The list of diseases linked to smoking keeps growing.

Surgeon General Richard Carmona's first official assessment of smoking, released Thursday, concluded that smoking causes a number of diseases not previously attributed to smoking.

Serious ailments added to the list include acute myeloid leukemia and cancers of the cervix, kidney, pancreas and stomach, as well as abdominal aortic aneurysm, cataracts, periodontitis and pneumonia.

On average, smokers die 13 to 14 years before nonsmokers, according to the report.

The report's findings have strong implications for Cowlitz County, where the smoking rate exceeds both the state and national averages.

While smokers -- and to some extent the people around them -- face a growing list of health threats, the report also found that everyone pays a high price for tobacco use.

Smoking already had been strongly linked to chronic lung disease, chronic heart and cardiovascular disease, reproductive problems and cancers of the bladder, esophagus, larynx, lung, mouth and throat.

"We've known for decades that smoking is bad for your health, but this report shows that it's even worse than we thought," Carmona said in a statement released with findings in the report, compiled by 19 scientists. "The toxins from cigarette smoke go everywhere the blood flows. I'm hoping this new information will help motivate many more people to quit smoking and help convince many more young people not to start in the first place."

"Smoking is still the leading preventable cause of premature death in the United States," said Jeffrey Fellows, who co-authored a key chapter in the report and now is a researcher with Kaiser Permanente's Center for Health Research in Portland.

Carmona's report also ranked states by deaths attributed to smoking. Washington ranked 28th, with 279 annual deaths from smoking for every 100,000 residents. Oregon ranked 31st, with a rate of nearly 274. Both states were below the national average of 289 deaths and well under Nevada's first-place ranking with 399 deaths per 100,000. Hawaii had the lowest death rate among smokers at 168.

The surgeon general's report, including data from Fellows, further concluded:

• About 440,000 Americans die of smoking-related diseases each year. More than 12 million people have died from smoking-related diseases in the 40 years since the first surgeon general's report on smoking and health was released in 1964. That first report linked just lung and larynx cancer and chronic bronchitis to smoking.

• Nationwide, the number of people who smoke has dropped from about 42 percent in 1965 to about 22 percent in 2002. (In Cowlitz County, 25 percent of residents smoke, compared to 20 percent statewide, according to the state Department of Health's 2002 survey.)

• Smoking cost the nation an estimated $157 billion a year from 1995 to 1999 for medical treatment and lost productivity, including about $3 billion in Washington and $1.8 billion in Oregon.

• Smoking "low-tar" or "low-nicotine" cigarettes does not offer a health benefit over smoking regular cigarettes.

• Quitting smoking has immediate and long-term health benefits.

• Current evidence is not conclusive enough to say smoking causes colorectal cancer, liver cancer, prostate cancer or erectile dysfunction.

• Evidence suggests smoking may not cause breast cancer in women overall but that some women may increase their risk of getting breast cancer by smoking, depending on genetics.