Is smoking finally out of style?

• Position: World Health

The U.S.--the country that gave the world tobacco--now is leading it away from cigarettes, according to Earth Policy Institute, Washington, DC. After climbing for nearly a century, the number of cigarettes smoked per person in this country peaked at nearly 2,900 in 1976 and began to decline. By 2003 the figure had dropped to 1,545--a fall of 46%.

As the costs of smoking become clear, pressure to phase out cigarettes is gaining momentum. At its annual meeting in 2003, the American Society of Clinical Oncology called for the total elimination of tobacco. At a broader level, the World Medical Association, which includes organizations representing 10,000,000 physicians from 117 countries, has called for strong measures to reduce smoking. The 4,900,000 annual deaths from inhaling cigarette smoke exceed the 3,000,000 from all other air pollutants combined. Meanwhile, the World Health Organization (WHO) has launched a 'Tobacco Free Initiative.' Its Framework Convention on Tobacco Control was approved unanimously by the 192 countries attending the World Health Assembly. It calls for bans on advertising, higher taxes on cigarettes, and restrictions on smoking in the workplace.

World usage of this addictive product peaked in 1987 at 1,038 cigarettes smoked per person. Though the decline lagged behind trends in the U.S. by roughly a decade, the global figure fell to 887 cigarettes per person in 2002. In France, the number dropped from 1,750 in 1985 to 1,338 in 2003. In Japan, where most men once smoked, the peak came in 1992. Since then, annual consumption has dipped from 2,744 to 2,247 cigarettes in 2003, In China, the world's most populous country, smoking peaked in 1990 at 1,440 cigarettes per person and then fell to 1,330 by 2003. Keep in mind, though, that total tobacco usage worldwide still is growing, as the per person drop is less than the rise in population.

Evidence of the damaging effects of cigarette smoking on human health continues to accumulate. Today, there are at least 25 known tobacco-related diseases. Research findings show that smoking increases breast cancer in women by 30% and contributes to impotence in men. The constriction of small blood vessels that can prevent an erection in men who smoke is a forerunner of the blockage of the larger coronary arteries that leads to heart disease.

The number of deaths per year worldwide from smoking-related illnesses-currently at 4,900,000--is projected by WHO to reach 10,000,000 by 2020. The...