By Roy Benaroch, M.D., Emory University
11 January 1964 was a turning point in one of the most significant public health challenges of the last millennium. On that day, a Saturday, the US Government released the Surgeon General’s report. It was published in all major newspapers, especially the business ones. And this report changed the way smoking was perceived in the United States. Why?
The ‘Smoking and Health’ Report
The full title of the Surgeon General’s report was “Smoking and Health: Report of the Advisory Committee to the Surgeon General of the United States”.
With the help of 150 additional consultants, 7,000 scientific publications were reviewed to distill and summarize what was known about the effects of smoking on health. The report was very careful not to overstate what published studies could support.
There were only two causative inferences—that is, only two health outcomes that the authors felt were positively shown to have been directly caused by smoking: chronic bronchitis and lung cancer.
Correlations were also found between smoking and four other outcomes: a 70% increase in age-adjusted mortality, emphysema, heart disease, and decreased birth weights in babies born to mothers who smoked during pregnancy.
The Impact of the Surgeon General’s Report
The Surgeon General, Dr. Luther Terry, later said that the report, “Hit the country like a bombshell. It was front page news and a lead story on every radio and television station in the United States and many abroad.”
And the impact of the report was huge. A graph of smoking rates in the US hits its peak right around 1964, when half of men and a third of women were current smokers. In 2014, the smoking rate had dropped to about 17% overall, with a continued drop in the percentage of youth smokers, which means that the source of all future smokers continues to dry up.
Corresponding to this change has been a dramatic shift in the public’s perception of the health effects and social acceptance of smoking. Though the 1964 report was a turning point, there had been hundreds of other government and scientific reports implicating smoking as a health risk, both before and after 1964. It wasn’t just this report that changed minds and behaviors—doing that was a much more gradual process.
This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, on Wondrium.
Cigarette Advertising in the Media
Cigarette smoking took off in the early 20th century, with the development of automatic cigarette rollers and the rise of unprecedented advertising and promotional efforts. There was some token opposition from temperance advocates, but neither the general public nor physician leaders recognized that there was much of a health threat from smoking. This, despite research from the 1920s showing a rise in lung cancer among smokers.
By the 1930s, cigarette ads often included explicit positive health claims. One especially ironic ad from Philip Morris claimed “an ounce of prevention is worth a pound of cure”. Some ads featured smoking physicians touting health claims, and radio, and later television, spots focused on cigarettes making you feel and look young and vigorous.
In 1953, cigarette sales dipped slightly for the first time, this was in the wake of increased press coverage of published studies linking smoking with lung cancer. The response of the tobacco industry was to introduce filtered cigarettes. By 1954, sales had rebounded and continued to increase for another decade.
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Positive Reporting in the Media
The year 1953 marked another shift from the cigarette manufacturers: Public relations firms were brought on board to begin a massive campaign challenging the evidence that smoking was harmful.
The aim was to reassure the public, not perhaps that smoking was definitely safe, but that whether smoking was harmful was a matter of opinion or an open controversy. Evidence continued to grow, and once media opinions shifted, public opinion followed.
The year 1963 marked the peak year of per capita cigarette consumption in the US, at 4,336 cigarettes per person per year. And then came the 1964 Surgeon General’s Report—the turning point in consumption. But that report could not have had the impact it did had the public not been ready to change their perception of cigarettes.
In 1958, 44% of Americans had come to believe that smoking caused cancer. Not yet half, but near a critical tipping point. After the Surgeon General’s 1964 report, that percentage went up to almost 80%. This was a major shift in public perception, led by a somewhat belated media effort. From here, dominoes continued to fall.
Growing Restrictions on Smoking
In 1966, the US Congress passed the Federal Cigarette Labeling and Advertising Act, which required packages to include a cautionary label, “Caution: Cigarette smoking may be hazardous to your health.” A few years later, that warning was strengthened to: “Cigarette smoking is dangerous to your health.” Television and radio ads, and most sponsorships, were banned completely, though print and billboard ads remained pervasive.
As the public perception of smoking shifted, political winds started to change, too. In the 1970s, a growing number of communities began to restrict smoking. The 1988 Surgeon General’s report, for the first time, declared that smoking was truly addictive and not just a habit, and this chemical addiction was driven by nicotine.
By the 1990s, higher tobacco excise taxes along with further restrictions on smoking both in public and at many businesses continued to make smoking more and more inconvenient. That added to declining social acceptance of smoking and continued the downward pressure on smoking rates.
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The Impact of Media on Smoking
Do you see what was happening, here, in the big picture? What really made a difference was the change in the public acceptance of smoking. Once that began to erode, initiatives like increased taxes, mass media campaigns, and smoke-free policies were not only more palatable to the public, they also became inevitable, and they all reinforced smoking’s decline.
From 1964 to 2012, an estimated 8 million premature deaths were prevented by the drop in smoking rates. That illustrates the power of an effective health media.
And by ‘media’, here, we have to include not only the traditional health news media, but also the influence of television commercials, movies, and TV shows. We are, of course, not done yet. Almost 38 million Americans still smoke.
And there is far more smoking in many other countries, who’ve lagged behind in both public perceptions of smoking and in laws and policies that support anti-smoking efforts.
Common Questions about the Surgeon General’s Report of 1964
There were only two causative inferences of the Surgeon General’s Report of 1964—that is, only two health outcomes that the authors felt were positively shown to have been directly caused by smoking: chronic bronchitis and lung cancer.
After the Surgeon General’s Report of 1964, the percentage of Americans who believed that smoking caused lung cancer went up to almost 80%. After the report, the percentage of Americans who smoked kept dropping.
In 1966, the US Congress passed the Federal Cigarette Labeling and Advertising Act, which required packages to include a cautionary label, “Caution: Cigarette smoking may be hazardous to your health.” A few years later, that warning was strengthened to: “Cigarette smoking is dangerous to your health.”