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PREFACE 



This Report of the Surgeon General is the U.S. Public Health 

 Service's 20th Report on the health consequences of tobacco use and 

 the 7th issued during my tenure as Surgeon General. Eighteen 

 Reports have been released previously as part of the health 

 consequences of smoking series; a report on the health consequences 

 of using smokeless tobacco was released in 1986. 



Previous Reports have reviewed the medical and scientific evi- 

 dence establishing the health effects of cigarette smoking and other 

 forms of tobacco use. Tens of thousands of studies have documented 

 that smoking causes lung cancer, other cancers, chronic obstructive 

 lung disease, heart disease, complications of pregnancy, and several 

 other adverse health effects. 



Epidemiolc^c studies have shown that cigarette smoking is 

 responsible for more than 300,000 deaths each year in the United 

 States. As I stated in the Preface to the 1982 Surgeon General's 

 Report, smoking is the chief avoidable cause of death in our society. 



From 1964 through 1979, each Surgeon General's Report ad- 

 dressed the major health effects of smoking. The 1979 Report 

 provided the most comprehensive review of these effects. Following 

 the 1979 Report, each subsequent Report has focused on specific 

 populations (women in 1980, workers in 1985), specific diseases 

 (cancer in 1982, cardiovascular disease in 1983, chronic obstructive 

 lung disease in 1984), and specific topics (low-tar, low-nicotine 

 cigarettes in 1981, involuntary smoking in 1986). 



This Report explores in great detail another specific topic: nicotine 

 addiction. Careful examination of the data makes it clear that 

 cigarettes and other forms of tobacco are addicting. An extensive 

 body of research has shown that nicotine is the drug in tobacco that 

 causes addiction. Moreover, the processes that determine tobacco 

 addiction are similar to those that determine addiction to drugs such 

 SIS heroin and cocaine. 



Actions of Nicotine 



All tobacco products contain substantial amounts of nicotine. 

 Nicotine is absorbed readily from tobacco smoke in the lungs and 

 from smokeless tobacco in the mouth or nose. Levels of nicotine in 



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