Fighting tobacco use in America is the leading public health goal of our time. Today, smoking is the number one cause of death and disease in the United States, triggering heart disease, cancer, stroke, emphysema and chronic obstructive pulmonary disease, and other illnesses. To put tobacco's toll into perspective, smoking kills more Americans than AIDS, alcohol, illegal drug use, car accidents, fires, murders and suicides combined.

The Legacy Foundation is proud to work with 11 of the 13 Community Voices sites funded by the W.K. Kellogg Foundation to integrate tobacco control into their efforts to help the uninsured and underinsured populations, who especially lack access to tobacco cessation and prevention programs. Legacy awarded $8 million to establish smoking cessation and prevention programs as part of the health care services provided to the underserved at the Community Voices sites.

Smoking-related death and disease affects our families and communities and burdens our society as a whole. The numbers tell the story of the story of the tragic spectrum of loss:

• 430,000 Americans die from smoking every year that's 1,200 people a day.
• Another 38,000 Americans die annually from secondhand smoke.
• Per year, smoking is responsible for about one in five deaths.
• Lung cancer kills 27,000 more women than breast cancer every year, yet 80 percent of all women mistakenly believe that breast cancer kills more women.
• Smoking during pregnancy or exposing babies and children to secondhand smoke has been linked to one in 10 infant deaths, including 1,000 cases of Sudden Infant Death Syndrome a year.
• The total annual cost to society to treat the illnesses caused by tobacco is estimated to be about $85 billion a year.
• Related costs also include another $1.4 billion to $4 billion for health and developmental problems of infants and children exposed to secondhand smoke during pregnancy or after birth.
• According to Professor Neil Grunberg of the Uniformed Services University in Maryland, and an expert in the field, 90 percent of smokers become addicted to tobacco, while heroin addicts 50 percent of its users and alcohol addicts 10 percent.

And our future is at risk: Every day, more than 2,100 children under 18 become regular smokers. For the first time, girls are now smoking at about the same rate as boys. That's why the American Legacy Foundation is working across the country to prevent youth smoking, to help all smokers quit, to reduce exposure to secondhand smoke, and to improve access to smoking prevention and cessation services.

Legacy's award-winning "truth" counter-marketing campaign, for example, is the largest national campaign to prevent youth smoking in American history. The U.S. Centers for Disease Control and Prevention this May cited "truth" as one of the reasons for sharp declines in smoking by high school students nationally. The University of Michigan's "Monitoring the Future" survey, sponsored by the National Institute on Drug Abuse, reported sharp declines in youth smoking rates, also citing Legacy's "truth" ads as one reason for the decline.

Through advertising, grass roots activities and the Internet, "truth" provides teens with facts to help them make an informed choice, and encourages youth to share what they learn about the dangers of smoking with their peers.

Legacy also seeks to break tobacco's deadly grip on minorities, the poor, and those who are uninsured or underinsured. Low-income Americans, members of racial, ethnic and cultural minorities, and the underserved have less access to smoking prevention and cessation services than other Americans. Those who are uninsured lack coverage for the cost of smoking cessation aids or programs. For example:

• Americans below the poverty line are more than 40 percent more likely to smoke than others, and are more likely to be among the uninsured or the underinsured.
• At 41 percent, Native American/Alaska Native adults have the highest smoking rate of all groups.
• More than 32 percent of African American adults are exposed to secondhand smoke on a daily basis.
• Estimated smoking rates for lesbian, gay, bisexual and transgender youth range from 38 to 59 percent, far above the approximately 30 percent national average for all adolescents.

Through its Priority Populations grants program, Legacy is working to broaden the active participation of underserved populations and community-based groups that, to date, have been largely excluded from tobacco control activities. It is imperative to help those who have the fewest resources to fight tobacco, especially those without health insurance or who are underinsured.

Although tobacco is our nation's leading killer, all the deaths and disease stemming from its use are preventable. With active partnerships such as the one forged by Legacy and Community Voices, we can take control and build a tobacco-free future, community by community, together.

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Dr. Cheryl Healton is the president and CEO of the American Legacy Foundation, a national, independent, public health foundation located in Washington, D.C., dedicated to fighting for the health and well being of all generations of Americans. The foundation, created by the November 1998 Master Settlement Agreement, collaborates with organizations interested in decreasing tobacco consumption. For more information, visit www.americanlegacy.org.