U.S. Surgeon General Reports on Tobacco and Health
The U.S. Surgeon General Reports on Tobacco and Health are a series of influential publications tracing the health impacts of smoking in the United States, beginning with the landmark 1964 report that established a clear link between cigarette smoking and lung cancer. Over the years, these reports have documented changes in smoking prevalence, health consequences, and public health strategies aimed at reducing tobacco use. For instance, the 1989 report highlighted a significant decline in adult smoking rates from 40% in 1965 to 29% in 1987, attributing this change to increased awareness of health risks and the effectiveness of cessation efforts. It noted that smoking remains the leading preventable cause of death, affecting diverse demographic groups differently, with heightened prevalence among certain socio-economic and racial categories.
The reports not only present statistical findings but also emphasize the challenges of nicotine addiction and the need for targeted public health interventions to discourage smoking, especially among youth. They have spurred legislative actions aimed at creating smoke-free environments and reducing tobacco accessibility. Furthermore, these reports have influenced public discourse and policy, leading to a greater societal understanding of smoking as a public health issue rather than merely a personal choice. Overall, the Surgeon General Reports have played a pivotal role in shaping anti-smoking campaigns and health regulations in the U.S., fostering ongoing discussions about tobacco use and health equity.
U.S. Surgeon General Reports on Tobacco and Health
Date 1989
In its annual report on smoking and health, the office of the U.S. surgeon general examined the progress made toward a smoke-free America and the health consequences of smoking.
Also known asReducing the Health Consequences of Smoking
Locale Washington, D.C.
Key Figures
C. Everett Koop (b. 1916), surgeon general of the United StatesGeorge H. W. Bush (b. 1924), vice president of the United StatesJim Wright (b. 1922), Speaker of the U.S. House of Representatives
Summary of Event
On December 29, 1988, the U.S. secretary of health and human services, Otis R. Bowen, delivered to Jim Wright and George H. W. Bush, in their capacities as Speaker of the House of Representatives and president of the U.S. Senate, respectively, copies of the 1989 surgeon general’s report on the health consequences of smoking. Titled Reducing the Health Consequences of Smoking: Twenty-Five Years of Progress, the report examined changes and developments in American smoking prevalence as well as mortality caused by tobacco use in the United States since the first surgeon general’s report on smoking in 1964.
The most important change that had occurred during the twenty-five-year period since the first report involved the overall prevalence of smoking among Americans, which dropped from 40 percent of the populace in 1965 to 29 percent in 1987. In addition to statistics on smoking, the report focused on possible approaches to be followed by the U.S. Public Health Service in working toward its goal of a smoke-free society by the year 2000.
The first comprehensive federal report on the health consequences of smoking was proposed in June, 1961, and approved by President John F. Kennedy in June of 1962. The selection process for the members of the committee that would prepare the report reflected the high stakes of the outcome. The names of more than 150 scientists and physicians were submitted for consideration by representatives of all the groups involved in the question of a link between smoking and health problems. These included the American Cancer Society, the American Medical Association, the Federal Trade Commission, the U.S. Food and Drug Administration, and the Tobacco Institute. The groups settled on ten committee members—half smokers and half nonsmokers—none of whom had ever taken a public position on the question.
The completed report was delivered to the White House and then presented to the press on January 11, 1964, from a locked briefing room. It declared that “cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction . . . the risk of developing lung cancer increases with the length and duration of smoking and the number of cigarettes smoked per day, and is diminished by discontinuing smoking.”
Although the Tobacco Institute and other industry-related organizations denied the link found by the committee, the Federal Trade Commission (FTC) moved to require that warning labels appear on all cigarette packages. In 1965, Congress preempted the FTC with the passage of Public Law 89-92, the Cigarette Labeling and Advertising Act of 1965. In addition to requiring the first health warning, this law also required that the Department of Health, Education and Welfare (later the Department of Health and Human Services) submit annual reports to Congress on the health consequences of smoking, along with any legislative recommendations resulting from new research. The 1989 report was the twentieth in the series of annual reports.
In the twenty-five years since the first report, scientific research had supported and extended the original conclusions of the 1964 study. As this connection became more clear, the overall rate of smoking declined, and the number of public and private measures to prohibit and discourage smoking expanded dramatically.
The 1989 report reached five conclusions regarding smoking’s prevalence and consequences for mortality. First, the overall prevalence of smoking among adults had declined from 40 to 29 percent, and almost half of all living adults who ever smoked had quit. Second, approximately 750,000 smoking-related deaths had been avoided or postponed because of individuals’ decisions to quit smoking or not to start the habit. Third, the prevalence of smoking remained higher among African Americans, blue-collar workers, and the less educated among the population, and the rate of decline among women was significantly lower than that among men. Fourth, 80 percent of smokers begin smoking during childhood and adolescence, with the age of initiation dropping over time, especially for females. Finally, smoking remained the single most preventable cause of death in the United States, playing a role in more than one out of every six deaths.
In the preface to the report, Surgeon General C. Everett Koop discussed the question of smoking as a matter of individual choice. Drawing on the 1988 report, The Health Consequences of Smoking: Nicotine Addiction, Koop rejected the frequent claim by tobacco interests that the decision to smoke constitutes a reasonable and calculated decision. He cited statistics on the ages at which most smokers begin the habit—80 percent of all smokers born after 1935 started smoking before they reached their twenty-first birthday. Consistent survey data showed that when most smokers reach adulthood, when the appreciation of the health effects is significantly greater, many have great difficulty quitting because of their nicotine addiction. Specifically, more than 80 percent of all American smokers indicated that they would like to quit, and two-thirds of them had made at least one serious attempt to do so. Koop concluded that if the number of new, young smokers were to decline significantly from its 1987 level of three thousand per day, a major effect would be seen on smoking prevalence among adults.
