The 1964 Surgeon General's report and Americans' beliefs about smoking

Journal of the History of Medicine and Allied Sciences

Volumn 70, Issue 2, 2015, Pages 250-278

  Marshall, Thomas R ^a  

^a UNIVERSITY OF TEXAS AT ARLINGTON   (United States)

Author keywords

Cigarettes; Heart disease; Lung cancer; Polls; Public opinion; Smoking; Surgeon General

Indexed keywords

ADVERSE EFFECTS; ATTITUDE TO HEALTH; HISTORY; HUMAN; PREVENTION AND CONTROL; PSYCHOLOGY; PUBLIC HEALTH SERVICE; PUBLIC OPINION; SMOKING; STANDARDS; UNITED STATES;

ATTITUDE TO HEALTH; HISTORY, 20TH CENTURY; HUMANS; PUBLIC OPINION; SMOKING; UNITED STATES; UNITED STATES PUBLIC HEALTH SERVICE;

EID: 84941954196     PISSN: 00225045     EISSN: 14684373     Source Type: Journal    
DOI: 10.1093/jhmas/jrt057     Document Type: Review

References (149)

1. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (Washington, DC: U. S. Department of Health, Education, and Welfare, 1964).
2. Hereafter cited as Surgeon General, Smoking and Health.
3. For the importance of the 1964 report, see Allan M. Brandt, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America (New York: Basic Books, 2007), 211-39;
4. A. Lee Fritschler, Smoking and Politics: Policymaking and the Federal Bureaucracy, 3rd ed. (Englewood Cliffs, New Jersey: Prentice-Hall, 1969), 39-49;
5. Richard Kluger, Ashes to Ashes: America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris (New York: Vintage, 1997), 221-62;
6. Surgeon General, Smoking and Health, 19-21, 179-89;
7. Mark Parascandola, "Skepticism, Statistical Methods, and the Cigarette", Persp. Biol. Med., 2004, 47, 244-61.
8. Kenneth E. Warner, "Tobacco Policy Research: Insights and Contributions to Public Health Policy", in Tobacco Control Policy, ed. Kenneth E. Warner (San Francisco: Jossey-Bass, 2006), 21.
9. The iPOLL archive at http://www.ropercenter.uconn.edu is a searchable database of poll questions from major polling companies.
10. For summaries of poll questions on cigarette smoking, see Hazel Gaudet Erskine, "The Polls: Smoking", Public Opin. Q., 1966, 30, 140-52
11. and "The Polls: Cancer", Public Opin. Q., 1966, 30, 308-14;
12. Julianna Pacheco, "Trends-Public Opinion on Smoking and Anti-Smoking Policies", Public Opin. Q., 2011, 75, 576-92;
13. Lydia Saad, "A Half-Century of Polling on Tobacco: Most Don't Like Smoking but Tolerate It", The Public Perspective, 1998, August/September, 1-4.
14. see the iPOLL archives or Gallup's web site at http://www.gallup.org.
15. Unless otherwise noted, the poll reports cited herein may be accessed through the Legacy Tobacco Documents Library at http://legacy.library.ucsf;
16. see also E. Balbach, R. Gasior, and E. Barbeau, "Tobacco Industry Documents: Comparing the Minnesota Depository and Internet Access", Tob. Control, 2002, 11, 68-72;
17. R. E. Malone, "Tobacco Industry Documents: Comparing the Minnesota Depository and Internet Access", Tob. Control, 2002, 11, 285;
18. Ruth E. Malone and Edith D. Balbach, "Tobacco Industry Documents: Treasure Trove or Quagmire?" Tob. Control, 2000, 9, 334-38.
19. Brandt, Cigarette Century, 416-23.
20. Ruth Clifford Engs, Clean Living Movements: American Cycles of Health Reform (Westport, Connecticut: Praeger, 2000);
21. John P. Pierce and Elizabeth A. Gilpin, "A Historical Analysis of Tobacco Marketing and the Uptake of Smoking by Youth in the United States: 1890-1977", Health Psychol., 1995, 14, 500-8;
22. D. J. Ringold and J. E. Calfee, "The Informational Content of Cigarette Advertising: 1926-1986", J. Public Pol. Manag., 1990, 9, 30-41;
23. Kerry Segrave, Women and Smoking in America, 1880-1950 v (Jefferson, North Carolina: McFarland & Company, 2005);
24. Cassandra Tate, Cigarette Wars (New York: Oxford University Press, 1999).
