. For alcohol, policy options focused on raising the price of cheap, high-strength alcohol. For tobacco, policy options focused on raising the price of all tobacco products, especially the cheapest products, which are hand-rolling tobacco. For alcohol and tobacco, there were options such as levies that take money from the industries to help reduce the societal costs of their products. Due to the perceived social and economic importance of alcohol in contrast to tobacco, policy options also discussed supporting pubs and small breweries. Conclusions: This review has identified a set of tax policy options for tobacco and alcohol, their objectives, evidence of effects and related mediating factors. The differences between alcohol and tobacco tax policy options and debates suggest an opportunity for cross-substance policy learning.

Tobacco tax evasion in Western Balkan countries: tax evasion prevalence and evasion determinants

Background and objectiveTobacco tax evasion undermines the goal of tobacco taxes as a tobacco control measure to make tobacco products less affordable, increases the health risks for those who smoke...

How the Bidi Tobacco Industry Harms Child-workers: Results From a Walk-through and Quantitative Survey.

ObjectiveBidi is an inexpensive, low-processed, hand-rolled tobacco product. In Bangladesh, especially in Rangpur, tobacco farming and bidi processing are common. In this study, we aimed to evaluate the impact of bidi making on children working in bidi factories.MethodsThis qualitative(walk-through survey) and quantitative(questionnaire-based survey and a urine cotinine level quantitation) study was conducted in Rangpur, Bangladesh in 2017. Study population included child-workers aged ≤14 years who were regularly employed as bidi makers.FindingsThe results of the walk-through survey revealed hazardous working environments at bidi factories. For the quantitative survey, 171 child-workers were categorized into “less-working”(<5 hours/day) and “more-working”(≥5 hours/day) groups; additionally, “forced-working”(forced into work by parents) and “voluntary-working”(working voluntarily) groups were delineated within the same population. In the logistic regression analysis, odds ratios(ORs) of respiratory symptoms and unusual absence(absent ≥5 days/month) were higher in the “more-working” group than in the “less-working” group(unusual absence: OR, 2.91; 95% confidence interval[CI], 1.43-5.94), and this association became higher in the “forced-working” group with longer working hours(OR, 5.68, 95%CI 2.30-14.00).ConclusionsCheap, hand-rolled tobacco(bidi) is harmful to the health of bidi-making child-workers. Children in poverty bow to the demands of cheap labor and poverty and jeopardize their health and future prospects by working in bidi factories. Tobacco control policies should consider the social effects of tobacco beyond its biological effects.

The Relation Between Tobacco Tax Structure and Corruption in European Union Member States.

Background: Taxing tobacco products is one of the most effective tobacco control measures, and most countries apply a combination of specific taxes, which comprise a fixed amount per cigarette or gram of hand-rolling tobacco, and ad valorem taxes, which increase in proportion to the cost of the product. Since specific taxes reduce price differentials across tobacco product ranges while ad valorem taxes amplify them, we hypothesised that tobacco companies seeking to minimise the effect of tax increases on sales across a range of products will tend to favour, and hence lobby for, ad valorem rather than specific taxes; and that relatively corrupt governments would be more susceptible to such lobbying and hence, more likely to favour ad valorem taxes. Methods: We searched for cigarette tax data and Transparency International Corruption Perceptions Index (CPI) scores for current 28 EU Member States for the years 1995 to 2017/8. Trends in cigarette tax levels and the ratio of ad valorem to specific taxes at a national and mean EU level were analysed by visual inspection, the within-country relation between the ad valorem to specific tax ratio and CPI scores over time by time-series regression analysis, and at EU level, for which complete data were available from 1995 to 2017, using a multi-level regression model. Results: Within most Member States, the ad valorem to specific cigarette tax ratio declined over the study period and was not significantly associated with corruption score. However, at an aggregate EU-level, our multi-level model indicated that reduced corruption was associated with a significant increase in the ad valorem to specific cigarette tax ratio, by 0.04 (95% confidence interval: 0.003–0.077, p < 0.036) per unit increase in CPI score. Conclusions: The ratio of ad valorem to specific taxes declined in most EU Member States over the study period, with no evidence that those with higher levels of perceived corruption tended to favour ad valorem taxes.

