Fifty years ago this Saturday, U.S. Surgeon General Luther Terry dropped a bomb, of sorts, on modern American culture.
Those cheery Lucky Strike ads ("It's toasted!"), those movie star sponsors, the glamorous mystique associated with smoking -- all of that was blasted to smithereens when Terry announced what only a few knew or suspected until then: A scientifically proven link existed between cigarette smoking and lung cancer, as well as to heart disease. Smokers had a 70 percent greater chance of death and smokers were 20 times more likely to develop lung cancer than non-smokers.
It would take awhile, however, for the real effects to be felt. Many Americans listened, but most still reached for their cigarettes, including Ann Sailor, a New Castle, Pa., mother of two. She didn't actually quit until three years later, after her two daughters came home from grade school one day clamoring to tell her about what they had learned -- that smoking was dangerous.
"I thought, I can't do this, I can't make them worry,'" said Ms. Sailor, 77. "I quit right then and there. Not one more cigarette."
Today, the number of Americans who smoke has dropped dramatically, from 43 percent to 18 percent, a group of doctors, scientists and anti-smoking activists said at a Washington, D.C., news conference Wednesday. Now, they want the number to drop to below 10 percent in 10 years.
Also this week, the Journal of the American Medical Association issued a study showing that tobacco-control efforts since 1964 have added 20 years of life for 8 million Americans. Without tobacco control, half of those Americans would have died before the age of 65.
"Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people," Thomas Frieden, director of the federal Centers for Disease Control and Prevention, wrote in a JAMA commentary.
Progress has been steady but slow. Just look at the first label warnings, which said, "Smoking could be hazardous to your health."
By 1970, the language was stronger: "The surgeon general has determined that cigarette smoking is dangerous to our health." And today, anyone buying a pack of cigarettes will read that "Cigarettes are addictive"; "Cigarettes cause fatal lung disease"; and "Smoking can kill you."
The current adult smoking rate in Pennsylvania is 21 percent, two points above the national average of 19 percent -- or 43 million people -- and there has not been a cigarette tax increase in Pennsylvania since 2009. The state also ranks 39th in the nation for funding programs to help prevent young people from becoming addicted to tobacco.
But companies in the public and private sector are picking up the slack, making it easier for employees to access smoking-cessation programs -- and harder for them to smoke.
At UPMC, a new Tobacco-Free Workday Policy will be launched this summer that will only allow employees to smoke on their own time, not during their shifts, said Hilary Tindle, a physician and director of the Tobacco Treatment Service at UPMC Presbyterian and Montefiore hospitals . "We want our employees to be tobacco free for the duration of their shift," she said.
Dr. Tindle manages smoking-cessation and treatment programs for employees at the health care provider's 21 hospitals and hundreds of clinics, and also contributed to the chapter on "Treatment of Tobacco Use" in the 50th Anniversary Surgeon General's Report, to be released Jan. 18.
"If I walk from my research office, which is two blocks from Montefiore, I have to walk through several clouds of smoke, so it really does seem like a lot of people are still lighting up," she said, noting that hospital patients have been known to wheel their IV poles out of the building to smoke.
Even though smoking rates have dropped by more than half because of successful education, legislative and smoking-cessation efforts, lung cancer remains the No. 1 cancer killer and the leading preventable cause of death in the United States, said Robert Keenan, a physician and chair of the department of thoracic surgery at Allegheny General Hospital.
And while lung cancer rates among men -- who were the vast majority of smokers in the 1930s, 1940s and 1950s -- have dropped, reflecting the decrease in smoking among males beginning in the 1960s, lung cancer rates among women are flat or rising slightly, because females didn't start smoking heavily until the 1960s and 1970s.
Tremendous progress has been made treating lung cancers, Dr. Keenan noted, but since it often takes several decades for smoking's effects to appear as cancer, women's rates will not drop for some time. "Everyone could stop smoking today and I will be busy as a thoracic surgeon for the rest of my life," he said.
Moreover, one recent study found that numerous people lie about their smoking habits, and very little research is out there about the health effects of e-cigarettes, which dispense nicotine water vapor instead of smoke.
Much more needs to be done, said Dr. Tindle, noting how aggressively tobacco is marketed to residents of low-income neighborhoods and young people. There is intensive advertising in magazines and social media, with candy-flavored tobacco products -- "Cap'n Crunch," "Cotton Candy" or "Gummy Bear."
Moreover, U.S. warning labels aren't anywhere near as graphic as those overseas, where cigarette packages include pictures of tracheotomies, although tobacco companies have threatened to sue some countries for violation of overseas trade agreements.
Last year, an appeals court blocked a Food and Drug Administration mandate for stronger labels.
Ms. Sailor, whose children were the first to hear about the harmful effects of smoking as part of their school's curriculum, credits the surgeon general's report for her education about smoking, and indirectly helping her to quit.
"My only regret is not listening to the report sooner, in 1964," she said. "That was three more years of me smoking."
"It was a way of living," she said of the smoking culture. "Unfortunately, it was also a way of dying."
She would know.
While she was able to quit, Ms. Sailor's husband, John, could not. He died of lung cancer in 1993 at age 56.
Mackenzie Carpenter, firstname.lastname@example.org, 412-263-1949. On Twitter @MackenziePG. Reporter Lauren Lindstrom contributed.