Americans Still Smoking After All These Years

40 Years After the First Surgeon General Warning, Why Haven't Americans Quit?

Reviewed By Brunilda Nazario, MD
on Friday, January 09, 2004

Jan. 9, 2004 -- Forty years after the federal government first warned that smoking cigarettes can kill you, nearly one in four Americans still lights up on a regular basis and 1,200 die from tobacco-related causes every day. Did they miss the message?

The U.S. surgeon general's report on smoking and health on Jan. 11, 1964, marked the first official recognition that cigarette smoking is a cause of cancer and a host of other serious diseases. But the landmark report is probably best known for prompting passage of the Cigarette Labeling and Advertising Act of 1965, which mandated the now-familiar surgeon general's health warning on cigarette packages.

Fast-forward to 2004, and even the tobacco industry now openly agrees with the overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema, and other serious diseases in smokers and has agreed to pay $246 billion in tobacco-related health-care costs to the 50 U.S. states.

But a report card issued this week shows that most states have failed at spending that money as it was intended -- to fund tobacco prevention and control programs -- and a new CDC survey backs up the fact that states with laws that encourage people to stop smoking have fewer smokers.

40 Years of Warnings Unheeded?

After 40 years of hearing warnings about the dangers of smoking, not to mention reading about them on every pack of cigarettes, 47 million adults still smoke and one in five adolescents is just starting what is likely to be a lifetime of addiction.

Experts say it's not a matter of smokers not getting the message that smoking is a killer. They just don't think it can happen to them.

"The average American completely underestimates the lethality of smoking," says Cheryl Healton, DrPH, president of the American Legacy Foundation.

Healton says it's a classic example of how people disregard the most common health risks and overestimate the rare ones, like thinking flying in a plane is more dangerous that riding in a car. That underestimation, coupled with the power of addiction and a history of misinformation from the tobacco industry, makes it difficult for most smokers to fully understand the health risks associated with smoking.

Deciding to quit is only the first step. Research shows that of the 70% of smokers who say they want to quit, only 2% are successful at kicking the habit for more than six months.

"Very few Americans understand what it takes to quit," Healton tells WebMD. "They misunderstand the tools and how to use them."

Those tools currently include nicotine replacement therapy, antidepressants, and counseling/social support programs, most of which weren't available back in the 1960s.

Since then, smoking rates among adults have dropped from more than 42% in 1965 to about 23% in 2002, according to the CDC. But that's still a far cry from the federal government's goal of reducing smoking prevalence to less than 12% by 2010.

"The greatest success has been that 50% of the people who have ever smoked who are alive today have quit," says Healton. "The greatest challenge is that we still as nation have not done what we should to ensure that the 47 million people still smoking can quit."

States Can Help Stop Smoking

Cassandra Welch, director of national advocacy at the American Lung Association (ALA), says one of the most interesting developments in the last 40 years is that researchers now have data on what can be done to reduce the death and disease caused by tobacco.

"We know what reduces tobacco use in the states, and really what it takes is the political will. It takes the political will of state legislatures to step up to bat and pass comprehensive tobacco prevention measures," says Welch. "When they do, what we find is not only does it save lives, but it saves money in the state."

Those prevention measures include laws prohibiting smoking in public areas and the workplace, raising cigarette taxes, preventing sales of tobacco to youth, and funding smoking prevention and cessation programs.

The ALA's 2003 state of tobacco control report card graded states on how they fared in each of these areas and found:

38 states and the District of Columbia received an "F" in funding tobacco prevention and control programs
35 states and the District of Columbia received an "F" in smoke-free air laws
13 states received an "F" in tobacco taxes
23 states got an "F" in limiting youth access to tobacco

But Welch says states that have taken these actions have seen amazing results. Maine, for example, had one of the highest teen smoking rates in the country. Then the state passed one of the highest cigarette taxes in the country at the time, banned smoking at almost all workplaces, and funded tobacco prevention programs at a level recommended by the CDC. Now Maine has seen a 48% drop in smoking rates among high school students and a 59% drop among middle school students.

On the other hand, a new CDC study issued this week shows that Kentucky has the highest percentage of adult smokers in the U.S. at nearly 33%. According to the ALA report card, Kentucky scored an "F" in all four measures of tobacco control.

"We've come a long way," says Welch. "There's much larger public awareness, more protection in the workforce, and we've seen a decrease in adult smoking. But each year still 440,000 people in the U.S. die of tobacco-related diseases."

SOURCES: Cassandra Welch, director of national advocacy, American Lung Association. Cheryl Healton, DrPH, president and CEO, American Legacy Foundation; professor of public health, Columbia University. American Lung Association State of Tobacco Control: 2003; Jan. 6, 2004. CDC. Morbidity and Mortality Weekly Report, Jan. 8, 2004; vol 52: pp 1277-1280. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States, Jan. 11, 1964.