50 Years Later: A Closer Look at the Impacts of First Surgeon General's Report on Smoking

In 1964 the U.S. Surgeon General fundamentally changed the way Americans viewed tobacco when it released its report, "Smoking and Health," directly linking cigarette smoking as a cause of lung cancer, heart disease and other detrimental ailments. The historic report inspired in its wake increases in cigarette taxes, smoke-free air laws, educational media campaigns, marketing and sales restrictions, lawsuits, and cessation treatment programs. In a new 50th Anniversary report released Jan. 17, the U.S. Surgeon General highlights the progress in tobacco control and prevention, while also showcasing new data on the continued health consequences of tobacco use.

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"This report provides the impetus to accelerate public health and clinical strategies to drop overall smoking rates to less than 10 percent in the next decade. Our nation is now at a crossroads, and we must choose to end the tobacco epidemic once and for all," said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH.

According to the anniversary report, despite reductions in mortality from smoking over the last five decades, "approximately 5.6 million American children … will die prematurely from smoking-related diseases unless current smoking rates drop." Further, "cigarette smoking kills nearly half a million Americans a year, with an additional 16 million suffering from smoking-related conditions. It puts the price tag of smoking in this country at more than $289 billion a year in direct medical care and other economic costs."

An earlier report published Jan. 8 in the Journal of the American Medical Association  found similar results. Using modeling reductions in smoking-related mortality associated with the implementation of tobacco control since 1964, researchers found that an estimated 8 million premature smoking-attributable deaths have been avoided, with the beneficiaries of such circumvention gaining, on average, nearly two decades of life. The study also found that for the population as a whole, the estimated life expectancy for men at age 40 has increased 7.8 years, with the life expectancy of women age 40 increasing to 5.4 years. Without tobacco control the estimated increase for these men and women would have been 5.5 years and 3.8 years respectively.

However, despite this success, data also showed that smoking-attributable death occurred in approximately 17.7 million people during this time period. A half century after the Surgeon General's first pronouncement, nearly a fifth of U.S. adults continues to smoke, claiming hundreds of thousands of lives annually, the report authors note. With no other behavior coming close to contributing so heavily to the nation's mortality burden key policy changes from government officials are still needed.

"The surgeon general's report in 1964 was groundbreaking and led to an important cultural shift against smoking," said ACC President John Gordon Harold, MD, MACC. "Those important findings have been followed up by countless studies on the effects of smoking, which we now know are even worse than we thought. Physicians often discuss 'moderation' when helping patients change and maintain their health habits, but that is not the case with smoking. No amount of smoking is good and several studies have shown that even a small amount tobacco is very harmful. As a society we need to eliminate smoking from our culture. Heart disease is the leading cause of death in both men and women, and if almost half of those cases are from tobacco, then that is a serious problem."

Keywords: Cause of Death, Public Health, Research Personnel, Life Expectancy, Tobacco Use Disorder, Smoking

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