25. Segrave, Women and Smoking, 162-78;
26. Robert Sobel, They Satisfy: The Cigarette in American Life (New York: Anchor Books, 1978);
27. Brandt, Cigarette Century, 200-1;
28. Gerard S. Petrone, Tobacco Advertising: The Great Seduction (Atglen, Pennsylvania: Schiffer, 1996);
29. http://tobacco.stanford.edu/tobacco-main/index.php. All web address cited herein were last accessed September 3, 2013.
30. Frederick Hoffman, "Cancer and Smoking Habits", Ann. Surg., 1931, 93, 50-67;
31. Herbert L. Lombard and Carl R. Doering, "Cancer Studies in Massachusetts", N. Engl. J. Med., 1928, 18, 481-87;
32. Raymond Pearl, "Tobacco Smoking and Longevity", Science, March 4, 1938, 216-17;
33. and James J. Short, Harry J. Johnson, and Harold A. Ley, Jr., "The Effects of Tobacco Smoking on Health", J. Lab. Clin. Med., 1938, 1938, 586-89;
34. see also Robert N. Proctor, The Nazi War on Cancer (Princeton: Princeton University Press, 1999)
35. and "The Nazi War on Tobacco: Ideology, Evidence, and Possible Cancer Consequences", Bull. Hist. Med., 1997, 71, 435-88.
36. The Gallup results combine responses to two questions, "Do you smoke?"
37. and "What do you prefer to smoke-cigarettes, cigars, or a pipe?" Both the Fortune and Gallup figures are in iPOLL.
38. Jean M. Converse, Survey Research in the United States: Roots and Emergence, 1890-1960 (Berkeley: University of California Press, 1987).
39. Colin Talley, Howard Kushner, and Claire Sterk, "Lung Cancer, Chronic Disease, Epidemiology, and Medicine 1948-1964", J. Hist. Med. Allied Sci., 2004, 59, 329-74.
40. Karen S. Miller, The Voice of Business: Hill & Knowlton and Postwar Public Relations (Chapel Hill: University of North Carolina Press, 1999)
41. and "Smoking up a Storm: Public Relations and Advertising in the Construction of the Cigarette Problem", Journal. Monogr., 1992, 136, 1-35;
42. David T. Courtwright, "Public Relations and Advertising Strategies of American and British Tobacco Companies since 1950", Bus. Hist., 2005, 47, 421-32.
43. Talley, Kushner, and Sterk, "Lung Cancer"
44. Leroy E. Burney, "Statement, July 12, 1957", Bull. Cancer Prog., 1958, 8, 44
45. and "Smoking and Lung Cancer: A Statement of the Public Health Service", JAMA, November 28, 1959, 171, 1829-36;
46. Jon M. Harkness, "The US. Public Health Service and Smoking in the 1950s: The Tale of Two More Statements", J. Hist. Med. Allied Sci., 2007, 62, 171-212;
47. J. Mark Parascandola, "Cigarettes and the US Public Health Service in the 1950s", Am. J. Public Health, 2001, 91, 196-205.
48. For similar estimates based on the Reader's Guide to Periodical Literature, see Frank R. Baumgartner and Bryan D. Jones, Agendas and Instability in American Politics (Chicago: University of Chicago, 2009), 90-93, 114-17, 257-59;
49. Ronald J. Troyer and Gerald E. Markle, Cigarettes: The Battle over Smoking (New Brunswick, New Jersey: Rutgers University Press, 1983), 57-59;
50. Gary T. Ford, Debra J. Ringold, and Martha Rogers, "Cigarettes in the Popular Press, 1930-1960: Preliminary Research", Adv. Consum. Res., 1990, 17, 467-73.
51. Constance A. Nathanson, "The Contingent Power of Experts: Public Health Policy in the United States, Britain, and France", J. Policy Hist., 2007, 19, 71-94;
52. Talley, Kushner, and Sterk, "Lung Cancer", 370-71.
53. For a comparison to earlier efforts to discourage spitting; see Jeanne E. Abrams, "'Spitting Is Dangerous, Indecent, and against the Law!' Legislating Health Behavior during the American Tuberculosis Crusade", J. Hist. Med. Allied Sci., 2012, 67, 29-31.
54. Lieberman Research, The Teenager Looks at Cigarette Smoking (New York: American Cancer Society, 1969), 64-67.
