Illnesses caused by tobacco addiction contribute to more than 40,000 deaths each year, with costs adding up to more than 50 billion in direct medical bills.  This is an enormous loss of human life, and could be eradicated if we all followed one simple rule: Don’t smoke!  Each year, smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murder, suicides, and fires combined! Every year, 1,400 people die in the state of Montana from tobacco related illnesses. 36% of Native Americans are smokers or have tried smoking. That’s higher than any other race. 35% of Montana High School students smoke. (34.8% in the U.S). Many adults started smoking at the age of 18 or before the age of 18. Research has shown that some youth have started smoking at ages younger than 10 years old! Tobacco is the single most preventable cause of premature death in the US. Kills more people each year than aids, alcohol, car accidents, murder, suicides, drugs, and fires combined. Nicotine is more addictive than cocaine and heroin. 3,500 Americans successfully quit smoking each day. 1,500 Americans die each day from smoking. Everyday 6,000 teens light up a cigarette for the first time. Women 3 times more likely to get lung cancer than men. 1 in five women start smoking while pregnant. Fastest growing group of smokers are women under 23. One in five deaths are smoking related. 90%of adult smokers started before 18, 50% by 14 and 80% by 18. More than 3 million youth regularly smoke. In past ten years number of kids under 18 who became daily smokers increased by over 70%? Less than 5% of daily smoking high school seniors think they will ‘definitely’ be smoking five years in the future. BUT of the daily smokers in high school 73% are still smoking an average of 8 years later. 2/3s of adult smokers get hooked in adolescence. 75% of kids who smoke 3-4 cigarettes will be hooked. Average of 15 million people use smokeless tobacco, 4 million between 10 and 20. Initiation of smokeless tobacco use 10. Regular use by 12 50 times higher risk of developing oral cancer. 27,000 new cases of oral cancer reported every year. Every hour someone is diagnosed with oral cancer- if diagnosed one in three chances of dying from it. 13 million men and women smoke cigars and pipes thinking it is safer. Average cigar smoker smokes 6-8 cigars a week. Secondhand smoke form cigars is more dangerous, it’s equal to secondhand smoke from 3 cigarettes. Carbon monoxide released is 30 times higher than cigarette. Smoke from one large cigar burned in a home takes 5 hours to go away. Carbon monoxide from 2 social cigar gatherings is higher than levels found on a California highway. ADULT SMOKING RATES ARE VERY HIGH:  Cigarette smoking among Indians adults in Montana is twice that of non-Indians at 38% and 18% respectively. SMOKING AMONG YOUTH IS A BIG CONCERN:  Current smoking rates for American Indian youth are not available, but national data from1990-1994 showed that about 40% of American Indian high school seniors smoked compared to 33% of white high school seniors.  It is estimated that on average each day in Montana five of our youth start the deadly habit of smoking and that one-third of those five will die prematurely of a tobacco-related disease.  Many of these youth will be American Indian. SMOKING CAUSES MOST DEATHS:  Nationally, lung cancer is the leading cause of cancer death among American Indians, and cardiovascular disease is the leading cause of death.  Tobacco-use is a critical risk factor for both these diseases. THE TOBACCO INDUSTRY TARGETS AMERICAN INDIANS:  To build its image and credibility, the tobacco industry has targeted American Indians by funding cultural events like powwows and rodeos and using Indian cultural symbols and designs in advertisements.  Tobacco companies spend about $26 million per year advertising their deadly products in Montana. STATE FUNDING FOR AMERICAN INDIAN PROGRAMS IS LACKING:  Montana’s Legislature and Governor Martz substantially reduced state funding for tobacco prevention programs for American Indians. The number of tribal governments who receive state funding for their communities was cut from seven to three for state fiscal years 2002 and 2003.  Montana receives about $30 million per year from the lawsuit settlement with the tobacco companies but spends less than 2% on tobacco prevention programs for its citizens. FACTS ABOUT WOMEN SMOKERS 24% of all adult Americans and 22% of American women are currently smokers. 