Smoking in America: 35 Years after the Surgeon General's Report: A Report on the 2000 National Social Climate Survey

In 1964, the U.S. Surgeon General formally announced the health risks of tobacco, thereby providing the impetus for one of the most intensive public health interventions in the history of the United States. Spanning several decades, the tobacco control movement has developed an increasingly effective series of social programs and policies designed to encourage nonsmoking and protect nonsmokers from environmental tobacco smoke. In the years following the initiation of the tobacco control movement, the percentage of current cigarette smokers in the American adult population has decreased dramatically from 42.2 percent in 1965 to 22.7 percent in 1999. This decrease translates into about 40 million fewer adult smokers in the United States today than had the rate remained at 42.2 percent. As the Office of Smoking and Health of the CDC notes, “This achievement has few parallels in the history of public health. It was accomplished despite the addictive nature of tobacco and the powerful economic forces promoting its use.” In the 35 years following the release of the historic 1964 Surgeon General’s Report on Smoking and Health, the antismoking campaign has been a major success. In 1997, the state of Mississippi won an historical settlement against the tobacco industry; several other states followed this precedent. A coalition of 46 state Attorneys General reached a Master Settlement Agreement with the tobacco companies in 1998. These settlements have provided resources for the implementation of a national tobacco control program directed by the American Legacy Foundation, as well as the resources for several state-level comprehensive tobacco control programs. To our knowledge, the present project is the most comprehensive survey of the extent to which tobacco control impacts the daily lives of Americans; it is also the first project to describe the social climate of tobacco control since most of these comprehensive programs were implemented. The 2000 National Social Climate Survey adds new knowledge about the public health movement by determining the degree to which tobacco control practices, beliefs, and norms have become ingrained in the societal fabric of America. The Social Climate Survey monitors tobacco control in the social institutions of everyday life - the American family, the American school, the workplace, government, health care, recreation/leisure, and mass media. There is substantial variability in the penetration of tobacco control across social institutions. Americans are very supportive of tobacco control measures within the family, education, and government institutions that restrict youth access to tobacco but fail to generalize this support for restrictions on youth exposure to environmental tobacco smoke, adult role models, tobacco advertisements, and tobacco logos. Some aspects of tobacco control had considerable impact upon the institutions of the workplace, health and medical care, and government and political order; yet there remains substantial work to be done. Also, tobacco control has met the most resistance in the institutions of recreation, sports, and, notably, leisure and mass communication and culture. Although important gains have been made by the tobacco control movement, the progress has not been universally realized across society. Because 46 million American adults continue to smoke cigarettes, it is clear there is substantial unfinished business for tobacco control. This report investigates one aspect of the unfinished business for tobacco control: the current social climate for tobacco control in American society. In July 2000, the National Social Climate Survey was conducted by the Social Science Research Center at Mississippi State University to determine tobacco use, norms, practices, and beliefs throughout the fabric of American society. Seven social institutions are included in our approach: American family life, education, work, recreation and leisure, government, health, and mass communication. In each of these, tobacco use and tobacco control have evolved. It is these institutional beliefs, norms, and practices that form the essence of the ingrained status of tobacco use in the social fabric of American society. By monitoring the social climate, it becomes possible to identify the arenas in which tobacco control has been successfully ingrained in the fabric of society.