Approximately 5.6 million American children alive today or one out of every 13 children under age 18 will ultimately die prematurely from smoking-related diseases unless current smoking rates drop, according to a new Surgeon General’s report.

Over the last 50 years, more than 20 million Americans have died from smoking. The new report concludes that cigarette smoking kills nearly half a million Americans a year, with an additional 16 million suffering from smoking-related conditions. It puts the price tag of smoking in this country at more than $289 billion a year in direct medical care and other economic costs.

How cigarettes are made and the chemicals they contain have changed over the years, and some of those changes may be a factor in higher lung cancer risks.

Today, scientists add diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and other conditions to the list of diseases caused by smoking.

In addition, the report concludes that secondhand smoke exposure is now known to cause strokes in nonsmokers.