The 1989 report also discussed a growing concern among health officials: The rate of cigarette use had dropped most among the most-educated members of society, making smoking a habit of the poor and working classes. Although only 28 percent of all white-collar workers smoked in 1985, more than 40 percent of all blue-collar workers did. The report also indicated the elevated rates of smoking among certain racial and ethnic minority groups, many of which already suffered from a disproportionate share of high-risk factors and illnesses, such as hypertension.
The overall picture of cigarette smoking had changed significantly in the twenty-five years following the first surgeon general’s report. The 1989 report reflected an assessment of the steps required to carry the nation toward the long-term goal of a smoke-free society.
Significance
The 1989 surgeon general’s report propelled the issue of smoking to the front of American consciousness. In the weeks that followed the report’s release, newspapers and magazines focused on the disparities in smoking rates between men and women, whites and racial minorities, blue-collar and white-collar workers, and college graduates and those with a high school diploma or less. At the same time, a number of legislative bills were introduced throughout the country to limit further the locations where smoking was permitted. In March, 1989, two members of the New York State Assembly introduced a bill designed to require local boards of education to make schools completely smoke-free as a means of reducing cigarette use among children and adolescents. Just two days after the report’s release, in a highly praised move, William Bennett, the man George H. W. Bush picked to lead the American “war on drugs,” declared that he would give up his own “drug habit,” cigarette smoking.
Throughout the months after the report’s release, tobacco companies continued campaigns that portrayed cigarette smokers as a law-abiding group under siege. The Philip Morris Company, in preparation for the bicentennial of the Bill of Rights in 1991, paid for a series of television, radio, and print ads that stressed the democratic right of choice and the need to defend that right against all tyrannical invasions. At the same time, marketing for the new cigarette brand Dakota continued. This brand purportedly was targeted specifically at young women with a high school education or less, one of the groups mentioned in the report as among the most difficult for health organizations to reach and thus among the most likely to develop a cigarette habit. Later, plans were made for the sale of a brand of cigarettes specifically for African Americans, called Uptown. When the plans became public, Secretary of Health and Human Services Louis Wade Sullivan led a successful campaign to have the brand withdrawn.
One of the greatest losses in the fight against cigarette smoking was the departure of C. Everett Koop from the U.S. Public Health Service. During his tenure as surgeon general, Koop pushed the Public Health Service into the forefront of American health crises on a number of issues, especially the fight against acquired immunodeficiency syndrome (AIDS). His outspokenness was a source of embarrassment to President Ronald Reagan’s administration, which had selected Koop in part because of his work as a pediatric surgeon who opposed abortion. As a result, when Koop’s term as surgeon general expired, President George H. W. Bush did not reappoint him. Although the Public Health Service continued to work toward reducing Americans’ use of tobacco products, the loss of the highly visible and respected Koop reduced the attention the popular press paid to these efforts. Nonetheless, antismoking forces in the United States had achieved a substantial victory, and over the succeeding years, tobacco companies were increasingly on the defensive as juries awarded compensation to victims of smoking-related illnesses and as the federal and state governments increased their efforts to limit smoking in the light of increasing health care costs.
Bibliography
Brandt, Allan M. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America. New York: Basic Books, 2007. Comprehensive “biography” of the cigarette covers all aspects of the topic of smoking. Sections address the culture, science, politics, law, and globalization of tobacco products.
Fritschler, A. Lee, and Catherine E. Rudder. Smoking and Politics: Bureaucracy Centered Policymaking. 6th ed. Upper Saddle River, N.J.: Prentice Hall, 2006. Examines the complex issues involved in policy making concerning tobacco use in the United States. Includes bibliography and index.
Goodin, Robert E. No Smoking: The Ethical Issues. Chicago: University of Chicago Press, 1989. Discusses the issues prompted by the existence of the tobacco industry, which produces and markets a product that is recognized as dangerous. Treats smoking as a political issue, one with a proper moral position. Includes list of scientific studies on tobacco and index.
Patterson, James T. The Dread Disease: Cancer and Modern American Culture. Cambridge, Mass.: Harvard University Press, 1987. Scholarly study of cancer in American society includes an engaging chapter that examines the relationship between tobacco and cancer. Provides thorough discussion of the issue of cigarette advertising. Includes bibliographic references and index.
Schaler, Jeffrey A., and Magda E. Schaler, eds. Smoking: Who Has the Right? Amherst, N.Y.: Prometheus Books, 1998. Collection of essays addresses the history of the regulation of tobacco use, smoking as a public health issue, and debates concerning the rights of smokers and nonsmokers. Includes suggestions for further reading.
Tollison, Robert D., ed. Smoking and Society: Toward a More Balanced Assessment. Lexington, Mass.: Lexington Books, 1986. Collection of papers presented at a 1984 conference examines the economic, health, psychological, and social aspects of tobacco use in American society. Valuable to readers in search of specific data. Includes bibliographic references and index.
Troyer, Ronald J., and Gerald F. Markle. Cigarettes: The Battle over Smoking. New Brunswick, N.J.: Rutgers University Press, 1983. Focuses on the cultural evolution of smoking, specifically the progress of the habit from a mark of immorality to a mark of social sophistication to deviant behavior. Includes discussion of the powerful groups with vested interests in destigmatizing smoking. Includes index.