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wars to follow—helped promote its popularity and respectability (DHHS 2000). There was no medical consensus regarding health dangers; in fact, many physicians openly smoked and sometimes even promoted the product (DHHS 2000; Walsh 1937). The anti-tobacco forces were unable to stem the growing popularity of cigarettes over the first half of the next century (DHHS 2000; Schudson 1984).

By the middle of the 20th century, researchers were studying the health effects of smoking. In 1952, an article in Reader’s Digest reporting on the emerging evidence linking smoking and cancer aroused public concern (Norr 1952). More than 10 years later, publication of the 1964 Surgeon General’s report (HEW 1964) was widely regarded as a turning point in the history of smoking in the United States and the point of departure for the modern tobacco control movement (DHHS 2000).

The 1964 report consolidated the growing body of research that linked smoking to lung cancer, chronic bronchitis, and emphysema, disseminating the emerging data on tobacco’s adverse effects to a wide audience (HEW 1964). The report’s authoritative voice—the Surgeon General is the country’s top health officer—and compelling documentation were impossible to ignore. The steady growth in smoking prevalence that had begun in 1920s came to a halt.

After publication of the report, public debate over smoking could never again be divorced from its documented adverse health effects. Smoking could no longer be viewed exclusively as a matter of consumer choice based on the idea that tobacco is an ordinary consumer good. Smoking had officially become a medical problem and a public health challenge. As the 1964 report stated, “cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action” (HEW 1964).

The Surgeon General’s report stimulated a significant change in public attitudes about smoking and new public health and public policy responses. The story of the past four decades, however, is not one of unmitigated public health success. The decades following the report’s release can be divided into two periods. The first phase, which lasted through the late 1980s, was characterized by largely unsuccessful efforts by those involved in the antismoking movement to gain political footing against the tobacco industry, a commercial giant with many tools at its disposal. Beginning in the mid-1980s, however, the understanding of the tobacco problem and the tools used to combat it underwent dramatic transformations. Smoking came to be recognized as a form of drug addiction, one that typically begins by the age of 18 years and that is fostered by the marketing and other actions of cigarette companies. In addition, the harms that smoking causes to nonsmokers, as well as smokers, also changed the political landscape of tobacco control efforts.

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