Cigarettes Become a Dangerous Product: Tobacco in the Rearview Mirror, 1952–1965

Abstract

Tobacco control’s unparalleled success comes partly from advocates broadening the focus of responsibility beyond the smoker to include industry and government. To learn how this might apply to other issues, we examined how early tobacco control events were framed in news, legislative testimony, and internal tobacco industry documents. Early debate about tobacco is stunning for its absence of the personal responsibility rhetoric prominent today, focused instead on the health harms from cigarettes. The accountability of government, rather than the industry or individual smokers, is mentioned often; solutions focused not on whether government had a responsibility to act, but on how to act. Tobacco lessons can guide advocates fighting the food and beverage industry, but must be reinterpreted in current political contexts.

Tobacco control shines as a beacon of success in public health, having demonstrated unequivocally that policy interventions can improve environments and reduce morbidity and mortality at a population level.^1–3 Yet tobacco remains the leading cause of preventable death in the United States⁴ and worldwide.⁵

Indeed, the tobacco industry continues to resist a wide variety of tobacco control initiatives by insisting that there is no need for government intervention: smoking is a choice, and if smokers want to quit, they should take personal responsibility for their own health and just quit. For example, the Centers for Disease Control and Prevention’s Communities Putting Prevention to Work program, which emphasized tobacco control interventions, came under attack from tobacco industry representatives claiming that,

All across the country, Americans are growing increasingly concerned about the role of government, and it’s believed by a substantial population in this country that the government is overreaching its bounds and getting too involved in our personal lives.⁶

Indeed, beginning in the 1980s the tobacco industry was instrumental in fomenting conservative activism focused on concerns about the role of government.⁷ Thus, it is no surprise that public health advocates working on other issues are subject to similar arguments. The food industry, for example, has responded to concerns about obesity with arguments that focus attention on personal responsibility and negate the role of government.⁸

We were interested in better understanding how public health has weathered the drumbeat of personal responsibility rhetoric to inform ongoing tobacco control efforts and emerging public health interventions to address obesity. We know, for example, that successful tobacco control programs such as California’s^9,10 have sought to denormalize tobacco use and the tobacco industry by employing a spectrum of strategies from individually oriented cessation programs to tax policy and environmental changes to reduce exposure to secondhand smoke.¹¹ California’s famously effective media campaign illustrated that comprehensive approach with advertising that ranged from messages reminding smokers that “quitting takes practice” to warning that “the tobacco industry is not your friend.” One set of messages placed responsibility on individuals to quit smoking; the other set placed responsibility on the tobacco industry and government regulation.¹² Both discourses exist in tobacco control just as they coexist in society at large, though one or another may dominate the public discussion at any given time.

Since the 1970s in the United States, personal responsibility rhetoric has increasingly dominated public policy debate.^13,14 President Clinton’s 1996 landmark welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act,¹⁵ and the rise of the Tea Party¹⁶ in 2010 are 2 manifestations of this perspective.

“Framing” refers to how an idea or issue is defined, portrayed, and understood. Frames operate at the cognitive level, consciously or unconsciously, to construct meaning¹⁷ by promoting “a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described.”^18(p52)

One of the most enduring frames in American discourse is “rugged individualism,”¹⁹ which presents problems as a matter of personal choice or accomplishment independent of—or despite—social, historical, or environmental forces. This frame presumes that individuals or the laissez-faire market, not government or other entities, are the genesis of and appropriate agent for remedy of problems.²⁰ Alternatively, American discourse at times includes frames suggesting collective responsibility in which government or institutions are the source of or solution to social problems.²¹

The precursor to questions about individual responsibility or institutional accountability in tobacco control is this: does smoking harm health? Although for most people this question was definitively answered by the 1964 Surgeon General’s Report, it was doggedly contested by the tobacco industry for another 3 decades.^22,23

Once the cause of the health harm is established, responsibility can be framed along the continuum from individuals to the environment surrounding them, including society and its institutions. Within the individualism frame, if people experience harm from cigarettes it is because they choose to smoke; to avoid the harm individuals can avoid smoking. A public health approach demands a broader conception that includes shared responsibility between individuals and the forces that shape the environment in which those individuals act. From a public health perspective, responsibility for creating and solving health problems, including from tobacco, can be assigned to individuals and to institutions, either of which may be culpable for the problem or accountable for remedial action. How causality, culpability, and accountability are framed can determine whether society calls upon individuals, industry, or government to take action.