41% of American Indian women are smokers. Over 30% of women below the poverty line smoke. Despite being the smallest percentage of the population in the U.S, American Indian women have the highest smoking rate. In 1997 37.9% of American Indians and Alaska Native men smoked compared to 27.4% of white men. 31.3% of American Indian and Alaska Native women  smoked compared to 23.3% white women. Among men and women combined 4.5% of American Indians and Alaska Natives use chewing tobacco or snuff compared to 3.4% whites. Approx 38,000 people die from secondhand smoke each year in the US. Exposure to secondhand smoke from a spouse is a cause of death from coronary heart disease among women who don’t smoke. One in five women in America are smokers. Every year tobacco related diseases kills 178,000 women making it the largest preventable cause of death among women in the US. Smoking is responsible for the premature death of approx. 3 million women since 1985. Women who die of a smoking related disease lose on average 14.5 years of potential life. Lung cancer is the leading cause of cancer death among women and has been for 15 years. However 80% of American women mistakenly believe that breast cancer is the primary cause of cancer death among women. In 1987 lung cancer surpassed breast cancer as the leading cause of cancer death among women. Nationally lung cancer is the leading cause of cancer death among American Indians and Alaska Natives. Today lung cancer remains the leading cause of cancer death among women with 72% of lung cancer deaths attributed to smoking. In 1999 about 62,000 women died of lung cancer. Lung Cancer is the number one killer of American Indian women followed by heart disease, breast and cervical cancer (all of which are aggravated by smoking). Women who begin smoking at an early age or who use smokeless tobacco may be at a higher risk for developing breast cancer. Studies show that smoking increases a woman’s risk of cervical cancer and pre cancerous conditions of the cervix. Recent studies suggest that this increase in risk is independent of Human Papillomavirus (HPV) infection. Evidence suggests that breast cancer is more likely to spread to the lungs in women who smoke than in women with breast cancer who do not smoke. Cardiovascular disease is the primary cause of death in the U.S. heart diseases and stroke together accounted for more than one third of all deaths in the U.S. in 1999. It is estimated that as many as 30% of deaths from cardiovascular disease are a result of commercial tobacco use. In 1999, heart disease killed more than 370.00 women in the U.S. Men were slightly less likely than women to die from heart disease. About 17% of all deaths from heart disease are attributed to smoking. However for women under the age of 65 smoking accounts for over twice as many (37%) deaths from heart disease. Women who smoke and are diabetic are three times more likely to have a stroke or to develop heart disease than diabetic women who do not smoke. Data estimates that as many as 22% of pregnant women and girls smoke. Approx 27% of pregnant women quit smoking upon learning they are pregnant, about 12% quit later in their pregnancy. In 1999 20.0% of American Indian women smoked during pregnancy. Women who smoke during their first pregnancy may be at increased risk of early-onset breast cancer. American Indian women have the highest rate of smoking during pregnancy in the country. Women who smoke increase their risk for infertility. Women who smoke may increase their risk for ectopic pregnancy and spontaneous abortion. Maternal smoking is associated with an increased risk of having a stillborn child. The risk of SIDS is greater among children who are exposed to secondhand smoke. Babies born to women who smoked during pregnancy are more likely to be underweight. Quitting smoking before or during pregnancy reduces the risk of poor reproductive outcomes. 41% of all smokers tried to quit during the past year. *Data Sources: Montana DPHHS. Montana Tobacco Use Surveillance Report:  Tobacco use among American Indian and non-Indian adults in Montana, 1999. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethic Minority Groups – African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics; A Report of the Surgeon General.  1998. Campaign for Tobacco-Free Kids – www.tobaccofreekids.org CDC. (2001). Cigarette Smoking Among Adults- United States, 1999 MMWR50 (4): 869-872 US Dept of Health and Human Services. Women and Smoking. A report of the Surgeon General. Rockville, MD/ US Dept of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001 Hoyert, DL, Arias, E. 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