Introduction
January 11, 2014, marks the 50th anniversary of what is arguably one of the most important documents in the history of public health in America: Smoking andHealth. Report of the AdvisoryCommittee to the Surgeon Generalof the Public Health Service, more commonly known as the first Surgeon General's report on smoking and health. The New York Public Library ranked the report one of 10 "books of the century" in the area of "nature's realm," alongside Einstein's Meaning of Relativity, Watson's Double Helix, and Rachel Carson's Silent Spring. The report spawned an era of interventions that earned tobacco control inclusion on the Centers for Disease Control and Prevention's (CDC's) list of 10 great public health achievements in the 20th century, as well as the first decade of the 21st.
The report definitively labeled cigarette smoking the principal cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women (data were then insufficient to draw the causal conclusion), the most important cause of chronic bronchitis in both genders, and associated with numerous other diseases, including coronary heart disease and emphysema. Massive publicity about the report's findings (coverage of the report ranked among the top news stories of 1964) abruptly halted a six-decade-long pattern of nearly uninterrupted annual increases in adult per capita cigarette consumption. With but a few exceptions, smoking has declined annually in the subsequent 50 years. Adult smoking prevalence was 43% in the mid-1960s, with more than 50% of men and nearly one third of women having been smokers. Today, prevalence has fallen to 18%, with just more than one fifth of men and one sixth of women smoking.
(Enlarge Image)
Genesis Club, an employment and resource center for people with mental illness, has created a national model for exercise, nutrition, and smoking cessation. April Vargas is trying to quit smoking and has cut back on her cigarette consumption. During a recent test of the carbon monoxide level in her lungs, her reading was much improved. Photograph by Suzanne Kreiter. Printed with permission of Getty Images.
The report's advisory committee concluded that the evidence from the 7000 studies it had reviewed was sufficient "to warrant appropriate remedial action." Since then the forces of public health have secured cigarette tax increases and smoke-free workplace laws, restrictions on advertising and promotion and mass media counter-advertising campaigns, sales-to-minors prohibitions and school health education, the development of smoking cessation treatments and litigation against the tobacco industry. Research has documented the effectiveness of many of these interventions, as well as the ineffectiveness of others, creating a strong evidence base for the development of effective tobacco control policy. Those jurisdictions that have pursued the evidence-based interventions most aggressively have driven smoking rates well below the national average, notably including California (12.6%), Massachusetts (16.4%), and New York (16.2%).