Like other social problems, public health problems—and their solutions—are in large part defined by how they are framed and who is influencing the framing.²⁴ Framing takes place in private communications as well as public forums that shape policy decisions, including the news media as well as judicial, regulatory, and legislative proceedings.

Decades of communications research show that the news sets the agenda and frames debate for the public and policymakers.^25–29 News frames can affect attributions of responsibility for both lung cancer and obesity.³⁰ Although news stories typically contain several frames, on balance, most reinforce an individualistic point of view.¹⁷ The power of framing in judicial, regulatory, and legislative forums is less well documented, but may directly affect the policy decisions on controversial public health issues.^31–33

In addition, different speakers within these public forums may frame issues in conflicting ways.^34,35 In the context of a public debate about a controversial topic such as tobacco policy, different actors will frame the issue to serve their own interests.^36–38

To learn how responsibility for causing and remedying tobacco-related problems has been characterized, we examined how the policy debate was framed during the events leading up to and including the first major national policy in tobacco control, the Federal Cigarette Labeling and Advertising Act (FCLAA) of 1965.³⁹ We examined how arguments about responsibility were framed in tobacco industry internal documents, legislative testimony, and news coverage about tobacco. In our investigation, responsibility could be characterized in 3 ways. Causality addresses whether tobacco—in this era, almost always cigarettes—causes health harms, usually lung cancer. Culpability assumes that smoking is harmful and points to whom or what might be to blame. Accountability frames go further to name who has responsibility for taking action to remedy the problem—individual smokers, government agencies, the tobacco industry, or clinicians. By asking how responsibility for causing health harms from cigarettes was framed, who was blamed for them, and who was held accountable for rectifying them during this early era to control tobacco, we can peer back through a window in time before the tobacco industry—and before government—were both demonized.

METHODS

We conducted a content analysis to examine responsibility rhetoric in tobacco-related issues from the time period beginning with the publication of “Cancer by the Carton” by Reader’s Digest magazine in December 1952 through the passage of the FCLAA in July 1965 in 3 sources: news coverage from the New York Times and Washington Post, internal tobacco industry documents, and the Congressional Record and Congressional Index.

News Articles

We examined the New York Times and Washington Post because both newspapers have complete archival records through the 1950s and because of the status of the New York Times as a national paper of record and the Washington Post’s in-depth coverage of national policy.

To select the news sample we performed keyword searches of the Nexis database for all articles published in both newspapers from 1952 through 1965 that contained any word starting with “smok*” (e.g., smoke, smoking) within 75 words of “cigarette” or “tobacco,” or articles with “tobacco” within 75 words of “cigarette.” We collected all articles, including stories filed by reporters, wire stories, editorials, op-ed pieces, and letters to the editor. Because of the large volume of articles returned from our search, we compiled a random sample of 50% of each paper’s total coverage by selecting every other record from each year for each newspaper. We read each piece to confirm that it dealt substantially with cigarette and tobacco issues and responsibility, eliminating stories with no discussion of responsibility or only minimal references to tobacco, such as off-hand mentions of a celebrity who was “smoking a cigarette” in a story that was mainly about entertainment news.

Industry Documents

Tobacco industry internal documents, disclosed and archived online as a result of the 1998 Master Settlement Agreement,⁴⁰ require a different search strategy because simple keywords that suffice for news coverage are not specific enough. Using the snowball method,⁴¹ we examined internal memos, letters, presentations, advertising copy, strategy plans, surveys, and other materials found in the Legacy Tobacco Documents Library’s online database⁴² for the period 1952 to 1965. We located relevant documents by using key words we identified from a literature review of the FCLAA, “Cancer by the Carton,” “The Frank Statement,” and other literature concerning the early response to concerns about smoking and health.^43–45 Initial search terms included “personal responsibility,” “individual responsibility,” “personal choice,” “Frank Statement,” “1954 statement,” “Hill & Knowlton,” “Federal Cigarette Labeling Advertising Act,” “FCLAA,” “label,” and “labeling,” and the names of legislators who vocally opposed or supported regulating tobacco products during the relevant time periods. We also examined tobacco company internal documents that contained the industry’s private strategy discussions about how to react to current events, including the publication of the first scientific studies that linked smoking with disease in the 1950s and the release of the 1964 Surgeon General’s Report.

