New report: US battle against tobacco use far from finished: Surgeon general’s report marks 50 years
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* Charlotte Tucker

Fifty years after the U.S surgeon general first announced that smoking causes serious health problems, scientists are still cataloging its effects, and Americans continue to battle tobacco addiction.

At the same time, science has started to get a hold on why people become addicted, and new treatments have made a marked difference on the smoking rate in the U.S., which is now half what it was when then-Surgeon General Luther Terry, MD, released his landmark report on smoking in 1964.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/44/2/1.2/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/44/2/1.2/F1)

U.S. Health and Human Services Secretary Kathleen Sebelius speaks about the health consequences of smoking during the release of a new surgeon general’s report. The report found smoking has killed more than 20 million people in the U.S. since the first surgeon general’s report on the topic in 1964.

Photo by Chip Somodevilla, courtesy Getty Images

“We’re still a country very much addicted to tobacco,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius at an event announcing the release of “The Health Consequences of Smoking — 50 Years of Progress,” held Jan. 17 at the White House. “It has serious ramifications for our families, our communities, our overall health and our economy. (But) there are things each of us can do in our own communities that make a significant contribution to ending this epidemic.”

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[Figure2](http://www.thenationshealth.org/content/44/2/1.2/F2)

A man walks by a no smoking sign on the University at Buffalo, N.Y., campus in 2012. Policies curbing tobacco use have become prevalent since the first surgeon general’s report on smoking 50 years ago, but the nation still has a ways to go, says a new report.

Photo by David Duprey, courtesy AP Images

The most recent surgeon general’s report found that smoking has killed more than 20 million people since the first report was issued, and 2.5 million of those people were nonsmokers who died because they breathed secondhand smoke.

“We have made enormous progress in the past 50 years, preventing millions of deaths and tens of millions of illnesses,” said Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, in a statement. “But we have much further to go. Tobacco remains, by far, the single leading preventable cause of death in the United States and the world.”

The report also revealed that researchers are continually discovering links between smoking and diseases that, at first, were not so clear.

For instance, smoking has now been determined to be a cause of diabetes, rheumatoid arthritis, erectile dysfunction and poor response to medical treatment, said acting Surgeon General Boris Lushniak, MD, MPH, at the White House event. In addition, smoking has been linked to two additional types of cancer: colorectal and liver cancer, and studies suggest a link between smoking and breast cancer, though the evidence is not as firm, according to the report.

Studies have also found that men who have prostate cancer and are smokers might be more likely to die than those who do not smoke, and that smoking can prevent cancer treatments from working as well as they do for nonsmokers, the report said.

“It is critical that all Americans understand the importance of not smoking,” Lushniak said.

While many likely do grasp the importance, quitting has proved difficult, though recent research has seen some breakthroughs.

The *Journal of the American Medical Association* devoted its Jan. 8 issue to the theme “50 Years of Tobacco Control,” with studies looking at tobacco cessation efforts and smoking rates in the U.S. and world, among other topics.

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[Figure3](http://www.thenationshealth.org/content/44/2/1.2/F3)

Former surgeons general David Satcher, MD, MPH, second from left, and Regina Benjamin, MD, MBA, third from left, attend the January White House event releasing the new report on smoking. More than 20 million people in the U.S. have died from smoking since the first surgeon general’s report in 1964.

Photo by Chip Somodevilla, courtesy Getty Images

One study, which focused on people with severe mental illness — who have been found to smoke at a much higher rate than the general public — found that drug treatment combined with behavioral therapy was much better at helping people stay away from cigarettes, even after treatment stopped.

In the study, 87 people with either schizophrenia or bipolar disorder who had been treated with the drug Varenicline and managed to quit smoking, were assigned to receive either more of the drug or a placebo over the course of the next 40 weeks. Both groups received cognitive-behavioral therapy. The researchers found that after those 40 weeks, 60 percent of the people receiving the drug were still not smoking, while just 19 percent of those taking the placebo still abstained. Even six months after stopping all treatment, 30 percent of those who received the drugs were abstinent, while just 11 percent of placebo group members were.