55. Elmo Roper and Associates. A Study of Attitudes toward Cigarette Smoking and Different Types of Cigarettes. January 1959. Philip Morris. http://legacy.library.ucsf.edu/tid/jco76b00/pdf.
56. Timothy Dewhirst, "Public Relations", in Tobacco in History and Culture: An Encyclopedia, ed. Jordan Goodman, vol. 2 (Detroit: Charles Scribner's Sons, 2005), 473-79;
57. Robert N. Proctor, "Agnotology", in Agnotology: The Making & Unmaking of Ignorance, ed. Robert N. Proctor and Londa Schiebinger (Palo Alto: Stanford University Press, 2008), 1-33;
58. Jon Christensen, "Smoking Out Objectivity: Journalistic Gears in the Agnogenesis Machine", in Agnotology, 266-82;
59. Mark Parascandola, "Skepticism, Statistical Methods, and the Cigarette", Persp. Biol. Med., 2004, 47, 244-61.
60. "U. S. Acts to Curb Cigarette Claims", New York Times, September 16, 1954, 33;
61. "'Guide' Published on Cigarette Ads", New York Times, September 23, 1955, 44;
62. Debra Jones Ringold and John E. Calfee, "The Informational Content of Cigarette Advertising: 1926-1986", J. Public Pol. Mark., 1989, 8, 1-23;
63. John E. Calfee, Cigarette Advertising, Health Information and Regulation before 1970 (Washington, DC: Federal Trade Commission, 1985).
64. Ringold and Calfee, "Cigarette Advertising", 9-18;
65. Debra Jones Ringold and John E. Calfee, "What Can We Learn from the Informational Content of Cigarette Advertising: A Reply and Further Analysis?" J. Public Pol. Mark., 1990, 9, 30-41;
66. "Embattled Tobacco's New Strategy", Fortune, January 1963, pp. 100 following.
67. Ringold and Calfee, "Informational Content"
68. Gideon Doron, The Smoking Paradox: Public Regulation in the Cigarette Industry (Cambridge, Massachusetts: Abt, 1979), 131-34;
69. Kenneth Friedman, Public Policy and the Smoking-Health Controversy (Lexington, Massachusetts: D. C. Heath and Company, 1975).
70. Representative John A. Blatnick, "Report of the Hearings: False and Misleading Advertising (Filter-Tip Cigarettes) " (Washington, DC: U. S. Congress, 1958), 25.
71. Elmo Roper and Associates. A Study of Attitudes toward Cigarette Smoking and Different Types of Cigarettes, Vol. II. January 1959. Philip Morris. http://legacy.library.ucsf.edu/tid/nnc04e00.pdf.
72. The Gallup Organization. Trends in Public Attitudes on the Possibility of a Health Hazard in Cigarette Smoking. June 1959. American Tobacco. http://legacy.library.ucsf.edu/tid/gma15f00/pdf.
73. Elmo Roper and Associates. A Study of Cigarette Smokers' Habits and Attitudes in 1960, Vol. I. April 1960. Philip Morris. http://legacy.library.ucsf.edu/tid/lht28e00/pdf.
74. The Gallup Organization. Trends in Public Attitudes on the Possibility of a Health Hazard in Cigarette Smoking. March 1964. R. J. Reynolds. http://legacy.library.ucsf.edu/tid/zni99d00/pdf.
75. Figures are recomputed from Eva Salber, R. B. Reed, and S. V. Harrison, "Smoking Behavior, Recreational Activities, and Attitudes toward Smoking among Newton Secondary School Children", Pediatrics, 1963, 32, 911-18.
76. "Students See Link between Smoking and Cancer", Sr. Scholast, February 17, 1960, 27.
77. Attitudes of Young American Adults-A Survey Conducted for the Saturday Evening Post (Princeton, New Jersey: Public Opinion Surveys, August 1961).
78. M. Powell Lawton and Alfred E. Goldman, "Cigarette Smoking and Attitude toward the Etiology of Lung Cancer", J. Soc. Psych., 1961, 54, 235-48;
79. Julian Simon, "Doctors, Smoking, and Reference Groups", Pub. Opin. Q., 1967-68, 31, 646-47;
80. "Doctors Have Changed Their Smoking Habits", Resid. Physic., 1957, 3, 50-63.
81. "Kennedy Promises Reply on Smoking", New York Times, May 24, 1962, 26.
82. Parascandola, "Skepticism";
83. Talley, Kushner, and Sterk, "Lung Cancer"
84. Surgeon General, Smoking and Health, 19-21.