We reviewed our sample of documents and selected for coding those with substantive discussions of responsibility. We triangulated⁴⁶ and verified internal document information by examining it against historical accounts of the period contained in books,^{43–45,47–50} scholarly articles,^51–53 and Web sites.⁵⁴

Legislative Documents

With keywords generated from the literature review, we used the HeinOnline database to search historical congressional data sets (e.g., the Congressional Index and the Congressional Record) for relevant testimony and legislation published from 1952 to 1965.

We reviewed these records to determine whether they included discussions concerning responsibility and were not about topics such as smoke from industrial pollution or terms such as “smoking gun” that were not about smoking. This process yielded 31 documents that we retained for coding. Certain committee reports, notably the Blatnick Committee report from 1957, were not part of the Congressional Record and were obtained through the Legacy Tobacco Documents Library.⁴²

Coding

Because we wanted to compare frames that appeared in news coverage with those related to legislation, we pursued an iterative process⁵⁵ to develop a single coding instrument that we could use for all document types. Trained coders coded each article for its identifying information (e.g., type of article—news, legislative testimony), main topic, and the responsibility frames present.

The topic was what each piece was primarily about (e.g., “policy” or “dangers of smoking”). We coded whether tobacco was said to cause health harms as well as whether speakers assigned responsibility to individuals, government, the tobacco industry, medical practitioners, or society at large.

For all documents, the sentence was the primary unit of analysis for frames. This is in keeping with the common journalistic practice of 1-sentence paragraphs⁵⁶ and follows the social science understanding that the functions of frames can be evoked within the structures of individual sentences.¹⁷ If there were multiple frames in a sentence, we coded all of them. For example, we coded the following statement as containing both “cigarettes cause health harms” and “government has responsibility for acting on health harms” frames:

I fully concur with the report that the American people will not be convinced of the health hazards of smoking until the Federal Government take affirmative action which manifests its concern.^57(p30)

We also coded the speaker of each frame; in this example, the speaker was former Sen Maurine Neuberger (D-OR) and was coded as “elected official.”

For legislative or tobacco industry documents in excess of 20 pages, we coded only the sections in which discussions of responsibility were present. For example, in a document in which numerous members of Congress were making remarks into the Congressional Record but only 1 was related to tobacco and responsibility, we coded only that speaker’s remarks.

We established intercoder reliability by using Krippendorf α,⁵⁸ repeating the iterative process until we reached an acceptable level of agreement among the coders (α > 0.71 for news articles; α > 0.66 for other documents).

RESULTS

We found 2282 articles published in the New York Times and Washington Post between 1952 and 1965 reporting on tobacco. After we randomly selected 50% of the articles and then eliminated those with (1) only passing mentions of tobacco and (2) no responsibility arguments, we had 663 substantive news pieces to analyze. Most articles (80%) were general news reports. The remainder were opinion pieces such as letters to the editor.

Using our identified search terms, we initially found 24 984 tobacco industry documents from the time period; after we eliminated duplicates and unrelated documents, we reviewed 306 that were relevant and retained for coding 65 that discussed responsibility or related to key policy events such as the FCLAA. We identified more than 100 legislative transcripts that contained our keywords from which we retained 31 for coding because they contained substantive discussions of responsibility.

Topics of Tobacco News Coverage

News coverage in these early years of tobacco control centered on the health harms of cigarettes. News coverage spiked with reports in 1954 from the American Cancer Society, with the US Surgeon General’s landmark 1964 report,⁵⁹ and with the Congressional hearings in anticipation of the FCLAA (Figure 1).

FIGURE 1—

New York Times and Washington Post news coverage of major tobacco topics by year, 1952–1965.

Note. The sample size was n = 663 articles. Topics with minimal news coverage not displayed here.

Typical stories covered the dangers of smoking and findings from the Surgeon General’s Report, policies to address the harms of smoking, smoking trends in a particular region, or profiles of smokers who were trying to quit, such as Washington Post columnist Bill Gold’s chronicle of his own difficulties.⁶⁰ Articles describing the tobacco industry’s business contributed less than 10% of the substantive news on tobacco with stories about how the Surgeon General’s Report affected the tobacco market.

