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Years of public awareness campaigns highlighting the health risks of smoking, along with state and local bans on indoor smoking in public places, have led to a significant cultural shift in how many Americans now view smoking

in some the rates in men are still rising, in others they are falling, and in less developed countries where there has only in recent decades been a large increase in cigarette use among men, large increases in mortality from tobacco in men must be expected in the early decades of the next century as the future health effects of current smoking patterns.44,45 The substantial differences between the effects of tobacco during the first and second halves of the present study underline the need for a worldwide network of prospective studies that can monitor the increases, and eventual decreases, in this great epidemic throughout the world

The authors are grateful to Thomas Kirchner, Deborah Scharf and Sarah M

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