“This is an enormously important theme issue for *JAMA,*” said journal Editor in Chief Howard Bauchner, MD, in an audio commentary accompanying the issue. “There’s probably no other single health habit that so adversely affects health as tobacco smoking.”

Efforts to help people quit — both with the use of drugs and without — are widespread. Sebelius noted that cessation assistance is now covered as a result of the Affordable Care Act, and that many communities have taken up the cause of driving down smoking rates. She specifically called out Ringgold County, Iowa, which is using funding from CDC’s Communities Putting Prevention to Work initiative to use evidence-based methods to reduce smoking. In the county, about 8 percent of adults are current smokers, and Ringgold ranks 15th highest of 99 Iowa counties for mothers who smoke during pregnancy, according to CDC.

Since funding began in 2010, the county has put a number of efforts in place, including a public awareness initiative targeting women of reproductive age, quitline referrals and a tobacco-free park policy, according to CDC.

Helping people quit smoking is one thing, but Sebelius also noted that it is even healthier never to start smoking.

“Most of the people who die from smoking began smoking when they were kids,” she said, adding that about 3,000 kids try cigarettes every day, and of those, about 1,000 become smokers. “If we fail to reverse this trend, 5.6 million American children who are alive today will die prematurely,” she said.

The goal, she said, is a tobacco-free generation.

“The federal government can’t do this alone,” she said. “We have a significant role, but it’s not the only role. We need an all-hands-on-deck approach to take tobacco out of the hands of America’s youngest generation.”

Tobacco control efforts have made inroads, according to the surgeon general’s report. In 2012, about 18 percent of American adults were smokers, compared with 42 percent in 1965. According to a *JAMA* study, tobacco control has been associated with an estimated 8 million fewer tobacco-related deaths than there would have been if the controls had not been in place.

Cancer deaths related to smoking are also on the decline, according to a Jan. 10 study published in CDC’s *Morbidity and Mortality Weekly Report.*

It found that between 2005 and 2009, lung cancer rates among men declined 2.6 percent per year, and 1.1 percent per year among women. Rates of cancer for men are diminishing more quickly than they are for women, and what had once been a much larger gap — men had much more lung cancer than women — is becoming more narrow.

The study also found that lung cancer incidence decreased most rapidly from 2005 to 2009 among men and women ages 35-49. It attributes at least some of that decrease to a 2008 study of 44 states that found that strong tobacco control is correlated with lower lung cancer rates.

Globally, the trend is also that a smaller percentage of the world population is smoking, but it is not all good news, according to another *JAMA* study. It found that the prevalence of smoking between 1980 and 2010 is lower, falling from 41 percent to 31 percent among men over age 15. Among women over 15, the worldwide smoking rate fell from about 11 percent to 6 percent, the study found.

But a larger world population means that more people smoke now than in 1980. Then, it was estimated that there were 721 million smokers. Today, there are 967 million.

The surgeon general’s report was met with new calls to action to help cut tobacco use even further. A coalition of seven health groups released a statement calling for a “new national commitment to end the tobacco epidemic for good” and setting out three goals:

*   reducing smoking rates from 18 percent to less than 10 percent within 10 years,

*   protecting all Americans from secondhand smoke within five years, and

*   eliminating death and disease caused by tobacco.

“Over the past 50 years, we have developed proven strategies that can achieve these goals if they are fully and effectively implemented,” said the statement from the coalition, made up of the American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco-Free Kids and Legacy. “These strategies include tobacco tax increases, comprehensive smoke-free workplace laws, hard-hitting mass media campaigns, health insurance coverage to ensure smokers have access to quit-smoking treatments, and well-funded, sustained programs to prevent kids from smoking and help smokers quit.”

The coalition pointed to the Food and Drug Administration’s authority to regulate tobacco manufacturing, marketing and sales as a key tool.

“We have the tools to end the tobacco epidemic for good,” said the coalition in its statement. “We cannot afford to wait another 50 years.”

For more information on the new surgeon general’s report, visit [www.surgeongeneral.gov](http://www.surgeongeneral.gov). For more from CDC, visit [www.cdc.gov/tobacco](http://www.cdc.gov/tobacco).

*Editor’s note: This article was corrected post-publication.*

*   Copyright The Nation’s Health, American Public Health Association