1 in 5 Americans Still Smoke

More than 50 years after the first U.S. surgeon general's report on its dangers, smoking remains the leading cause of preventable disease and death in the United States. And almost three out of four of those in this country who still smoke say they want to quit, so they know the consequences.

The good news is that because so many did quit, smoking, at least in the United States, has been in decline. Robert Proctor, professor of the history of science at Stanford University, said cigarette smoking continued to grow throughout the 1960s and 1970s, reaching a peak of about 630 billion cigarettes, or more than 31 billion packs, smoked annually in the United States before the start of its decline in 1982.

The 1964 surgeon general's report set off one of the most powerful public health efforts ever, dramatically cutting the number of smokers. But tobacco products still pose significant risks to the health of Americans, and while the number of smokers in the U.S. has significantly declined, for every American smoker who has quit, the global rate of smoking has increased, said Allan Brandt, a professor at Harvard Medical School.

Within months of the 1964 report, the Federal Trade Commission ordered cigarette companies to put warning labels on packaging, and in 1969, cigarette advertising was banned from television and radio. Since then, according to the surgeon general's office, adult smoking rates have been cut in half.

Erika Sward, of the American Lung Association, said that those who are most likely to smoke today generally are the less educated of a lower socioeconomic status. Targets of aggressive tobacco company marketing campaigns are the poor, the needy, the impaired, the vulnerable, those who are unable to quit, and children, she added.

"People who still smoke," Proctor said, "are those who have lost the freedom not to." He added that Hollywood still depicts smoking as glamorous, accounting for about one third of new smokers.

The tobacco industry, according to Proctor, clearly knew by the mid-1950s that cigarettes were dangerous, and the surgeon general's office charged that it deliberately misled the public about the risks.

The evolving tobacco market offers little comfort. A spokesman for the MD Anderson Cancer Center in Houston confirmed that all tobacco products, including e-cigarettes and hookahs, contain highly addictive levels of the chemical nicotine. Thus the tobacco habit hangs on.