85. Brandt, The Cigarette Century, 218-30;
86. Kluger, Ashes to Ashes, 242-48.
87. Four major newspapers, the Atlanta Constitution
88. the Los Angeles Times
89. the Chicago Tribune
90. and the New York Times, published an average of twelve smoking-related news stories, including two front-page stories, per paper, from January 15 through 31, 1964.
91. "Smoking-The Government Report", Time, January 17, 1964, 42;
92. "Verdict on Cigarets: Guilty as Charged", Life, January 26, 1964, 56A-64A;
93. "Cigarette Smoking Is a Health Hazard", Newsweek, January 13, 1964, 48-50.
94. Kluger, Ashes to Ashes, 260-61;
95. Brandt, The Cigarette Century, 30-237.
96. William G. Mayer, The Changing American Mind (Ann Arbor: University of Michigan, 1992), 131-32, 229-75, 310-11;
97. Jon D. Miller, "The Challenger Accident and Public Opinion", Space Policy, 1987, 3, 122-40;
98. Benjamin Page and Robert Shapiro, "Changes in Americans' Policy Preferences, 1935-1979", Public Opin. Q., 1982, 46, 24-42;
99. Benjamin Page, Robert Shapiro, and Glenn Dempsey, "What Moves Public Opinion?", Am. Polit. Sci. Rev., 1987, 81, 23-43;
100. Theresa Rogers, Eleanor Singer, and Jennifer Imperio, "Poll Trends: AIDS-an Update", Public Opin. Q., 1993, 57, 92-114.
101. Opinion Research Corporation. The Impact on Public Attitudes of the Surgeon General's Report. March 1964. American Tobacco. http://legacy.library.ucsf.edu/tid/mup60a00/pdf.
102. Elmo Roper and Associates. A Study of Reactions to the Surgeon General's Report on Cigarette Smoking. February 1964. Philip Morris. http://legacy.library.ucsf.edu/tid/jro53e00/pdf.
103. Elmo Roper and Associates. A Study of Reactions to the Surgeon General's Report on Cigarette Smoking. February 1964. Philip Morris. http://legacy.library.ucsf.edu/tid/jro53e00/pdf.
104. For the Centers for Disease Control and Prevention figures, see http://www.cdc.gov/tobacco/data-statistics/tables/economics/consumption/.
105. For mixed evidence on the report's impact on cigarette consumption or mortality, see J. L. Hamilton, "The Demand for Cigarettes: Advertising, The Health Scare, and the Cigarette Advertising Ban", Rev. Econ. Stat., 1972, 54, 401-11;
106. Kenneth Warner, "The Effects of the Anti-Smoking Campaign on Cigarette Consumption", Am. J. Public Health, 1977, 67, 645-40
107. and "Effects of the Antismoking Campaign: An Update", Am. J. Public Health, 1989, 79, 144-51;
108. cf., Richard Ippolito, Dennis Murphy, and Donald Sant, Staff Report on Consumer Responses to Cigarette Health Information (Washington, DC: Federal Trade Commission, Bureau of Economics, 1979), 3-8;
109. Youth and Tobacco-Preventing Tobacco Use among Young People (Washington, DC: U. S. Department of Health & Human Services, 1992), 163-69.
110. Warner, Tobacco Control Policy, 22-24.
111. Hans Toch, Terrence Allen, and William Lazer, "Effects of the Cancer Scares: The Residue of News Impact, Journal. Mass Comm. Q., 1961, 38, 25-34, 126;
112. Hans Toch and William Lazer, "The Public Image of Cancer Etiology", Public Opin. Q., 1961, 25, 411-14;
113. Edward J. Robinson, "Analyzing the Impact of Science Reporting", Journal. Q., 1960, 37, 306-14;
114. Charles Cannell and James MacDonald, "The Impact of Health News on Attitudes and Behavior", Journal. Q., 1956, 33, 315-23.
115. For reviews of this extensive literature, see Laura Bogart and Douglas Delahanty, "Psychosocial Models", in Handbook of Clinical Health Psychology, ed. Thomas Boll, vol. 3 (Washington, DC: American Psychological Association, 2004), 214-28;
116. Edwin Fisher, Ross Brownson, Andrew Heath, Douglas Luke, and Walton Sumner II, "Cigarette Smoking", in Handbook of Clinical Health Psychology, ed. Thomas Boll, vol. 2 (Washington, DC: American Psychological Association, 2002), 75-120;
