The title of this book, Learning to Smoke: Tobacco Use in the West, originally suggested to me that it was about the western part of the U.S. so I imagined that it would be wrapped in historical cowboy mystique. Instead, "west" refers to western civilization, thus including all of Europe and the whole of the Western Hemisphere. I am not sure that "west" helps clarify the differences between the origins of smoking in the western hemisphere versus the eastern hemisphere. A better title might have been "A Sociologist's Review of the Historical Development of Smoking in Western Civilization."

The book contains many historical anecdotes which are ostensibly presented to buttress the sociological position being postulated. Some of the anecdotes are new, having been discovered in very obscure historical books, but most are well known. Some of the anecdotes do indeed illustrate the point being made while others have tenuous linkages at best.

One chapter engages in the argument that tobacco use has been "medicalized" but does not relate its medicalization to that of other addictions, as if tobacco were unique in this area of drugs. The final chapter reports on the results of a qualitative study which the author conducted in the mid-1990s in one city in England. He interviewed two nonsmokers, nine ex-smokers, and 39 regular smokers in an attempt to ascertain the trajectory of nicotine use and nicotine addiction. The sample was not randomly selected but included a broad mix of occupations and ages, and ostensibly "represents a broader population." Direct quotations are heavily used in this chapter, elucidating themes the author discovered during the interviews. Not much new information is provided here. For instance, the first cigarette was tried because of peer pressure, they hated the taste, may have gotten sick but kept using because of perceived benefits (group membership), became addicted and realized it when withdrawal symptoms occurred, used cigarettes to fight boredom or stress, and now wishes they could quit. The author then takes this trajectory and attempts to relate it to the use of tobacco in Western society. This part is fairly brief, but given the overall utility of that proposal, is probably the right length.

For those among us who are not already familiar with the history of smoking in "the West," this book may provide some enlightening and even entertaining excerpts about the rise of smoking vis-à-vis changing political, social, and business mores. However, throughout the narrative, parsimony is often sacrificed. While you may find yourself wading through the writing style, it may be worth it, at least as a starting point in this field.

R. Craig Stotts RN, DrPH,
[cstotts@utmem.edu] is a Professor in the College of Nursing at the University of Tennessee Health Sciences Center, and Managing Editor of the Southern Online Journal of Nursing Research.

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