In contemporary understanding, the harmful health impacts of smoking are widely recognized, with extensive public health campaigns reinforcing this knowledge. This makes it challenging to imagine a past when smoking was not only accepted but, at times, even suggested as beneficial. The journey from perceived harmlessness to definitive danger involved a complex interplay of cultural norms, marketing strategies, scientific inquiry, and public health initiatives.
The Era of Perceived Benefits
During the early to mid-20th century, smoking was deeply ingrained in Western societies and often associated with positive attributes. Cigarettes were marketed extensively, with advertisements frequently depicting doctors, athletes, and other respected figures endorsing various brands. For instance, American Tobacco’s Lucky Strike campaigns in the 1930s claimed that “20,679 Physicians say ‘LUCKIES are less irritating'” to the throat. R.J. Reynolds launched a similar campaign for Camels from 1940 to 1949 with the slogan, “More doctors smoke Camels than any other cigarette.”
This cultural acceptance was fueled by a lack of comprehensive scientific understanding about tobacco’s long-term effects. Smoking was often seen as a sophisticated habit, a sign of maturity, or a way to relieve stress. Advertisements sometimes suggested cigarettes could aid digestion or even help with weight loss, contributing to a perception of benign or even advantageous use. The presence of smoking in movies and its widespread practice across social classes, including among women as traditional gender norms shifted, further normalized the habit.
Unveiling the Health Risks
The perception of smoking began to shift as scientific evidence linking tobacco to serious health problems emerged in the mid-20th century. While isolated concerns about tobacco’s effects appeared as early as the 17th century, systematic research gained traction in the 20th century as lung cancer rates increased. Pioneering epidemiological studies in the 1950s marked a significant turning point.
In 1950, researchers Richard Doll and Bradford Hill in the United Kingdom published a case-control study that strongly implicated smoking as a cause of lung cancer. Concurrently, similar findings were reported in the United States by Wynder and Graham. These initial studies were followed by larger cohort studies, such as the British Doctors Study in 1954 and a study by Hammond and Horn for the American Cancer Society, which provided further compelling evidence.
The cumulative scientific evidence led to a landmark moment on January 11, 1964, when U.S. Surgeon General Luther L. Terry released “Smoking and Health: Report of the Advisory Committee to the Surgeon General.” This comprehensive report, analyzing over 7,000 scientific articles, definitively concluded that cigarette smoking caused lung cancer and laryngeal cancer in men, and was a probable cause in women. The report also identified smoking as the primary cause of chronic bronchitis and correlated it with emphysema and coronary heart disease. This report was a significant step, transforming the discussion from individual choice to a major public health concern.
The Shift in Public Understanding
The 1964 Surgeon General’s Report catalyzed a significant shift in public understanding and policy regarding smoking. Within a year, the Federal Cigarette Labeling and Advertising Act of 1965 mandated a health warning on cigarette packages: “Caution: Cigarette Smoking May Be Hazardous to Your Health.”
Over the subsequent decades, public health campaigns intensified, and further legislative actions followed. Restrictions on tobacco advertising, particularly on television and radio, were implemented by the Public Health Cigarette Smoking Act of 1969. Public health messaging evolved, with campaigns becoming more aggressive in highlighting the severe consequences of smoking, sometimes using graphic imagery. Smoking bans gradually became more widespread, initially in public spaces and workplaces, then extending to restaurants and bars. These policy changes, coupled with sustained public awareness efforts, contributed to a dramatic decline in smoking rates in many countries. For example, the percentage of U.S. adults who smoked cigarettes dropped significantly from a high of 45% in 1954 to around 12% by 2023.