Second-hand smoke generated by combustion and electronic smoking devices used in real scenarios: Ultrafine particle pollution and age-related dose assessment

Aerosol measurements were carried out in a model room where both combustion (conventional and hand-rolled cigarettes, a cigar and tobacco pipe) and non-combustion (e-cigarette and IQOS®) devices were smoked. The data were used to estimate the dose of particles deposited in the respiratory systems of individuals from 3months to 21years of age using the multiple-path particle dosimetry (MPPD) model. Regardless of the smoking device, the highest doses were received by infants, which reached 9.88×108particles/kg bw during a cigar smoking session. Moreover, 60% to 80% of the particles deposited in the head region of a 3-month-old infant were smaller than 100nm and could be translocated to the brain via the olfactory bulb. The doses due to second-hand smoke from electronic devices were significantly lower, below 1.60×108particles/kg bw, than those due to combustion devices. Dosimetry estimates were 50% to 110% higher for IQOS® than for e-cigarettes.

Impact of the Spanish smoking laws on tobacco consumption and secondhand smoke exposure: A longitudinal population study

BackgroundIn Spain, two smoke-free laws have been passed after the approval of the WHO-FCTC. This study assesses the impact of these Spanish smoking legislations on the active and passive smoking through a population cohort in Barcelona (Spain). MethodsThis is a longitudinal study before and after the implementation of two national smoking bans in Spain in a representative sample (n=1245) of adults (≥16years old) from Barcelona (Spain) surveyed in 2004–2005 and followed-up in 2013–2014. The final sample analyzed was 736 individuals. Both questionnaires (before and after the two laws) included the same variables about active and passive smoking. We calculated the prevalence and the prevalence ratio (PR, with their 95% confidence intervals, 95% CI) of smoking cigarettes and hand-rolled tobacco and also the prevalence of exposure to secondhand smoke (SHS) at home, work, public transport, leisure time and at any setting after vs. before Spanish legislations. ResultsAfter the implementation of the two Spanish smoke-free bans, a significant decrease was observed in the smoking prevalence (from 34.5% to 26.1%, PR=0.76, p<0.001), in the average cigarettes per day (median from 15.2 to 10.0, p<0.001), and in the percentage of conventional tobacco consumption (from 92.6% to 74.4%, PR=0.80, p<0.001). Furthermore, a significant increase in the use of hand-rolled tobacco (from 6.1% to 30.9%, PR=5.07, p<0.001) and other tobacco products (from 17.1% to 32.8%, PR=1.92, p<0.001) was observed. In addition, a significant decrease in the self-reported SHS exposure was observed in all the assessed settings (home, work, transport, and leisure time). ConclusionsThe implementation of the two smoke-free legislations in Spain is related to a reduction in smoking prevalence and SHS exposure. However, the smoking of other tobacco products, particularly hand-rolled tobacco, has increased among young population.

Effects of bidi smoking on all-cause mortality and cardiorespiratory outcomes in men from south Asia: an observational community-based substudy of the Prospective Urban Rural Epidemiology Study (PURE).

Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35-70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) adjusted for socioeconomic status and baseline risk factors between non-smokers, light smokers of bidis or cigarettes (≤10 pack-years), heavy smokers of cigarettes only (>10 pack-years), and heavy smokers of bidis (>10 pack-years). 14 919 men from 158 communities were included in this substudy (8438 non-smokers, 3321 light smokers, 959 heavy cigarette smokers, and 2201 heavy bidi smokers). Mean duration of follow-up was 5·6 years (range 1-13). The adjusted prevalence of self-reported chronic wheeze, cough or sputum, dyspnoea, and chest pain at baseline increased across the categories of non-smokers, light smokers, heavy cigarette smokers, and heavy bidi smokers (p<0·0001 for association). Adjusted cross-sectional age-related changes in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio were larger for heavy bidi smokers than for the other smoking categories. Hazard ratios (relative to non-smokers) showed increasing hazards for all-cause mortality (light smokers 1·28 [95% CI 1·02-1·62], heavy cigarette smokers 1·59 [1·13-2·24], heavy bidi smokers 1·56 [1·22-1·98]), cardiovascular events (1·45 [1·13-1·84], 1·47 [1·05-2·06], 1·55 [1·17-2·06], respectively) and respiratory events (1·30 [0·91-1·85], 1·21 [0·70-2·07], 1·73 [1·23-2·45], respectively) across the smoking categories. Bidi smoking is associated with severe baseline respiratory impairment, all-cause mortality, and cardiorespiratory outcomes. Stricter controls and regulation of bidis are needed to reduce the tobacco-related disease burden in south Asia. Population Health Research Institute, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Ontario.

