The World Health Organization says five million people die prematurely each year of tobacco-related causes. In May, the organization adopted the world's first international treaty aimed at curbing tobacco smoking. The United States has been a leader in warning of the health risks associated with smoking, and taking steps to curb smoking. California has the most restrictive anti-smoking laws, and is using tobacco taxes to fund its anti-smoking campaign.
California health officials say they are waging a war on two fronts. The first is the "air" campaign. On the air, in radio and television spots, the message is the same: that cigarettes are addictive and deadly.
"I can't go more than a few hours without a cigarette," says one voice on TV advertisement. "I can't go more than a few feet without the oxygen tank," says the other speaker.
In English, Spanish, Korean and other languages, viewers are told that tobacco destroys their health and, through second-hand smoke, the health of those around them.
Ken August of the California Department of Health Services says his state is a leader in tobacco control, with smoking banned in nearly all places of work and public buildings.
"California was the first state in the nation with smoke-free restaurants, which occurred in 1995, and then followed that up with smoke-free bars in 1998," said Mr. August.
Even before that, California was warning its citizens about the dangers of smoking.
In 1988, the state's voters approved a ballot initiative that placed a 25 cent ($0.25) tax on each pack of cigarettes. Officials say the measure, called Proposition 99, counteracts the $800 million a year that the tobacco industry spends in the state on advertising.
The revenue funds medical services, scientific research and anti-tobacco ads, and what officials call their "ground war," which consists of prevention projects in schools and communities.
Ken August of the state health department says the multi-front campaign is working. "Adult smoking rates in the state have dropped from roughly 21.7 percent in 1989 to 16.6 percent in 2002, and that's a record low for California," he said.
Those rates are among the lowest in the country.
Smoking in California declined substantially after 1998, when another ballot measure called Proposition 10 placed an additional 50 cent tax on each pack of cigarettes.
Funds from Proposition 10 go to preschool education for children under five and tobacco education programs for parents.
"Prop. 10 basically pays for ads to run statewide to educate parents about the harm of second-hand smoke for young children and the dangers of smoking while you're pregnant," said Michael Trujillo of First Five California, the group that coordinates the program.
Officials say California's declining smoking rates have led to reduced rates of lung and bronchial cancer, which declined 15 percent through the 1990s. They say rates of heart disease are also dropping.
Still, nearly five million Californians are smokers, out of a population of 35 million. And at one Los Angeles discount shop, cigarette sales are brisk.
Smokers complain about the taxes and restrictions.
"People look [at you] like you have a kind of sickness," said a woman, who adds that when she smokes, she feels like an outcast.
"There's an unfair taxation and unfair stigma against smokers," said Dennis Etchison, a writer of horror novels, who believes smokers are targeted unfairly. "I don't see the additional taxes being levied on alcohol or automobiles or other products that are harmful and deadly," he added. Or such as fattening foods, added the other smoker.
The tobacco companies are tying to improve their image with their own advertising campaign, by urging children not to smoke, while insisting that their parents are free to do so.
According to research, parents play an important role in helping children avoid risky behaviors, including smoking. The parent resource center at PhilipMorrisUSA.com offers advice from experts about how to talk with kids about not smoking and a downloadable brochure on raising kids who don't smoke.
The tobacco industry has also challenged California's media effort in court, so far, unsuccessfully.
Anti-smoking activists appear to be winning the war. This is shown by the drop in revenue from cigarette taxes, which reflects a decline in smoking. Proposition 10, for example, generated $700 million the year it took effect, in 1999. Revenues last year were under $600 million.
That's good, say state officials, who say the real cost of smoking is seen in the health care system and the workplace. They say California pays $16 billion a year for its five million smokers. Half is for treatment of tobacco-related illness. State officials add that 43,000 Californians die prematurely every year from tobacco-related disease, and say lost productivity due to illness or death accounts for the rest of the cost.