Landmark smoking report anniversary: Progress but work remains


Major conclusions from the report

1. The century-long epidemic of cigarette smoking has

caused an enormous avoidable public health tragedy.

Since the first Surgeon General’s report in 1964 more

than 20 million premature deaths can be attributed to

cigarette smoking.

2. The tobacco epidemic was initiated and has been

sustained by the aggressive strategies of the tobacco

industry, which has deliberately misled the public on

the risks of smoking cigarettes.

3. Since the 1964 Surgeon General’s report, cigarette

smoking has been causally linked to diseases of nearly

all organs of the body, to diminished health status,

and to harm to the fetus. Even 50 years after the

first Surgeon General’s report, research continues to

newly identify diseases caused by smoking, including

such common diseases as diabetes mellitus, rheumatoid

arthritis, and colorectal cancer.

4. Exposure to secondhand tobacco smoke has been

causally linked to cancer, respiratory, and cardiovascular

diseases, and to adverse effects on the health of

infants and children.

5. The disease risks from smoking by women have risen

sharply over the last 50 years and are now equal to

those for men for lung cancer, chronic obstructive

pulmonary disease, and cardiovascular diseases.

6. In addition to causing multiple diseases, cigarette

smoking has many adverse effects on the body, such

as causing inflammation and impairing immune

function.

7. Although cigarette smoking has declined significantly

since 1964, very large disparities in tobacco use

remain across groups defined by race, ethnicity, educational

level, and socioeconomic status and across

regions of the country.

8. Since the 1964 Surgeon General’s report, comprehensive

tobacco control programs and policies have

been proven effective for controlling tobacco use.

Further gains can be made with the full, forceful, and

sustained use of these measures.

9. The burden of death and disease from tobacco use in

the United States is overwhelmingly caused by cigarettes

and other combusted tobacco products; rapid

elimination of their use will dramatically reduce this

burden.

10. For 50 years the Surgeon General’s reports on smoking

and health have provided a critical scientific foundation

for public health action directed at reducing

tobacco use and preventing tobacco-related disease

and premature death.

SOURCE: “The Health Consequences of Smoking— 50 Years of Progress”

A Report of the Surgeon General

Fifty years ago, the Surgeon General’s report warning of the dangers of smoking marked a watershed moment for public health.

Public opinions about smoking shifted. Smoking rates sharply declined.

A new report released Friday highlights progress over the past five decades – from a dramatic decline in lung cancer cases to encouraging signs for lowering smoking rates even more, and for preventing young people from ever lighting up.

But the rate of progress is not fast enough, the report says. About one in five Americans still smoke. And smoking remains the leading preventable cause of death in the United States — cigarette smoking causes more than 440,000 deaths each year, according to the Centers for Disease Control and Prevention.

If smoking rates remain stable, 5.6 million of today’s children will die prematurely from a smoking-related illness, according to the report.

The Atlanta Journal-Constitution interviewed Dr. Fadlo Khuri, deputy director of Emory University’s Winship Cancer Institute and a lung and head and neck cancer expert, to discuss the new report.

Q: Talk about the impact of that landmark report back in January 1964.

A: Before this report, the American people had every reason to be suspicious of cigarettes, but we didn't have enough scientific proof that smoking caused lung cancer. But now finally we had a report that was clear, evidence-based and unequivocal. It proved beyond a shadow of a doubt that smoking caused both lung cancer and larynx cancer.

The impact on the public was astonishing. If you look at Gallup polls, in 1958, only 44 percent of Americans believed that smoking seriously impacted health. Ten years later, and four years after the report’s release, that number had climbed to 78 percent.

In 1964, 52 percent of men and 35 percent of women smoked cigarettes. By 2011, this has fallen to 21.6 percent of men, and 16.5 percent of women.

Q: What are some of the most encouraging signs in the current report?

A: The lung cancer rates have dropped significantly. The overall decrease from 2005 to 2009 was 2.6 percent per year for men and 1.1 percent for women. That is a 6 to 8 percent overall drop. There are many reasons. First of all, smoking cessation and smoking prevention programs early on after the settlements from the tobacco industry have been effective. We have also gotten better at screening for lung cancer and screening with CT scans. We have found that you if you screen smokers between the ages of 55 and 75, you have an 80 to 84 percent chance of catching lung cancer in stage 1.

Q: According to The Campaign for Tobacco-Free Kids, Georgia is ranked No. 43 for spending for state tobacco prevention programming, spending $2.2 million during the 2014 fiscal year, only a fraction of $117 million as recommended by the CDC. What do you think of the efforts to get people stop smoking in Georgia?

A: Georgia fails… States need to be rigorous and we have an opportunity to be tough. We can increase cigarette taxes to discourage people from smoking. This has been proven to work. Teens without much money, if you raise the tax, they can't afford cigarettes. They won't buy them and they will find something else that is cool. We have to do the right thing and we haven't done enough of it.

Q: What about the tobacco epidemic troubles you?

A: The increase in young people smoking. We see it particularly in teens with working class backgrounds or the working poor. The tobacco industry is successful at marketing to people who are struggling and want to make a name for themselves. They've done a good job at associating smoking with independence.

Q: What would you say to someone who wants to quit smoking?

A: I'd say come spend a day with one of us in the clinic and meet the patients and talk to them about how they deal with the challenges of the disease. Do what you can to avoid this disease. Prevention is more effective than treatment. …We have medications to help you quit, we have counseling to help you quit. Don't get down on yourself. Let us help you. There is tremendous power in saying it's important to quit and then providing support to people as they struggle while quitting. It's fundamentally critical to make sure you remove any blame and guilt the best you can.