Topics in Internal Industry and Legislative Documents

The 65 internal tobacco industry documents focused primarily on issues related to advertising (43%) such as the Federal Trade Commission’s (FTC’s) prohibition of health claims in 1955 as well as general issues related the tobacco industry (27%), government involvement in tobacco (11%), and public relations strategies (10%). Only 9% focused on health harms caused by cigarettes.

Of the 31 legislative documents, 51% were policy discussions about package labeling and educational efforts, which are an explicit response to concerns about the health harms of cigarettes, 13% expressly focused on the health harms of cigarettes, 13% discussed news coverage of tobacco, 11% focused on marketing, and 13% addressed miscellaneous topics.

Responsibility Frames in Debates Over Cigarettes, 1952–1965

Our framing analysis examined how speakers framed responsibility in tobacco-related news and selected legislative and industry documents from 1952 to 1965. We found responsibility characterized in 3 ways across all document types (Table 1): causality, culpability, and accountability.

TABLE 1—

Responsibility Frames (n = 3725) Regarding Smoking in the New York Times and the Washington Post, Congressional Record, and Internal Tobacco Industry Documents, 1952–1965

	Causality: Do Cigarettes Cause Health Harms?, No. (%)a		Culpability: Who Is to Blame for Harms From Cigarettes?, No. (%)a		Accountability: What Should Be Done and Who Should Do It?, No. (%)a
Frame Type	Yes	No	At Fault	Not at Fault	Has Obligation	No Obligation
News (n = 1929)
Cigarettes	803 (68)	377 (32)	0	0	0	0
Individual consumers	0	0	84 (30)	41 (15)	44 (9)	98 (21)
Tobacco industry	0	0	127 (46)	25 (9)	50 (11)	3 (1)
Government	0	0	0	0	206 (44)	32 (7)
Private doctors	0	0	0	0	38 (8)	1 (0)
Total news frames	1180 (61)		277 (14)		472 (24)
Congressional Record (n = 800)
Cigarettes	235 (57)	180 (43)	0	0	0	0
Individual consumers	0	0	31 (23)	10 (7)	12 (5)	9 (4)
Tobacco industry	0	0	80 (59)	14 (10)	11 (4)	0
Government	0	0	0	0	180 (72)	28 (11)
Private doctors	0	0	0	0	9 (4)	1 (0)
Total Congressional Record frames	415 (52)		135 (17)		250 (31)
Industry document (n = 996)
Cigarettes	113 (24)	349 (76)	0	0	0	0
Individual consumers	0	0	51 (25)	12 (6)	11 (6)	5 (2)
Tobacco industry	0	0	48 (23)	95 (46)	86 (46)	0
Government	0	0	0	0	122 (37)	94 (29)
Private doctors	0	0	0	0	9 (3)	1 (0)
Total industry documents frames	462 (46)		206 (20)		328 (33)

^aPercentages may not total 100 because of rounding.

Causality frames.

Causality frames could point to cigarettes as responsible or not responsible for lung cancer or other health harms. Across all document types—news coverage, internal industry documents, or in legislative testimony—causality frames were the most frequent. The majority (68%) of the causality debate in the news held cigarettes responsible for health harms. A typical news article quoted scientists affirming the link between cigarettes and lung cancer, at times accompanied by a rebuttal from industry spokespeople. In legislative documents causality frames pointed to cigarettes more often (57%) than not (43%), but in the industry documents we found that more than three quarters (76%) of the causality frames denied that cigarettes harmed health.

