This week marks the 50th anniversary of the first Surgeon General’s report on smoking and health — a report that launched one of the most successful public health campaigns in U.S. history.
Indeed, a new study published today in the Journal of the American Medical Association (JAMA) estimates that the anti-smoking efforts that followed the 1964 Surgeon General’s report have added almost 20 years to the lives of 8 million Americans.
You — or someone you care about — may be one of those 8 million people and not even know it. Perhaps the public-health efforts kept you from ever taking up smoking, or perhaps they encouraged and helped you to successfully quit the highly addictive habit.
Smoking was everywhere
Anybody who is a Baby Boomer or older can likely recall how ubiquitous — and accepted — cigarette smoking used to be. When that first Surgeon General’s report was released (and for a considerable number of years afterwards), smoking was permitted almost everywhere, including offices, restaurants, airplanes and elevators.
Etiquette books even instructed nonsmoking people to keep cigarettes in their homes for their smoking guests to enjoy after dinner.
In the 1960s, cigarettes were also cheap and easy to buy. Cigarette vending machines could be found in a wide variety of public places, including gas stations, convenience stores and shopping centers. And ads for cigarettes popped up everywhere — even during TV shows widely watched by children, such as “The Flintstones.”
No wonder, then, that in 1964, some 46 percent of American adults smoked.
Today, only 18 percent do so. That dramatic decline is a direct result of a multi-pronged public-health crusade that included educational messages, smoke-free laws, media campaigns, marketing restrictions, lawsuits (for deceptive and fraudulent practices by the tobacco industry), and the development of more effective smoking-cessation programs.
Without all those efforts, an estimated 50 to 64 percent of men and 38 to 52 percent of women would be smoking today, according to the JAMA study.
Extending life by 20 years
For the study, a team of researchers associated with the government-funded Cancer Intervention and Surveillance Modeling Network (CISNET) used statistical modeling to better understand the effect of tobacco control interventions on U.S. smoking-related deaths from 1964 through 2012.
They estimated that 17.6 million smoking-related premature deaths had occurred during that 48-year period. That’s a troubling and tragic number. But it’s about 8 million fewer premature deaths (4.4 million before age 60) than would have occurred if tobacco control efforts had not gotten under way.
In all, some 157 millions years of life were saved — a mean average of 19.6 additional years for each smoker who quit.
The 1964 Surgeon General’s report was “really a landmark moment,” said Robert Moffitt, communications director for the American Lung Association in Minnesota, in a phone interview Tuesday. “Previously, surgeon generals had mentioned the harm caused by smoking, but the message wasn’t really connecting.”
Even doctors were reluctant to accept the evidence that smoking was potentially deadly. Moffitt recalls how a physician he saw during his childhood would give him shots for asthma and allergies while puffing on a cigarette.
The Minnesota connection
Minnesota has something of a special connection to the 1964 Surgeon General’s report. Leonard Schuman, an epidemiologist at the University of Minnesota, was among the 10 experts chosen by Surgeon General Luther Terry to serve on the committee that analyzed all the scientific evidence regarding smoking and health and drafted the final report.
“Interestingly, he was a smoker himself when he started the report, and by the time [it] was finished, he quit,” Moffitt said.
Minnesota also played several key roles in the nationwide tobacco control campaign that followed the Surgeon General’s report. It was the first state, for example, to restrict indoor smoking in the 1970s. And in 1998, the state settled a $6.1 billion lawsuit against the tobacco industry that has been called one of the greatest public health achievements of the 20th century.
“That lawsuit had major implications, not just here in the state, but nationwide,” said Moffitt. “It opened up secret tobacco company documents, it banned tobacco billboards nationwide and it ended paid product-placement in movies, among other things. It was really a big deal.”
‘A hit-and-run approach’
Yet despite all the dramatic tobacco-related changes that have occurred in Minnesota and in the nation since the publication of the 1964 Surgeon General’s report, smoking remains the country’s major cause of preventable disease and death. Each year, smoking claims the lives of more than 440,000 Americans, including almost 50,000 from secondhand smoke, according to the Centers for Disease Control and Prevention.
In Minnesota, smoking is linked to about one in seven premature deaths.
“One thing we need to do is come up with a consistent approach to reducing youth smoking in this state,” said Moffitt. “We’ve kind of had a hit-and-run approach.”
Minnesota’s pattern, he explained, is something like this: A program is started. Smoking rates among youth go down. Funding problems arise. The program is ended. Smoking rates among youth start to go up again. A new program is begun, and the cycle repeats itself.
“What we need to do is make a commitment in this state that we’re really going to focus on youth smoking,” Moffitt said. “If we can get people to age 21 without smoking, the chance that they will ever pick up the habit is very low.”
Last year, the Minnesota Legislature raised the state tobacco tax by $1.60 per pack of cigarettes — an action that won strong praise from Moffitt and health officials.
“In this one instance,” said Moffit, “higher is better when it comes to taxes.” Research has shown, he added, that increasing the cost of cigarettes significantly reduces the number of young people who take up smoking.
An unfinished story
The U.S. Food and Drug Administration recently announced plans to launch a five-year, $600 million campaign to persuade teens to remain tobacco-free. The agency is up against some powerful pro-tobacco marketing headwinds, however. The tobacco industry will spend $8.5 billion on advertising and promoting its products in the United States this year alone, including almost $165 million in Minnesota.
“Tobacco control has been a great public health success story, but it is an unfinished one and requires continued efforts to eliminate tobacco-related morbidity and mortality,” stress the authors of the JAMA study.
A new report on smoking and health by the U.S. Surgeon General will be released Thursday.