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Are we losing the war on smoking?

Despite 50 years of progress, 42 million Americans are still addicted to tobacco, and cigarettes kill more people than any other plague on the planet.
Occupy Oakland Threatened With Eviction
A protester lights a cigarette at Occupy Oakland in Frank H. Ogawa Plaza on November 13, 2011 in Oakland, California.

When the Office of the Surgeon General first declared smoking a health hazard in 1964, more than 40% of U.S. adults were already hooked. Fifty years later, the nation’s smoking rate is just 18% and falling. Former smokers now outnumber current ones. Current smokers are smoking less heavily, and most are trying to quit. These trends have saved an astounding 8 million American lives over the past half-century and helped increase overall life expectancy by six years. In an anniversary report released Friday, the surgeon general’s office calls the decline in smoking one of the greatest successes in the history of public health.

Excellent news to be sure. Unfortunately, 42 million Americans are still addicted, and cigarettes are still killing and maiming more people than any other plague on the planet. In this country alone, smoking still snuffs nearly a half-million people every year, including thousands of nonsmokers who develop cancer and heart disease from chronic exposure to secondhand smoke.  Millions more suffer smoking-related illnesses that cost the country $289 billion a year. And, worst of all, the tobacco industry’s million-dollars-per-hour marketing efforts are still snaring generations of new addicts.

“Every cigarette is a finely engineered nicotine-delivery device,” Assistant Health Secretary Howard Koh said during a White House event to unveil the new surgeon general’s report. “And every year the industry introduces new products with special appeal to young people.” The result: more than 2,000 teens and young adults become habitual smokers every day. If that trend continues, one of every 13 children alive today will die an early, ugly death from tobacco.

Like most health hazards, this one doesn’t affect us all equally. In a separate bulletin released this week, the CDC shows that smoking rates vary widely by region and socioeconomic status. Prevalence is higher in the South (20%) and Midwest (21%) than in the West (14%) or Northeast (17%). And though white people smoke at higher rates than than blacks or Hispanics, the epidemic is highly concentrated among the poorest and least educated Americans. In 2012, the most recent year on record, only 7% of adults with graduate degrees were still smoking. The rate was 48%—nearly seven times higher—among people who’d completed only GEDs.

The poisonous effects of cigarette smoke are no secret; past surgeon generals’ reports have shown how it ravages every organ system in the body. Yet the new report manages to expand the list of known health risks. The latest additions include diabetes, sexual dysfunction and immune dysfunction, as well as colon and liver cancer.

Fortunately, the research has also shown that public initiatives can reduce smoking and save lives. “Where effective policies are in place, they work astonishingly well,” CDC Director Tom Frieden said during the White House event. The proven antidotes to addiction include steep cigarette taxes, smoke-free air laws, easy access to smoking-cessation programs, and in-your-face media campaigns.

Smoke-free air laws have swept the country since the late 1990s, and new taxes have pushed the price of cigarettes above $10 a pack in some states. The president’s budget proposal for the 2014 fiscal year pushes the federal tax alone from $1.01 to $1.95 a pack.

The Obama administration has also expanded cessation programs through the Affordable Care Act, and mounted the first nationwide, federally funded anti-smoking media campaign. Through searing testimonials by former smokers, the campaign quadrupled visits to the government’s cessation website ( in 2012, prompting an estimated 1.6 million attempts to quit smoking.

The tobacco industry, for its part, has been forced to come clean about its decades-long effort to deceive the public about the hazards of smoking. Next week, under federal court order, tobacco giants Altria, Lorillard, Phillip Morris and R.J. Reynolds will run full page ads in 35 major-market newspapers, admitting that they “intentionally designed cigarettes to make them more addictive,” and “deliberately deceived the American public by falsely selling and advertising low tar and light cigarettes as less harmful than regular cigarettes.” The American Cancer Society’s Cancer Action Network has already posted mock-ups of an ad that may appear in The New York Times this Sunday.

Unfortunately, experts agree that none of this is enough to stop the tobacco epidemic. As the CDC’s Frieden noted on Friday, cigarette makers still spend the equivalent of $28 per person on U.S. advertising each year. States and localities receive more than that amount from cigarette taxes and industry payoffs from the Master Settlement Agreement. Yet the average state spends only $1.50 per person to counter the industry’s promotions—about an eighth of the $12 the CDC recommends. In its most recent report card on state spending, the American Lung Association awards just two A’s (to Alaska and North Dakota), one B (to Delaware), two C’s (to Hawaii and Wyoming), and four D’s (to Arkansas, Oklahoma, Maine and Vermont). The other 41 states and DC all receive F’s.

“The nation stands poised at the crossroads of tobacco control,” Assistant Secretary Koh writes in a preface to the new surgeon general’s report. “The 50th anniversary . . . prompts us to pause and ask why this addiction persists when proven interventions can eliminate it.” The reason is no great mystery: tobacco control is one of countless priorities competing for finite public action and resources. The new report confirms that 50 years later, it still merits urgent attention.