Government representatives and scientists, from the Surgeon General’s office to local officials, doctors, researchers, and some elected officials, were the most frequent speakers in news stories voicing the position that cigarettes were harmful products. As early as 1954 renowned American Cancer Society statistician E. Cuyler Hammond said: “We know enough now to take action. It has been proved beyond reasonable doubt that cigarette smoking is a major cause of lung cancer.”^61(p39) In the legislative sources, we found political leaders acknowledging the health harms of cigarettes but with more equivocation. In a statement about whether to require cigarette labeling, Sen Thruston Morton (R-KY) said,

I believe that the evidence against smoking, based on statistics and, therefore, far from conclusive, is sufficient to require a statement on the label with respect to the possible health hazards of smoking.^{62(p13 857)}

Tobacco industry spokespeople used 2 arguments to raise doubts about whether cigarettes harm health. Most argued that correlational studies were “just statistics” and that more research was needed. A typical industry statement from the news coverage in this period is illustrated by E. A. Darr, then-president of RJ Reynolds Tobacco Company, who maintained there was “‘no real or substantiated evidence’ showing cigarettes cause lung cancer.”^63(p42) Along with denying that cigarettes cause harm, industry spokespeople highlighted cigarettes’ benefits, such as “a feeling of well-being and refreshment, a defense against fatness and possibly against bacterial infections of the respiratory system.”^64(p3) Nonindustry speakers also voiced these arguments at times, such as when doctors cast doubt on the cigarette–lung cancer link by arguing that cancer is complex with many factors at play.

Culpability frames.

Speakers who added blame, but not accountability, to the responsibility frame appeared the least often across all document types, in 14% of news frames, 17% of frames in the congressional documents, and 20% of the industry documents. These frames assigned blame but without a naming a concomitant action or responsible actor.

Individuals were framed as culpable in statements that referred to their choice, or “free will,” to smoke. In 1957, for example, a Rabbi quoted in the New York Times argued that “[man] is free to smoke cigarettes that may incur the danger of cancer, but he is just as free to make other choices.”^65(p46) When individuals were not blamed for health harms it was because they were influenced by outside factors, as in this statement by John Willig, a writer for the New York Times: “Children grow up in a world that regards smoking as the mark of adulthood, so that to show their virility and grown-up-ness, they smoke.”^66(pSM11)

In news coverage and congressional documents—and occasionally in the industry documents—tobacco industry culpability was evoked when it was accused of inducing smoking through its advertising, especially to youths, and of acting in bad faith. In a background memo about its new tobacco company clients, Hill & Knowlton assigned culpability to the industry:

Do the companies consider that their own advertising and competitive practices have been a principle [sic] factor in creating a health problem? The companies voluntarily admitted this to be the case even before the question was asked.^67(p3)

Blame in this case is assigned but without naming a remedial action.

The opposing frames denied industry’s culpability, often by questioning the health claim as a way to deflect responsibility. One tactic was to dismiss the statements of organizations that attempt to blame them: in 1958 Timothy V. Hartnett, then–Tobacco Institute Research Committee (TIRC) chairman, dismissed a Public Health Service report as “something less than fair” and “misleading” in the use of “scare headline material.”^68(p44) Internal documents illuminate industry strategies for deflecting blame by taking the moral high ground. In an RJ Reynolds Tobacco Co. memo discussing how best to respond to “attacks on use of cigarettes,” the company proposes adopting a defensive posture to affirm that it is “honestly concerned with the public welfare.”^69(p3)

Individual smokers and the tobacco industry are the focus of culpability frames. Government did not appear in this category in any of the document types. This means that government was not being held responsible for causing the problem but could be held responsible for fixing the problem. This era precedes the notion that government inaction can contribute to the problem.

Accountability frames.

When speakers apply accountability frames, responsibility is portrayed as the duty or obligation of a particular actor, either in the form of personal responsibility for individuals or for institutions such as industry or government. Individuals were rarely framed as accountable for doing something about smoking, in the news (9%), in legislative documents (5%), or even in industry documents (6%). By contrast, across all documents, government, more than any other actor, was held accountable for doing something about the health harms from smoking. And although the tobacco industry was rarely framed as accountable in public discussions (11%) or in the Congressional Record (4%), this was a central topic in the industry’s own internal deliberations (46%).

