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Many of us in the public health arena have been fighting for decades to help create a worldwide society free of the disease and premature death associated with tobacco use. This effort has forced us to confront not only large, wealthy, deceitful industries, but also the nature of tobacco itself. Despite many public health efforts to promote a tobacco-free life, tobacco remains popular virtually everywhere in the world.

The public health struggle, however, is a mere shadow compared with the inner struggles of tobacco users themselves. They must deal not only with an addiction to nicotine, but with the other powerful and seductive effects of tobacco on their bodies and minds. Make no mistake: this is a struggle to the death. Smoking alone kills more than three million people worldwide every year, and is the direct cause of diseases that affect many millions more.

The numbers are so large that we can hardly envision them. Some 1.1 billion people worldwide use tobacco. This represents about 30 percent of the entire adult population of the world. Yet, as Dr. Janet Brigham writes in this book, we have become so accustomed to smoking as part of our culture, we no longer see it. We are so used to the cigar displays in convenience stores, smokers standing outside doorways on break, and groups of youngsters smoking as they walk down a street, we no longer notice these things.

Yet they affect us all.

Nearly forty years ago, a scientist named Rachel Carson wrote a book called Silent Spring that served as a wake-up call about the hazards we humans were posing to our environment. It became the herald for a new movement that had the potential to preserve our world.

Now it is time for us to preserve our lives. Dying to Quit is written in the same spirit as Silent Spring, and it has a message as alarming but as necessary to hear. Silent Spring outlined findings from the science of environmentalism. This book is also a book of science—the science of tobacco's effects on those who use it. It is not a how-to book, not a book about politics. It is a book about how human beings' feelings, thoughts, and lives are affected by nicotine and the many other constituents of tobacco.

Smoking must become a topic we care about; it must become a topic we are aware of, and one we follow with interest and concern. Our worldwide society needs not only legislation and public health initiatives, but also knowledge about the way tobacco affects those who use it. We need to know about tobacco if we are to deal successfully with its influence on the life of each smoker—particularly if we are to help those who want to quit. With that knowledge will come the ability to minimize the disease and death associated with long-term use of tobacco. And this is the most propitious time in history to quit, because of pharmaceuticals and nicotine replacement therapy never before available.

The backbone of our public health efforts has been the dedicated labor of hundreds of scientists and other researchers who have painstakingly learned how tobacco works and why its hold is so powerful. As I write this, we have just become aware of current science-based statistics indicating that smoking and other uses of tobacco are increasing alarmingly quickly among our young people. For many, this will not be surprising news, because we have seen this phenomenon on our streets and in our schools; but for most of us it is not welcome news.

The struggles of society are born anew with each person who comes into the world. Politics and science alone will not win the war that each tobacco user wages when he or she chooses to quit. That war must be fought—and can be won—only within the confines of the soul. This book goes far toward providing both the individual and the society with the weapons needed to succeed.

U.S. Surgeon General 1981—1989

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Copyright 1998 National Academy Press