Smoking Regulations 50 years Later: A Big Victory for Simple Measures

U.S. Surgeon General Luther Terry addressing press conference at release of the 1964 Report on Smoking and Health. (Archives of The National Library of Medicine)

by Osefame Ewaleifoh (PhD/MPH Student)

U.S. Surgeon General Luther Terry addressing press conference at release of the 1964 Report on Smoking and Health. (Archives of The National Library of Medicine)

U.S. Surgeon General Luther Terry addressing press conference at release of the 1964 Report on Smoking and Health. (Archives of The National Library of Medicine

Few public health initiatives have been as successful as the government led policy to actively discourage smoking. This government policy has been effective in changing both attitudes and actions towards smoking [1]. Exactly 50 years ago, on the 11th of January 1964, the federal government under President Lyndon Johnson initiated policy measures to curb the growing tide of smoking in the U.S.

Before 1964 over 50% of Americans were active smokers; thus ashtrays were an imperative for every occasion including Doctors offices. Society was awash with smoking: The smoking Marlboro cowboy was still the king of cool, celebrities like soon-to-be President Ronald Reagan endorsed tobacco products [2]  and even Surgeon general Luther Terry was still a smoker at the beginning of the study [3].There were no warning labels and you could even purchase cigarettes in vending machines.

Empirical data from both the medical and public health community had previously clearly showed the public health peril of smoking. Still there was no formal government position outlining these risks. Finally these reports and studies were condensed into the groundbreaking 1964 report Smoking and Health: Report of the Advisory Committee to the Surgeon General [4].

For the first time the government was publicly aligned with data that smoking was severely detrimental to health. In the face of such overwhelming evidence and need for remedial action, the surgeon general took the first big step of many towards managing smoking as a public health challenge: he gave the public the clear and simple message that smoking causes cancer. In the words of then Surgeon General Luther Terry:

“Cigarette smoking is associated with a 70% increase in the age-specific death rates of males… In view of the continuing and mounting evidence from many sources, it is the judgment of the Committee that cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate”[5].

While the Surgeon General’s report was neither novel nor surprising to either the medical or public health community, it provided the political capital and momentum desperately needed by public health advocates to address the alarming health needs posed by smoking.

Clearly this report by the Surgeon General was not the first to implicate smoking as a major risk factor for lung cancer and other health conditions. As we celebrate the 50th anniversary of this report it is a valuable public health question to ask – why was the Surgeon General’s report so successful?

Perhaps it was because of the authority or legitimacy of the Surgeon General’s office placed behind the report? Perhaps it was because it was a thoroughly methodical work that aggregated over 7000 past studies and pulled on experts from both the medical and non-medical community to analyze the available data? [4] Perhaps it was because the Surgeon General was very adept at getting his message out, as his report was on the cover of every newspaper and the center of every conversation for weeks and months after its publication in January 1964? Perhaps the time was just right for a change in smoking habits. Whatever the reason, the 1964 Surgeon General’s report against smoking marked a major inflection point  and milestone in smoking and public health in the United States.

Trends in Current Cigarette Smoking from 1965-2011

Trends in Current Cigarette Smoking from 1965-2011

Immediately following the 1964 Surgeon General’s Report on Smoking and Health, the U.S. Congress adopted the Federal Cigarette Labeling and Advertising Act of 1965 and the Public Health Cigarette Smoking Act of 1969[7]. These two laws introduced three invaluable regulations to the sale and distribution of cigarette products. Through these laws, Congress:

  • Required package warning label— Warning: “The Surgeon General Has Determined that Cigarette Smoking Is Dangerous to Your Health”
  • Prohibited cigarette advertising on television and radio
  • Required Department of Health, Education, and Welfare (DHEW) to report annually to Congress on the health consequences of smoking.

It is impossible to determine how many lives have been saved by the 1964 Surgeon General’s report or the simple measures it birthed like smoking labels and a ban on smoking advertisements. Still there is no doubt that these measures have been effective.

In 1985, 21 years after the 1964 report, the percentage of U.S adult smokers was down by 33.3%[1]. By 2011 the number of adult smokers in the U.S was down by 57% compared to 1964[1]. Despite its obvious benefits and merits, the regulation of smoking continues to be contentious and heavily debated as cities like New York continue to pass more stringent laws to limit smoking.

While much work remains to be done, much progress has been achieved in managing smoking as a public health concern. As we mark the 50th anniversary of this milestone in public health, we should be encouraged as health care workers and public health advocates that though progress might be small and halting, simple measures can lead to big public health victories.


  1. NLM, N.L.o.M. Profiles in Science.  [cited 2014 01/07]; Available from:
  2. Calahan, R. Progression of Tobacco Advertisement. Available from:      
  3. Stobbe, M. The smoking report  – 50th anniversary. 2014  01/04/2014]; Available from:
  4. General, T.S., Smoking and Health the surgeon generals report, in Smoking and Health 19641964: Washington.
  5. Glantz, S.A., John Slade, Lisa A. Bero, Peter Hanauer, and Deborah E. Barnes, The Cigarette papers, ed. D.E. Barnes. 1996, Berkeley: University of California Press.
  6. CDC, C.f.D.C. Smoking Trends.  1/10/2014]; Available from: 1.
  7. CDC, C.f.D.C. Smoking regulations. Available from:
About NPHR Blog (254 Articles)
The is the blog of the Northwestern Public Health Review journal. The blog and journal are both student run and contain research articles, opinions, interviews and other content pertaining to public health.

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