The question of whether the tobacco industry was accountable for addressing the negative effects of its cigarettes was expressed by legislators, such as Robert F. Kennedy, who called for federal regulation on cigarette marketing: “The cigarette companies themselves, who certainly bear the brunt of the responsibility, have not undertaken significant action.”^70(p1793)

We found that during this era the tobacco industry itself was a vocal advocate for its own accountability for the problem, through scientific research and self-regulation. In 1954, in response to the mounting scientific evidence linking smoking and disease and the public’s increasing awareness and concern about it, the tobacco industry published an advertisement called “A Frank Statement to Cigarette Smokers,” in hundreds of newspapers throughout the United States, which stated “We accept an interest in people’s health as a basic responsibility, paramount to every other consideration in our business.”⁷¹ The industry announced the creation of TIRC, which would fund scientific research to ascertain whether cigarettes caused health harms, as an internal memo from the public relations firm that advised its creation said, “From the point of view of its responsibilities to the public, the industry continues to support research that contributes to medical knowledge about tobacco’s effects on health.”^72(p36) The motivation for assuming this pose of accountability was revealed in numerous internal industry strategy memos, including one proposing that, to answer attacks, RJ Reynolds state that “The Company is honestly concerned with the public welfare.”^69(p3)

Government accountability refers to the idea that government should act on behalf of its citizens and on behalf of the employees in its own agencies by protecting them through education or some other means. The countervailing frame is that government action is inappropriate or even illegal. Within this debate, the overwhelming majority of news frames and those in the legislative documents evoking government responsibility supported government intervention of some kind. Indeed, the framing of government in news coverage and legislative documents during this period primarily focused not on whether government had a responsibility to act, but rather on how it should intervene. We saw this frame contested only in internal industry documents, not in public debate. However, even in the internal industry documents, frames holding government accountable appeared more often (37%) than those asserting government was not accountable (29%).

Speakers framed the responsibility of government to act in terms of protecting its citizens in light of the harms of cigarettes that recently had been identified. The more adamant critics of the tobacco industry, including academic researchers, members of the Public Health Service, and a few members of Congress, insisted that government should not drag its feet in acting on cigarettes. As Sen Frank Moss (D-UT) said during the debate on the Tobacco Amendment to the Federal Food and Drug Act,

I submit that such a threat does now exist and that the Congress has not only the duty but a rare opportunity to take appropriate steps to ensure a greater degree of protection to the American people from that threat.^73(p1)

The few voices arguing that the government had no responsibility to act were largely from the tobacco industry and its allies in Congress. Sen John Sherman Cooper (R-KY), from the tobacco-growing state of Kentucky, argued that the Senate should refrain from regulating tobacco because it “was not competent to judge what effect smoking had on lung cancer.”^74(p38)

Most of the public discussion over governmental responsibility was over which part of government—the FTC or Congress—had the jurisdictional authority to properly regulate cigarettes. This frame was evoked by all types of spokespeople involved in the debate, including those from the tobacco industry, who largely did not question, at least publicly, the legitimacy of the government acting to protect the public’s health. Industry representatives argued that Congress should handle any action on smoking rather than the FTC. The then-chairman of RJ Reynolds testified before the House Committee on Interstate and Foreign Commerce in 1965 saying,

It is wholly inappropriate, therefore, for a decision of this scope to be made by the Federal Trade Commission, or by any other single Federal administrative agency whose jurisdiction and expertise are confined to one particular phase of the complex problem. I repeat: This matter should be handled by Congress and by no one else.^75(p282)

Conversely, the New York Times ran an editorial supporting the FTC, which, it said, “has the legal responsibility to regulate advertising of any substance that may be injurious to health.”^76(p28) In between was Wendell G. Scott, president of the American Cancer Society, who told a House Committee that it did not matter whether the FTC, Federal Drug Administration, or Congress handled labeling and advertising restrictions, but he was concerned about a lack of action because of a “jurisdiction dispute.”^77(p2) The debate over whether the FTC had the authority to act or whether only Congress could regulate cigarettes dominated the discussion after the 1964 Surgeon General’s Report was released and support grew for congressional action in the form of the FCLAA.

Frames Summary

Causality frames were the most frequent responsibility frame expressed during the earliest days of tobacco control; they dominated the discussion, particularly in news coverage (61%). Speakers evoking these frames in the news and in the Congressional Record—the public debate—were making the case that cigarettes caused lung cancer. In internal tobacco documents the story was reversed as industry speakers questioned or denied that cigarettes caused health harms. In both sets of causality arguments, cigarettes appear disconnected from the industry that produced them. That is, when speakers mentioned cigarettes they did not usually connect them to specific companies or the industry as a whole; it is as if cigarettes just “are.”

