Barbara Izzarelli was in her early teens in the 1970s when she began smoking Salem cigarettes. She was soon hooked by the nicotine. She smoked heavily every day — all day — for more than 20 years.

In 1996, at age 36, she developed larynx cancer. The following year she underwent a total laryngectomy. That was followed by radiation and chemotherapy treatments. The Norwich, Conn., woman can no longer breathe through her mouth or nose; she uses a tube in her throat. Her diet consists of soft foods like pudding and mashed potatoes.