Forty years after the first U.S. Surgeon General’s report linking tobacco to lung cancer, a large percentage of Americans are still smokers.

When U.S. Surgeon General Luther Terry issued the watershed report in January 1964 that smoking causes cancer and other serious illnesses, 45 percent of the adult population smoked. Today the number is less than one in four, but despite four decades of prevention efforts, tobacco use remains the No. 1 cause of preventable disease and death in America.

Tobacco-related disease kills about 440,000 Americans each year, and health costs associated with smoking run about $75 billion annually, according to the Centers for Disease Control.

About 48 million Americans smoke cigarettes, according to the American Heart Association, but most smokers are either actively trying to quit or want to quit. About 40 percent of adults how have ever smoked have quit.

Ex-smokers are being replaced by a generation of younger smokers, however. An estimated 3,000 children become regular smokers each day, and nearly a quarter of students are smokers by the time they graduate high school.

According to the American Lung Association, 90 percent of adult smokers started before they were 21 and half were regular smokers when they turned 18. Often, it becomes a long and hard habit to break.

A female college student in Nashville, Tenn., who asked not to be identified by name, said she started smoking because of boredom and has tried a couple of times to quit.

“I think it is gross and don’t enjoy it all the time,” she said. “When I go back home I don’t smoke, but because of my environment and the people I know here in Nashville, it’s harder to stop here.”

She said a lot of her friends smoke, including a roommate, and when one lights up the other usually follows.

“Then we come up with every excuse in the book to not stop–stress of school is the big one,” she said. “We think we are invincible at this age, and no doctor or anyone can tell or show me something that will make me quit. So nothing is really working, until I actually want to quit. My goal now is after I graduate.”

Smoking is highest among younger adults and the poor.

A number of anti-smoking measures have come and gone since 1964. More than 1,600 American communities have passed ordinances banning smoking in workplaces, along with some states.

A 1998 out-of-court settlement forced four major U.S. tobacco companies to pay $246 billion to 46 states which had brought lawsuits against big tobacco. Five years later, however, only four of those states have kept promises to use those funds primarily for programs aimed at stopping or preventing smoking. Thirty-eight states and the District of Columbia fund tobacco prevention programs at less than half the CDC minimum, or provide no state funding at all, according to a report by Campaign for Tobacco-Free Kids.

Cigarette advertising was banned on TV and radio in 1965, but the industry continues to spend about $11 billion a year in marketing and advertising, according to the Washington Post.

As U.S. smoking rates have dropped, tobacco companies have turned to new markets overseas. About 1.1 billion people around the world smoke, and the number is expected to grow to 1.6 billion by 2025.

Tobacco is the second-leading cause of death around the world. One in 10 deaths globally is smoking related, according to the World Heath Organization. If current trends continue, smoking will kill one in six people by 2030. Half the people who smoke today will die from tobacco-related diseases, a death toll of 600 million.

On top of health costs, tobacco contributes to poverty. Nearly 60 percent of the 5.7 billion cigarettes smoked each year and three-fourths of tobacco users are in developing countries, where governments often don’t try to limit tobacco use through methods like taxation.

“The contribution of tobacco to death and disease is well documented. Less attention is given to the ways in which tobacco increases poverty,” says a WHO paper promoting a “World No Tobacco Day,” which is celebrated May 31. “This is the damage that is done when scarce family resources are spent on tobacco products instead of food and other essential needs such as schooling and nutrition.”

Poor households in some parts of the world spend between 4 percent and 5 percent of their disposable income on tobacco, diverting scarce resources away from food and other basic needs, the WHO says. If two thirds of the money spent on cigarettes in Bangladesh were spent on food instead, it could save more than 10 million people from malnutrition.

The WHO also claims that tobacco growing harms the environment by leaching nutrients from the soil, pollution from pesticides and fertilizers and deforestation that results from fire curing of some common varieties of tobacco. In the late 1990s, UNICEF concluded that the use of children in tobacco production was widespread in many tobacco-producing countries.

Bob Allen is managing editor of Chasity Ann Gunn is a student at Belmont University and intern with the Baptist Center for Ethics.

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