As MPs debate plans for England to follow Scotland's lead and ban smoking in public, it seems our 500-year love-hate relationship with tobacco may finally be heading for the ashtray of history. So is it all over bar the coughing, or does the deadly weed still have a few tricks up its sleeve? Thanks to a concerted effort by doctors to raise awareness of the health risks involved in its use, tobacco can no longer be said to rule. But in schools, as in wider society, its power to divide appears to be stronger than ever.
The properties of Nicotiana tabacum, a member of the nightshade family, were known to the people of North and South America long before Europeans gave the plant a name. For thousands of years, they chewed its leaves or used them to make drinks, dressings and even enemas. And, of course, they smoked them, a practice for which the Mayans used the term "sik'ar". In 1497, Robert Pane, who accompanied Christopher Columbus on his second voyage to the Americas, described the plant and, over the next century, its reputation grew, first as a medicine (doctors recommended it for toothache, falling fingernails, worms, halitosis, lockjaw and, paradoxically, cancer) and finally as what one writer termed a "cushion on the sofa of pleasure".
The Elizabethans called it "softweed", and the Virgin Queen herself was persuaded to puff at a pipe. By 1604, so many Britons were smoking that King James I was moved to write A Counterblaste to Tobacco and increase import tax by 4,000 per cent. But by 1618, Virginia alone was exporting 50,000lb of the crop a year. And so began a succession of restrictions and relaxations that characterise Europe's love-hate relationship with the plant to the present day.
Such is the demand for tobacco wherever it takes hold (Sir Francis Bacon, writing in 1610, called it "a custom hard to quit") that its sale has always guaranteed a healthy income for producers and governments alike, a fact that has done nothing to hasten its demise. But just how far it affects users' health has long been a cause for concern.
As early as 1586, tobacco was referred to in Germany as a "violent herb"; 16 years later, an English text suggested it might affect users in the same way soot affected chimney sweeps. James I reckoned tobacco smoke was "harmful to the brain" and "dangerous to the lungs", and throughout the century, many outlandish claims were made on both sides of the debate. But without hard evidence, the arguments against tobacco use tended to be moral rather than medical. Not until the 1760s were the first clinical studies carried out, identifying the carcinogenic properties of snuff. Only in 1912 was a strong connection made between lung cancer and smoking, as the condition was still relatively rare. But the outbreak of the First World War two years later was to change all that, bringing a dramatic increase in the numbers lighting up. By the 1930s, smoking had become a mass habit, and people who had started smoking heavily in wartime were suffering the effects. Several studies made a link between disease and tobacco use and, in 1948, it was reported that the incidence of lung cancer had grown five times faster than that of other cancers since 1938, making it the most common form of the disease. By then, another world war had pushed cigarette sales to unprecedented levels. When the British Medical Journal broke the news in 1950 that heavy smokers were 50 times more likely than non-smokers to contract lung cancer, it was clear to many doctors that something had to be done.
In 1947, a 43 per cent increase in cigarette tax brought, overnight, a 14 per cent drop in tobacco consumption among British men. But although the notion of "giving up" was planted firmly in the public consciousness, it would be another decade before the state attempted anything more imaginative than fiscal intervention. 1958 saw the opening in Salford of the first local health authority smoking withdrawal clinic, but the Royal College of Physicians wanted central government to do more. Its landmark 1962 report, Smoking And Health, called for curbs on tobacco advertising, restrictions on sales to children and smoking in public places, and an increase in information on the tar and nicotine content of cigarettes. It also demanded further tax increases. Three years later, cigarette ads vanished from British TV screens and, in 1966, the first health warnings appeared on packets. A poster campaign asked: "Why learn about lung cancer the hard way?" For the first time, it looked as though the tobacco industry might have a serious fight on its hands.
