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News item: However bad you thought smoking was, it’s even worse.

That’s the lead sentence of an article from last Thursday’s paper about a study published in the New England Journal of Medicine that links five more diseases and attributes 60,000 more deaths annually in the United States to tobacco.

To put that number in perspective, it’s as if everyone in Petaluma died prematurely — every year.

And those 60,000 deaths are on top of 500,000 — approximately the population of Sonoma County — deaths already tied to cigarettes and other tobacco products.

The study, based on 10 years of health data for about a million people, concluded that, in addition to lung cancer and pulmonary disease, tobacco use increases the potential for fatal infections and kidney and intestinal disease. Researchers also identified heart and lung ailments that haven’t been previously linked to tobacco use, and further research is being done to address possible connections between smoking and breast and prostate cancer.

A half-century has passed since the U.S. surgeon general first linked smoking to throat and lung cancer, and anti-smoking ads and education programs are common, and changing social norms have brought new restrictions on smoking in public and even in multi-family dwellings. Yet more than 40 million Americans still light up, risking premature death.

Smoking cessation programs are widely available. Indeed, the Affordable Care Act requires private health insurance plans to cover preventive services including tobacco cessation. States that opted to expand their Medicaid programs also are required to cover programs that help people quit smoking.

Quitting isn’t easy. Ask anyone who has tried. The most effective approach is to keep people from becoming hooked in the first place.

One popular approach has been to raise tobacco taxes, with revenue supporting anti-tobacco ads, education and cessation programs. There is evidence that this approach works, but the more effective it is, the less money it produces for programs supported by the tax. In California, tobacco tax revenue has dropped by more than $100 million a year since 1999. The state’s tax, at 87 cents a pack for cigarettes, is 33rd in the nation. Voters rejected an increase in 2012, with tobacco companies mounting an aggressive opposition campaign. Another measure may qualify for the ballot in 2016.

In the meantime, two Sonoma County cities are trying another approach.

In October, Healdsburg became the first city in California to ban tobacco sales to anyone under 21 years old, the rule that applies for alcohol. Sonoma is now considering a similar prohibition.

Two small cities can’t make much of a dent in smoking, but a state law might, and a measure unveiled in Sacramento this month would set a minimum age of 21 statewide.

“Tobacco companies know that people are more likely to become addicted to smoking if they start at a young age,” said state Sen. Ed Hernandez, a West Covina Democrat who is sponsoring the legislation. “We can no longer afford to sit on the sidelines while Big Tobacco markets to our kids and gets another generation of young people hooked on a product that will ultimately kill them.”

Tobacco is a factor in one in four U.S. deaths annually. A surgeon general’s report published last year projected that 5.6 million Americans under age 18 will die prematurely due to smoking. Making it harder for them to buy tobacco would be a big step toward reducing that number.

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