This 1992 report of the Surgeon General, Smoking and Health in the Americas, is the second on smoking and health during my tenure as Surgeon General. Over the years, the reports have systematically examined the effect of smoking on human health: the biologic effects of substances in tobacco, the risks of disease, the susceptibility of target organs, the addictive nature of nicotine, and the evolving epidemiology of the problem. The reports summarize a massive amount of information that has accumulated on the untoward effects of tobacco use, now easily designated the single most important risk to human health in the United States. The 1990 report, The Health Benefits of Smoking Cessation, documented the positive impact of quitting and thus furthered the logical argument leading to a smoke-free society. This report is a departure from its predecessors in that it treats the evidence against smoking as an underlying assumption. The issue for the future is how we will go about achieving a smoke-free society, and a consideration of smoking in the Americas is an early step in that direction. The report explores the historical, epidemiologic, economic, and social issues that surround tobacco use in the Americas. It focuses on cultural antecedents and trends, on social and economic structure, and on the local, national, and regional efforts that are currently under way to control tobacco use (SURGEON GENERAL-Antonia C. Novello)