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Smoking is costing the nation nearly $300 billion in medical bills, lost productivity and other costs, officials said. Yet Frieden said states are spending less than $1.50 a person on tobacco control each year when they should be spending about $12 a person.

The report urges increased use of proven tobacco-control measures, including price hikes for cigarettes and expanding comprehensive indoor-smoking bans that currently cover about half the population.

The report also encourages research into newer ideas, such as whether lowering the amount of addictive nicotine in cigarettes would help people quit.

Here are some ways the smoking landscape has changed between the 1964 surgeon general’s report and Friday’s:

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1964: The surgeon general declares that cigarette smoking increases deaths.

2014: About 20.8 million people in the U.S. have died from smoking-related diseases since then, a toll the report puts at 10 times the number of Americans who have died in all of the nation’s wars combined. Most were smokers or former smokers, but nearly 2.5 million died from heart disease or lung cancer caused by secondhand smoke.

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1964: Heavy smoking is declared the main cause of lung cancer, at least in men. “The data for women, though less extensive, point in the same direction.”

2014: Today, lung cancer is the top cancer killer, and women who smoke have about the same risk of dying from it as men. As smoking has declined, rates of new lung cancer diagnoses are declining nearly 3 percent a year among men and about 1 percent a year among women.

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1964: Male smokers were dying of heart disease more than nonsmokers, but the surgeon general stopped short of declaring cigarettes a cause of heart disease.

2014: Today, heart disease actually claims more lives of smokers 35 and older than lung cancer does. Likewise, secondhand smoke is riskier for your heart. Smoke-free laws have been linked to reductions in heart attacks. Friday’s surgeon general report also finds that secondhand smoke increases the risk of a stroke.

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1964: Smoking in pregnancy results in low-birth-weight babies.

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