CARROLL COUNTY, Ky. — Lester Duncan smoked for four decades — about as long as he grew tobacco — and now the 73-year-old has the emphysema to prove it.

        His friends, Elmer Yocum, 80, and Ansel H. Cox, 70, are also reformed smokers. They have cancer.

        All three have suffered shortness of breath. Mr. Cox used to wake up every morning and cough up a tarlike substance that came in the size of golf balls until he quit smoking.

        Yet these men — residents of a county where tobacco is king and smoking seems synonymous with the American way — are reluctant to blame their health problems on their tobacco use.

        Instead, they point to factories, pollution, chemicals and pesticides as causes, not the product many have dubbed cancer sticks.

        Like Mr. Duncan, tobacco farmers tend to stand by the leaf that has made them a living. But this almost patri otic loyalty to the state's biggest crop is affecting the lives of Kentucky's youths, hooking them sooner and faster than anywhere else in the nation, health advocates and even politicians say.

        Centers for Disease Control and Prevention statistics tell the story:

        • Kentucky has the highest percentage of minor smokers in the nation. At least 47 percent of ninth- through 12th-graders have smoked in the past month.

        • An estimated 87,000 of today's young smokers in Kentucky are expected to die prematurely because of tobacco.

        • About 8,000 Kentuckians die each year from smoking, and the related medical costs are estimated at close to $1 billion a year.

        • One in three people smokes in Kentucky — the second-highest rate in the nation, behind Nevada. The smoking rate in Ohio is 27.6 percent and in Indiana 27 percent.

        When Steve Wyatt moved from Atlanta to Lexington more than two years ago to become the University of Kentucky's Markey Cancer Center director, the sight of 12-year-old boys smoking in public bothered him. He soon realized, though, that nobody else considered it odd.

        “It certainly is cultural here. It's very acceptable for all ages of folks,” he said.

        Mr. Duncan, the grower, said he acquired the habit at age 18 during the 1940s, when cigarette sold for a nickel a pack and he and his friends didn't think twice about lighting up.

        “You'd get a bunch of kids together and you'd start smoking,” he said.

        Sick tobacco growers such as Mr. Duncan are in denial about the health effects of tobacco because they rely financially on the tobacco crops, said Dr. Timothy Mullett, a University of Kentucky doctor who practices thoracic and cardiovascular surgery.

        “It's definitely a pathologic relationship,” he said.

        “You have to remember that cigarette smoking is a very powerful addiction. To implicate that addiction means that they are go ing to lose an important part of their lifestyle.

        Yet smoking in parts of Kentucky can be seen as support for hometown values.

        Lynn Carol Birgmann, director of Kentucky ACTION. an anti-smoking coalition in Louisville, described how, in 1994, her group advertised that it would pay $10,000 to eight high schools proposing tobacco and health education programs. Students from the winning schools picked up the awards in Lexington and returned home to be greeted by angry townspeople, she said.

        Even a county health worker whose job involves helping people stop smoking says to go easy on tobacco farmers.

        “It's part of our life,” said Mary Francis Hardin, the Three Rivers District Health Department employee who organizes smoking cessation programs for Carroll, Owen, Gallatin and Pendleton counties.

        “Tobacco is a legal crop,” she said. “You don't need to badger your farmers at all. They're just trying to make an honest living.”

        Evidence against cigarettes was around even in the late 1940s. It caused “cancer scares” in the 1950s, and the surgeon generallinked smoking to lung cancer, disease and death in 1964.

        Yet Mr. Duncan didn't quit until 1983, when he smoked up to three packs — or 60 unfiltered cigarettes — a day. Mr. Duncan says he has no regrets.

        Mr. Cox, his longtime friend, does.

        “I wouldn't smoke or drink a beer for a million dollars,” Mr. Cox said. “It's just a damn nervous habit. It's so damn dumb.”

        Like Mr. Cox, some Kentuckians are changing their views.

        Anti-smoking advocates cite Kentucky's declining smoking rate, 31.6 percent in 1996 to 29.7 percent in 1999.

        But progress against the tobacco culture in Frankfort is painfully slow, anti-smoking lobbyists said.

        “We started late and we lagged behind,” Ms. Birgmann said.

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