Illicit tobacco trade in Greece: the rising share of illicit consumption during crisis

The paper presents the tobacco black market in Greece, its structure and actors, and explores the financing and the financial management of illicit tobacco trade as a manifestation of organised crime. During the era of economic crisis (since 2008) there has been a significant surge in tobacco smuggling, especially in illicit cigarettes, either in illicit whites or counterfeit brands and legal brands. Additionally, hand-rolling tobacco (HRT) is the new trend and it is easily accessible, even online. Criminal organizations involved in tobacco smuggling are generally not confined by national borders, as they often create partnerships within and outside the EU either with individuals or with other networks. Their main and sometimes sole illegal activity is tobacco smuggling. They appear to be increasingly involved in the illegal market and they are divided into those that deal with the illegal importation and transfer of the tobacco from abroad to Greece or to other European markets, and those that deal exclusively with the selling of tobacco products in Greek markets. Finally, due to the increase of this transnational criminal phenomenon, the policy measures to tackle the tobacco smuggling must be oriented towards transnational cooperation.

Correlation between tobacco control policies, consumption of rolled tobacco and e-cigarettes, and intention to quit conventional tobacco, in Europe

ObjectiveTo analyse the correlation between the implementation of tobacco control policies and tobacco consumption, particularly rolling tobacco, electronic cigarettes (e-cigarettes) users and the intent to quit smoking in 27 countries...

The relation between cigarette price and hand-rolling tobacco consumption in the UK: an ecological study

ObjectivesCigarette price increases reduce smoking prevalence but as a tobacco control policy are undermined by the availability of lower cost alternatives such as hand-rolling tobacco. The aim of this descriptive...

Gynaecomastia, galactorrhoea, and lung cancer in a man

In September, 2012, a 60-year-old man presented with right shoulder pain, productive cough, and dyspnoea of 3 months' duration, with 5 kg weight loss and anorexia. He was a manual labourer and had no history of chest pain, fever, or haemoptysis. He had smoked 20 bidis (thin hand-rolled cigarette-like tobacco wrapped in dried tendu leaf) per day for the past 40 years. He reported no other substance misuse or supplements intake. On examination, we noted no clubbing or lymphadenopathy. Testicular examination was normal. Bilateral gynaecomastia (see appendix) with watery discharge from nipple on squeezing was seen (see video). Radiography (figure A) and CT of the chest showed a mass lesion 9·9×9·4 cm in the right upper lung lobe, with loss of fat planes in the aortic arch and chest wall, multiple nodules in both lower lobes, and enlarged lymph nodes. Fibreoptic bronchoscopy showed a growth in right upper lobe bronchus. Endobronchial biopsy showed squamous cell carcinoma (see appendix). Immunohistochemistry for β-HCG (figure B) was positive, and negative for oestrogen and testosterone. Serum β-HCG was 20 000 IU/L (normal <5 IU/L). Serum 17-β oestradiol was 1160 pmol/L (normal 45–609 pmol/L). A urine pregnancy card test was positive. Liver and renal function tests, and serum concentrations of prolactin, testosterone, luteinising hormone, follicle stimulating hormone, thyroid stimulating hormone, and cortisol, were normal. Visual acuity, visual fields, and fundus examination were normal.

A global toxicogenomic analysis investigating the mechanistic differences between tobacco and marijuana smoke condensates in vitro

Like tobacco smoking, habitual marijuana smoking causes numerous adverse pulmonary effects. However, the mechanisms of action involved, especially as compared to tobacco smoke, are still unclear. To uncover putative modes of action, this study employed a toxicogenomics approach to compare the toxicological pathways perturbed following exposure to marijuana and tobacco smoke condensate in vitro. Condensates of mainstream smoke from hand-rolled tobacco and marijuana cigarettes were similarly prepared using identical smoking conditions. Murine lung epithelial cells were exposed to low, medium and high concentrations of the smoke condensates for 6h. RNA was extracted immediately or after a 4h recovery period and hybridized to mouse whole genome microarrays. Tobacco smoke condensate (TSC) exposure was associated with changes in xenobiotic metabolism, oxidative stress, inflammation, and DNA damage response. These same pathways were also significantly affected following marijuana smoke condensate (MSC) exposure. Although the effects of the condensates were largely similar, dose–response analysis indicates that the MSC is substantially more potent than TSC. In addition, steroid biosynthesis, apoptosis, and inflammation pathways were more significantly affected following MSC exposure, whereas M phase cell cycle pathways were more significantly affected following TSC exposure. MSC exposure also appeared to elicit more severe oxidative stress than TSC exposure, which may account for the greater cytotoxicity of MSC. This study shows that in general MSC impacts many of the same molecular processes as TSC. However, subtle pathway differences can provide insight into the differential toxicities of the two complex mixtures.

Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey

ObjectiveLittle evidence, other than that commissioned by the tobacco industry, exists on the size of the illicit tobacco trade. This study addresses this gap by examining the level and nature...

Golden-Silk Smoke: A History of Tobacco in China, 1550-2010 (review)

Reviewed by: Golden-Silk Smoke: A History of Tobacco in China, 1550-2010 Matthew P. Romaniello Golden-Silk Smoke: A History of Tobacco in China, 1550-2010. By Carol Benedict. Berkeley: University of California Press, 2011. 352 pp. $49.95 (cloth and e-book). In recent years there has been an undeniable turn toward the history of commodities. As an approach, it offers the opportunity to examine cross-cultural contacts, technology transfers, and the transmission of medical knowledge, among other attributes. At the same time, commodities history can uncomfortably straddle the intersections of economic and cultural history, as well as domestic and international history. It is a challenge at which few have excelled, but Carol Benedict is undoubtedly among those who have. Her study of the long history of China's experience with tobacco considers both national and international implications, the introduction and dissemination of foreign knowledge, and the remarkable progress by which tobacco became a "Chinese" product with its own cultural connotations. The book relates its history through the various tobacco products China consumed. Beginning with a long section on the arrival and spread of pipe tobacco, the narrative then discusses the differentiation of tobacco consumption with the rising popularity of snuff and water-pipe tobacco, and ends with the mass consumption of the machine-rolled cigarette. Though unquestionably a history of tobacco, the shifts in consumption reveal the underlying stages of commoditization. Borrowing Sidney Mintz's terminology, the early era is one of "extensification," when a new product is accepted and its consumption spreads throughout the social ranks. Snuff and water-pipe tobacco became popular with Chinese elites in the eighteenth century, and this class differentiation was "intensification" in which the commodity became a marker of elite social status. The cigarette, by comparison, was first consumed as a hand-rolled tobacco product among the urban poor, but, with the rise of machine-rolled cigarettes in the late nineteenth [End Page 426] century, modern marketing targeted all social groups, inventing new ways of appealing to elite consumers. Its overall popularity marks the cigarette as a prime example of an extensified commodity, but the connection between marketing and status meant it remained intensified as well. While the overarching narrative of tobacco's consumption resembles numerous other commodities, the depth of Benedict's research still offers new insights into the peculiarities of tobacco and Chinese society. China adopted a number of new crops from the New World, via the Spanish trade through Manila. First to be domesticated were maize and the sweet potato in the late sixteenth century, and tobacco arrived soon thereafter. Reflecting the diversity of the early modern global economy, tobacco appears to have arrived from Spanish and Portuguese traders along the coasts, from Korean merchants over land, and along Central Asian caravan routes. The Chinese reaction to tobacco has its similarities to and differences from that of the West. Unlike in Europe, there was little concern with the foreign nature of tobacco or of any particular association with "barbaric" peoples. Also unlike most Western societies, there was no particular fear of women smoking. Rather, overindulgence was condemned "as a wasteful extravagance." Furthermore, the criticism "was directed at all tobacco producers and consumers, not at female smokers in particular. To smoke was to indulge one's own pleasure at the expense of one's extended family and, by extension, the imperial order" (p. 85). Unquestionably, this is quite different from in the West, where a woman smoking was widely seen as a moral danger, even if female smokers were hardly unknown. The evaluation of the Chinese medical community, however, would have been familiar to Western doctors. Overindulgence placed patient's "health at risk by crossing moral boundaries of frugality and abstinence into the hedonism of overindulgence" (p. 97). While this verdict was the product of Chinese knowledge of "systematic correspondences," learning to moderate tobacco use was also the verdict of seventeenth-century English and Dutch medical authorities, whose knowledge came from Galenic principles. The mixture of Eastern and Western agreement and marked differences makes tobacco a template for comparing cross-cultural exchanges. Furthermore, one of the great strengths of Benedict's work is that the era of global exchange...

Determining the Factors Effecting the Cigarette, Narghile and Hand-rolled Tobacco Smoking Among Medical Technology Vocational Training School Students and Evaluation of their Opinions About Starting and Continuing with their Habits of Smoking

Determining the Factors Effecting the Cigarette, Narghile and Hand-rolled Tobacco Smoking Among Medical Technology Vocational Training School Students and Evaluation of their Opinions About Starting and Continuing with their Habits of Smoking