Surgeon General's Perspectives

A HISTORIC MOMENT: THE 50TH ANNIVERSARY OF THE FIRST SURGEON GENERAL'S REPORT ON SMOKING AND HEALTH

This year, 2014, marks the 50th anniversary of the release of the landmark Surgeon General's report on smoking and health. In a historic moment for public health, Surgeon General Luther Terry identified smoking as a cause of lung cancer and a likely cause of heart disease. Terry called for “appropriate remedial actions”¹ to address the negative health effects of smoking. During the following years, 30 additional Surgeon General's reports on smoking were released. Each subsequent report provided increasing evidence of the negative health effects of smoking and secondhand smoke exposure, such as heart disease, chronic obstructive pulmonary disease, cancers, pregnancy complications, and pediatric diseases.

We have made incredible progress in the half-century since the 1964 report. From 1963 to 2012, per-capita cigarette consumption declined by 72%. Since 1965, the prevalence of adult smoking has been reduced by more than 50%.² As of 2013, 100% comprehensive smoke-free policies (e.g., in private worksites, restaurants, and bars) exist in 26 states and the District of Columbia.³ In 2009, the Family Smoking Prevention and Tobacco Control Act gave the U.S. Food and Drug Administration explicit regulatory authority over tobacco products to further protect and promote the health of the American public.⁴ The U.S. Centers for Disease Control and Prevention Tips from Former Smokers national education and ad campaign, featuring real people living with the effects of smoking-related disease, has also been successful in decreasing the prevalence of smoking. It is estimated that more than 200,000 Americans quit smoking immediately following the three-month campaign, of which researchers estimate that more than 100,000 people will likely quit smoking permanently.⁵

Although great progress has been achieved, the war against tobacco is far from over; the cost of tobacco use remains high for our nation. More than 440,000 Americans die every year from smoking-related causes, and 8 million Americans live with at least one serious chronic disease caused by smoking.^6,7 Moreover, the cost to the U.S. economy due to smoking-related illness is $193 billion a year, with nearly $96 billion in direct medical costs and $97 billion in lost productivity.⁶

Our current focus is on preventing children and adolescents from starting to smoke in the first place. Today, more than 600,000 middle school students and 3 million high school students smoke cigarettes. As former Surgeon General Regina Benjamin noted last year upon the release of the Surgeon General's report, “Preventing Tobacco Use Among Youth and Young Adults,” for every one of the 1,200 adults who die each day in this country due to smoking, at least two young people or young adults become regular smokers. Almost 90% of those replacement smokers smoke their first cigarette by age 18 and 99% start by age 26. One out of five daily smokers say they first smoked before age 12.⁸

One of the most serious health effects of smoking is nicotine addiction, which prolongs tobacco use and can lead to severe health consequences. The younger people are when they start using tobacco, the more likely they are to become addicted—and the more strongly addicted they will become. Young people are sensitive to nicotine and can feel dependent earlier than adults. Because of nicotine addiction, about four out of five teen smokers end up smoking into adulthood, even if they intend to quit after a few years. Progression from occasional to daily smoking almost always occurs by age 26.⁸ We can make strides in creating a tobacco-free generation by empowering young people from middle school age through their 20s to make the right decision regarding tobacco use. If we can prevent smoking among young people, we can essentially eliminate this epidemic in one generation.

In 2011, the tobacco industry spent more than $1 million an hour in this country on marketing their products.⁹ Young people are particularly vulnerable to social and environmental influences to use tobacco, and messages and images that make tobacco use appealing to them are everywhere. Adolescents and young adults see smoking in their social circles, the movies they watch, the video games they play, the websites they visit, and the communities where they live. Smoking is often portrayed as a social norm—what everyone is doing—and young people who are exposed to these images are more likely to smoke. This social norm is not one that we in public health want to perpetuate.

Even 50 years after the 1964 report, we are still finding diseases caused by smoking and exposure to tobacco smoke, such as colorectal cancer.¹⁰ The enormous public health and economic burden to our nation is preventable. Comprehensive tobacco-control programs and policies, such as increasing the average retail price of a pack of cigarettes, providing indoor protection from exposure to secondhand smoke for 100% of Americans, and using sustained, hard-hitting media campaigns, have proven effective in reducing tobacco use. These strategies are essential to achieving more rapid progress in helping the more than 42 million adult smokers in our nation quit completely.

There is no risk-free level of exposure to tobacco smoke. The goal is rapid elimination of the use of cigarettes and other combustible tobacco products. Let's all work to empower our population to make the right decision.

Boris D. Lushniak, MD, MPH RADM, U.S. Public Health Service Acting Surgeon General