WASHINGTON — It’s no secret that smoking causes lung cancer. But what about diabetes, rheumatoid arthritis, erectile dysfunction? Fifty years into the war on smoking, scientists still are adding diseases to the long list of cigarettes’ harms – even as the government struggles to get more people to kick the habit.

A new report from the U.S. Surgeon General’s office says the nation is at a crossroads, celebrating decades of progress against the chief preventable killer but not yet poised to finish the job.

“The real emphasis needs to be put on the fact that we still have a major and tragic catastrophe going on,” said acting Surgeon General Boris Lushniak.

Far fewer Americans smoke today – about 18 percent of adults, down from more than 42 percent in 1964. But the government may not meet its goal of dropping that rate to 12 percent by 2020, the new report cautioned.

Nearly half a million people will die from smoking-related diseases this year. Each day, more than 3,200 kids smoke their first cigarette. New products such as e-cigarettes, with effects that aren’t yet understood, complicate public health messages. And if current trends continue unabated, 5.6 million of today’s children and teens will go on to die prematurely during adulthood because of smoking, the report found.

Remarkably, the report adds more entries to the official list of smoking-caused diseases, including Type 2 diabetes, rheumatoid arthritis, erectile dysfunction, the macular degeneration that can blind older adults, two additional cancers – liver and colorectal – and cleft palate birth defects.

“Enough is enough,” said Lushniak. He urged new resolve to end smoking by increasing use of proven tobacco-control measures, including price hikes for cigarettes and expanding comprehensive indoor-smoking bans that he said currently cover about half the population.

The report also encourages research into newer ideas, such as whether lowering the amount of addictive nicotine in cigarettes would help people quit.

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