Deaths related to smoking will more than triple worldwide in the next 25 years, and teen-age smoking in the United States is on the rise, according to a recent report from the American Heart Association.

World Health Organization statistics included in the report indicate the global death toll from diseases associated with tobacco will grow to 10 million in 2025, up from three million in the 1990s. "Anyone who sees these statistics should be very concerned," said AHA president Lynn Smaha. Smoking in the U.S. already is linked to one in five deaths due to cardiovascular disease, and approximately 430,700 Americans die each year from smoking-related sicknesses, according to the AHA's 2000 Heart and Stroke Statistical Update, the latest in a series of annual reports. Beyond mortality rates, smoking has other dire effects on individuals and community infrastructure. "Smoking costs U.S. residents an estimated $130 billion annually in medical care," said Smaha. "This includes costs related to smoking during pregnancy, which has been associated with low birth weight babies." Other negative impacts related to smoking run the gamut from missed workdays to lost productivity from disability to premature death to damages from fires caused by cigarettes. The increase in smoking among teen-agers is another alarming statistic. Surveys conducted from 1988 to 1996 show a 30 percent increase in the number of Americans aged 12 to 17 years who tried smoking, and a 50 percent increase among those who smoke on a daily basis. Researchers estimate that each day approximately 6,000 kids smoke for the first time and half of them end up using tobacco on a daily basis. Researchers estimate the cost of smoking in medical care alone is $130 billion a year. Adjusting these rates for the year 2000 indicates that about 4.1 million Americans aged 12 to 17 years use tobacco, and the number continues to grow. "If the trend continues," the report notes, "about five million of these young people will eventually die from a disease attributed to smoking" in coming years. There is hope for those willing to quit smoking. According to WHO, a smoker can decrease his chance of heart disease within one year of kicking the habit. An ex-smoker's comparative risk of dying from heart disease approaches that of a long-time non-smoker after 15 years without smoking. Researchers are focusing on the best ways to encourage kids to avoid smoking altogether. This is a crucial target audience since at least 80 percent of adult tobacco users began their habit before they are 18 years old. A recent study conducted in the Midwest indicates that active involvement in a program that teaches kids how to say no to cigarettes is much more effective than lecturing them on health risks. Researchers examined the effectiveness of the Minnesota Smoking Prevention Program, a project aimed at the social pressures to smoke. In the three-week program, kids evaluate cigarette advertisements and carry out role-playing in various peer-pressure situations. The smoking prevention program "had a significant impact on the students' confidence in their ability to say no," said Rick Petosa, a co-author of the study, after evaluating the surveys. "It also increased their belief that their peers would think that the decision not to smoke was an acceptable one." On the other hand, the students who attended lectures on health risks became less confident about refusing a cigarette and were more concerned about peer acceptance. "Lecturing to teenagers about the health risks of smoking does not discourage them from smoking. Social influence programs, on the other hand, focus specifically on the things that adolescents worry about," said Petosa. "The successful programs focus on social pressures and on developing the skills necessary to resist those pressures. It's more appropriate to teach teenagers about short-term consequences. Other researchers have found that these kinds of programs can cut the rate at which adolescents begin to smoke by 30 to 50 percent." The results of the study were published in a recent issue of Journal of School Health. The statistics found in the AHA's 2000 Heart and Stroke Statistical Update are compiled from data provided by several groups, including the World Health Organization, Centers for Disease Control and the National Health Interview Survey.

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