117. Neil D. Weinstein, "What Does It Mean to Understand a Risk? Evaluating Risk Comprehension", J. Natl. Cancer Inst. Monog., 1999, 25, 15-20
118. and "Accuracy of Smokers' Risk Perceptions", Ann. Behav. Med., 1998, 20, 135-40.
119. The Gallup Organization's 1959, 1960, 1961, 1962, 1963, and 1964 reports may be found under the titles "Trends in Public Attitudes on the Possibility of a Health Hazard in Cigarette Smoking" as follows: http://legacy.library.ucsf.edu/tid/gma15f00/pdf, http://legacy.library.ucsf.edu/tid/bkn04d00/pdf
120. http://legacy.library.ucsf.edu/tid/inb99d00/pdf, http://legacy.library.ucsf.edu/tid/ckn04d00/pdf
121. http://legacy.library.ucsf.edu/tid/dkn04d00/pdf
122. and http://legacy.library.ucsf.edu/tid/zni99d00/pdf.
123. Smoking and Health: A Report of the Royal College of Physicians of London on Smoking in relation to Cancer of the Lung and Other Diseases (London: Pittman, 1962);
124. Virginia Berridge, "Medicine and the Public: The 1962 Report of the Royal College of Physicians and the New Public Health", Bull. Hist. Med., 2007, 81, 286-311.
125. Surgeon General Burney's 1957 and 1959 statements and the 1962 British report received only an average of two to three stories apiece in major newspapers including the New York Times
126. the Dallas Morning News
127. the Los Angeles Times
128. and the Chicago Tribune.
129. U. S. Department of Health, Education, and Welfare, Uses of Tobacco-Practices, Attitudes, Knowledge, and Beliefs-United States-Fall 1964 and Spring 1966 (Washington, DC: Public Health Service, 1969), 103-26.
130. U. S. Department of Health, Education, and Welfare, Adult Use of Tobacco 1970 (Washington, DC: Public Health Service, 1973), 11.
131. Kluger, Ashes to Ashes, 325-35;
132. Brandt, The Cigarette Century, 270-73.
133. American National Election Study, "Trust the Federal Government 1958-2008", www.electionstudies.org/nesguide/toptable/tab5a-1.htm.
134. Connie De Boer and Ineke Catsburg, "The Impact of Nuclear Accidents on Attitudes toward Nuclear Energy", Public Opin. Q., 1988, 52, 254-61;
135. Allan Mazur, "Media Coverage and Public Opinion on Scientific Controversies", J. Commun., 1981, 31, 106-15.
136. Brandt, The Cigarette Century, 159-277;
137. Fritschler, Smoking and Politics, 19-50;
138. Kluger, Ashes to Ashes, 141-291.
139. Talley, Kushner, and Sterk, "Lung Cancer", 371.
140. Roper Research Associates. A Study of Public Attitudes toward Cigarette Smoking and the Tobacco Industry in 1968. July 1970. R. J. Reynolds. Page 5. http://legacy.library. ucsf.edu/tid/irk15d00/pdf.
141. In addition to the surveys cited herein, see, Political Surveys and Analyses. A Study of Cigarette Smokers' Attitudes toward Smoking and Related Issues. April 1969. R. J. Reynolds. Vol. 2. http://legacy.library.ucsf.edu/tid/wll44d00/pdf;
142. The Roper Organization. A Study of Smokers' Habits and Attitudes with Special Emphasis on Low Tar Cigarettes. May 1976. Philip Morris. http://legacy.library.ucsf.edu/tid/wwm10j00/pdf;
143. C. E. Hooper, Inc. Smoking Attitude Study-Marketing Research Report. October 1967. R. J. Reynolds. http://legacy.library.ucsf.edu/tid/ygo78d00/pdf.
144. "Liggett Pact: Harbinger of Legal Battles to Come", New York Times, March 21, 1997, A18;
145. "Chief of R. J. Reynolds Says Smoking Has Role in Cancer", New York Times, August 23, 1997, A7.
146. Brandt, The Cigarette Century;
147. Martha A. Derthick, Up in Smoke: From Legislation to Litigation in Tobacco Politics, 2nd ed. (Washington, DC: CQ Press, 2005);
148. A. Lee Fritschler and Catherine E. Rudder, Smoking and Politics: Bureaucracy Centered Policymaking (Upper Saddle River, New Jersey: Pearson Prentice Hall, 2007);
149. Kluger, Ashes to Ashes.