The tipping point
In 1971, an organisation called Action on Smoking and Health (ASH) was set up by the Royal College of Physicians with the aim of making non-smoking the norm. It was a tall order at a time when a visiting Martian might have been forgiven for thinking cigarettes were an essential adjunct to the human respiratory system. In the era of kipper ties and platform shoes, it seemed that everybody smoked most of the time: in staffrooms, offices, restaurants and even hospitals. But slowly, things were changing. No longer fearful of lost advertising revenue, TV companies began showing documentaries such as Death in the West - the Marlboro story. Life insurance companies offered discounts to non-smokers, and low-tar brands started to take off. Meanwhile, employees exposed to second-hand smoke at work were finding they could sue their employers for compensation - and win. Who can say at what precise moment the tide turned? Was it in 1990, when Virgin Atlantic launched the first smoke-free flights to the United States, or in 1992, when "Marlboro Man" Wayne McLaren died of lung cancer? Perhaps it was in 1993, when McDonald's banned smoking in its UK restaurants. Or that memorable day in April 1994 when a former tobacco industry scientist told a hushed courtroom how his employers had suppressed his findings about the extraordinary power of nicotine to alter the human brain. Whenever the tipping point occurred, it appeared that an unstoppable process had been set in motion. But had it?
The sticking point
Around 21 per cent of men and 27 per cent of women in the UK are now ex-smokers, and surveys suggest that 70 per cent of current smokers want to give up. But statistics published this year make it clear that the prevalence of smoking changed little during the 1990s, and that the decline among adult smokers has slowed to around 0.4 per cent a year. Given the remarkable nature of nicotine, this is hardly surprising. Intended to protect the tobacco plant from insects, this powerful toxin is so similar to the neurotransmitter acetylcholine that, within eight seconds of inhalation, it is controlling the flow of more than 200 neurochemicals and triggering a whole party-bag of reward sensations and mood enhancements.
In response to the flood of insecticide, the brain undergoes physical changes, growing millions of extra receptors and allowing others to wither.
In this altered state, smokers attempting to quit are at once beset by chemically induced anxieties and mood swings, and they quickly realise that, without tobacco, they can no longer feel relaxed or confident. In short, they can no longer be themselves. Thus, in a very real sense, smoking has become bound up with their self-identity, and it is this bond that, in some circumstances, no amount of health education can untie.
Anyone who has ever read the stark, black print on a cigarette packet knows that smoking not only causes cancer but it also damages the unborn child.
In fact our knowledge about the dangers of inhaling tobacco smoke has advanced so much since the days when the so-called "smoker's cough" was little more than a minor social embarrassment that a full run-down of the known medical consequences would fill most of this magazine. ASH points out that tobacco is the only legally available product that kills people when it is used entirely as intended.
Every year, around 114,000 smokers in the UK die as a result of their habit: five times more people than are killed by road and other accidents, by poisoning and overdose, murder and manslaughter, suicide and HIV infection all put together. In fact half of all regular cigarette smokers will eventually die from smoking-related ailments, including respiratory, circulatory and digestive conditions, heart disease and a host of cancers.
And unless they give up, half of all teenagers smoking today will be killed by tobacco.
The young ones
The power of nicotine, and the threat to emotional well-being that its abandonment entails, makes many long-term smokers prepared to take their chances with these terrifying statistics. And there is another factor that helps to keep tobacco sales afloat - cigarettes' appeal to children. As adult smokers quit or die, adolescent ones replace them, despite increasing efforts to discourage them and the dramatic change in public attitudes to smoking in recent years.
According to ASH, about 450 children in Britain start smoking every day, and the habit appeals particularly to girls. Tobacco advertising and sports sponsorship have been shown to be powerful factors, but more complex social mechanisms are also clearly at work. As with other activities, it seems likely that when the majority cease, group leaders take it up again to be different. The activity then becomes fashionable, and the cycle continues.
Surveys show that the overwhelming majority of children are aware of the health risks. But more than 80 per cent of smokers start before the age of 18, when any future illness seems a lifetime away. Some health educators argue that it would be more effective to teach children about the ways in which the tobacco industry manipulates them for profit rather than simply to highlight the health dangers. Others believe no lasting progress will be made as long as cigarettes are still legally obtainable.
According to ASH, growing up with two parents who smoke increases the likelihood that a child will also become a smoker threefold. But a 1998 survey of 1,515 16-year-old students in 48 Danish schools also suggested children are encouraged to use tobacco by seeing their teachers smoking.
