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  • Updated 06.12.2025
  • Released 06.12.2025
  • Expires For CME 06.12.2028

Smoking in neurologic disorders

Authors
Alejandra Duque Ramirez MD, Daming Shao MD
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Editor
Anthony T Reder MD
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Cite this article

Introduction

Overview

It is believed that tobacco use dates back to around 6000 BC. The plant Nicotiana tabacum, native exclusively to the Americas, was first smoked by Native American populations for medicinal and cultural purposes. After 1492, Spanish explorers observed these practices and brought the habit back to Europe (30).

Although initially condemned by the Holy Inquisition, smoking rapidly gained popularity among Europeans traveling between continents. Portuguese sailors began commercially cultivating tobacco in Brazil, laying the foundation for a profitable transatlantic industry. By the late 16th century, the use of tobacco, whether smoked or snuffed, had become widespread across Europe. At the time, physicians believed tobacco had medicinal benefits and promoted its use for therapeutic purposes (94).

In the 19th century, cigarettes emerged as a popular form of tobacco consumption. Initially sold as hand-rolled Turkish cigarettes, mass production began in 1881 with the invention of the first cigarette-making machine by James Bonsack. This innovation led to the establishment of the American Tobacco Company, which continues today as British American Tobacco (13). Cigarettes gained further popularity during World War I and World War II, when they were included in soldiers’ rations and widely used on the battlefield. By the 1920s, targeted advertising campaigns expanded their appeal to women, opening a new and rapidly growing consumer market (94).

Beyond its pharmacological effects, smoking developed deep sociocultural associations throughout the 20th century. It was portrayed in film and advertising as a symbol of status, sophistication, sexuality, and rebellion, often endorsed by celebrities and public figures (13).

Concerns about the harmful effects of smoking began to surface early on. In the 1760s, British and German physicians warned of a possible link between tobacco use and cancers of the nose and lip. In the United States, the association between smoking and lung cancer was not widely recognized until the 1930s and 1940s, culminating in the landmark studies of Doll and Hill in the 1950s (13).

From the 1970s through the 1990s, tobacco companies faced increasing legal challenges due to mounting evidence of the link between smoking and cancer. They were forced to limit marketing practices, print health warnings on product labels, and contribute to anti-smoking campaigns. By the end of the 20th century, public smoking bans had been implemented in most parts of the world (104).

In more recent decades, the use of electronic cigarettes (e-cigarettes) has grown exponentially. Introduced to the U.S. market around 2006, these devices became especially popular among teenagers, young adults, former tobacco users, and even individuals with no prior history of smoking (65). In 2016, the U.S. Food and Drug Administration (FDA) began regulating e-cigarettes and initiated long-term research through the NIH to better understand their health effects (26).

Key points

• Tobacco use remains a major global health concern, with 7.7 million deaths attributed to smoking in 2019 and projections estimating at least 9 million annual deaths by 2030.

• Smoking is an independent risk factor for neurologic diseases, including stroke, cognitive impairment, and multiple sclerosis.

• Nicotine drives addiction through its action on nicotinic acetylcholine receptors, leading to dopamine release and long-term tolerance and dependence.

• Vaping poses neurologic risks due to the presence of harmful compounds, such as nicotine, aldehydes, and nitrosamines, on the combusting liquids.

• Cannabis smoking has also been linked to neurologic effects, including reported associations with cerebral ischemia and increased oxidative stress.

Historical note and terminology

It is believed that tobacco use dates back to around 6000 BC. The plant Nicotiana tabacum, native exclusively to the Americas, was first smoked by Native American populations for medicinal and cultural purposes. After 1492, Spanish explorers observed these practices and brought the habit back to Europe (30).

Although initially condemned by the Holy Inquisition, smoking rapidly gained popularity among Europeans traveling between continents. Portuguese sailors began commercially cultivating tobacco in Brazil, laying the foundation for a profitable transatlantic industry. By the late 16th century, the use of tobacco, whether smoked or snuffed, had become widespread across Europe. At the time, physicians believed tobacco had medicinal benefits and promoted its use for therapeutic purposes (94).

In the 19th century, cigarettes emerged as a popular form of tobacco consumption. Initially sold as hand-rolled Turkish cigarettes, mass production began in 1881 with the invention of the first cigarette-making machine by James Bonsack. This innovation led to the establishment of the American Tobacco Company, which continues today as British American Tobacco (13). Cigarettes gained further popularity during World War I and World War II, when they were included in soldiers’ rations and widely used on the battlefield. By the 1920s, targeted advertising campaigns expanded their appeal to women, opening a new and rapidly growing consumer market (94).

Beyond its pharmacological effects, smoking developed deep sociocultural associations throughout the 20th century. It was portrayed in film and advertising as a symbol of status, sophistication, sexuality, and rebellion, often endorsed by celebrities and public figures (13).

Concerns about the harmful effects of smoking began to surface early. In the 1760s, British and German physicians warned of a possible link between tobacco use and cancers of the nose and lip. In the United States, the association between smoking and lung cancer was not widely recognized until the 1930s and 1940s, culminating in the landmark studies of Doll and Hill in the 1950s (13).

From the 1970s through the 1990s, tobacco companies faced increasing legal challenges due to mounting evidence of the link between smoking and cancer. They were forced to limit marketing practices, print health warnings on product labels, and contribute to anti-smoking campaigns. By the end of the 20th century, public smoking bans had been implemented in most parts of the world (104).

In more recent decades, the use of electronic cigarettes (e-cigarettes) has grown exponentially. Introduced to the U.S. market around 2006, these devices became especially popular among teenagers, young adults, former tobacco users, and even individuals with no prior history of smoking (65). In 2016, the U.S. Food and Drug Administration began regulating e-cigarettes and initiated long-term research through the NIH to better understand their health effects (26).

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