When the U.S. Surgeon General Luther Terry released the first report from the Surgeon General’s Advisory Committee on Smoking and Health in 1964, he lit up the reality of smoking’s effects and the tobacco industry’s role in causing addiction among Americans.
The report was impactful, but instead of the tobacco industry letting out one last puff and allowing itself to be stomped on and left behind, it began to challenge the health consequences researched by the U.S. government, according to Cancer Network.
“(The advisory committee’s) findings are what we all know,” Athens City-County Health Department Health Commissioner and Medical Director James Gaskell said. “Their findings were that there was a strong association between lung cancer and smoking and a strong association between smoking (and) chronic bronchitis and emphysema.”
Another association found in the report was between smoking and coronary artery disease, Gaskell said.
Smoking and tobacco cause high rates of mortality in the U.S., and tobacco use is the most preventable cause of death in the country, according to the CDC. About every one in five deaths in the U.S. each year is caused by smoking cigarettes.
The Great American Smokeout is a challenge led by the American Cancer Society to help people quit smoking. Around 34 million Americans smoke cigarettes today, according to the American Cancer Society, and although there was a 67% decrease – 42% to 14% – of smokers from 1965 to 2019, the successes have not been consistent.
The number of Americans who smoke cigarettes is also disproportionate among different identities. For instance, in a report from the CDC in 2020, 27.1% of Native Americans 18 years and older smoke cigarettes while 13.3% of white Americans smoke either every day or some days. This is partially because of cultural, ceremonial, religious and medicinal usage of tobacco in Indigenous cultures that may affect attitudes toward commercial tobacco. The different effects of systemic discrimination, poverty and other social factors are another potential reason for an increase in tobacco use, according to the CDC. Tobacco companies exploit and target vulnerable groups through advertising and marketing as well.
There are also associations with socioeconomic status as 20% of people with an annual household income of less than $35,000 smoke and 6.2% of people with an income of $100,000 smoke.
On the third Thursday of November, the American Cancer Society hosts the Great American Smokeout to encourage Americans to make a plan to quit smoking or to quit smoking for the day. The American Cancer Society recognizes that it is difficult to quit smoking because addiction to nicotine is one of the hardest to recover from.
Nicotine addictions were not always regarded as addictions. Gaskell said the 1964 report framed smoking cigarettes as a “bad habit.”
“And I think since that time, there’s (been ample) evidence to prove that smoking really is an addictive problem,” Gaskell said.
People who want to quit smoking, the American Cancer Society found, have success with telephone quitlines, nicotine anonymous meetings, books and other materials, counselors and coaches and support from friends and family members. These support systems are especially productive when two or more are used in tandem.
The American Cancer Society also has a Freshstart Program and to learn more about the resource, people can call 800-227-2345.
How the number of smokers in the U.S. decreased over the years was partially due to campaigns in children’s classrooms, Gaskell said. As a pediatrician, Gaskell said parents would tell him they quit smoking because their children learned it had negative health consequences.
“They said, 'my kids talked to me,'” said Gaskell. “'My kids told me I was poisoning them.' So I think that was one of the important measures in decreasing smoking in our society.”
Smoking is also prohibited in a number of places such as inside hospitals and schools where it was not before its health effects were discovered.
Advances made in bringing awareness to nicotine addiction have been met with a new challenge affecting more young people: e-cigarettes.
A lot of people refer to e-cigarettes as vape pens and they come in many different shapes and sizes, according to the American Cancer Society. They include a battery and a heating element that turns liquid, which usually contains nicotine, into an aerosol of particles to be inhaled. E-cigarettes do not include tobacco, but nicotine comes from tobacco so they are still classified as tobacco products.
“And I worry about the vaping industry,” Gaskell said. “The vaping industry seems to have supplanted the smoking industry. It’s the same product. It’s nicotine. In the vaping industry, they’re dispensing a product that has a lot of nicotine in it so people get high.”
The companies that made vape pens and e-cigarettes are now mainly owned by “Big Tobacco,” which include companies such as Philip Morris International, British American Tobacco, China National Tobacco Corporation and Japan Tobacco International, according to Annual Reviews. The Big Tobacco companies control the tobacco industry.
“We don’t have the same data on vaping that we have on smoking … or at least not much,” said Gaskell. “We don’t have long-term data but it would stand to reason that you would have some of the same difficulties. It’s a constrictive agent so you’re going to have coronary artery disease. You’re going to have coronary arteries that are narrowed and spastic and people are going to have heart attacks.”
E-cigarettes were originally intended to wean people off of smoking cigarettes, according to BMC Public Health. But younger people are more likely to use vape pens and smoke e-cigarettes than adults. Teenagers, ages 15 to 17, are 16 times more likely to currently be using JUUL pens – an e-cigarette company – than adults.
“I feel like it overall seems to have had more of a negative effect than a positive effect,” said Ashleigh Clabaugh, a junior studying chemical engineering. “It definitely does seem like a lot of young people are using (e-cigarettes and vape pens) to get into those types of products instead of the other ways around.”
Benjamin Melkey, a junior studying electrical engineering at the University of Akron visiting Athens, said he used to work at a factory where people would take smoking breaks using cigarettes and realized the amount of money that most likely went toward purchasing cigarettes. Melkey thought of vapes and e-cigarettes as a way for people to quit smoking but now sees the opposite.
“There’s a purpose for e-cigarettes, it’s to slowly tune down nicotine that people consume,” Melkey said. “But unfortunately, people our age use that to tune up nicotine that they consume.”
Also according to Truth Initiative, young people who have used e-cigarettes are seven times more likely to become smokers a year after using one compared to people who have never vaped.
The tobacco industry spends a great sum of money on advertising each year to convince people to buy nicotine products. In 2019, cigarette and smokeless tobacco companies spent $8.2 million on advertising in the U.S., according to the CDC.
People who want to quit smoking of any kind may find it challenging when the tobacco industry convinces its audience about its products. Gaskell said resourceful books can be a step in the right direction.
“The individual use(s) mostly psychological prophecies and basically make(s) a list of the good things that will happen to you if you quit smoking and bad things that will happen to you if you continue to smoke,” Gaskell said. “And when you are tempted to smoke, pull out your lists and look at them.
Relapses are also likely, Gaskell said, and they should not stop a person from trying again. And if people are willing to change the culture around smoking once again, who knows how much further the number of people addicted to smoking and nicotine could decrease.
“We changed the culture,” Gaskell said. “Somehow we changed the culture when I think that a lot of people thought that the culture could not be changed. But it took a long time.”