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Kevin McLaughlin Photo by Vera LaMarche​

The popular TV series Mad Men, set in a Manhattan advertising agency in the 1960s, has won praise for its accurate depiction of the clothing, hairstyles, attitudes and behaviors of that era. In one respect the show is dead-on: It portrays a casual acceptance of cigarette smoking in the office and at home, in restaurants and in bars, that is hard to imagine now.

Growing up in the 1960s, I remember ashtrays overflowing with cigarette butts in every room of my house. In the 1970s and 1980s, I worked in offices where the blue haze of cigarette smoke hung above coworkers’ cubicles. Lighting up was common on buses and trains, even on commercial flights.

What a contrast with current norms. In many states, smoking is prohibited in public areas. A clutch of smokers puffing outside a workplace in all kinds of weather is a common sight. Many outdoor facilities like sports stadiums limit smoking to designated areas. Smoking on commercial airlines is banned completely. Even the family home is no sanctuary: How many of us know family or friends who escape to the backyard for a quick cigarette?

Arguably, the transformation in smoking behavior in the United States began 50 years ago: On Jan. 11, 1964, Smoking and Health: Report of the Advisory Committee to the Surgeon General was released. The bland title belied the document’s revolutionary impact. The report’s conclusion that cigarette smoking is “causally related” to lung cancer was a bombshell that generated headlines across the country and laid the groundwork for anti-smoking initiatives that have had an enormous impact:

  • The Cigarette Labeling and Advertising Act of 1965 mandated that all cigarette packs carry health warning labels.
  • Federal legislation passed in 1971 prohibited cigarette advertising on television.
  • A 1986 surgeon general’s report on the dangers of secondhand smoke prompted legislation to ban smoking in public places. Today 30 states and many counties and municipalities have such laws on the books.
  • A federal ban on smoking on all U.S. flights passed in 1990 and was extended in 2000 to include international flights leaving from the United States.
  • The 1998 Master Settlement prohibited tobacco companies from marketing their products to youth and required Big Tobacco to fund anti-smoking information campaigns.
  • The 2009 Family Smoking Prevention and Tobacco Control Act gave the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products for the first time in U.S. history.

In the aftermath of these and other initiatives, the prevalence of cigarette smoking among adult Americans fell from more than 42 percent in 1965 to less than 19 percent in 2011. That’s the good news. The bad news? Nearly 44 million Americans used cigarettes in 2011, and an estimated 30 percent of the more than 580,000 cancer deaths in the U.S. in 2013 were attributed to tobacco use.

Clearly, more work needs to be done to reduce tobacco-related deaths, and fresh challenges abound. A new concern is the growing popularity of electronic cigarettes, popularly called e-cigarettes. Touted as a safer alternative to real cigarettes for delivering nicotine to smokers, e-cigarettes have alarmed anti-smo​king activists concerned about toxins and contaminants found in the products’ nicotine cartridges. Also disconcerting is the burgeoning use of e-cigarettes among middle- and high-school students. FDA officials will soon decide how the agency will regulate e-cigarettes under the Family Smoking Prevention and Tobacco Control Act. You can read more about e-cigarettes here.

Fifty years ago, in 1964, Americans were largely unaware of the dangers of smoking. In the half-century since the release of the surgeon general’s report, progress has been made to change that. Besides lung cancer, researchers have linked tobacco use to 17 other types of cancer in the urogenital and digestive systems and the head and neck. The benefits of kicking the habit, no matter your age or how long you’ve smoked, are well established. But with nearly one in five American adults still smoking despite compelling evidence of its dangers, it’s clear that regulating tobacco access and use, educating the public about tobacco risks, and promoting smoking cessation are just as important now as in 1964.