The first link between smoking and lung cancer was reported in 1912 by American physician Isaac Adler. In the 1960s, the US Surgeon General began publishing annual reports detailing the health consequences of smoking. Since that time many measures have been taken by both the public and private sectors to reduce the health and economic consequences of smoking. These measures have included banning tobacco advertising on television, raising cigarette taxes, promoting anti-smoking education in schools, restricting smoking in public places, and providing assistance for those seeking to quit smoking. Currently, the economic impact of smoking-related illness exceeds $300 billion annually in the US with $170 billion attributable to direct medical care and over $156 billion attributable to lost productivity.

A California public health nurse is preparing educational material for a smoking cessation class. The focus of the unit she is preparing is the economic impact of smoking. The nurse is particularly interested in emphasizing the magnitude of the health care costs.