Americans know cigarette smoking kills, but the Surgeon General’s report this year revealed how many different ways both direct as well as secondhand smoking cause harm.

The current report builds on findings first issued 50 years ago when the Surgeon General explored the health hazards of smoking. Experts cite the current report as an additional reason to advance anti-tobacco legislation and reduce the public health burden of primary and secondhand smoking.

Among the 2014 report’s findings:

  • Secondhand smoke exposure can directly cause stroke. Ongoing exposure to secondhand smoke can increase the risk of stroke by 20 to 30 percent.
  • More diseases have been added to the growing number of chronic illnesses directly caused by smoking including rheumatoid arthritis, impaired immunity, liver cancer, colorectal cancer, tuberculosis, diabetes, age-related macular degeneration, erectile dysfunction, and birth defects due to maternal smoking.
  • Between 1965 and 2014, smoking caused 20 million deaths in America, including nearly 7.8 million deaths due to cardiovascular and metabolic disease.
  • Although smoking rates have declined, about 42 million Americans still smoke; many began smoking before they were 18 years old.
  • Today, 3.5 million middle and high school students smoke, and an estimated 5.6 million young Americans will die prematurely due to smoking.

The report’s findings didn’t surprise cardiologists and other physicians, says Michael C. Fiore, MD, MPH, MBA, director of the Center for Tobacco Research and Intervention at the University of Wisconsin in Madison, Wis.

Instead, he said, the Surgeon General’s report should be used as a guide for policy makers to tighten anti-tobacco legislation, such as raising the age an individual can buy cigarettes from 18 to 21 nationwide.

“The ripple effects from this report go beyond the fact that we now have more diseases that result from smoking,” said Dr. Fiore, “and reaffirms that what we really need to focus on is completely eliminating tobacco use from our society, particularly with regards to the risks of secondhand smoke and with stopping our young people from getting hooked on cigarettes.”

Johnny Lee, MD, president of New York Heart Associates in New York City, said he would like to see if the findings of the current Surgeon General report have any impact on curbing the growing popularity of electronic cigarettes, a nicotine product that is not regulated like tobacco products.

“This is a time for public health partners to push for even stricter anti-tobacco laws, including e-cigarettes, which many teens are now turning to,” Dr. Lee said. “I would love to see e-cigarettes fall under current tobacco laws. Anti-smoking regulations and attitudes differ around the country. We need all 50 states behind this. What this report tells us, as a society, is that we need bolder goals.”