Perhaps the issue that generates the least debate amongst healthcare professionals as well as within the general public is the issue of the health risks of cigarette smoking. But this was far from the case in 1964, when the first Surgeon General’s Report on Smoking and Health was published, 60 years ago this week. The report, issued by Surgeon General Dr. Luther Terry, was a compilation of nearly two years of data collection after several years of clinical research to assess the link between cigarette smoking and cancer of lungs and throat. It also linked cigarette smoking to early development of chronic lung and heart conditions such as emphysema and cardiovascular disease, as well as the risks of smoking during pregnancy and its potential effects on both the mother and the fetus. While these causal relationships may seem obvious to us today, at that time the scientific correlation and later causation were still in the works.
The report stated that cigarette smokers had a 70 percent increased risk of mortality compared to non-smokers, and a 10- to 20-fold risk of developing lung cancer. At the time of the report’s release, over 50% of American males and nearly 40% of American females were cigarette smokers. The tobacco industry was a $15 billion source of income for over 600,00o workers in the U.S. alone. That’s about $155 billion in today’s dollars. As several research studies were published in the 1950’s, all demonstrating a clear link between tobacco use and lung cancers, the tobacco industry soon questioned the validity of the data. In fact, they cited many instances of physicians not only smoking cigarettes, but also promoting the use of cigarettes in advertisements.
Despite a fair amount of tobacco industry pushback, as more and more studies were published documenting a link between cigarette smoking and adverse health consequences, coupled with the 1964 report, this was one of the most important examples of science driving public awareness and action. Prior to the report, only 44% of Americans believed that smoking was linked to cancer. Just a few years after the report’s release, this jumped to nearly 80%.
Following the release of the 1964 Surgeon General’s Report, tobacco companies were required to include warning labels on cigarette packages by 1965. What followed were further restrictions, including removing television advertisements for cigarettes when children’s television shows aired, followed by removing cigarette television ads altogether by 1970. In 2021, the size and placement of the health warning was required to be larger and more visibly placed.
The past decade has brought new issues regarding cigarettes, when electronic cigarettes, also known as e-cigarettes or vaping pens, were introduced as a bridge to help individuals quit tobacco cigarettes. However, marketing campaigns selling fruity and bubble gum flavors were targeted at teens and tweens. While buying e-cigarettes were restricted to those ages 18 years and older, vaping soon became popular in middle and high school kids. In addition to the soon discovered multiple health risks from e-cigarettes, it was also found that use of e-cigarettes in teens led to a higher incidence of teens transitioning to smoking tobacco cigarettes. While the multiple vaping flavors are now banned in the U.S., they are still obtained illegally as well as from international retailers.
A current additional issue is the potential banning of menthol flavored tobacco cigarettes. The U.S. Food and Drug Administration has issued a plan to completely eliminate menthol flavored cigarettes, which are disproportionately utilized by Black Americans. The pushback on this issue has been substantial from tobacco companies, and the White House remains in discussion regarding when to formally institute this new restriction.
Sixty years after the Surgeon General’s Report on Smoking, there continues to be work to be done. There were no slickly packaged candy-flavored e-cigarettes in the 1960’s, nor was it well known how menthol cigarettes were impacting some demographic groups more than others. Erika Sward, the National Vice President of Advocacy for the American Lung Association, notes: “While we have made progress, sixty years later, our nation remains one step behind the tobacco industry’s efforts to addict our nation’s youth to tobacco products and to keep current users addicted.”
When it comes to understanding the health, socioeconomic and changing demographic impacts of cigarette smoking, we’ve come a long way, baby. But we still have a long way to go.