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Unqualified, this word refers to tobacco smoking, which became popular and socially acceptable among European and American men in the 18th and 19th centuries. During and after World War I, cigarette smoking, the most dangerous form, increased rapidly among men, and it gained social acceptability among women in the 1930s and 1940s. In the mid-20th century, it was a widespread social custom when introduced to strangers to offer a cigarette. The addictive properties of nicotine had been empirically understood long before then and were confirmed by many pharmacological studies in the final third of the 20th century. The prevalence of smoking began to decline among men in the United Kingdom and the United States after the mid-20th century but increased sharply among girls and women. In the late 20th and early 21st centuries, smoking became increasingly prevalent in low- and middle-income countries, with female rates lagging behind those of men. Pandemic respiratory and other cancers and increasing coronary heart disease and stroke follow cigarette smoking trends, with a lag time of about 3 decades. Smoking control measures have often been ineffectual unless reinforced by consistent strong government support, e.g., with strict enforcement of policies that prohibit smoking in many public places. Tobacco companies and their advertisers wield enormous economic and political leverage and have successfully thwarted most efforts to reduce the appeal of smoking to new child addicts. Smoking therefore remains among the most pervasive and intractable public health problems in the world. The WHO Framework Convention on Tobacco Control (FCTC), approved by the World Health Assembly in 2003 and ratified by 57 nations as of 2005, came into effect in February 2005. The FCTC outlines strategies and tactics to deal with the problem. Time will tell how effective this will be.

Subjects: Public Health and Epidemiology.

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