50 Years After Surgeon General's Warning, Smokers Still Light Up

In the 50 years since the Surgeon General's landmark report on smoking, what's worked to convince people not to smoke, and what hasn't? NPR's Scott Simon talks with Kenneth Warner, professor of public health at the University of Michigan, about cigarette consumption before and after the report.

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SCOTT SIMON, HOST:

This is WEEKEND EDITION from NPR News. I'm Scott Simon. Fifty years ago, the first Surgeon General's report on smoking and health came out, and said that smoking is bad for you. So much has changed since then. Cigarette jingles and commercials, gone now from the airwaves. Warnings are on cigarette packs; taxes on cigarettes are huge in many states.

But millions of people still have died from what are figured to be smoking-related causes and about 20 percent of Americans still smoke. We're joined now by Kenneth Warner, professor of public health at the University of Michigan. He's co-authored two new studies on the impact of tobacco-controlled policies. Professor Warner, thanks so much for being with us.

KENNETH WARNER: Thank you for having me.

SIMON: So 50 years ago how common was smoking?

WARNER: It was incredibly common 50 years ago. Well over 50 percent of adult males were smokers. More than a third of women were smokers and that number was rising and would have continued to rise. And it was essentially the norm.

SIMON: Did the change occur quickly?

WARNER: It took a few years for it to kind of kick in, but if you look at adult per capita cigarette consumption, which is total cigarettes divided by the adult population, you'll see that that rose almost every single year from 1900 through 1963, and then it fell in 1964 and started to reverse course. Since 1973 that has fallen every single year.

SIMON: So what's worked and what hasn't?

WARNER: We know a number of policies that work very well. The single most important one is raising the price of cigarettes and doing so substantially. That is the policy that will get us the largest reduction in smoking as quickly as possible. It also is the most effective policy for reducing smoking among young people.

SIMON: So raising the price has been a more effective deterrent to smoking for young people than all those commercials?

WARNER: The commercials are very important. If you look at the Truth Campaign out of the American Legacy Foundation, that has been documented to have reduced smoking. But I think it is pretty much unarguable that price is the single most important variable in youth smoking. I would say that the messages you've seen in the mass media, like the Truth Campaign, are the second most.

And actually we have a great deal of difficulty knowing exactly what to do to get kids not to smoke once you get beyond those two policies or interventions.

SIMON: What do you think of e-cigarettes?

WARNER: E-cigarettes are something of an anomaly. They are a very interesting, novel product. We don't really know at this stage what difference they're going to make in either direction. The worry about e-cigarettes is that they're being marketed currently to encourage what we call dual use. They're being used to encourage adults who can't smoke at work to use a product like e-cigarettes so they can tide themselves over between the times when they can smoke.

By the same token, there's no question that by itself an e-cigarette is inherently less dangerous - that's not to say not dangerous - but much less dangerous than cigarettes. There's nothing other than combusted tobacco that really creates an enormous hazard to health, so the cigarette in other forms of combusted tobacco really need to be the target.

SIMON: Since we have you here, based on your experience and research, do you have strong opinions about nicotine gum, cigarette patches, anything like that?

WARNER: We know that all the nicotine pharmaceuticals and other techniques for quitting help some people to quit. When you talk about something like nicotine gum, we have the unfortunate fact that many people don't use it properly, so many people take the word gum literally and they chew it. And if you actually chew it, it doesn't work. You need to bite into it and let the tingle last for a while till that subsides and then bite it again.

That's something that very few users of the produce understand. In fact, it's something that relatively few physicians who will tell their patients to use the product understand.

SIMON: Professor Warner, what do you think's important in the next few years as far as you're concerned?

WARNER: One of the most important issues is worrying about how smoking relates to the mentally ill. We know that 40 to 50 percent of cigarettes and possibly 40 percent or more of smokers have a concurrent mental illness or other substance abuse problem that's diagnosable within the last 30 days. That's something that we in tobacco control mention and then forget all about. It deserves a lot more attention.

The other issue that's critically important is that smoking has become increasingly concentrated in the low income, low education populations. I'm always fascinated that we in public health talk about disparities in health and how important they are and then we tend to forget about smoking. Smoking may well be the single most important behavioral factor in health disparities between the rich and the poor.

SIMON: Kenneth Warner, public health professor at the University of Michigan. Thanks so much for being with us.

WARNER: Thank you very much.

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