A. General Health Effects

Smoking is the leading cause of preventable death in the United States, and increasingly, around the world. More than 400,000 Americans die of smoking-attributable causes each year.1 Currently, worldwide smoking is estimated to cause 3 million deaths each year and this is expected to increase to 10 million deaths a year by around 2020. Approximately half of all long term smokers will die from smoking-related disease; one-quarter in middle age (35-69), losing 20 to 25 years of life expectancy, one-quarter in old age (70+), losing, 5-10 years of life expectancy.2 The majority of deaths attributed to smoking occur from lung cancer, coronary heart disease, emphysema and chronic bronchitis. Other important causes of smoking-attributable death include cancer of the larynx, oral cavity, esophagus, bladder, kidney, pancreas and stomach, stroke, atherosclerotic peripheral vascular disease and aortic aneurysm.3 Although the prevalence of smoking has declined dramatically since 1965, the decline has slowed in the last few years. In 1993, the prevalence of female smoking was 22.5 %, while male prevalence was 28.0%. Smoking was far more common among people with lower levels of education; 13.5 % of those with 16 or more years of education were smokers, as opposed to 36.8 % of those with 9-11 years of education.4 The nicotine contained in tobacco products is responsible for their addictive potential. The 1988 Report of the Surgeon General concluded that, "The pharmacological and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine. "