The researchers concluded that this finding "might provide support for those working to establish smoke-free schools". Although between 10 and 15 per cent of teachers in the UK are believed to smoke, and despite 1992 regulations requiring employers to provide smokers with "suitable arrangements in rest rooms and rest areas", bans on school premises are increasingly making designated areas a thing of the past. Such blanket bans are frequently seen as necessary in a setting where children are being taught about the benefits of a healthy lifestyle.
Madeleine Vigar, head of Castle Manor community upper school in Haverhill, Suffolk, and an ex-smoker, believes an outright ban gives students a consistent message. "It has been much easier to stop children smoking now we have a no-smoking site," she says. But in some schools, concerns about staff smoking outside the school gates, coupled with a desire to minimise stress levels among teachers, has ensured the retention of a smoking area on site. Mark Parsons, head of Oliver Goldsmith primary school in the south London borough of Southwark, believes facilities should be provided, albeit out of children's sight. "I've never smoked," he says. "But it's an addiction, after all, and some of my best teachers need a cigarette."
A problem shared
Not all teachers are equally convinced of the need to insulate students - particularly older teenagers - from the realities of tobacco use. When Claire Fox taught at an FE college in Hertfordshire, she often found herself smoking off site alongside 16-year-old students. "We'd end up talking about lessons," she says. "But senior colleagues would tut as they went past and make barbed comments in meetings about me setting a bad example. In a college where we were encouraging the 16-upward brigade to see themselves as young adults, the teachers who were smokers were treated as children. In such a sanctimonious, moralising atmosphere, any kids who had anything about them would be more inclined to rebel on the question."
By breaking the taboo on staff smoking alongside students, south London drug education adviser and former science teacher Sarah Blackshaw believes she can help both groups give up. As part of the Lewisham, Lambeth and Southwark Healthy Schools initiative, she is persuading teachers from those boroughs to join Year 10 and 11 students in joint smoking cessation groups (see case study).
Simon Clark, director of the smokers' pressure group, Forest, acknowledges that teachers need to be careful about smoking around younger children. But he adds: "As a parent, I'd far rather know my child was being taught by a good teacher, irrespective of whether or not he or she was a smoker." His comment implies that some people believe smokers should not be teachers.
And it seems likely that, as tobacco users become an ever smaller minority, they will be increasingly marginalised, infantilised and, in some circles, dehumanised. Nor are teachers immune from this hardening of attitudes, as a recent thread on a TES website discussion forum revealed. "Could they not short-cut the system and go smoke at the local cemetery?" one non-smoker asked. "Sorry," said another, "I can't bring myself to be remotely sympathetic to a smoker's plight as I loathe the dirty, filthy habit with a passion."
Indeed words such as "disgusting", "filthy", "stinking" and "revolting" peppered the contributions from non-smokers, giving the impression that, in some schools, a form of bloodless revolution has already taken place, in which the once dominant majority who ruled the smoke-filled staffrooms of yesteryear are in full retreat and therefore fair game for a good kicking.
The last stand
In response to this online onslaught, anonymous smokers who took part in the TES discussion were equally merciless. They characterised their critics as "health fascists", a smug and humourless bunch whose puritanism has all but extinguished that warming torch of humanity that once brightened every corridor and dining hall. One correspondent summed up the state of affairs at her school: "The best conversation is to be had in the smokers' room, which we affectionately refer to as 'nicotine nook'. But over the summer, it will be converted to a lab. We have been offered the use of a staff car, but there are five of us. And it's a Smart car..." Like the Mayans of old, it seems, modern-day users of Nicotiana tabacum face an uncertain future.
* For a complete chronology of tobacco use, from earliest times to 1997, visit History Net at www.historian.orgbysubjecttobacco1.html Read a blow-by-blow account of the battle for hearts, lungs and minds, on the ASH website at www.ash.org.uk. This site is packed with facts, figures and resources.l To read the full TES online smoking debate, or to make your own point, visit www.tes.co.uk and search "smoking" in the "all forums" archivel For a detailed but accessible account of how nicotine addiction works, see: http: whyquit.comwhyquitlinksaaddiction.html
Main text: David Newnham
Pictures: Corbis; Photonica
Additional research: Sarah Jenkins
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