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TUESDAY, March 9 (HealthDayNews) -- Poor eating habits, lack of exercise and smoking are to blame for more than a third of all deaths in the United States.

Tobacco continues to be the number one killer. It was responsible for 435,000 deaths -- or 18.1 percent of all fatalities -- in the year 2000, says a report in the March 10 issue of the Journal of the American Medical Association. The study was done by researchers at the U.S. Centers for Disease Control and Prevention.

Poor diet and lack of physical activity, taken together because of their impact on heart disease, stroke and other cardiovascular conditions, was a close second, causing 400,000 deaths, or 16.6 percent of the total.

Alcohol came in a rather distant third. About 85,000 Americans drank themselves to death that year, 3.5 percent of all deaths, the report says.

In fourth place were microbial infections such as influenza and pneumonia, which caused 75,000 deaths.

Then came toxic agents such as pollutants and asbestos (55,000 deaths); motor vehicle accidents (43,000); firearms (29,000); sexual behavior that led to diseases such as AIDS (20,000); and illicit drug use (17,000).

So, a lot of Americans would live longer if they paid attention to the longstanding advice on the value of diet and exercise, says study leader Ali H. Mokdad, chief of the CDC's Behavioral Surveillance Branch.

"Americans just haven't changed their behavior enough," he says.

Many are trying, Mokdad says. He cites a 1999 report showing that more than 75 percent of Americans were trying to lose weight. "But only 20 percent were doing it," he adds.

The overall mortality picture hasn't changed much during the past decade, says Dr. J. Michael McGinnis, senior vice president of the Robert Wood Johnson Foundation. He did a comparable study in 1990, and is co-author of an editorial accompanying the Mokdad report.

But some trends have changed, he says.

The two most noticeable changes are that "the impact of diet and lack of physical activity has increased as a source of preventable mortality, and it appears that there has been a slight decline in the contribution of sexual behavior, a change triggered by AIDS," McGinnis says.

It's vital that Americans improve their diet and exercise habits, but "these things don't turn on a dime," he says. "It's like turning a battleship."

Yet tobacco use is a prime example of how such changes can occur, McGinnis says. When the U.S. Surgeon General issued the 1964 landmark report on tobacco and its health risks, 64 percent of Americans smoked. Now 23 percent do -- still too many, but a remarkable reduction, he says.

The problem, McGinnis says, is that poor dietary habits are built into the American way of life, and "systematically, over the last 50 years, we have engineered physical activity out of our environment."

"It is vitally important that we deal with these things as cultural, not individual, choices," he says.

The CDC itself offers a model of how a large organization can promote a healthy lifestyle, Mokdad says. The food service vendor at its Atlanta headquarters offers a large variety of fruits, vegetables and other healthful choices. Employees are given time during the workday to exercise, and there is a free health club available to them. Smoking is banned in all buildings and soon will be forbidden on the entire campus.

"Corporations are starting to realize that such measures can save money," Mokdad says. "The money that goes into prevention reduces medical costs."

More information

You can learn more about the benefits of a healthy lifestyle and how to achieve it from the American Heart Association. For more on the health benefits of exercise, visit Georgia State University.

(SOURCES: Ali H. Mokdad, chief, U.S. Centers for Disease Control and Prevention's Behavioral Surveillance Branch, Atlanta; J. Michael McGinnis, M.D., senior vice president, Robert Wood Johnson Foundation, Princeton, N.J.; March 10, 2004, Journal of the American Medical Association)

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