The Smoking War Isn't Over

By Tom Farley

When I talk to people about the nation’s biggest health problems, nearly everyone brings up the epidemic of obesity, but surprisingly few mention smoking. I guess tobacco just feels like yesterday’s problem. 

That in itself should worry us, because smoking is still a national and global public health tragedy of historic proportions. In the United States, smoking kills over 400,000 current and former smokers a year. And the damage goes way beyond smokers. Second-hand smoke kills some 40,000 people a year (causing lung cancer in 3,400 nonsmokers), and is a major trigger for asthma, the problem that puts more children in the hospital than any other. Even with our smoke-free air laws, one in four nonsmokers have a chemical called cotinine in their blood, meaning that they are exposed to second-hand smoke – or, to put it another way, smoking against their will.

Over the last 50 years, we’ve won many battles in the tobacco wars. In 1965, over 40% of adults in this country smoked. A half century later, smoking rates are less than half that. But that still means one in five adults has a habit that could kill one-third of them, which hardly feels like a victory.

It doesn’t have to be that way, though. Cigarette consumption per capita in 1900 was a fraction of what it is now. I see no reason that the smoking rate in this country couldn’t fall to where it was in 1900, which looks like it would be about 1-2%.

Annual adult per capita cigarette consumption and major smoking and health events - United States, 1900-1998

Annual adult per capita cigarette consumption and major smoking and health events - United States, 1900-1998

Why then, when everyone knows that smoking is deadly, do millions of people still take up the habit?

Almost every smoker starts during the teenage years, when children are rebelling against their parents to create their own identity. It’s a perfect time to try something that looks “cool”, especially if parents tell them not to do it. By the time those teens are old enough to worry about what cigarettes are doing to their bodies, they’re hooked.

But then why, when it smells bad, stains your teeth, and makes you cough, is smoking still “cool”?

That’s where the tobacco companies come in.  In the 1960s, tobacco companies ran ads on television, showing sexy, sophisticated actors smoking, and linking that image to their particular brands. Today, tobacco companies have to be more creative. Under a 1970 federal law, they can’t advertise on television, and based on a legal settlement in 1998, they are not supposed to pay movie and TV producers for product placements on screen. But smoking in movies hasn’t changed much since then, and actors smoke often on screen, including in movies rated for children. The Surgeon General concluded that “there is a causal relationship” between children seeing those images and taking up smoking.


Then the tobacco companies spend billions for ads, discounts, and promotions at the point of sale, in drug stores, convenience stores, and grocery stores. Those are ads that kids see every time they buy a pack of gum. The ads must work or the tobacco companies wouldn’t spend so much money on them.

tobacco ads

So why are smoking rates so high? Sure, nicotine is addictive, but the real answer is that the tobacco companies spend so much marketing smoking.

The situation isn’t hopeless, though. Typical, rebellious kids aren’t bound to experiment with, and then become addicted to, this killer drug. If the tobacco companies can use time-tested techniques of marketing to get people to smoke, we can use the same techniques to market non-smoking.