When arguments moved to blame, both individuals and the industry were portrayed as culpable in news coverage and legislative debate; in the industry’s internal documents, naturally, there were more frames that denied industry responsibility for health harms. Tobacco documents posted online show that tobacco companies mostly dealt with their alleged culpability by arguing that, although they are aware of the charges, they would do their best to sow doubt and delay public action; if pressed, they would assume a defensive posture and point to alternative disease vectors such as air pollution as distractions to slow the emerging scientific consensus.⁴⁵

Though individuals and industry were blamed for health harms from smoking, they rarely were held accountable. Instead, speakers called upon government to act. Aside from the question of the whether cigarettes damage health, the responsibility of government to act was the most frequently voiced frame overall, and when it was expressed, the portrayal assumed government ought to act. This connects to the dominant topic we found in news coverage—the idea that if a product is harmful, then the government has a responsibility to do something to protect the public.

Although the idea of consumer choice appeared in the coverage, largely absent from public discussion of tobacco at the time were arguments insisting that “the market should decide” or that the industry should be left to regulate itself. Industry spokespeople did occasionally express this sentiment when arguing against the need for legislative action on tobacco, but not until the industry was threatened with government regulation. For instance, TIRC scientist Clarence Cook Little made the now-familiar argument that the industry was best positioned not only to regulate itself but also to contribute to the social good:

TIRC can do a good job, can be patient, intelligent, and work without bias, we may be able to contribute to setting up a precedent of support of basic research that will have tremendous influence on the country later on.^78(p34,35)

DISCUSSION

Definitive scientific reports on the health harms of cigarettes, particularly the 1964 US Surgeon General’s Report, attracted news coverage and elevated health concerns about smoking to an urgent policy debate. However, the stakeholders in those debates framed the problem in terms of the product as distinct from the industry that produces it. News coverage as well as statements on the record by federal lawmakers focused the issue narrowly around cigarettes with little reference to who was responsible for manufacturing and marketing them.

The earliest debates about smoking and health are stunning for their absence of the sort of personal responsibility rhetoric prominent today. Public health advocates, journalists, and others focused almost entirely on the question of whether cigarettes caused diseases such as lung cancer. We were surprised to find little mention of personal responsibility, even from the public comments of tobacco industry spokespeople. At the time, it was enough to note that the product itself was harmful to warrant government action, or at least a robust public discussion about it.

A possible explanation for this observation is that these policy debates were held against a political backdrop that differs markedly from today’s. For example, Americans’ trust in the federal government has declined significantly over the past half century, from 68% of the population saying they trust government to do the right thing during the Johnson and Kennedy administrations to 22% during President Obama’s first term.⁷⁹ In addition, unlike the highly polarized⁸⁰ and antigovernment sentiments that characterize many of today’s policy discussions,⁸¹ in the debates around the FCLAA, government was assumed to be an appropriate actor. The news coverage and legislative documents articulated various positions about which government entity, Congress or the FTC, should set the policy, not whether such policy should be set. In private, the tobacco industry was willing to criticize the legitimacy of government action. In public discourse, however, the majority of the debate reflects a tendency to move directly from causality to accountability, without major concern over blame: the assumption underlying this era of tobacco policy debate is that, because cigarettes are now a proven health harm, government should take action.

The industry’s focus on conferring legitimacy on Congress to regulate cigarette advertising in preference over the FTC was not based on innocent faith in government, however.⁴⁹ The FTC had a pending proposal to require warnings on TV, radio, and other cigarette advertising, which FCLAA killed.⁴⁹ The industry likely felt it could more easily shape legislation through its many allies in Congress than influence the FTC and may have anticipated a long-term benefit in having a weak regulatory regime to help protect it in a litigation context. Still, the debate had a markedly different tone than today’s characterization of government.

Once the public dialogue about the dangers of cigarettes was established, the industry and governmental actions were about providing consumers with warnings. Government accountability was evoked, but the action turned out to be weak, in part because warning labels hand responsibility back to the individual. Once warned, all remaining responsibility presumably rested with smokers. This may have appeared to public health advocates as an acceptable strategy, because, if rational choice is understood to be the dominant driver for individual behavior, there is no need to consider the influence of the environment on behavior. Rational choice assumed that cigarettes were like other consumer products in that few people would choose to smoke once the dangers were known, in much the same way that one would assume that a skull and crossbones on a poison container would act as an effective deterrent. This of course ignored nicotine addiction, but to the extent that smoking was thought to be a “habit” but not an “addiction,” a perspective reinforced by the Surgeon General’s Report (as a result of the tobacco industry efforts⁸²), knowledge dissemination would have been sufficient.

