Progress made in the field of tobacco control is "probably the greatest public health success story of the past half century," Kenneth Warner '68, former dean of the University of Michigan School of Public Health, said in the second annual C. Everett Koop Institute Lecture at the Norris Cotton Cancer Center on Thursday afternoon.
Since 1963, half of all individuals in the United States who were addicted to cigarettes have stopped smoking, and the prevalence of smoking throughout the country has decreased by more than 50 percent, Warner said. These trends have saved "millions of lives," he said.
"The image and place of smoking in society has changed forever," Warner said.
Although tobacco control is rarely the focus of modern health care discussions, it is widely recognized as an important aspect of national health policy, according to Warner.
"If you can name anything in the entire field of medicine and public health that could have the impact that is attributed to smoke-free laws of reducing [heart attacks] by 10 to 15 percent, I'd love to hear what it is," he said.
In the first half of the 20th century, smoking was considered a "relatively normative behavior," Warner said. During the three months after the first Surgeon General's report was published in 1964 which illustrated the significant health risks associated with smoking the United States experienced a 15 percent decline in the prevalence of smoking. "When historians look back on the 20th century, they are going to describe the rise and fall of the cigarette as the seminal historical event of the 20th century in a developed country," Warner said.
Some of the most effective elements of the anti-smoking movement included activism among the social and economic elite, tax increases on tobacco products and, more recently, smoke-free regulation that prohibits smoking in certain restaurants and other commercial areas, according to Warner. Due to such efforts, smoking is now "very much non-normative," he said.
Tax increases on tobacco products have also reduced the number of consumers since the 1970s, according to Warner.
"If you raise prices, consumption will fall and that's simply the law of demand," he said.
Although the federal government does not have a national smoke-free workplace law, over 30 states have laws mandating completely smoke-free workplaces, including restaurants and bars, Warner said. Some states have also begun implementing laws prohibiting smoking in public parks, on university campuses and in cars where children are passengers. This legislation has reduced workers' exposure to toxic smoke, decreased daily consumption of tobacco, decreased employer health care costs and increased the number of individuals who successfully quit smoking each year, Warner said.
Despite this progress, tobacco use remains the "single most preventable cause of death in the U.S." and over 20 percent of adults in the country continue to smoke, he said.
Although more than 70 percent of current smokers say they want to quit, only approximately 40 percent of them actually attempt to quit each year and only 2.6 percent of those who attempt to quit succeed, he said.
Studies have shown that health education in schools has failed to deter children from smoking, Warner said. One study even found that students who completed the Drug Abuse Resistance Education program were likely to try marijuana at an earlier age than those who did not enroll in the program, he said.
Cigarette boxes should contain more explicit warnings regarding the dangers of tobacco use, according to Warner. Canada, Brazil, Uruguay and Australia all have started implementing more "innovative labeling policies" to deter potential smokers, Warner said.
"We, the U.S., are way behind the eight-ball on this one," he said.
The lecture, "Til Death Do Us Part: The Past, and Future, of Tobacco Control in the U.S," took place in the Rubin Building at Dartmouth-Hitchcock Medical Center.
