A growing list of harms from smoking

WASHINGTON - It's no secret that smoking causes lung cancer. But what about diabetes, rheumatoid arthritis, erectile dysfunction? Fifty years into the war on smoking, scientists still are adding diseases to the long list of cigarettes' harms - even as the government struggles to get more people to kick the habit.

A new report from the Surgeon General's Office says the nation is at a crossroads, celebrating decades of progress against the chief preventable killer but not yet poised to finish the job.

"The real emphasis needs to be put on the fact that we still have a major and tragic catastrophe going on," said acting Surgeon General Boris Lushniak.

The report, being released Friday, is a dash of cold water after last week's headlines marking the 50th anniversary of the landmark 1964 surgeon general's report that launched the antismoking movement. Yes, far fewer Americans smoke today. But the government may not meet its goal of dropping that rate to 12 percent by 2020, the new report cautioned.

Nearly half a million people will die from smoking-related diseases this year. Each day, more than 3,200 youths smoke their first cigarette. New products such as e-cigarettes, with effects that aren't yet understood, complicate public health messages. And if current trends continue unabated, 5.6 million of today's children and teens will go on to die prematurely during adulthood because of smoking, the report found.

Remarkably, the report adds more entries to the official list of smoking-caused diseases, including Type 2 diabetes, rheumatoid arthritis, erectile dysfunction, the macular degeneration that can blind older adults, two additional cancers - liver and colorectal - and cleft palate birth defects.

"Enough is enough," Lushniak said. He urged new resolve to end smoking by increasing use of proven tobacco-control measures, including price hikes for cigarettes and expanded comprehensive indoor-smoking bans that he said currently cover about half the population.

The report also encourages research into newer ideas, such as whether lowering the amount of addictive nicotine in cigarettes would help people quit.

Here are some ways the smoking landscape has changed between the 1964 surgeon general's report and Friday's:

1964: The surgeon general declares that cigarette smoking increases deaths.

2014: About 20.8 million people in the United States have died from smoking-related diseases since then, a toll the report puts at 10 times the number of Americans who have died in all of the nation's wars combined.

1964: Heavy smoking is declared the main cause of lung cancer, at least in men. "The data for women, though less extensive, point in the same direction."

2014: Lung cancer is the top cancer killer, and women who smoke have about the same risk of dying from it as men.

1964: Male smokers were dying of heart disease more than nonsmokers, but the surgeon general stopped short of declaring cigarettes a cause of heart disease.

2014: Heart disease claims more lives of smokers 35 and older than lung cancer does. Likewise, secondhand smoke is riskier for the heart. Smoke-free laws have been linked to reductions in heart attacks.