There is little doubt that reducing the morbidity and mortality from tobacco use remains one of the most important public health challenges of the 21st century. More than 480 000 deaths occur annually in the United States as a result of smoking.1 There is essentially no such thing as moderate use of tobacco, which fuels addiction and illness, with enormous costs to society: $132 billion in direct medical costs and $157 billion in lost productivity, according to recent estimates.1