In March 2001, the U.S. Surgeon General released Women and Smoking, the sec
ond Surgeon General's report to focus on tobacco use among women, compellin
g the nation to make reducing tobacco use among women one of the highest pr
iorities for women's health. Since 1980, 3 million women have died prematur
ely from smoking-related diseases and injuries. Lung cancer mortality rates
among U.S. women have increased about 600% since 1950, and now lung cancer
is the leading cause of cancer death among U.S. women, having surpassed br
east cancer in 1987. Although the report documents the devastating impact o
f the tobacco epidemic among women, a growing arsenal of science-based reco
mmendations for implementing comprehensive tobacco control programs suggest
s that achieving the nation's ambitious Healthy People 2010 objectives, inc
luding cutting in half the rates of smoking among women and girls, is withi
n our reach. While states continue to debate the use of tobacco settlement
funds, it is important to note that when significant resources have been de
voted to the implementation of evidence-based strategies, the results have
been dramatic for the population overall and for women in particular. For e
xample, in California, which has had a comprehensive tobacco control progra
m for 11 years, smoking prevalence has declined throughout the 1990s at rat
es two or three times faster than in the rest of the country, and while lun
g cancer incidence rates increased by 13% among women in other parts of the
United States, they decreased by 4.8% among women in California. These pro
mising findings indicate that although tobacco-related diseases have become
a women's health issue of epidemic proportions, we have the ability to rev
erse these trends.