Indeed, the publicity around the 1964 Surgeon General’s Report itself was enough prompting for some people to quit smoking.⁸³ The policy emphasis, then, would logically be on downstream education efforts. Simple warnings on cigarette packages should do the trick. In hindsight, it is clear that a naïve understanding of the nature both of the product and of the industry promoting it was an important factor underlying the relatively weak response of consumer warnings under FCLAA.

Implications for Tobacco Control

Understanding the arguments and policy dynamics of this earlier time may provide guidance to public health leaders in parts of the world where governments still harbor doubts about the risks posed by tobacco. In Korea, for example, recent judicial decisions⁸⁴ have shown that the judiciary there may still find that proof that smoking causes lung cancer is lacking. There are many nations where the public has not been well-informed; in a policy sense, it is like going back in time.

The typical public health shorthand for framing issues as either individual or environmental⁸⁵ may be too broad a brush. Parsing responsibility among causality, culpability, and accountability frames can help tobacco control advocates differentiate between how the problem arises and who or what should remedy it. This way, the role for government—so important in successful tobacco control—can continue to be brought to bear in the United States and internationally.

Implications for Other Public Health Issues

This historical examination provides a reassuring reminder for those concerned about food environments that tobacco control began with a focus on the product itself, much as public health advocates today are pointing to sugary beverages,⁸⁶ sugary cereals,⁸⁷ or fast food⁸⁸ in relation to diabetes or other chronic diseases. Tobacco control advocates, over time, were able to shift the focus from the product to the industry that manufactures and markets it, and to government’s role in protecting the public’s health.^89,90 Nutrition advocates may be able to do the same with sugary, salty, high-fat foods that are linked to morbidity and mortality.⁹¹ Like tobacco control advocates, nutrition advocates will need to go beyond a focus on a product’s health harms and shift the focus to the food industry’s harmful corporate behavior to make the case for government intervention, and they will have to do so in a political environment that has become characterized by divisive party politics and public distrust of government.^{13–15,79,80}

In addition, there are important differences between tobacco and food products that have a bearing on policy approaches to regulate the latter. Namely, food is necessary for life, and even foods with high amounts of added sugar, salt, or fat may be consumed in small amounts without deleterious health effects, unlike tobacco, which has no safe level of use. However, diet has been identified as a major risk factor in what is now the greatest health burden worldwide—chronic, noncommunicable disease.⁹² In particular, marketing practices for sugary beverages and other foods high in added sugar face increasing scrutiny because of the growing body of epidemiological evidence showing that fructose can catalyze processes leading to liver toxicity and other chronic diseases.^93,94 Many studies are also now examining the addictive properties of sugar in humans.^95,96 With the lessons of tobacco control in mind,⁹¹ nutrition advocates may be able to move faster toward engaging government in environmental strategies likely to have a broader population effect than simple education campaigns usually provide.

Conclusions

Although we examined only 2 newspapers and a limited sample of industry documents and legislative transcripts, these findings elucidate a previously unexamined aspect of the history of tobacco control. The data surprised us, no doubt because the present shapes our understanding of the past. The causality frame is peculiar from today’s vantage point because it is rare these days to see tobacco referred to absent its connection to industry. In the early days of tobacco control, however, one could credibly speak about the health harms from cigarettes without evoking the tobacco industry’s role in producing and marketing them. Our investigation of responsibility rhetoric was influenced by today’s political discourse in which we see repeated vigorous attacks on government intervention and calls for personal responsibility even when the issue, like tobacco, has a well-established evidence base for prevention policy involving government action. But exhortations to personal responsibility were not present with any force in discussions about tobacco before 1965 as the tobacco industry worked to preserve its sales and fight early regulation. The lessons from tobacco control provide much guidance for those fighting the food and beverage industry, but those lessons must be interpreted anew with the current political context in mind.